Diagnostic Innovations in Glaucoma:Structural Assessment

描述：据估计，超过220万美国人患有青光眼，超过13万人在法律上因青光眼而失明。早期、准确的诊断和治疗对于防止疾病的进展和视觉功能的丧失是重要的。国家眼科研究所国家计划计划的目标突出了“开发改进的诊断方法以检测视神经疾病、进展和治疗效果”的必要性。青光眼诊断创新研究(DIGS)：结构评估建议继续1995年开始的纵向研究，以开发新的方法来诊断和监测青光眼视盘和视网膜神经纤维层(RNFL)的变化，并使用最有前途的新光学成像设备：共焦扫描激光眼底镜(CSLO)、扫描激光偏振(SLP)和光学相干断层扫描(OCT)。到目前为止，这项研究已经确定了这些新技术的重复性和诊断准确性，并导致了我们检测青光眼能力的显著改善。当前提案的目标是开发改进的方法来1)检测青光眼引起的结构损伤的进展，2)测量青光眼进展的速度及其决定因素，以及3)表征结构和功能随时间变化之间的复杂关系。方法：这项研究将包括至少600名青光眼患者和250名健康对照。在拟议的研究结束时，300多名患者将对每种技术进行5年的随访。每名受试者每6个月完成一次眼科和视野检查。此外，还将获得CSLO和OCT图像来测量视盘，以及SLP和OCT图像来测量RNFL。还将评估视盘和RNFL变化的摄影记录，并将其与成像技术进行比较。这项研究将提供重要的纵向数据，以确定最敏感和最具体的方法来检测青光眼随时间的变化。意义：这一队列的研究将提高我们在临床实践中监测青光眼随时间变化的能力，并增强我们在临床试验中利用视盘和视网膜神经纤维层的结构变化作为终点的能力。

DESCRIPTION: It is estimated that over 2.2 millions American have glaucoma and that over 130,000 are legally blind from the disease. Early, accurate diagnosis and treatment is important to prevent the progression of the disease, and loss of visual function. The National Eye Institute National Plan program objectives highlight the need to "develop improved diagnostic measures to detect optic nerve disease, progression and treatment effectiveness". The Diagnostic Innovation in Glaucoma Study (DIGS): Structural Assessment proposes to continue the longitudinal study initiated in 1995 to develop novel methods to diagnose and monitor glaucomatous changes of the optic disc and retinal nerve fiber layer (RNFL) with the most promising new optical imaging instruments: confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP) and optical coherence tomography (OCT). To date, this study has determined the reproducibility and diagnostic accuracy of these new techniques and has led to significant improvements in our ability to detect glaucoma. The objectives of the current proposal are to develop improved methods to 1) detect the progression of structural damage due to glaucoma, and 2) measure the rate of glaucomatous progression and its determinants, and 3) characterize the complex relationship between structural and functional change over time. Methods: This study will include at least 600 glaucoma patients and 250 healthy controls. At the end of the proposed study, over 300 patients will have >5 years of follow-up on each technique. Each subject will complete an ophthalmologic and visual field exam every 6 months. In addition, CSLO and OCT images will be obtained to measure the optic disc and, SLP and OCT images to measure the RNFL. Photographic documentation of optic disc and RNFL changes also will be evaluated and compared to the imaging techniques. This study will provide important longitudinal data to identify the most sensitive and specific methods for detecting glaucomatous changes over time. Significance: Study of this cohort will improve our ability to monitor glaucomatous change over time in clinical practice and enhance our ability to utilize structural changes of the optic disc and retinal nerve fiber layer as endpoints in clinical trials