The Relationships Between Blink Rates Before, During Perimetry and Perimetry Reliability

Perimetry was performed using the Humphrey Visual Field Analyzer II (model 750) with the Swedish interactive threshold algorithm (SITA) standard strategy, the 30-2 program, and a size III white stimulus on a white background (equivalent to 31.5 apostilbs). The fixation loss, false positive, and false negative rates were used to assess the reliability of perimetry. (A) Data for patients with dry eye. (B) Data for normal control subjects. Group 1; eyes with decreased blink rates during perimetry in patients with dry eye; Group 2; eyes with increased or unchanged blink rates during perimetry in patients with dry eye; Group 3; eyes with decreased blink rates during perimetry in normal control subjects; Group 4; eyes with increased or unchanged blink rates during perimetry in normal control subjects. Pre-perimetry blink rates in the eyes with blink rates that decreased during perimetry varied from 3 to 44/min in patients with DE (Group 1) and from 4 to 48/min in normal control subjects (Group 3). Blink rates before perimetry in the eyes with blink rates that increased or remained unchanged during perimetry were < 17/min in patients with DE (Group 2) and 19/min in normal control subjects (Group 4), respectively (Fig 1). Blink rates during perimetry were significantly lower in Group 1 compared to Group 2, and in Group 3 compared to Group 4: Group 1, 4.6 (1.7-7.0 [0-21]) vs. Group 2, 13.4 (11.4-16.0 [2-39]) /min and Group 3, 2.6 (0.9-5.4 [0-12]) vs. Group 4, 20.1 (11.0-30.5 [4-36]) /min (P=0.007 and P<0.001, respectively, Fig 1). Fixation loss rate was significantly higher in eyes with decreased blink rates among patients with dry eye (P=0.002). Strip meniscometry value was directly correlated with fixation loss rate (r=0.341, P=0.025), and blink rate during perimetry was negatively was correlated with fixation loss rate (r=- 0.393, P=0.009). Dry Eye-related Quality of Life score was negatively correlated with false negative rate (r=- 0.323, P=0.035) in patients with dry eye. However, there were no apparent correlations among the perimetry reliability parameters and other parameters in normal control subjects.

本研究采用汉弗莱视野分析仪II型（型号750，Humphrey Visual Field Analyzer II 750）实施视野检查，选用瑞典交互式阈值算法（Swedish Interactive Threshold Algorithm, SITA）标准策略、30-2检测程序，以III号白色视标在白色背景下呈现（亮度等效于31.5阿熙提（apostilb））。以固视丢失率、假阳性率及假阴性率评估视野检查的可靠性。(A) 干眼症（Dry Eye, DE）患者数据；(B) 正常对照受试者数据。
组1：干眼症患者中视野检查期间眨眼频率降低的患眼；组2：干眼症患者中视野检查期间眨眼频率升高或无变化的患眼；组3：正常对照受试者中视野检查期间眨眼频率降低的患眼；组4：正常对照受试者中视野检查期间眨眼频率升高或无变化的患眼。
干眼症组1（眨眼频率于视野检查期间降低的患眼）的检查前眨眼频率为3~44次/分钟，正常对照组3的患眼为4~48次/分钟。视野检查期间眨眼频率升高或无变化的患眼，其检查前眨眼频率分别为：干眼症组2患眼＜17次/分钟，正常对照组4患眼为19次/分钟（见图1）。
组1的视野检查期间眨眼频率显著低于组2，组3显著低于组4：组1为4.6（1.7~7.0 [0~21]）次/分钟，组2为13.4（11.4~16.0 [2~39]）次/分钟；组3为2.6（0.9~5.4 [0~12]）次/分钟，组4为20.1（11.0~30.5 [4~36]）次/分钟（分别P=0.007、P＜0.001，见图1）。
干眼症患者中眨眼频率降低的患眼，其固视丢失率显著升高（P=0.002）。泪河测量值与固视丢失率呈显著正相关（r=0.341，P=0.025），视野检查期间的眨眼频率与固视丢失率呈显著负相关（r=-0.393，P=0.009）。干眼症患者的干眼症相关生活质量评分与假阴性率呈显著负相关（r=-0.323，P=0.035）。然而，正常对照受试者的视野检查可靠性参数与其他参数之间未发现明显相关性。