Visual acuity and functional measurements in the aging eye

老化眼睛的视力和功能测量

• 批准号: 10478474
• 负责人: ANN E ELSNER
• 金额: $ 63.24万
• 依托单位: AEON IMAGING, LLC
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10478474
• 关键词: Address; Adult; Affect; Aftercare; Age; Age related macular degeneration; Aging; Algorithms; American; Blindness; Burn injury; Cataract; Certification; Clinical; Clinical Trials; Computer software; Computers; Contrast Sensitivity; Data; Detection; Developed Countries; Devices; Diabetes Mellitus; Diabetic Retinopathy; Disease; Drusen; Epiretinal Membrane; Excision; Exudative age-related macular degeneration; Eye; Film; Future; Goals; Hyperopia; Image; Imaging technology; Indiana; Legal patent; Lesion; Light; Lighting; Liquid substance; Matched Group; Measurement; Measures; Methods; Miosis disorder; Modeling; Morphologic artifacts; Near-infrared optical imaging; Optics; Outcome; Outcome Measure; Patients; Pattern; Performance; Photoreceptors; Pigmentation physiologic function; Population; Price; Protocols documentation; Psychophysics; Pupil; Refractive Errors; Reporting; Reproducibility; Residual state; Resolution; Retina; Retinal Diseases; Sample Size; Savings; Scanning; Series; Speed; Stimulus; Testing; Time; Training; Universities; Vision; Visual; Visual Accommodation; Visual Acuity; adaptive optics; adaptive optics scanning laser ophthalmoscopy; algorithm development; base; cost; cost effective; design; detector; diabetic; feature detection; flexibility; follow-up; geographic atrophy; imager; improved; individual patient; light scattering; macular edema; medical schools; primary outcome; rapid technique; relating to nervous system; retina blood vessel structure; retinal imaging; sample fixation; tool; treatment trial; visual stimulus

Project Summary Age-related macular degeneration (AMD) remains the most common cause of permanent vision loss in the US and many industrialized countries. Diabetic retinopathy and diabetic macular edema are the leading cause of visual acuity loss in working age Americans. Visual function is a key component in almost all of the 1,861 US clinical trials for AMD and 262 for diabetic retinopathy and macular edema. If outcome measures, including visual acuity, could be made more accurate and cost-effective and with decreased test-retest variability, then clinical trials could use smaller sample sizes, giving savings in cost and time to bring therapies to market. By building a new device, the Potential Vision Tester™ (PVT), we will improve measurements by minimizing the issues from the optics of the aging eye. Simultaneous retinal imaging will clarify fixation locus and fixation stability of the patient’s eye. The optical errors of a patient’s eye will be measured as wavefront aberrations, and the target display will be corrected with moderately priced adaptive optics to overcome retinal elevation from exudation as well as refractive error. Reporting out of wavefront errors distinguishes between neural damage vs. optical issues. A high resolution display, suitable for visual acuity testing, will project stimuli onto the eye in Maxwellian view to minimize pupil size effects found in older eyes. Competing devices for microperimetry lack the resolution needed for visual acuity. We will use psychophysical techniques that are rapid, accurate, and provide better measures of variability: 4 alternative forced choice. In Aim 1, we will build an adaptive optics-corrected PVT visual display and NIR illumination for retinal imaging. The imaging light is comfortable and dim enough not to interfere with visual tasks. The patented NIR imaging technology projects a series of stripes onto the retina in a raster pattern, providing line scanning for imaging. The detection is via a 2D CMOS detector with a rolling shutter, with the serial read-out of the lines either synchronized with the illumination or offset in time. This provides a flexible electronic aperture under computer control. Both confocal and multiply scattered light images are available, revealing drusen and other subretinal thickening. We will optimize image quality in 10 subjects with a range of refractive error, ocular pigmentation, and age. In Aim 2, we will quantify and validate the Hartmann-Shack wavefront measurements of the PVT in 20 patients with retinal disease vs. 20 without to determine the effect on wavefront measurements. In Aim 3 we will optimize the algorithm for efficient testing and metric for Potential Visual Acuity (PVA), using data from Aims 1 and 2, reporting central tendency (expected value) and variability, including optical errors and fixation data, to address the acuity this patient could reach with retinal treatment. In Aim 4, for 20 patients with exudative AMD and 20 with diabetic macular edema, we will assess PVA reproducibility and validity by comparison to standard VA and the prediction at baseline to actual post-treatment measured VA and PVA at follow up.

项目摘要 老年性黄斑变性(AMD)仍然是美国永久性视力丧失的最常见原因 以及许多工业化国家。糖尿病视网膜病变和糖尿病黄斑水肿是 美国工作年龄的人视力下降。视觉功能在1861名美国人中几乎都是一个关键组成部分 AMD和262治疗糖尿病视网膜病变和黄斑水肿的临床试验。如果结果衡量标准，包括 视力，可以变得更准确和更具成本效益，并减少测试-重测的变异性，然后 临床试验可以使用较小的样本量，从而节省将疗法推向市场的成本和时间。通过 构建一种新的设备，潜在的视力测试仪™(PVT)，我们将通过最小化 来自老化眼睛的光学问题。同步视网膜成像将明确注视位置和注视 病人眼睛的稳定性。患者眼睛的光学误差将被测量为波前像差， 目标显示器将使用价格适中的自适应光学设备进行校正，以克服视网膜抬高 由于渗出和屈光不正。报告波前误差区分神经 损坏与光学问题。一种适用于视力测试的高分辨率显示器，将刺激投影到 马克斯韦尔视野中的眼睛，以最大限度地减少年龄较大的眼睛的瞳孔大小影响。竞争对手的 微视野检查缺乏视觉敏锐度所需的分辨率。我们将使用心理物理技术，这些技术 快速、准确，并提供更好的变异性衡量标准：4可供选择的强制选择。在目标1中，我们将建立 用于视网膜成像的自适应光学矫正PVT视觉显示器和近红外照明。成像光是 舒适和昏暗，不会干扰视觉任务。获得专利的近红外成像技术项目 视网膜上的一系列条纹，形成一个栅格图案，为成像提供线条扫描。该检测是通过 带滚动快门的2D CMOS探测器，其线路的串行读出与 时间上的照明或偏移。这提供了一个在计算机控制下的灵活的电子孔径。两者都有 可获得共焦和多次散射光图像，显示玻璃体和其他视网膜下增厚。 我们将优化10个受试者的图像质量，包括屈光不正、眼部色素沉着和年龄。在……里面 目的2，我们将量化和验证20名患者的PVT的Hartmann-Shack波前测量 有视网膜疾病的人与没有视网膜疾病的人相比，无法确定对波前测量的影响。在《目标3》中，我们将 使用AIMS 1的数据优化算法，以进行有效的潜在视觉敏感度(PVA)测试和度量 2、将包括光学误差和固定数据在内的中心趋势(期望值)和变异性报告给 解决这位患者通过视网膜治疗可以达到的敏锐度。在目标4中，针对20名渗出型AMD患者 和20例糖尿病黄斑水肿，我们将通过与标准比较来评估PVA的重复性和有效性 治疗前和治疗后预测的VA和PVA在随访时测量。