The BCI (Brain Computer Interface) Glaucoma Study: Objective Home-Based Detection of Progressive Visual Function Loss in Glaucoma

项目摘要 青光眼是世界上最主要的不可逆性失明和视力损害的原因。随着疾病 通常直到晚期才出现症状，早期发现功能损伤至关重要， 可以开始或提前治疗，以避免发展为残疾。功能丧失的检测是 传统上使用标准自动视野检查（SAP）进行。然而，SAP测试受到主观性的限制， 患者反应和大变异性，需要大量测试来检测随时间的变化。这些 测试在基于诊所的环境中进行，并且由于有限的患者可用性和卫生保健资源， 随着时间的推移，通常会获得不充分的测试，导致进展的延迟检测。的要求 对于训练有素的技术人员来说，SAP的成本、复杂性和缺乏可移植性也妨碍了其用于筛选 在缺乏医疗服务的人群中，为了解决目前评估视觉效果的方法的缺点， 功能，我们开发了一种创新的脑机接口（BCI），可以便携且客观 通过多焦稳态视觉诱发电位（mfSSVEP）评估视功能丧失。的BCI 包括采用与无线通信技术集成的头戴式显示器（HMD）的可穿戴设备， 脑电图（EEG）。在横断面调查中，我们证明了BCI mfSSVEP 参数能够成功地检测到昏迷性损伤，具有良好的重测重复性。基于 基于初步研究的令人鼓舞的结果，我们现在建议进行一项多中心研究， 纵向BCI mfSSVEP参数检测青光眼进展。在具体目标1中，我们将收集 青光眼患者和健康受试者在临床访视期间的纵向BCI mfSSVEP数据。我们 假设BCI mfSSVEP数据将能够成功地检测进展并测量变化率， 与SAP的功能评估和光学相干断层扫描的结构评估相比。在 目的2，我们将收集基于家庭的纵向mfSSVEP数据，并研究其检测性能 青光眼进展和测量变化率。我们假设测试频率的增加 基于家庭的BCI测试将导致更早的检测和预测进展相比，诊所- 数据和常规测试。在目标3中，我们将研究BCI mfSSVEP数据预测 青光眼患者报告的生活质量。总之，该提案采用了高度创新的BCI设备， 采集纵向mfSSVEP数据，主要目的是改善青光眼的检测和预测 进展该方法有可能解决目前标准测试的主要局限性， 影响疾病的管理。客观的家庭视功能测试可以代表一个 诊断和监测进展的变革方式。

PROJECT SUMMARY Glaucoma is the leading cause of irreversible blindness and visual impairment in the world. As the disease generally remains asymptomatic until late stages, early detection of functional damage is paramount, so that treatment can be initiated or advanced in order to avoid progression to disability. Detection of functional loss is traditionally made with standard automated perimetry (SAP). However, SAP testing is limited by subjectivity of patient responses and large variability, requiring a large number of tests for detection of change over time. These tests are conducted in clinic-based settings and, due to limited patient availability and health care resources, insufficient tests are usually acquired over time, resulting in delayed detection of progression. The requirement for highly trained technicians, cost, complexity, and lack of portability of SAP also preclude its use for screening of visual field loss in underserved populations. To address shortcomings of current methods to assess visual function, we have developed an innovative brain-computer interface (BCI) that allows portable and objective assessment of visual function loss through multifocal steady-state visual-evoked potentials (mfSSVEP). The BCI consists of a wearable device employing a head-mounted display (HMD) integrated with wireless electroencephalography (EEG). In cross-sectional investigations, we demonstrated that the BCI mfSSVEP parameters were able to successfully detect glaucomatous damage with excellent test-retest repeatability. Based on the encouraging results of the preliminary studies, we now propose a multicenter investigation of the ability of longitudinal BCI mfSSVEP parameters in detecting glaucoma progression. In Specific Aim 1, we will collect longitudinal BCI mfSSVEP data during clinic-based visits in glaucoma patients and healthy subjects. We hypothesize that BCI mfSSVEP data will be able to successfully detect progression and measure rates of change, as compared to functional assessment by SAP and structural assessment by optical coherence tomography. In Aim 2, we will collect home-based longitudinal mfSSVEP data and investigate their performance for detecting glaucoma progression and measuring rates of change. We hypothesize that the increased frequency of testing from home-based BCI testing will result in earlier detection and prediction of progression compared to clinic- based data and conventional testing. In Aim 3, we will investigate the ability of BCI mfSSVEP data in predicting patient-reported quality of life in glaucoma. In summary, this proposal employs a highly innovative BCI device to acquire longitudinal mfSSVEP data with the central aim of improving detection and prediction of glaucoma progression. The approach has the potential to address major current limitations of standard testing, significantly impacting management of the disease. Objective home-based testing of visual function could represent a transformative way of diagnosing and monitoring progression.