Novel perimetry for identifying changes in visual field sensitivity in glaucoma

青光眼是一种慢性的、进行性的、与年龄相关的视网膜神经节细胞变性，其特征是缓慢的、不可逆转的视野丧失。它是世界上导致不可逆转的失明的主要原因，影响到英格兰和威尔士的大约50万人，以及全球8000万人。随着人口老龄化，青光眼的患病率正在上升。周围视野首先会慢慢消失，直到晚期才会被患者注意到。根据视野检查，确定视野损失的临床方法包括将刺激(光点)呈现给视网膜，并确定在视野中的多个位置可以检测到的最暗的部分。然而，目前的标准视野检查是在40年前设计的，那时青光眼的发病机制还没有被了解。当测试变得更加自动化时，很大程度上是从当前标准(Goldmann动态视野检查)的前身引入的测试设计，以及高度相关的测量变异性，使得在第一时间识别青光眼损失和检测进展迹象变得困难。事实上，可能需要多年的反复措施才能确定即使是适度的恶化速度。有必要及时重新设计视野检查，利用40年来基础科学(生理、心理物理)和临床研究的知识和理解，以及更容易获得和负担得起的技术，以增加检查的可及性，更早发现视力损失，更早治疗，并改善视力预后。在这个多学科、多地点的项目中，我们将在最近发现的两种青光眼功能生物标志物的基础上，开始将一种新颖的、更循证的视野检查形式从实验室转化到临床环境中。我们提出了第一阶段的研究计划，在该计划中，我们将优化各种测试参数，以最大限度地提高识别青光眼视野丧失的新测试的准确性、精密度和效率。

Glaucoma, a chronic, progressive, age-related degeneration of retinal ganglion cells, is characterised by a slow, irreversible loss of visual field. It is the world's leading cause of irreversible blindness, affecting approximately 500,000 people in England and Wales, and 80 million people worldwide. With an ageing population, prevalence of glaucoma is rising. The peripheral visual field is slowly lost first, often going unnoticed by patients until advanced. Perimetry, the clinical method for identifying visual field loss involves presenting stimuli (spots of light) to the retina and determining the dimmest that can be detected at multiple locations in the field. However, the current standard perimetry test was designed >40 years ago, before the disease mechanisms in glaucoma were understood. A test design that was largely imported from the predecessor of the current standard (Goldmann kinetic perimetry) when tests became more automated, and high associated measurement variability, make it difficult to identify glaucomatous loss in the first instance and detect signs of progression. In fact, it can take many years of repeated measures to identify even moderate rates of deterioration. There is a timely need to redesign perimetry with 40 years of knowledge and understanding from basic science (physiological, psychophysical) and clinical studies, as well as with more accessible and affordable technology, in order to increase accessibility to testing, detect visual loss sooner, treat sooner, and improve prognosis for vision. In this multi-disciplinary, multi-site project, we will initiate the path to translation of a novel, more evidence-based form of perimetry from the laboratory to the clinical setting on the basis of two recently discovered functional biomarkers for glaucoma. We propose a stage 1 programme of research in which we will optimise various test parameters to maximise the accuracy, precision, and efficiency of the novel test for identification of glaucomatous visual field loss.