{"id":303,"date":"2015-01-23T12:23:48","date_gmt":"2015-01-23T14:23:48","guid":{"rendered":"http:\/\/www.planetaw.com.br\/temp\/sbg\/?p=303"},"modified":"2019-06-24T15:45:43","modified_gmt":"2019-06-24T18:45:43","slug":"perda-do-campo-visual-qual-a-percepcao-do-paciente","status":"publish","type":"post","link":"https:\/\/www.sbglaucoma.org.br\/medico\/perda-do-campo-visual-qual-a-percepcao-do-paciente\/","title":{"rendered":"PERDA DO CAMPO VISUAL: QUAL A PERCEP\u00c7\u00c3O DO PACIENTE – “SUA ATEN\u00c7\u00c3O ESPECIAL PARA”"},"content":{"rendered":"
\n
\n

\"\"<\/span><\/p>\n

Editor Associado e Comentarios por Mauro Leite sobre:<\/strong>
\nRef.: How does glaucoma look? Patient perception of Visual Field loss<\/strong>
\nCrabb DP, Smith ND, Glen FC, Burton R, Garway-Heath DF.
\nOphthalmology 2013.<\/strong><\/p>\n<\/div>\n<\/div>\n

Diversas fontes educadoras descrevem o defeito glaucomatoso como manchas escuras no campo de vis\u00e3o na fase inicial e um t\u00fanel escuro nas fases mais tardias.<\/span> Basta digitar o termo glaucoma em algum site de busca para encontrarmos a cl\u00e1ssica representa\u00e7\u00e3o do defeito glaucomatoso como um t\u00fanel escuro. No entanto, essa representa\u00e7\u00e3o simplificada pode n\u00e3o ilustrar o real d\u00e9ficit campim\u00e9trico no paciente com glaucoma, dificultando a educa\u00e7\u00e3o e conscientiza\u00e7\u00e3o do glaucoma. Em um estudo bem conduzido, Crabb e colaboradores avaliaram como o glaucoma afeta a percep\u00e7\u00e3o visual<\/span> nos pacientes com glaucoma e, especificamente, se o defeito \u00e9 percebido como manchas escuras no campo visual.<\/p>\n

Os autores selecionaram 50 pacientes com acuidade visual melhor do que 20\/30 e defeito campim\u00e9trico em ambos os olhos, excluindo pacientes com defeito perim\u00e9trico avan\u00e7ado. Os pacientes eram submetidos \u00e0 campimetria convencional e a uma entrevista na qual respondiam sobre como o glaucoma afetava sua vis\u00e3o e cotidiano. Em seguida, os autores mostravam seis figuras simulando diferentes padr\u00f5es de perda visual e o paciente escolhia o padr\u00e3o mais representativo de sua defici\u00eancia visual. As seis representa\u00e7\u00f5es mostravam a mesma figura com padr\u00f5es de defeitos campim\u00e9tricos distintos: inalterado (paciente assintom\u00e1tico), t\u00fanel escuro, t\u00fanel borrado, manchas pretas, manchas borradas, partes faltando (imagem criada com Photoshop, na qual partes da imagem s\u00e3o substitu\u00eddas por pixels adjacentes).<\/p>\n

“As palavras mais usadas pelos pacientes para descrever a diminui\u00e7\u00e3o do campo visual foram missing (faltando) e blur (emba\u00e7amento).”<\/span>O estudo mostrou resultados relevantes. A maioria escolheu as figuras com partes borradas (54%) e partes faltando (16%) para representar sua defici\u00eancia visual. Treze (26%) dos pacientes eram assintom\u00e1ticos do ponto de vista campim\u00e9trico. Nenhum dos participantes escolheu as manchas escuras ou t\u00fanel escuro como a melhor representa\u00e7\u00e3o do defeito campim\u00e9trico glaucomatoso.<\/span> As palavras mais usadas pelos pacientes para descrever a diminui\u00e7\u00e3o do campo visual foram missing (faltando) e blur (emba\u00e7amento). As atividades cotidianas mais afetadas segundo os pacientes foram dificuldade de leitura, uso de computador, dirigir e vis\u00e3o noturna. Um achado interessante foi a discord\u00e2ncia entre o gr\u00e1fico de tons de cinza no campo visual e os sintomas dos pacientes.<\/p>\n

“A principal conclus\u00e3o do estudo \u00e9 que os pacientes n\u00e3o percebem a diminui\u00e7\u00e3o do campo visual como manchas escuras ou t\u00fanel escuro.”<\/span>A principal conclus\u00e3o do estudo \u00e9 que os pacientes n\u00e3o percebem a diminui\u00e7\u00e3o do campo visual como manchas escuras ou t\u00fanel escuro. O estudo tem algumas limita\u00e7\u00f5es como n\u00famero pequeno de participantes, a falta de pacientes com defeito campim\u00e9trico mais avan\u00e7ado e a escolha for\u00e7ada de um padr\u00e3o de defeito campim\u00e9trico. No entanto, esses achados tem implica\u00e7\u00f5es cl\u00ednicas importantes. “O estudo fornece fundamentos que possibilitam mostrar aos pacientes padr\u00f5es de perda visual mais parecidos com os reais, facilitando o entendimento dos sintomas”<\/span>O estudo fornece fundamentos que possibilitam mostrar aos pacientes padr\u00f5es de perda visual mais parecidos com os reais,Esses achados s\u00e3o importantes tanto para os pacientes como para os m\u00e9dicos que tratam e educam indiv\u00edduos com glaucoma.”<\/span> facilitando o entendimento dos sintomas e, consequentemente, aumentando a ader\u00eancia ao tratamento. Finalmente, o aparecimento de manchas escuras na vis\u00e3o do paciente provavelmente n\u00e3o ir\u00e1 acontecer, ent\u00e3o, a sua falta n\u00e3o exclui a doen\u00e7a. Esses achados s\u00e3o importantes tanto para os pacientes como para os m\u00e9dicos que tratam e educam indiv\u00edduos com glaucoma.<\/p>\n

Veja coment\u00e1rios do International Glaucoma Review sobre este artigo:
\nhttp:\/\/www.e-igr.com\/ABS\/index.php?AbID=52541&page=Abstracts&issue=151<\/a><\/p>\n

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Resumo deste artigo<\/h3>\n
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Ophthalmology<\/em>. 2013 Jun;120(6):1120-6. doi: 10.1016\/j.ophtha.2012.11.043. Epub 2013 Feb 12.
\nHow does glaucoma look?: patient perception of visual field loss<\/strong>.
\nCrabb DP, Smith ND, Glen FC, Burton R, Garway-Heath DF.
\nAuthor information<\/strong><\/p>\n

Abstract<\/p>\n

OBJECTIVE<\/strong>:<\/p>\n

To explore patient perception of vision loss in glaucoma and, specifically, to test the hypothesis that patients do not recognize their impairment as a black tunnel effect or as black patches in their field of view.<\/strong>
\nDESIGN<\/strong>:
\nClinic-based cross-sectional study.<\/p>\n

PARTICIPANTS<\/strong>:
\nFifty patients (age range, 52-82 years) with visual acuity better than 20\/30 and with a range of glaucomatous visual field (VF) defects in both eyes, excluding those with very advanced disease (perimetrically blind).<\/p>\n

METHODS<\/strong>:
\nParticipants underwent monocular VF testing in both eyes using a Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Dublin, CA; 24-2 Swedish interactive threshold algorithm standard tests) and other tests of visual function. Participants took part in a recorded interview during which they were asked if they were aware of their VF loss; if so, there were encouraged to describe it in their own words. Participants were shown 6 images modified in a variety of ways on a computer monitor and were asked to select the image that most closely represented their perception of their VF loss.
\nMAIN OUTCOME MEASURES<\/strong>:
\nForced choice of an image best representing glaucomatous vision impairment.<\/p>\n

RESULTS<\/strong>:
\nParticipants had a range of VF defect severity: average HFA mean deviation was -8.7 dB (standard deviation [SD], 5.8 dB) and -10.5 dB (SD, 7.1 dB) in the right and left eyes, respectively. Thirteen patients (26%; 95% confidence interval [CI], 15%-40%) reported being completely unaware of their vision loss. None of the patients chose the images with a distinct black tunnel effect or black patches. Only 2 patients (4%; 95% CI, 0%-14%) chose the image with a tunnel effect with blurred edges. An image depicting blurred patches and another with missing patches was chosen by 54% (95% CI, 39%-68%) and 16% (95% CI, 7%-29%) of the patients, respectively. Content analysis of the transcripts from the recorded interviews indicated a frequent use of descriptors of visual symptoms associated with reported blur and missing features.<\/p>\n

CONCLUSIONS<\/strong>:
\nPatients with glaucoma do not perceive their vision loss as a black tunnel effect or as black patches masking their field of view. These findings are important in the context of depicting the effects of glaucomatous vision loss and raising awareness for glaucoma detection.<\/p>\n

FINANCIAL DISCLOSURE(S)<\/strong>:
\nThe author(s) have no proprietary or commercial interest in any materials discussed in this article.<\/p>\n

Copyright \u00a9 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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