3D RNFL Structure and High-resolution Perimetry for Assessing Glaucomatous Damage

描述（由申请人提供）：青光眼是可预防失明的主要原因之一，目前可用的治疗不足以阻止青光眼的进展。 很多病人。虽然已经了解了很多关于青光眼的生物学，但新形式的治疗的发展受到三个障碍的阻碍：正常眼睛中神经节细胞数量的受试者间变异性高，青光眼患者中受试者内变异性高，以及疾病进展缓慢。拟议的研究将神经建模和临床研究相结合，以开发用于诊断青光眼和评估失明进展的改进方法。这些结果旨在改善临床试验和持续患者护理的措施，同时提高对青光眼病理生理学的基础科学理解，并为疾病过程的生物学研究提供指导。临床设备的创新使用将指导定制系统的测试，统计分析将利用昏迷损伤的结构和功能措施之间的协同作用。将使用定制的高级自适应光学扫描激光检眼镜（AOSLO）以及定制使用的光谱域眼部相干断层扫描（SD-OCT）对青光眼患者进行视网膜神经纤维层（RNFL）的高分辨率视网膜成像。将在视野的相应区域进行高分辨率视野检查，使用能够抵抗影响常规视野检查的光学伪影的自定义刺激。将采用创新的统计方法评估结果，该方法利用视野检查和成像测量之间的协同作用。具体目标1将把这些方法应用于没有眼疾的人，建立RNFL的三维模型，捕获结构和厚度，目的是利用结构克服正常眼睛中神经节细胞数量的受试者间差异性高的障碍。具体目标2将集中在颞视网膜，它具有独特的特点，使其有可能定位视网膜神经纤维开始的地方，从几个轴突开始。颞叶视网膜对应于鼻侧视野，在早期青光眼中视野丧失是常见的，重点将是在纵向研究中检测一些最早的变化。具体目标3将集中在黄斑，这是非常重要的，因为它提供了用于许多日常生活活动的高分辨率视力。黄斑还具有独特的特征，使其能够对视网膜神经纤维的起始位置进行成像，并且非常适合高分辨率视野检查。具体目标4将通过检查具有“楔形”RNFL缺陷的患者将这种方法扩展到鼻视网膜，所述“楔形”RNFL缺陷在视盘处狭窄，然后在受损的RNFL的楔形处变宽。而具体目标2和3地址RNFL纤维开始的独特位置，具体目标4将解决如何解释RNFL缺陷在视网膜的其余部分。

DESCRIPTION (provided by applicant): Glaucoma is one of the leading causes of preventable blindness, and currently available treatments are not sufficient to halt progression in many patients. While much has been learned about the biology of glaucoma, development of new forms of treatment has been stymied by three barriers: high between-subject variability in ganglion cell number in normal eyes, high within-subject variability in patients with glaucoma, and the slow rate of progression of the disease. The proposed research integrates neural modeling and clinical research to develop improved methods for diagnosing glaucoma and for assessing progression towards blindness. The results are intended to improve measures for both clinical trials and ongoing patient care, while at the same time improving basic science understanding of the pathophysiology of glaucoma and providing guidance for biological studies of the disease process. Innovative uses of clinical devices will guide testing with custom systems, and statistical analyses will utilize the synergy between structural and functional measures of glaucomatous damage. High-resolution retinal imaging of retinal nerve fiber layer (RNFL) will be performed on patients with glaucoma using a custom advanced adaptive optics scanning laser ophthalmosope (AOSLO) as well as custom use of spectral domain ocular coherence tomography (SD-OCT). High-resolution perimetry will be performed in corresponding regions of the visual field, using custom stimuli that are resistant to optical artifacts that affet conventional perimetry. The results will be assessed with innovative statistical methods that utilize the synergy between perimetry and imaging measures. Specific Aim 1 will apply these methods to people free of eye disease, building three-dimensional models of RNFL that capture both structure and thickness, with the goal of using structure to overcome the barrier of high between-subject variability in ganglion cell number in normal eyes. Specific Aim 2 will focus on temporal retina, which has unique characteristics that make it possible to locate where retinal nerve fibers begin, starting with just a few axons. Temporal retina corresponds to nasal visual field, where visual field loss is common in early glaucoma, and the emphasis will be on detecting some of the earliest changes in a longitudinal study. Specific Aim 3 will focus on the macula, which is of great importance because it provides high-resolution vision used for many activities of daily living. The macula also has unique characteristics that make it possible to image the starting locations of retinal nerve fibers, and is well-suited for high-resolution perimetry. Specific Aim 4 will extend this approach to nasal retina, by examining patients with "wedge" RNFL defects that are narrow at the optic disc and then widen in a wedge of damaged RNFL. Whereas Specific Aims 2 & 3 address unique locations where RNFL fibers begin, Specific Aim 4 will address how to interpret RNFL defects across the rest of the retina.