VISUAL FUNCTION IN GLAUCOMA AND OCULAR HYPERTENSION

本申请描述了一项为期五年的青光眼视觉功能的前瞻性纵向研究，该研究建立在之前两个资助期在该领域的先前工作的基础上。本研究将使用各种视觉功能的心理物理测试来确定青光眼视力丧失的性质和程度，并将解决视力丧失与疾病进展、遗传标记和临床管理的关系。具体的目标。A.继续采用多变量方法分析与青光眼相关的视力功能变化，并进一步描述这些变化与潜在生理机制的关系。B.改进包括几种视觉功能测量在内的诊断和分析技术。C.改进评估进展的技术，以便更好地监测当前和新疗法的有效性。D.描述与青光眼相关的视觉功能丧失与某些分子遗传标记的存在或缺失之间的关系。科目。该研究包括正在进行的登记。我们将对450名患者的眼睛进行标准、SWAP、FDP和MAP领域的测试，他们同意完成为期五年的研究。此外，我们有一个广泛的数据库，所有受试者的总n为1295，其中超过569人使用SWAP。我们还与Jeffrey Liebmann博士合作提供了500个非裔美国人的眼睛来分析这个提议的5年时间。这些患者具有良好的临床特征，我们的数据库包括危险因素、病史、其他影响疾病、青光眼亚型、立体影像分级、所有视力测试、视神经结构测量、眼压史、药物、手术等信息。据我们所知，这个广泛的数据库是独一无二的，包含了更多的视觉功能和视神经结构的测量在相当长的时间框架比任何其他实验室。方法。心理物理测试的目的是分离各种视觉功能。我们将使用各种统计方法（信号检测理论、Cox比例风险模型、生存分析、进展算法）来确定每种方法的敏感性和特异性、缺陷率和模式、结果的可重复性和临床实用性的最佳参数。此外，还将确定与遗传和种族的关系。结论。拟议实验的结果将提供对与青光眼相关的潜在视力损害的更深入的了解，随着时间的推移，视力损害的相对进展，以及预测哪些患者由于遗传、种族或其他因素而面临最大风险的可能性。

This application describes a five-year prospective longitudinal study of visual function in glaucoma, which builds upon prior work in this area during two previous grant periods. This study will use a variety of psychophysical tests of visual function to determine the nature and extent of glaucomatous vision loss, and will address the relationship of vision loss to progression of disease, genetic markers, and clinical management. Specific Aims. A. To continue this multivariate approach for analysis of the functional changes in vision associated with glaucoma and to delineate further the relationship of these changes to underlying physiological mechanisms. B. To improve diagnostic and analysis techniques encompassing several measures of visual function. C. To improve techniques for evaluating progression in order to better monitor effectiveness of current and new therapies. D. To delineate the relationship between visual function loss associated with glaucoma and the presence or absence of certain molecular genetic markers. Subjects. The study includes ongoing enrollment. We will have 450 patient eyes tested on standard, SWAP, FDP and MAP fields, who agree to complete the five year study. In addition, we have an extensive database for all subjects with total n of 1295, over 569 of these with SWAP. We have also developed a collaboration with Dr. Jeffrey Liebmann to provide 500 African-American eyes for analysis over the 5 years of this proposal. These patients are clinically well-characterized and our database includes information such as risk factors, medical history, other influencing disease, subtypes of glaucoma, stereophoto grades, all vision testing, measures of optic nerve structure, intraocular pressure history, medications, surgeries, and more. To our knowledge, this extensive database is unique, encompassing more measures of visual function and optic nerve structure over a considerably longer time frame than any other laboratory. Methods. The psychophysical tests are designed to isolate various visual functions. We will use a variety of statistical methods (signal detection theory, Cox proportional hazard modeling, survival analysis, progression algorithms) to determine best parameters for sensitivity and specificity of each, rate and pattern of defect, reproducibility of results and clinical utility. In addition, the relationship to genetics and ethnic group will be determined. Conclusion. The results from the proposed experiments should provide a greater understanding of the underlying damage to vision associated with glaucoma, the comparative progression of loss over time, and the likelihood of predicting which patients are most at risk due to genetic, ethnic or other factors.