African and European Descent, Ocular Blood Flow and Glaucoma Progression

描述(申请人提供)：这项研究的目的是调查血管风险因素在解释为什么非洲人后裔(AD)与欧洲人后裔(ED)相比更容易受到青光眼影响的作用。研究表明，眼部血流在某些人青光眼损害的演变中起着重要作用。众所周知，阿尔茨海默病患者的全身和脑血管疾病的患病率也有所增加。鉴于这些发现，这项研究旨在调查患有青光眼的AD患者的眼睛灌注压和血流异常是否导致在AD人群中观察到的青光眼患病率和进展的差异。这项研究涉及对印第安纳波利斯青光眼进展研究(IGPS)现有数据进行精心设计的二次分析。这项研究的独特之处在于，它是唯一一项长期前瞻性观察研究 眼血流和血流与结构性和功能性青光眼进展的关系。在IGPS中登记的113名开角型青光眼患者除了接受青光眼进展的全面临床标记外，还接受了全面的眼血流和血流参数评估。广泛的临床和血流动力学指标在两次相同的基线检查中进行相同的评估，两次检查间隔一周，然后在三年内每年进行两次检查。每次就诊时，患者都要接受全面的检查，包括：多项眼压测量(Goldmann和Psaal)，视力，对比敏感度，中央角膜厚度，高度，体重，体重指数，血压，心率，病史，视野检查(使用标准自动视野计)，傅立叶域多普勒光学相干断层扫描(FD-OCT)和视网膜全血流量检查，层状光学相干断层扫描(OCT)结构成像，Heidelberg视网膜断层扫描III，球后血管彩色多普勒成像，激光共聚焦扫描视网膜毛细血管多普勒血流计，眼灌注压计算，屈光度，帕斯卡压(眼脉搏幅度)和医学问卷调查。拟议的二次数据分析将分析结构和功能疾病进展与眼血流灌注压和血流之间的关系，并调查AD和ED青光眼人群之间的差异。识别AD和ED患者之间血管参数的明显差异将为确定AD患者青光眼患病率和进展差异的机制提供有价值的见解。 公共卫生相关性：这项研究的目的是探索血管危险因素在解释非洲人后裔和欧洲人后裔青光眼差异背后的机制方面的作用。已知的全身性血管疾病在非洲裔人群中的患病率增加表明，眼睛灌注压和血流的缺陷可能在解释这些不平等方面起着重要作用。我们对印第安纳波利斯青光眼进展研究数据的独特二次分析，包括全面的眼血流灌注压、血流、视网膜和视神经结构、视觉功能及其与疾病进展的关系，首次有可能阐明非洲裔和欧洲裔青光眼疾病差异的原因。

DESCRIPTION (provided by applicant): The objective of this study is to investigate the role of the vascular risk factors in explaining why individuals of African descent (AD) are disproportionately affected by glaucoma compared to individuals of European descent (ED). Studies have suggested that ocular blood flow plays a significant role in the evolution of glaucomatous damage in some individuals. It is also well known that persons of AD have an increased prevalence of systemic and cerebral vascular diseases. Given these findings, this study is designed to investigate if abnormal ocular perfusion pressure and blood flow in persons of AD with glaucoma contribute to the differences observed in the prevalence and progression of glaucoma in the AD population. This investigation involves a carefully designed secondary analysis of the existing data from the Indianapolis Glaucoma Progression Study (IGPS). This study is unique in that it is the only long- term prospective observational study that investigates the relationship between ocular perfusion and blood flow and structural and functional glaucoma progression. The 113 open-angle glaucoma patients enrolled in the IGPS receive a comprehensive ocular blood flow and perfusion parameters assessment alongside comprehensive clinical markers of glaucoma progression. Extensive clinical and hemodynamic measures were identically assessed at two identical baseline visits one week apart followed by biannual visits over a 3 year period. At each visit, patients underwent comprehensive testing including: multiple measures of intraocular pressure (Goldmann and Psacal), visual acuity, contrast sensitivity, ultrasonic corneal pachymetry of central corneal thickness, height, weight, body mass index, blood pressure, heart rate, medical history, visual field testing (using standard automated perimetry), Fourier domain Doppler optical coherence tomography (FD-OCT) with total retinal blood flow assessment, Stratus optical coherence tomography (OCT) structural imaging, Heidelberg retina tomography III, color Doppler imaging of the retrobulbar blood vessels, confocal scanning laser Doppler flowmetry of retinal capillaries, ocular perfusion pressure calculations, refraction, Pascal applanation (ocular pulse amplitude) and medical questionnaires. The proposed secondary data analysis will analyze the relationship between structural and functional disease progression and ocular perfusion pressure and blood flow, and investigate the differences between AD and ED glaucoma populations. Identifying distinct differences in vascular parameters between individuals of AD and ED will provide valuable insight into determining the mechanisms of disparity in glaucoma prevalence and progression in persons of AD. PUBLIC HEALTH RELEVANCE: The objective of this study is to explore the role of vascular risk factors in explaining the mechanisms behind the disparity of glaucoma in persons of African descent compared to those of European descent. The known increased prevalence of systemic vascular disease in the African descent population suggests that deficiencies in ocular perfusion pressure and blood flow may have a significant role in explaining these inequalities. Our unique secondary analysis of the Indianapolis Glaucoma Progression Study data which includes comprehensive ocular perfusion pressure, blood flow, retinal and optic nerve structure, visual function and their relationship to disease progression has the potential to elucidate, for the firs time, the reason for the disparity in glaucomatous disease between those of African descent and European descent.