Assessing Ocular Hemodynamic Response to Surgical Intervention in Glaucoma

评估青光眼手术干预的眼血流动力学反应

• 批准号: 9198857
• 负责人: O'Rese J Knight
• 金额: $ 22.07万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198857
• 关键词: Accounting; Affect; Ambulatory Blood Pressure Monitoring; American; Award; Basic Science; Biomechanics; Biomedical Engineering; Blindness; Blood Pressure; Blood Vessels; Blood flow; Cataract Extraction; Cicatrix; Circadian Rhythms; Clinical; Clinical Research; Clinical Sciences; Clinical Trials Design; Communities; Contact Lenses; Cost Analysis; Data; Devices; Diagnosis; Drainage procedure; Early Intervention; Environment; Expenditure; Failure; Family Practice; Fellowship; Functional disorder; Funding; Gills; Glaucoma; Goals; Government; Home environment; Impairment; Institutes; Institution; K-Series Research Career Programs; Laser Surgery; Leadership; Master of Science; Measurement; Mechanics; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Nature; North Carolina; Open-Angle Glaucoma; Operative Surgical Procedures; Ophthalmology; Optic Nerve; Outcome; Outcomes Research; Outpatients; Oxygen; Parents; Participant; Pathogenesis; Patients; Perfusion; Pharmaceutical Preparations; Physiologic Intraocular Pressure; Pilot Projects; Principal Investigator; Procedures; Public Health; Research; Research Training; Retinal; Risk Factors; Role; Schools; Scientist; Services; Specialist; Statistical Data Interpretation; Surgical incisions; Techniques; Technology; Therapeutic; Time; Trabeculectomy; Training; Translational Research; Treatment Efficacy; United States National Institutes of Health; Universities; Venous; Vision; Visual Fields; Wages; Work; burden of illness; career; clinical efficacy; clinical practice; design; experience; glaucoma surgery; hemodynamics; implantation; improved; insight; instrumentation; interest; mathematical model; member; modifiable risk; new therapeutic target; normotensive; novel diagnostics; patient oriented research; pressure; prevent; professor; public health relevance; response; responsible research conduct; sensor; success; theories; therapeutic target; therapy design; tool; trend; vascular factor

 DESCRIPTION (provided by applicant): Assessing Ocular Hemodynamic Response to Surgical Intervention in Glaucoma PA-14-049: Mentored Patient-Oriented Research Career Development Award (Parent K23) Principal Investigator: O'Rese J. Knight, MD Institution: University of North Carolina at Chapel Hill (UNC) Candidate: O'Rese J. Knight, MD is a fellowship-trained glaucoma specialist who has been involved with patient-oriented research throughout his training and clinical career. He is currently an Assistant Professor in the UNC Department of Ophthalmology. He has specific interests in clinical outcomes research and is interested long-term in investigating emerging glaucoma medications and surgical techniques for clinical efficacy. The specific training objectives for the proposed career development award are: 1) gaining proficiency in clinical trial design, team leadership in research, and statistical analysis through coursework culminating in a Master's of Science in Clinical Research (MSCR), 2) completing the Responsible Conduct of Research training with the North Carolina Translational and Clinical Sciences Institute, and 3) conducting research focused on understanding the role of ocular hemodynamics in glaucoma pathogenesis, and evaluating whether OHD factors can be altered with medical and surgical interventions. His team of mentors and co-mentors include Donald Budenz, MD, MPH, Anthony Viera, MD, MPH, and Shawn Gomez, EngScD. Environment: The University of North Carolina is one of the nation's premier research institutions. It is a member of the Clinical and Translational Science Awards Consortium and has been since 2008. In FY2013, UNC ranked seventh among all universities nationwide in NIH funding. It provides an optimal environment for the proposed research. O'Rese will be completing his MSCR degree at the UNC Gillings' School of Global Public Health, which has been perennially recognized as the best public institution of public health. The Department of Ophthalmology is home to a number of extremely accomplished basic and clinical research scientists and boasts brand new facilities that are conducive to clinical research. Within the glaucoma division, there is an active and varied research portfolio which will provide O'Rese ample leadership experience in clinical research. The UNC research community is marked by its collegial nature, and this is demonstrated in the proposed research seamlessly spanning the Departments of Ophthalmology, Family Medicine, and Biomedical Engineering. O'Rese has taken the time to develop the necessary relationships with key stakeholders to accomplish the proposed research. UNC, in kind, has demonstrated its support of O'Rese's research career by providing the salary support that allowed him the time to complete the early work underpinning this current proposal. Research: Open angle glaucoma (OAG) is the third leading cause of blindness in the US, and is expected to affect 4.3 million Americans in 2032. Its pathogenesis is poorly understood and this has yielded treatment options that cannot optimally prevent glaucomatous vision loss. Elevated intraocular pressure (IOP) is widely seen as glaucoma's only modifiable risk factor, and thus all the current treatments are designed to reduce IOP. However, patients can continue to lose vision with appropriate IOP reduction. There are ocular hemodynamic (OHD) factors - ocular perfusion pressure (OPP), optic nerve blood flow (ONBF), and retinal oxygen saturation (RSO2) - which have been identified as contributory to glaucoma pathogenesis, but not adequately investigated as therapeutic targets. Thus the overarching goal of the proposed research is to assess whether OHD factors can enhance our ability to identify which patients are likely to slow or halt progressive visual field loss as a result of surgical intervention. The specific aims are to gather preliminary data on the effect of cataract surgery, iStent implantation, and GDD implantation on: 1) circadian IOP trends, 2) (a) ONBF and (b) RSO2 trends, and 3) OPP trends in OAG. To accomplish this, 25 patients undergoing each procedure will complete OHD assessments before and after their respective surgeries. We hypothesize that there will be less circadian IOP variability and improved OPP, ONBF, and RSO2 after surgery. We expect that this research will yield a greater understanding of the hemodynamic mechanisms of glaucoma pathogenesis and provide insight into how to begin to integrate this understanding into clinical practice.

 描述（由申请人提供）：评估青光眼手术干预的眼部血流动力学反应PA-14-049：指导患者导向研究职业发展奖（家长K23）主要研究者：O 'Rese J. Knight，医学博士机构：北卡罗来纳州大学查佩尔山（北卡罗来纳州）候选人：O 'Rese J. Knight，MD是一位经过奖学金培训的青光眼专家，他在整个培训和临床职业生涯中一直参与以患者为导向的研究。他目前是眼科学系的助理教授。他对临床结果研究特别感兴趣，并对研究新兴青光眼药物和手术技术的临床疗效长期感兴趣。拟议的职业发展奖的具体培训目标是：1）通过课程学习熟练掌握临床试验设计，研究团队领导和统计分析，最终获得临床研究科学硕士学位（MSCR），2）完成北卡罗来纳州转化和临床科学研究所的负责任的研究行为培训，3）开展研究，重点是了解眼血流动力学在青光眼发病机制中的作用，并评估药物和手术干预是否可以改变OHD因素。他的导师和共同导师团队包括Donald Budenz（医学博士、公共卫生硕士）、Anthony Viera（医学博士、公共卫生硕士）和Shawn Gomez（EngScD）。环境：北卡罗来纳州大学是全国首屈一指的研究机构之一。它是临床和转化科学奖联盟的成员，自2008年以来一直是。在2013财年，麻省理工学院在全国所有大学中排名第七。它为拟议的研究提供了最佳环境。O 'Rese将在Gillings全球公共卫生学院完成他的MSCR学位，该学院一直被公认为最好的公共卫生机构。眼科系拥有许多非常有成就的基础和临床研究科学家，并拥有有利于临床研究的全新设施。在青光眼部门内，有一个活跃而多样的研究组合，这将为O 'Rese在临床研究方面提供丰富的领导经验。该研究社区的特点是其合议性质，这是在拟议的研究无缝跨越眼科，家庭医学和生物医学工程部门证明。O 'Rese花时间与关键利益相关者建立必要的关系，以完成拟议的研究。以实物形式，通过提供工资支持，使他有时间完成支持目前提案的早期工作，证明了对奥里斯研究生涯的支持。开角型青光眼（OAG）是美国第三大致盲原因，预计到2032年将影响430万美国人。其发病机制知之甚少，这已经产生了治疗选择，不能最佳地预防青光眼性视力丧失。眼内压升高（IOP）被广泛认为是青光眼唯一可改变的危险因素，因此目前所有的治疗方法都旨在降低IOP。然而，适当降低IOP后，患者可能继续丧失视力。眼血流动力学（OHD）因素-眼灌注压（OHD）、视神经血流量（ONBF）和视网膜氧饱和度（RSO 2）-已被确定为青光眼发病机制的贡献因素，但尚未作为治疗靶点进行充分研究。因此，拟议研究的总体目标是评估OHD因素是否可以提高我们识别哪些患者可能因手术干预而减缓或停止进行性视野丧失的能力。具体目标是收集 关于白内障手术、iStent植入和GDD植入对以下方面影响的初步数据：1）昼夜IOP趋势，2）（a）ONBF和（B）RSO 2趋势，以及3）OAG的IOP趋势。为了实现这一目标，接受每种手术的25名患者将在各自的手术前后完成OHD评估。我们假设手术后昼夜IOP变异性较小，IOP、ONBF和RSO 2改善。我们希望这项研究将产生青光眼发病机制的血流动力学机制的更好的理解，并提供如何开始将这种理解融入临床实践的见解。