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Functional Testing for Glaucoma

青光眼功能测试

基本信息

批准号：
10227993
负责人：
Stuart Gardiner
金额：
$ 40.74万
依托单位：
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10227993
关键词：
Algorithms Anatomy Area Axon Blindness Characteristics Clinical Clinical Management Clinical Trials Cluster Analysis Data Data Collection Defect Detection Deterioration Disease Progression Eye Future Glaucoma Goals Individual Laboratories Light Location Longitudinal cohort Measurement Measures Monitor Neuroprotective Agents Pathway interactions Patients Perimetry Physiological Quality of life Reporting Research Research Personnel Retinal Ganglion Cells Scotoma Severity of illness Specificity Staging Stimulus Structure Techniques Test Result Testing Time Vision Visual Fields Work base clinical decision-making clinical practice cohort cost efficient design experience experimental study follow-up functional status glaucoma test improved indexing instrument neuromechanism next generation novel personalized management preservation primary endpoint rate of change treatment response trend analysis

项目摘要

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.

项目摘要在美国和全世界，青光眼都是导致失明的主要原因。这个项目的长期目标是就是改进青光眼的功能测试。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度变异性的阻碍，特别是在中度或重度区域青光眼损害。这项建议将建立在我们实验室先前的工作基础上，以减少变异性，增加动态范围，并改进对这些测试结果的分析和解释。我们的实验是明确的设计，以便他们的结果和结论将迅速转化为临床实践。这个项目将提高功能测试的准确性、效率和实用性，对这两个方面都有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。这个第一个具体目标是使用一种新的刺激来扩大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由白色背景上较亮的小圆圈组成的。我们建议使用一种新的刺激措施，我们预计它更容易检测到，允许在更多受损区域进行可靠的测量比目前可能的视野范围更大，并减少了可变性。第二个具体目标是更好地使用来自当前临床视野检查的数据。我们期望在寻找变化时能够更早地检测到变化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进行。我们将基于该聚类分析推导出变化率的度量符合有经验的临床医生对疾病进展的严重程度的看法，这将有助于对疾病进展进行分期和监测，从而帮助临床决策。第三个具体目标是以执行视野位置子集的高精度测试。目前的临床标准是对更广泛的位置选择执行低精度测试。我们将比较这两个人的能力检测功能变化的方法，并评估其对横断面和节段强度的影响与结构措施的纵向相关性。这三个目标是相辅相成的。预计这些在使用视野检查时，AIMS将改进数据收集、分析和解释。在测试中的这种改进与视野检查一样常见的检查方法将对未来的临床实践产生重大影响。