RAPD在青光眼早期诊断中的应用
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摘要
青光眼患者早期诊断以及治疗对患者有效视力的长期维持尤为重要。虽然青光眼是双眼疾病,但双眼早期的临床体征通常表现不一致,这种不一致在瞳孔表现上可能出现相对传入性瞳孔障碍(relative afferent papillary defect,RAPD)。目前对青光眼的诊断更多的是关注眼压及视野缺损,而眼压及视野检查结果的可靠性与患者的主动配合息息相关,且需要仪器配合。相对的,RAPD的检查在临床上却能够更加简便、快捷。对RAPD及其对青光眼早期诊断的价值应得到充分认识。本文主要对RAPD的检查方法与其灵敏性和特异性,以及RAPD与青光眼其他检查方式的相关性进行综述。
The early diagnosis and treatment of glaucoma patients is especially significant for the long-term maintenance of effective vision.Although glaucoma is a disease of the binoculus,the early signs of the eyes are often inconsistent,and this inconsistent in pupil' s performance may be relative to the relative afferent pupillary defect(RAPD).For the diagnostic criteria of glaucoma,more attention is focused on the intraocular pressure and visual field defect.The reliability of the examination results of intraocular pressure and visual field is closely related with the patients' active cooperation,and it is needed to coordinate with the instrument,but the test of RAPD is more convenient and quick for the examination in clinic.RAPD and its value in the early diagnosis of glaucoma should be fully understood.This article reviews the theory and examination methods of RAPD,sensitivity and specificity of each method,and discusses the correlation between RAPD and glaucoma examinations.
The early diagnosis and treatment of glaucoma patients is especially significant for the long-term maintenance of effective vision.Although glaucoma is a disease of the binoculus,the early signs of the eyes are often inconsistent,and this inconsistent in pupil' s performance may be relative to the relative afferent pupillary defect(RAPD).For the diagnostic criteria of glaucoma,more attention is focused on the intraocular pressure and visual field defect.The reliability of the examination results of intraocular pressure and visual field is closely related with the patients' active cooperation,and it is needed to coordinate with the instrument,but the test of RAPD is more convenient and quick for the examination in clinic.RAPD and its value in the early diagnosis of glaucoma should be fully understood.This article reviews the theory and examination methods of RAPD,sensitivity and specificity of each method,and discusses the correlation between RAPD and glaucoma examinations.
引文
[1]KERRIGAN-BAUMRIND LA,QUIGLEY HA,PEASE ME,KERRIGAN DF,MITCHELL RS.Number of ganglion cells in glaucoma eyes compared with threshold visual field tests in the same persons[J].Invest Ophthalmol Vis Sci,2000,41(3):741-748.
[2]余芳,顾宝文,李汉珍.相对性瞳孔传入障碍在致盲性眼病检测中的应用[J].国际眼科杂志,2013,13(3):504-506.
[3]李惠玲,江冰.相对性瞳孔传入障碍检查在神经眼科中的应用[J].中国眼耳鼻喉科杂志,2014,14(2):131-133.
[4]TAGOE NN,ESSUMAN VA,FORDJUOR G,AKPALU J,BANKAH P,NDANU T.Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana[J].Ghana Med J,2015,49(3):181-186.
[5]WAISBOURD M,LEE B,ALI MH,LU L,MARTINEZ P,FARIA B,et al.Detection of asymmetric glaucomatous damage using automated pupillography,the swinging flashlight method and the magnified-assisted swinging flashlight method[J].Eye(Lond),2015,29(10):1321-1328.
[6]LANKARANIAN D,ALTANGEREL U,SPAETH GL,LEAVITT JA,STEINMANN WC.The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma[J].Trans Am Ophthalmol Soc,2005,103:200-207.
[7]TATHAM AJ,MEIRA-FREITAS D,WEINREB RN,ZANGWILL LM,MEDEIROS FA.Detecting glaucoma using automated pupillography[J].Ophthalmology,2014,121(6):1185-1193.
[8]CHANG DS,XU L,BOLAND MV,FRIEDMAN DS.Accuracy of pupil assessment for the detection of glaucoma:a systematic review and meta-analysis[J].Ophthalmology,2013,120(11):2217-2225.
[9]KALABOUKHOVA L,FRIDHAMMAR V,LINDBLOM B.Relative afferent pupillary defect in glaucoma:a pupillometric study[J].Acta Ophthalmol Scand,2007,85(5):519-525.
[10]ICHHPUJANI P,ROME JE,JINDAL A,KHATOR P,LEIBY BE,GORDON H,et al.Comparative study of 3 techniques to detect a relative afferent pupillary defect[J].J Glaucoma,2011,20(9):535-539.
[11]RUKMINI AV,MILEA D,BASKARAN M,HOW AC,PERERA SA,AUNG T,et al.Pupillary responses to high-irradiance blue light correlate with glaucoma severity[J].Ophthalmology,2015,122(9):1777-1785.
[12]CAYLESS A,BENDE T.First results of automated RAPDSW IFT method in dynamic pupillometry[J].Z Med Phys,2015,[Epub ahead of print].
[13]COHEN LM,ROSENBERG MA,TANNA AP,VOLPE NJ.A novel computerized portable pupillometer detects and quantifies relative afferent pupillary defects[J].Curr Eye Res,2015,40(11):1120-1127.
[14]CHILINSKA A,EJMA M,TURNO-KRECICKA A,GURANSKI K,MISIUK-HOJLO M.Analysis of retinal nerve fibre layer,visual evoked potentials and relative afferent pupillary defect in multiple sclerosis patients[J].Clin Neurophysiol,2016,127(1):821-826.
[15]TAKIZAWA G,MIKI A,MAEDA F,GOTO K,ARAKIS,IEKI Y,et al.Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease[J].Clin Ophthalmol,2015,9:1895-1903.
[16]MARVASTI AH,TATHAM AJ,ZANGWILL LM,GIRKIN CA,LIEBMANN JM,WEINREB RN,et al.The relationship between visual field index and estimated number of retinal ganglion cells in glaucoma[J].PLoS One,2013,8(10):e76590.
[17]MEDEIROS FA,LISBOA R,WEINREB RN,LIEBMANN JM,GIRKIN C,ZANGWILL LM.Retinal ganglion cell count estimates associated with early development of visual field defects in glaucoma[J].Ophthalmology,2013,120(4):736-744.
[18]SCHIEFER U,DIETZSCH J,DIETZ K,WILHELM B,BRUCKMANN A,WILHELM H,et al.Associating the magnitude of relative afferent pupillary defect(RAPD)with visual field indices in glaucoma patients[J].Br J Ophthalmol,2012,96(5):629-633.
[19]SKORKOVSKA K,WILHELM H,LUDTKE H,WILHELM B.Relative afferent pupillary defect in glaucoma[J].Klin Monbl Augenheilkd,2011,228(11):979-983.
[20]SEHI M,ZHANG X,GREENFIELD DS,CHUNG Y,WOLLSTEIN G,FRANCIS BA,et al.Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes[J].Am J Ophthalmol,2013,155(1):73-82.
[21]TATHAM AJ,WEINREB RN,ZANGWILL LM,LIEBMANN JM,GIRKIN CA,MEDEIROS FA.Estimated retinal ganglion cell counts in glaucomatous eyes with localized retinal nerve fiber layer defects[J].Am J Ophthalmol,2013,156(3):578-587.
[22]TATSUMI Y,NAKAMURA M,FUJIOKA M,NAKANISHI Y,KUSUHARA A,MAEDA H,et al.Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect in asymmetric glaucoma[J].Br J Ophthalmol,2007,91(5):633-637.
[23]NAKANISHI Y,NAKAMURA M,TATSUMI Y,NAGAIKUSUHARA A,NEGI A.Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect[J].Graefes Arch Clin Exp Ophthalmol,2006,244(11):14804484.
[24]王晓贞,李树宁,吴葛玮,牟大鹏.频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用[J].中华实验眼科杂志,2011,29(9):820-824.
[25]NEGI A.New insights into the study of optic nerve diseases[J].Nihon Ganka Gakkai Zasshi,2013,117(3):187-210.
[26]CHEW SS,CUNNNINGHAM WJ,GAMBLE GD,DANESHMEYER HV.Retinal nerve fiber layer loss in glaucoma patients with a relative afferent pupillary defect[J].Invest Ophthalmol Vis Sci,2010,51(10):5049-5053.
[27]TATHAM AJ,WEINREB RN,ZANGWILL LM,LIEBMANN JM,GIRKIN CA,MEDEIROS FA.The relationship between cup-to-disc ratio and estimated number of retinal ganglion cells[J].Invest Ophthalmol Vis Sci,2013,54(5):3205-3214.
[28]田保和,杨宜家.青光眼相对性瞳孔传入障碍定量测定及其与盘沿面积差值的关系[J].眼科研究,1990,8(2):97-99.
[29]JONAS JB,BUDDE WM,PANDA-JONAS S.Ophthalmoscopic evaluation of the optic nerve head[J].Surv Ophthalmol,1999,43(4):293-320.
[30]SPAETH GL,HENDERER J,LIU C,KESEN M,ALTANGEREL U,BAYER A,et al.The disc damage likelihood scale:reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma[J].Trans Am Ophthalmol Soc,2002,100:181-186.
[2]余芳,顾宝文,李汉珍.相对性瞳孔传入障碍在致盲性眼病检测中的应用[J].国际眼科杂志,2013,13(3):504-506.
[3]李惠玲,江冰.相对性瞳孔传入障碍检查在神经眼科中的应用[J].中国眼耳鼻喉科杂志,2014,14(2):131-133.
[4]TAGOE NN,ESSUMAN VA,FORDJUOR G,AKPALU J,BANKAH P,NDANU T.Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana[J].Ghana Med J,2015,49(3):181-186.
[5]WAISBOURD M,LEE B,ALI MH,LU L,MARTINEZ P,FARIA B,et al.Detection of asymmetric glaucomatous damage using automated pupillography,the swinging flashlight method and the magnified-assisted swinging flashlight method[J].Eye(Lond),2015,29(10):1321-1328.
[6]LANKARANIAN D,ALTANGEREL U,SPAETH GL,LEAVITT JA,STEINMANN WC.The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma[J].Trans Am Ophthalmol Soc,2005,103:200-207.
[7]TATHAM AJ,MEIRA-FREITAS D,WEINREB RN,ZANGWILL LM,MEDEIROS FA.Detecting glaucoma using automated pupillography[J].Ophthalmology,2014,121(6):1185-1193.
[8]CHANG DS,XU L,BOLAND MV,FRIEDMAN DS.Accuracy of pupil assessment for the detection of glaucoma:a systematic review and meta-analysis[J].Ophthalmology,2013,120(11):2217-2225.
[9]KALABOUKHOVA L,FRIDHAMMAR V,LINDBLOM B.Relative afferent pupillary defect in glaucoma:a pupillometric study[J].Acta Ophthalmol Scand,2007,85(5):519-525.
[10]ICHHPUJANI P,ROME JE,JINDAL A,KHATOR P,LEIBY BE,GORDON H,et al.Comparative study of 3 techniques to detect a relative afferent pupillary defect[J].J Glaucoma,2011,20(9):535-539.
[11]RUKMINI AV,MILEA D,BASKARAN M,HOW AC,PERERA SA,AUNG T,et al.Pupillary responses to high-irradiance blue light correlate with glaucoma severity[J].Ophthalmology,2015,122(9):1777-1785.
[12]CAYLESS A,BENDE T.First results of automated RAPDSW IFT method in dynamic pupillometry[J].Z Med Phys,2015,[Epub ahead of print].
[13]COHEN LM,ROSENBERG MA,TANNA AP,VOLPE NJ.A novel computerized portable pupillometer detects and quantifies relative afferent pupillary defects[J].Curr Eye Res,2015,40(11):1120-1127.
[14]CHILINSKA A,EJMA M,TURNO-KRECICKA A,GURANSKI K,MISIUK-HOJLO M.Analysis of retinal nerve fibre layer,visual evoked potentials and relative afferent pupillary defect in multiple sclerosis patients[J].Clin Neurophysiol,2016,127(1):821-826.
[15]TAKIZAWA G,MIKI A,MAEDA F,GOTO K,ARAKIS,IEKI Y,et al.Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease[J].Clin Ophthalmol,2015,9:1895-1903.
[16]MARVASTI AH,TATHAM AJ,ZANGWILL LM,GIRKIN CA,LIEBMANN JM,WEINREB RN,et al.The relationship between visual field index and estimated number of retinal ganglion cells in glaucoma[J].PLoS One,2013,8(10):e76590.
[17]MEDEIROS FA,LISBOA R,WEINREB RN,LIEBMANN JM,GIRKIN C,ZANGWILL LM.Retinal ganglion cell count estimates associated with early development of visual field defects in glaucoma[J].Ophthalmology,2013,120(4):736-744.
[18]SCHIEFER U,DIETZSCH J,DIETZ K,WILHELM B,BRUCKMANN A,WILHELM H,et al.Associating the magnitude of relative afferent pupillary defect(RAPD)with visual field indices in glaucoma patients[J].Br J Ophthalmol,2012,96(5):629-633.
[19]SKORKOVSKA K,WILHELM H,LUDTKE H,WILHELM B.Relative afferent pupillary defect in glaucoma[J].Klin Monbl Augenheilkd,2011,228(11):979-983.
[20]SEHI M,ZHANG X,GREENFIELD DS,CHUNG Y,WOLLSTEIN G,FRANCIS BA,et al.Retinal nerve fiber layer atrophy is associated with visual field loss over time in glaucoma suspect and glaucomatous eyes[J].Am J Ophthalmol,2013,155(1):73-82.
[21]TATHAM AJ,WEINREB RN,ZANGWILL LM,LIEBMANN JM,GIRKIN CA,MEDEIROS FA.Estimated retinal ganglion cell counts in glaucomatous eyes with localized retinal nerve fiber layer defects[J].Am J Ophthalmol,2013,156(3):578-587.
[22]TATSUMI Y,NAKAMURA M,FUJIOKA M,NAKANISHI Y,KUSUHARA A,MAEDA H,et al.Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect in asymmetric glaucoma[J].Br J Ophthalmol,2007,91(5):633-637.
[23]NAKANISHI Y,NAKAMURA M,TATSUMI Y,NAGAIKUSUHARA A,NEGI A.Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect[J].Graefes Arch Clin Exp Ophthalmol,2006,244(11):14804484.
[24]王晓贞,李树宁,吴葛玮,牟大鹏.频域OCT视盘形态及神经纤维层厚度参数在青光眼诊断中的作用[J].中华实验眼科杂志,2011,29(9):820-824.
[25]NEGI A.New insights into the study of optic nerve diseases[J].Nihon Ganka Gakkai Zasshi,2013,117(3):187-210.
[26]CHEW SS,CUNNNINGHAM WJ,GAMBLE GD,DANESHMEYER HV.Retinal nerve fiber layer loss in glaucoma patients with a relative afferent pupillary defect[J].Invest Ophthalmol Vis Sci,2010,51(10):5049-5053.
[27]TATHAM AJ,WEINREB RN,ZANGWILL LM,LIEBMANN JM,GIRKIN CA,MEDEIROS FA.The relationship between cup-to-disc ratio and estimated number of retinal ganglion cells[J].Invest Ophthalmol Vis Sci,2013,54(5):3205-3214.
[28]田保和,杨宜家.青光眼相对性瞳孔传入障碍定量测定及其与盘沿面积差值的关系[J].眼科研究,1990,8(2):97-99.
[29]JONAS JB,BUDDE WM,PANDA-JONAS S.Ophthalmoscopic evaluation of the optic nerve head[J].Surv Ophthalmol,1999,43(4):293-320.
[30]SPAETH GL,HENDERER J,LIU C,KESEN M,ALTANGEREL U,BAYER A,et al.The disc damage likelihood scale:reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma[J].Trans Am Ophthalmol Soc,2002,100:181-186.