EARLY DETECTION OF GLAUCOMA DAMAGE

及早发现青光眼损伤

• 批准号: 6524953
• 负责人: SUSAN E VITALE
• 金额: $ 35.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-08-01 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6524953
• 关键词: clinical research; computer assisted diagnosis; diagnosis design /evaluation; diagnosis quality /standard; early diagnosis; eye disorder diagnosis; glaucoma; human subject; longitudinal human study; optic nerve disorder; pathologic process; patient care management; polarimetry; radioimmunoassay; retina degeneration; retinal ganglion; visual fields

Glaucoma is one of the leading causes of irreversible blindness worldwide. Because it is a chronic disease with a long course and is symptomless until the late stages, diagnosis and monitoring are essential to prevent permanent damage to the optic nerve. The National Eye Institute, in its "Vision Research: A National Plan", states that the development of "improved diagnostic techniques encompassing measures of visual function, optic nerve, and nerve fiber layer structure..." are program goals. In seeking better tools for the early diagnosis of glaucoma damage, we propose a new approach based on the assessment of retinal tissue loss at the posterior pole, where there is an abundance of ganglion cells which are essential to central vision and which are lost in glaucoma. We have developed a computerized optical method, the Retinal Thickness Analyzer (RTA), to map the retinal thickness at the posterior pole. Large losses in retinal thickness were detected by the RTA at the posterior pole of glaucoma patients due to the loss of ganglion cells and nerve fibers corresponding to the locations of documented visual field defects. Moreover, retinal thickness loss was found in areas devoid of visual field defects. In accordance with the NEI recommendation, we will use epidemiologic methods to develop reliable, valid criteria for the diagnosis and progression of primary open-angle glaucoma, based on the RTA. The NEI has identified an important research question to be addressed: "what is the relationship between visual function loss and structural changes to the optic nerve and retinal nerve fiber layer in glaucoma?". We propose to investigate the utility of the RTA for diagnosis and monitoring of glaucoma and assess, for the first time, the loss of the central ganglion cells and nerve fibers. We will examine: 1) in a cross-sectional study, whether the RTA can detect decreased retinal thickness, relative to normal thickness, in areas with well documented glaucomatous damage; 2) in a longitudinal study, the characteristics of RTA measurements which precede new visual field loss in established glaucoma patients. In addition, a second promising technology, the GDx Nerve Fiber Analyzer (NFA), a scanning laser polarimeter that measures nerve fiber layer retardation loss in the peripapillary area, will be evaluated and compared with the RTA. In sum, we propose to evaluate and compare the sensitivity, specificity, validity, and reliability of the RTA and the NFA in identifying eyes with glaucoma and in identifying eyes at increased risk of progression of glaucomatous visual field defects. This assessment of the RTA and NFA will help to establish their utility as outcome measures for clinical management of glaucoma, epidemiological research, and clinical trials.

青光眼是全世界不可逆转失明的主要原因之一。由于它是一种慢性疾病，病程较长，直到晚期才出现症状，因此诊断和监测对于防止视神经永久性损伤至关重要。美国国家眼科研究所在其“视觉研究：国家计划”中指出，开发“改进的诊断技术，包括视觉功能、视神经和神经纤维层结构的测量......”是该计划的目标。 在寻找更好的青光眼损伤早期诊断工具的过程中，我们提出了一种基于评估后极部视网膜组织损失的新方法，后极部有丰富的神经节细胞，这些神经节细胞对中央视力至关重要，但在青光眼中会损失。我们开发了一种计算机化光学方法，即视网膜厚度分析仪 (RTA)，用于绘制后极部的视网膜厚度图。 由于与记录的视野缺损位置相对应的神经节细胞和神经纤维的损失，RTA 在青光眼患者的后极检测到视网膜厚度的大量损失。此外，在没有视野缺损的区域发现视网膜厚度减少。根据 NEI 的建议，我们将在 RTA 的基础上，使用流行病学方法制定可靠、有效的原发性开角型青光眼诊断和进展标准。 NEI 确定了一个需要解决的重要研究问题：“青光眼视功能丧失与视神经和视网膜神经纤维层结构变化之间有何关系？”。我们建议研究 RTA 在青光眼诊断和监测中的实用性，并首次评估中央神经节细胞和神经纤维的损失。 我们将检查：1）在横断面研究中，RTA 是否可以检测到在有详细记录的青光眼损伤区域中视网膜厚度相对于正常厚度的减少； 2) 在一项纵向研究中，确定青光眼患者出现新视野丧失之前的 RTA 测量特征。 此外，第二个有前途的技术是 GDx 神经纤维分析仪 (NFA)，这是一种扫描激光偏振计，可测量视乳头周围区域的神经纤维层延迟损失，将进行评估并与 RTA 进行比较。总之，我们建议评估和比较 RTA 和 NFA 在识别青光眼眼睛和识别青光眼视野缺损进展风险增加的眼睛方面的敏感性、特异性、有效性和可靠性。对 RTA 和 NFA 的评估将有助于确定它们作为青光眼临床管理、流行病学研究和临床试验结果衡量指标的效用。