Improved Assessment of Visual Field Change

改进视野变化的评估

• 批准号: 8857393
• 负责人: Michael Wall
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857393
• 关键词: Age; American; Anatomy; Area; Blindness; Caliber; Central Nervous System Diseases; Clinical; Clinical Management; Clinical Research; Clinical Treatment; Clinical Trials; Confidence Intervals; Coupled; Data; Defect; Development; Disease; Early Diagnosis; Enrollment; Evaluation; Eye; Funding; Glaucoma; Goals; Healthcare; Imaging Techniques; Institutes; Linear Regressions; Location; Measurable; Measures; Methods; Modeling; Monitor; National Eye Institute; Nerve Fibers; Noise; Optic Nerve; Optical Coherence Tomography; Outcome Measure; Participant; Patients; Perimetry; Photophobia; Rehabilitation Outcome; Rehabilitation therapy; Research; Signal Transduction; Statistical Methods; Statistical Models; Stimulus; Structure; Techniques; Testing; Time; United States; Unnecessary Surgery; Veterans; Vision; Vision Tests; Visual; Visual Fields; Visual impairment; analytical tool; base; clinical practice; cohort; improved; instrument; luminance; new technology; optic nerve disorder; prevent; programs; rehabilitation strategy; research study; retinal nerve fiber layer; treatment trial; visual receptive field; visual threshold

DESCRIPTION (provided by applicant): Project Summary: Problem: Glaucoma is a leading cause of blindness in the United States. Treatment decisions for glaucoma and other optic nerve diseases are based largely on changes in visual function made by quantification of the visual field. The reliable identification of visual field change is the single most difficult problem in vision testing. With standard perimetry, in areas of moderate visual field damage, retest variability is greater than the physical dynamic range of the instrument and the retinal nerve fiber layer becomes so thin that it is not measurable by current OCT imaging techniques. However, visual function often remains in these damaged areas. We have shown that increasing the stimulus size can lower retest variability while maintaining the same sensitivity to detect new deficits, and extend the useful dynamic range of testing by about 50%. Hypothesis: Using a model of visual receptive field activation by different sized stimuli predicts an improved signal-to-noise ratio using larger perimetric stimuli. We propose that a large portion of perimetric variability and narrow effective dynamic range is due to a poor signal-to-noise ratio associated with using a small stimulus. Using larger perimetric stimuli will enhance the dynamic range of perimetry while lowering retest variability allowing for improved and earlier detection of visual field change. We will test a cohort of 120 glaucoma patients and 60 normals with automated perimetry using stimulus sizes III, V, VI and luminance size threshold perimetry a test that finds a visual threshold by changing stimulus size rather than luminance. Methods: Specific Aim 1: Identify the stimulus size with the lowest variability and broadest effective dynamic range. We will define, measure and compare the effective dynamic ranges and retest variabilities of perimetry with stimulus sizes III, V, VI and luminance size threshold perimetry; 50 subjects (40 glaucoma patients and 10 healthy participants) will be tested once a week for five weeks. Specific Aim 2: Identify the stimulus size that shows visual field change earliest in a patients' course by testing patients longitudinally. We will use linear regression and confidence intervals along with our statistical model (Specific Aim 3) to determine which stimulus size detects visual field change at the earliest time in our 180 subject cohort from our recent Merit Review. Specific Aim 3: Develop a statistical model of visual field change. Current techniques incorrectly assume visual field test locations are independent. Using Bayesian and Frequentist analytical tools we will build an exponential spatial correlation structure to model visual field data over time. Summary: We anticipate substantially increasing both the useful dynamic range of perimetry and our ability to detect visual field change. Potential Impact on Veterans Health Care: These methods would impact VA health care by (1) allowing earlier detection of visual field change; (2) minimize misdiagnosis, unnecessary testing and even unnecessary surgery that results from mistakenly interpreting fluctuation of the visual field as change; (3) allow better evaluation of visual function for clinical trials and VA vision rehabilitation programs.

描述（由申请人提供）： 项目摘要： 问题：青光眼是美国失明的主要原因。青光眼和其他视神经疾病的治疗决策主要基于视野量化引起的视功能变化。视野变化的可靠识别是视力测试中最困难的问题。使用标准视野检查时，在中度视野损伤的区域中，重新测试的变异性大于仪器的物理动态范围，并且视网膜神经纤维层变得如此薄，以至于当前的OCT成像技术无法测量。然而，这些受损区域通常仍保留视觉功能。我们已经证明，增加刺激大小可以降低重新测试的变异性，同时保持检测新缺陷的相同灵敏度，并将测试的有用动态范围扩大约 50%。假设：使用不同大小刺激的视觉感受野激活模型可以预测使用较大视野刺激时信噪比会得到改善。我们认为，视野变异性和有效动态范围窄的很大一部分是由于与使用小刺激相关的较差的信噪比造成的。使用更大的视野刺激将增强视野检查的动态范围，同时降低重新测试的变异性，从而改进和更早地检测视野变化。我们将使用刺激大小 III、V、VI 和亮度大小阈值视野检查，对 120 名青光眼患者和 60 名正常人进行自动视野检查，该测试通过改变刺激大小而不是亮度来找到视觉阈值。方法：具体目标 1：确定具有最低变异性和最宽有效动态范围的刺激大小。我们将定义、测量和比较刺激大小 III、V、VI 和亮度大小阈值视野检查的有效动态范围并重新测试视野检查的变异性； 50 名受试者（40 名青光眼患者和 10 名健康参与者）将每周接受一次测试，持续五周。具体目标 2：通过纵向测试患者，确定在患者病程中最早显示视野变化的刺激大小。我们将使用线性回归和置信区间以及我们的统计模型（具体目标 3）来确定在我们最近的优点评审中的 180 名受试者队列中，哪种刺激大小能够最早检测到视野变化。具体目标 3：开发视野变化的统计模型。当前的技术错误地假设视野测试位置是独立的。使用贝叶斯和频率分析工具，我们将构建指数空间相关结构来对随时间变化的视野数据进行建模。摘要：我们预计将大幅提高视野检查的有用动态范围和检测视野变化的能力。对退伍军人医疗保健的潜在影响：这些方法将通过以下方式影响退伍军人管理局的医疗保健：(1) 允许及早检测视野变化； （2）尽量减少因误将视野波动解释为变化而导致的误诊、不必要的检查甚至不必要的手术； (3) 可以更好地评估临床试验和 VA 视力康复计划的视觉功能。