Glokomda görme alanı defektleri

Yıl 2012, Cilt: 29 Sayı: 2s, 66 - 74, 22.06.2012

Nurşen Arıtürk

Öz

Glokom, ilerleyici, geri dönüşümü olmayan, optik disk ve retina sinir lifi tabakasındaki yapısal değişiklikler ve görme alanındaki fonksiyonel kayıplarla karakterize, birçok faktorün sorumlu olduğu bir hastalıklar grubudur. Oftalmologların birincil amacı, glokom tanısı ve takibinde sinir lifi kayıplarını belirlemek, kayıp gelişimini önlemek ve progresyonu durdurmaktır. Teşhis ve takipte kullanılan geleneksel yöntemler, göz içi basınç ölçümü, optik sinir başının subjektif incelenmesi ve görme alanı testidir. Göz içi basınç ölçümü diürnal varyasyon göstermesi, kişisel farklılıkların olması ve risk faktörlerinden sadece biri olması nedeniyle tek başına tanı koymada yeterli değildir. Optik sinir başının subjektif incelenmesi, gözlemci ve gözlemciler arası farklı değerlendirmeler ve kişisel farklılıklar olabilmesi güvenilirliğini azaltmaktadır. Görme alanı testi ise, glokomun klinik olarak takibinde vazgeçilmez değerlendirme yöntemlerinden biridir. Subjektif bir test olması, kısa ve uzun süreli değişikliklerin olması teste güvenilirliği azaltsa bile halen günümüzde tanı ve takipte, klinik olarak görme fonksiyonunu belirlemede vazgeçilmez altın standart yöntemdir. Bu makalede, glokomda görülen görme alanı kayıp tipleri, literatür verileri ışığında tartışılmıştır.


Visual field defects in glaucoma

Glaucoma, is a group of diseases caused by several factors characterized by progressive, irreversible structural changes at the optic disc and retinal nerve fiber layer, and the functional loss in the visual field. The primary purpose of the ophthalmologist is to determine the level of the loss of retinal nerve fibers during the glaucoma diagnosis and the follow-up; and to prevent and to stop the progression of nevre fiber loss. Conventional methods used for glaucoma diagnosis and follow-up are intraocular pressure measurements, subjective examination of the optic nerve head and visual field test. Intraocular pressure measurement is not enough alone for glaucoma diagnosis, because it shows diurnal variation, individual differences and it is only one of several risk factors. Subjective evaluation of the optic nerve head, the interobserver variability of the assessment and individual differences of optic disc size and type should reduce its reliability. The visual field test is one of the indispensable assessment methods. For today, it is still the gold standard method for the diagnosis and the follow-up of glaucoma, and to determine clinically the visual function. Even if it is a subjective test,and the short-and long-term fluctuations should decrease the reliability of the test.In this article, the types of visual field loss in glaucoma are discussed in the light of the current literature.

J. Exp. Clin. Med., 2012; 29:S66-S-S74

Anahtar Kelimeler

Glokom; Görme Alanı; Optik sinir; Perimetre; Retinal sinir lifi tabakası; Görme alanı defekti (Glaucoma; Visual field; Optic nevre; Perimeter; Retinal nerve fibre layer; Visual field defect)

Kaynakça

• Ahrlich, K.G., De Moraes, C.G., Teng, C.C., Prata, T.S., Tello, C., Ritch, R., Liebmann, J.M., 2010. Visual field progression differences between normal-tension and exfoliative high-tension glaucoma. Invest. Ophthalmol. Vis. Sci. 51, 1458-1463.
• Anderson, D.R., Patella, V.M., 1999. Automated Static Perimetry. St Louise:Mosby. 237, 29-34
• Araie, M., 1995. Pattern of visual field defects in normal-tension and high-tension glaucoma. Curr. Opin. Ophthalmol. 8, 36-45.
• Asman, P., Heijl, A., 1994. Diffuse visual field loss and glaucoma. Acta. Ophthalmol. 72, 303-308.
• Armaly, M.F., 1972. Selective perimetry for glaucomatous defects in ocular hypertension. Arch. Ophthalmol. 87, 518-524.
• Balon, B.J., Echelman, D.A., Shields, M.B., Ollie, A.R., 1992. Peripheral visual field testing in glaucoma by automated kinetic perimetry with the Humphrey Field Analyzer. Arch. Ophthalmol. 110, 1730-1732.
• Caprioli, J., Spaeth, G.L., 1984. Comparison of visual field defects in the low tension glaucomas with those in the high- tension glaucomas. Am. J. Ophthalmol. 97, 730-737.
• Drance, S.M., Airaksinen, P.J., Price, M., Schulzer, M., Douglas, G.R., Tansley, B.W., 1986. The correlation of functional and structural measurements in glaucoma patients and normal subjects. Am. J. Ophthalmol. 102, 612-616.
• Drance, S.M., 1969. The early visual field defects in glaucoma. Invest. Ophthalmol. 8, 84-91.
• Drance, S.M., Lakowski, R., 1981. Early psychophysical disturbances in choronic open-angle glaucoma.In Transactions of the New Orleans Academy of Ophthalmology, St Louis,Mosby.
• Flammer, J., Drance, S.M., Zulauf, M., 1984. Differantial light treshold.Short and long-term fluctuation in patients with glaucoma, normal controls, and patients with suspected glaucoma. Arch. Ophthalmol. 102, 704-706.
• Gordon, M.O., Beiser, J.A., Brandt, J.D., Heuer, D.K., Higginbotham, E.J., Johnson, C.A., Keltner, J.L., Miller, J.P., Parrish, R.K., Wilson, M.R., Kass, M.A., 2002. The Ocular hypertension Treatment study:baseline factors that predict the onset of primary open-angle glaucoma. Arch. Ophthalmol. 120, 714-720.
• Gramer, E., Gerlach, R., Krieglstein, G.K., Leydhecker, W., 1982.Topography of early glaucomatous visual field defects in computerized perimetry(in German). Klin. Monatsbl. Augenheilkd. 180, 515-523.
• Harrington, D.O., 1965. The bjerrum scotoma. Am. J. Ophthalmol. 59, 646-656.
• Hart, W.M., Becker, B., 1982. The onset and evaluation of glaucomatous visual field defects. Ophthalmol. 89, 268-271.
• Heijl, A., Bengtsson, B., 1996. The effect of perimetric experience in patients with glaucoma. Arch. Ophthalmol. 114, 19-24.
• Heijl, A., 2000. The glaucomatous visual field.In:Glaucoma in the 21st century. Weinreb RN, Kitazawa Y, Krieglstein GK eds. Mosby İnternational Ltd., London. 35-42.
• Heijl, A., Lindgren, G., Olsson, J., 1987. Normal variability of static perimetric treshold values across the central visual field. Arch. Ophthalmol. 105, 1544-1549.
• Heijl, A., Lundqvist, L., 1984. The location of earliest glaucomataus visual defecets documented by automatic perimetry. Acta. Ophthal. 62, 658-664.
• Katz, J., Sommer, A., 1988. Reliability indexes of automated perimetric tests. Arc. Ophthalmol. 106, 1252-1254.
• Lachenmayer, B.J., Drance, S.M., Airaksinen, P.J., 1992. Diffuse field loss and diffuse retinal nerve-fiber loss in glaucoma. Ger. J. Ophthalmol. 1, 22-25.
• Lau, L.I., Liu, C.J., Chou, J.C., Hsu, W.M., Liu, J.H., 2003. Pattern of viual field defects in chronic angle closure glaucoma with different disease severetiy. Ophthalmol. 110, 1890-1894.
• Lynn, J.R., 1975.Correlation of pathogenesis, anatomy, and patterns of visual loss in glaucoma. In:Symposium on Glaucoma. St.Louise: Mosby. 151.
• Mikelberg, F.S., Drance, S.M., 1996. Glaucomatous visual field defects.In:The Glaucomas, Glaucoma Therapy. Vol.1, Ritch R, Shields MB, Krupin T, eds. Mosby, St Louise. 523-537.
• Phelps, C.D., Hayreh, S.S., Montague, P.R., 1984. Comparison of visual field defects in the low-tension glaucomas with those in the high-tension glaucomas. Am. J. Ophthalmol. 98, 823-825.
• Phelps, C.D., 1979. Visual field defects in open angle glaucoma:Progression and regression. Doc. Ophthalmol. Proc. Series. 19, 187-196.
• Takada, M., Araie, M., Suzuki, Y., Koseki, N., Yamagami, J., 1993. The central visual field defects in low-tension glaucoma. A comparison of the central visual field defects in low-tension glaucoma with those in primary open angle glaucoma. Nippon Ganka Gakkai Zasshi. 97, 13201324.
• Trible, J.R., Anderson, D.R., 1997. Factors associated with intraocular pressure-induced acute visual field depression. Arch. Ophthalmol. 115, 15231527.
• Quigley, H.A., Dunkelberger, G.R., Gren, W.R., 1989. Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am. J.Ophthalmol. 107, 453-464.
• Quigley, H.A., Katz, J., Derick, R.J., Gilbert, D., Sommer, A., 2003. An evaluation of optic disc and nevre fiber layer examination in monitoring progression of early glaucoma damage. Ophthalmol. 99, 19-28.
• Wall, M., Hart, W.M.J., Burde, R.M., 1983. Visual field defects in idiopathic intracranial hypertension(pseudotumor cerebri). Am. J. Ophthalmol. 96, 654-669.
• Werner, E.B., Drance, S.M., 1977. Early visual field disturbances in glaucoma. Arch. Ophthalmol. 95, 1173.
• Werner, E.B., Drance, S.M.,1977. Early visual field disturbances in glaucoma. Arch. Ophthalmol. 95, 1173-1175.
• Zeiter, J.H., Shin, D.H., Juzych, M.S., Jarvi, T.S., Spoor, T,C., Zwas, F., 1992.Visual field defects in patients with normal-tension glaucoma and patients with high-tension glaucoma. Am. J. Ophthalmol. 114, 758-763.