Functional Testing for Glaucoma

项目摘要 青光眼在美国和世界范围内都是导致失明的主要原因。该项目的长期目的 是改善青光眼的功能测试。目前，对患者的评估和随访依赖于自动化的 视野检查以提供视野的功能测试。然而，评估进展和/或 使用视野检查对治疗的反应受到高变异性的阻碍，特别是在中度或重度 昏迷性损伤。这项建议将建立在我们实验室以前的工作，以减少变异性， 增加这些测试结果的动态范围，并改进分析和解释。我们的实验 是明确设计的，以便其结果和结论将迅速转化为临床实践。的 该项目将提高功能测试的准确性、效率和实用性，在两个方面都产生直接影响。 研究和临床环境，并为下一代仪器和算法奠定基础。的 第一个具体目标是使用一种新的刺激来扩展视野检查的有效动态范围，并减少其 可变性目前的临床视野检查依赖于测试对象在看到刺激时按下按钮 在白色背景上有一个小的、静止的明亮的光圈。我们建议采用新的刺激措施， 我们预计这将更容易检测到，从而可以在更多受损区域进行可靠的测量 比目前可能的视野，并减少可变性。第二个目标是更好地利用 来自当前临床视野检查的数据。我们期望在查找更改时能够更快地检测到更改 在基于解剖学的测试位置集群中，而不是单独考虑每个位置或考虑 所有地点同时。我们将根据这一聚类分析得出变化率的衡量标准， 符合有经验的临床医生对疾病进展严重程度的看法，这将有助于 分期和监测疾病进展，从而帮助临床决策。第三个具体目标是 以执行视野位置的子集的高精度测试。目前的临床标准是， 对更广泛的位置选择进行低精度测试。我们将比较这两个人的能力 检测功能变化的方法，并评估对横截面和 纵向相关与结构性措施。这三个目标是相辅相成的。预计这些 aims将改进使用视野检查时的数据收集、分析和解释。在测试中的这种改进 如视野检查一样通常执行，这将显著影响未来的临床实践。

Project Summary Glaucoma is a leading cause of blindness both in the US and worldwide. The long-term purpose of this project is to improve functional testing in glaucoma. Assessment and follow-up of patients currently relies on automated perimetry to provide functional testing of the visual field. However, the ability to assess progression and/or response to treatment using perimetry is hampered by high variability, especially in areas of moderate or severe glaucomatous damage. This proposal will build on previous work by our laboratory to reduce the variability, increase the dynamic range, and improve the analysis and interpretation, of these test results. Our experiments are explicitly designed so that their results and conclusions will be rapidly translatable to clinical practice. The project will improve the accuracy, efficiency and utility of functional testing, giving immediate impact in both research and clinical settings, and laying groundwork for the next generation of instruments and algorithms. The first Specific Aim is to use a novel stimulus to extend the effective dynamic range of perimetry and reduce its variability. Current clinical perimetry relies on the test subject pressing a button when they see a stimulus consisting of a small, stationary circle of brighter light on a white background. We propose to use a new stimulus, which we anticipate being easier to detect, allowing reliable measurements to be made in more damaged regions of the visual field than is currently possible, and reducing variability. The second Specific Aim is to better use data from current clinical perimetry. We anticipate being able to detect change sooner when looking for changes in anatomically-based clusters of test locations, rather than considering every location individually or considering all locations simultaneously. We will derive a measure of the rate of change based on this cluster analysis that corresponds with experienced clinicians’ opinions of the severity of disease progression, which would aid in the staging and monitoring of disease progression, and hence aid clinical decision making. The third Specific Aim is to perform high-accuracy testing of a subset of visual field locations. The current clinical standard is to instead perform low-accuracy testing of a wider selection of locations. We will compare the ability of these two approaches to detect functional change, and evaluate the effect on the strengths of the cross-sectional and longitudinal correlations with structural measures. The three aims are complementary. It is anticipated that these aims will improve data collection, analysis and interpretation when using perimetry. Such improvements in a test as commonly performed as perimetry will significantly impact future clinical practice.