Functional Testing for Glaucoma

青光眼功能测试

• 批准号: 8306736
• 负责人: Stuart Gardiner
• 金额: $ 30.6万
• 依托单位: LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8306736
• 关键词: Algorithms; Area; Blindness; Clinical; Contrast Sensitivity; Data; Data Collection; Data Set; Defect; Detection; Disease; Frequencies; Functional disorder; Future; Glaucoma; Laboratories; Location; Measurement; Measures; Noise; Optic Disk; Patients; Perimetry; Probability; Quality of life; Reporting; Research; Retinal Ganglion Cells; Source; Stimulus; Structure; Techniques; Testing; Time; Vision; Visual Fields; Visual system structure; Work; base; central visual field; clinical practice; cost; design; follow-up; functional status; glaucoma test; improved; indexing; instrument; luminance; next generation; novel; prevent; prognostic; response

DESCRIPTION (provided by applicant): Glaucoma is a leading cause of blindness both in the US and worldwide. The long-term purpose of this project is to improve functional testing in glaucoma. Assessment and follow-up of patients currently relies on automated perimetry to provide functional testing of the visual field. However, the ability to assess progression and/or response to treatment using perimetry is hampered by high variability, especially in areas of moderate or severe glaucomatous damage. Recent findings by our laboratory and others have advanced our understanding of perimetry by challenging key assumptions about the test. This proposal aims to use these advances to explain and reduce the test variability. This will improve the accuracy, efficiency and utility of current functional testing, giving immediate impact in both research and clinical settings, and laying groundwork for the next generation of instruments and algorithms. The first Specific Aim is to produce an accurate and physiologically justified measure of the Effective Dynamic Range (EDR) of perimetry. It is postulated that the very high contrast stimuli used by perimetry in glaucomatous defects saturate the response of the visual system. The resultant nonlinearity in the contrast-response function would cause the detection probability to asymptote below 100%, explaining the high variability in sensitivities in damaged areas. The limit of the EDR will be defined as the contrast beyond which response linearity cannot be assumed. This will be measured by collecting frequency-of-seeing curves in subjects with moderate or advanced glaucoma. The same technique will be used to determine whether the EDR is extended by use of an increased stimulus size. The second Specific Aim is to derive and test a spatial filter to reduce the variability. This will be the first filter to be based both on sensitivities at other locations in the visual field and on the structure of the optic nerve head. The third Specific Aim is to assess the potential utility of using a linear scale for sensitivity, rather than the current logarithmic decibel scale. First, an efficient linear-scaled thresholding algorithm will be derived and tested, to determine whether it will reduce variability both between tests and in the structure-function relation. Second, linear-scaled global indices of the central visual field will be examined, to determine whether they offer improved prognostic value compared with current decibel-scaled indices when assessing progression. The three aims are complementary. It is anticipated that by combining these aims, variability in perimetry will be better understood, and significantly reduced. Such an improvement in a test as commonly performed as perimetry will significantly impact future clinical practice.

描述（由申请人提供）：青光眼是美国和世界范围内致盲的主要原因。该项目的长期目的是改善青光眼的功能测试。目前，患者的评估和随访依赖于自动视野检查来提供视野的功能测试。然而，使用视野检查评估进展和/或对治疗的反应的能力受到高变异性的阻碍，特别是在中度或重度昏迷性损伤的区域。我们实验室和其他机构最近的研究结果通过挑战有关检查的关键假设，促进了我们对视野检查的理解。该提案旨在利用这些进展来解释和减少测试变异性。这将提高当前功能测试的准确性，效率和实用性，在研究和临床环境中产生直接影响，并为下一代仪器和算法奠定基础。第一个具体目标是产生视野检查的有效动态范围（EDR）的准确和生理合理的测量。据推测，非常高的对比度刺激所使用的视野检查在昏迷的缺陷饱和的视觉系统的反应。对比度响应函数中的所得非线性将导致检测概率渐近线低于100%，这解释了受损区域中灵敏度的高度可变性。EDR的限值将被定义为对比度，超过该对比度，则无法假定响应线性。这将通过收集中度或晚期青光眼受试者的视频曲线来测量。将使用相同的技术来确定是否通过使用增加的刺激大小来延长EDR。第二个具体目标是推导和测试空间滤波器，以减少变异性。这将是第一个基于视野中其他位置的敏感性和视神经乳头结构的滤波器。第三个具体目标是评估使用灵敏度线性标度而不是当前对数分贝标度的潜在效用。首先，一个有效的线性尺度阈值算法将推导和测试，以确定它是否会减少测试之间的变异性和结构功能关系。其次，将检查中央视野的线性标度全局指数，以确定在评估进展时，与当前的分贝标度指数相比，它们是否能提供更好的预后价值。这三个目标是相辅相成的。预计通过结合这些目标，视野检查的变异性将得到更好的理解，并显著降低。像视野检查这样常见的检查的这种改进将显著影响未来的临床实践。