Retinal Nerve Fiber Layer Area in Aging and Glaucoma

描述（由申请人提供）：本职业培训计划的主要目标是为学术验光师提供成为独立研究人员所需的教学和实验室培训。该项目的目的是提高视网膜神经纤维层（RNFL）的体内测量的精度和准确性，RNFL是眼内神经节细胞含量的替代品，使用定制扫描来早期发现或青光眼的进展。青光眼是一组疾病，如果不及时治疗，可能导致不可逆的失明。据估计，到2030年，全世界将有3700万人因这种疾病失明，其中82%的人年龄在50岁以上。在美国，青光眼是一个重大的公共卫生问题，影响着220万人，是导致失明的主要原因。青光眼的病因难以捉摸，其诊断或进展通常通过直接评估视神经、评估视网膜神经纤维层（RNFL）的完整性和测量视野灵敏度来确定。成像技术的进步使得对视网膜和视神经的客观评估成为可能。具体来说，光谱域光学相干层析成像（SD-OCT）允许高达75米的轴向分辨率。以视神经为中心的12度圆形扫描在临床上常用于测量RNFL的厚度。为了准确和精确地评估RNFL，重要的是考虑诸如眼部放大和非神经元内容物的贡献等因素。使用非侵入性方法来测量眼部生物计量，可以计算眼部放大倍率。虽然在SD-OCT扫描中无法看到胶质组织和小视网膜血管，但主要的视网膜血管在底层组织上投下阴影，并且可以解释。该项目的目标是在考虑眼部放大和主要视网膜血管的补偿后，研究视网膜内皮细胞的厚度和面积测量。特别地，这些方法将用于1)在非人灵长类动物模型中研究随青光眼疾病进展的RNFL厚度和横截面积的变化；2)研究正常衰老过程中发生的RNFL措施和血管对RNFL的贡献；3)探讨青光眼患者RNFL指标及其与视野的功能关系。该技术的临床应用将提高青光眼患者的诊断准确性和治疗效果。

DESCRIPTION (provided by applicant): The primary objective of this career training proposal is the provide an academic optometrist with the didactic and laboratory training necessary to be an independent researcher. The objective of this project is to improve the precision and accuracy of in vivo measures of the retinal nerve fiber layer (RNFL), a surrogate for the ganglion cell content within the eye, using customized scans for the early detection or progression of glaucoma. Glaucoma is a group of diseases that can lead to irreversible blindness if left untreated. It is estimated that by the year 2030, 37 million individuals worldwide will be blinded by this disease, with 82% of these individuals being over the age of 50. In the United States, glaucoma is a significant public health problem, affecting 2.2 million individuals, and being a leading cause of blindness. Having an elusive cause, the diagnosis or progression of glaucoma is often made by direct assessment of the optic nerve, evaluating the integrity of the retinal nerve fiber layer (RNFL) and measuring the sensitivity of the visual field. Advances in imaging technology allow for an objective assessment of the retina and optic nerve. Specifically, spectral domain optical coherence tomography (SD-OCT) allow for up to 75m axial resolution. A 12 degree circular scan centered on the optic nerve is often used clinically for measuring the thickness of the RNFL. For an accurate and precise assessment of the RNFL, it is important to account for factors such as ocular magnification and the contribution of the non-neuronal content. Using non-invasive methodologies to measure ocular biometry, ocular magnification can be computed. Although glial tissue and small retinal vessels cannot be visualized in SD-OCT scans, the major retinal vessels cast shadows on the underlying tissues, and can be accounted for. The goal of the project is to investigate RNFL thickness and area measures after consideration of ocular magnification and compensation for major retinal vasculature. In particular, these methodologies will be used to 1) investigate changes in the thickness and cross sectional area of the RNFL with glaucoma disease progression in the non-human primate model; 2) investigate RNFL measures and the vascular contribution to the RNFL that occur with normal ageing; 3) investigate RNFL measures and the functional relationship to visual fields in glaucoma patients. Clinical implementation of this technology will improve the diagnostic accuracy and treatment outcomes of patients with glaucoma.