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Archive Of Ukrainian Ophthalmology Том 7, №1, 2019

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Statistical modeling of the risk of progression of partial optic nerve atrophy of various etiologies

Authors: Салдан Й.Р.(1), Галінська І.В.(1), Гур’янов В.Г.(2)
(1) — Вінницький національний медичний університет імені М.І. Пирогова, м. Вінниця, Україна
(2) — Національний медичний університет імені О.О. Богомольця, м. Київ, Україна

Categories: Ophthalmology

Sections: Specialist manual

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Summary

В роботі наведено дані щодо побудови й аналізу логістичних моделей регресії тяжкості перебігу часткової атрофії зорового нерва різної етіології. Розроблено математичні моделі прогнозування низької (< 0,3) гостроти зору за показниками порогу електричної чутливості за фосфеном, коефіцієнтів MD/RNFL thickness, MD/Average GCL + IPL thickness. Також розроблено математичні моделі прогнозування тяжкої стадії за показниками коефіцієнтів MD/RNFL thickness, MD/Average GCL + IPL thickness.

В работе приведены данные по построению и анализу логистических моделей регрессии тяжести течения частичной атрофии зрительного нерва различной этиологии. Разработаны математические модели прогнозирования низкой (< 0,3) остроты зрения по показателям порога электрической чувствительности по фосфену, коэффициентов MD/RNFL thickness, MD/Average GCL + IPL thickness. Также разработаны математические модели прогнозирования тяжелой стадии по показателям коэффициентов MD/RNFL thickness, MD/Average GCL + IPL thickness.

Background. Optic nerve atrophy (ONA) is a severe multifactorial ophthalmopathy caused by common diseases (75.8 %), congenital pathology (18 %) and injuries (3–6.2 %). The disease is one of the main etiopathogenetic factors of blindness, low vision and vision disability. According to the statistics of Ukraine, the frequency of ONA as the main severe nosological form of ophthalmic pathology in primary visual disability was 8.9 %. Among the etiological factors of ONA, the diseases of the central nervous system, neuroinfections (meningitis, encephalitis, basal arachnoiditis, multiple sclerosis), ischemic heart disease, hypertension, diabetes mellitus, atherosclerosis prevail. Treatment of ONA is a complex task. The ability of the nerve tissue to regenerate is very limited, and the treatment of atrophy is reduced to increased vital activity of nerve fibers that have survived. There is no doubt that the full ONA can be attributed to incurable diseases. Therefore, all therapeutic measures relate to the so-called partial optic nerve atrophy, in which the visual functions are retained to varying degrees. The causes, nature and degree of damage to the optic nerve are diverse, making it difficult to create an optimal treatment regimen and to evaluate its efficacy. According to many authors, treatment should be combined and systematic, taking into account the etiology of the disease, the duration of the pathological process, age and general condition of the patient. The purpose of the study was to create a statistical model of the risk of progression of partial optic nerve atrophy of various etiologies. Materials and methods. Under our supervision, there were 52 patients (52 eyes) with partial ONA of various etiologies. Patients in the dynamics underwent visometry, refractometry, spheroperimetry, static Humphrey automated perimetry, tonometry, biomicroscopy, ophthalmoscopy, sonography, optical coherent tomography, phosphene threshold determination, and also calculations of ratios (mean deviation (MD)/retinal nerve fiber layer (RNFL) thickness, MD/average ganglion cell layer (GCL) + inner plexiform layer (IPL)). Methods for constructing and analyzing logistic regression models were used to identify the risk factors for ineffective treatment in patients with partial ONA of various etiologies, to evaluate the direction and degree of their influence. The observation time is 1 year. Results. Model of risk prediction does not achieve the effect by visual acuity. For the analysis of factor signs associated with the risk of not achieving the effect by visual acuity, all patients were divided into two groups: low visual acuity (initial variable Y = 1, with visual acuity < 0.3) and satisfactory visual acuity (output variable Y = 0, with visual acuity > 0.3). The analysis was conducted for 10 risk factors. To identify significant risk factors for low visual acuity, selection was performed using the step-by-step rejection-addition method. As a result, three indicators approximately equal in terms of significance were selected: threshold phosphene thresholds, μA, MD/RNFL thickness, MD/average GCL + IPL thickness. To determine the predictive qualities of each indicator and to select the optimal threshold for predicting the risk of low visual acuity, the method of constructing and analyzing the curves of the operational characteristics of the tests was used. Selection was carried out using the step-by-step method of adding attributes to determine the significant factors associated with the risk of severe partial ONA. Two indicators — MD/RNFL thickness and MD/average GCL + IPL thickness — were selected. Model for predicting the risk of severe partial ONA. To analyze the factors related to the risk of severe partial ONA, all patients were divided into two groups: severe partial ONA (initial variable Y = 1, at stages 4 and 5), and moderate partial ONA (initial variable Y = 0, at disease stages 1–3). The analysis was carried out for 9 factors: sex, age, etiology, total photoconductivity of central visual field, total photoconductivity of peripheral visual field, RNFL, μm, MD, PSD, MD/RNFL thickness, MD/average GCL + IPL thickness. Conclusions. The article presents data on the construction and analysis of logistic regression models of the severity of partial optic nerve atrophy of various etiologies. Mathematical models for predicting low (< 0.3) visual acuity with respect to phosphene threshold have been created. Also, mathematical models were developed to predict severe stage of the disease.


Keywords

зоровий нерв; атрофія зорового нерва різної етіології; логістична модель регресії

зрительный нерв; атрофия зрительного нерва различной этиологии; логистическая модель регрессии

optic nerve; optic nerve atrophy of various etiologies; logistic regression model


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Bibliography

1. Галінська І.В. До питання етіології та частоти атрофії зорового нерва судинного генезу // Архів офтальмології України. — 2018. — Т. 6, № 2(11). — С. 6-9.

2. Галінська І.В. Розповсюдженість та етіологія часткової атрофії зорового нерва // Архів офтальмології України. — 2018. — Т. 6, № 1(10). — С. 19-23.

3. Shin Y.W. A case of optic nerve atrophy with severe disc cupping after methanol poisoning / Y.W. Shin, K.B. Uhm // Korean J. Ophthalmol. — 2011. — Vol. 25, № 2. — P. 146-150.

4. Васюта В.А. Експертна оцінка трирівневої системи профілактики атрофії зорових нервів / В.А. Васюта // Галицький лікарський вісник. — 2015. — Т. 22, № 2. — С. 144-146.

5. Tan J.Ch.H. A pilot trial of tele-ophthalmology for diagnosis of chronic blurred vision / J.Ch.H. Tan, E.W.T. Poh, S. Srinivasan, T.H. Lim // J. Telemedicine and Telecare. — 2013. — Vol. 19. — P. 65-69.

6. Correlation of structural retinal nerve fibre layer parameters and functional measures using Heidelberg Retinal Tomography and Spectralis spectral domain optical coherence tomography at different levels of glaucoma severity / J. Leaney, P.R. Healey, M. Lee, S.L. Graham // Clin. Experiment Ophthalmol. — 2012. — Vol. 40, № 8. — P. 802-812.

7. Петренко А.Ю. Стволовые клетки. Свойства и перспективы клинического применения / А.Ю. Петренко, Ю.А. Хунов, Э.Н. Иванов. — Луганск: Пресс-Экспресс, 2011. — 368 с.

8. Newman N.J. Treatment of Leber hereditary optic neuropathy / N.J. Newman // Brain. — 2011. — Vol. 134. — P. 2447-2450.

9. Hoffmann J. Volumetric assessment of optic nerve sheath and hypophysis in idiopathic intracranial hypertension / J. Hoffmann, C. Schmidt, H. Kunte [et al.] // Am. J. Neuroradiol. — 2014. — Vol. 35. — P. 513-518.

10. Васюта В.А. Управление факторами риска развития атрофии зрительных нервов на основе системного подхода и комплексных оценок / В.А. Васюта // Вестник Витебского государственного медицинского университета. — 2015. — Т. 14, № 3. — С. 78-82.

11. Бржеский В.В. Принципы лечения патологии зрительного нерва. Сукцинатсодержащие растворы — современный подход в лечении патологии зрительного нерва / В.В. Бржеский. — СПб.: Тактик-Студио, 2010. — 95 с.

12. Морозов В. И. Заболевания зрительного пути. Клиника. Диагностика. Лечение / В.И. Морозов, А.А. Яковлев. — М.: Бином, 2010. — 650 с.


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