Visual acuity and functional measurements in the aging eye

项目摘要 视网膜相关性黄斑变性（AMD）仍然是美国永久性视力丧失的最常见原因 和许多工业化国家。糖尿病性视网膜病变和糖尿病性黄斑水肿是糖尿病性视网膜病变的主要原因。 工作年龄的美国人视力下降。视觉功能是几乎所有1,861名美国人的关键组成部分。 AMD的临床试验和262例糖尿病视网膜病变和黄斑水肿的临床试验。如果结果指标，包括 视力，可以更准确和成本效益，并减少重测变异，然后 临床试验可以使用较小的样本量，从而节省将疗法推向市场的成本和时间。通过 构建一个新的设备，潜在的视觉测试仪™（PVT），我们将通过最大限度地减少 老年人眼睛的光学问题。同步视网膜成像将澄清注视点和注视 患者眼睛的稳定性。患者眼睛的光学误差将被测量为波前像差， 目标显示器将用价格适中的自适应光学器件校正，以克服视网膜抬高 以及屈光不正。波前误差的报告区分了神经 损坏与光学问题。一个高分辨率的显示器，适用于视力测试，将刺激投射到 眼睛在麦克斯韦视图，以尽量减少瞳孔大小的影响，发现在老年人的眼睛。竞争器械， 微视野测定法缺乏视敏度所需的分辨率。我们将使用心理物理技术， 快速，准确，并提供更好的可变性措施：4替代被迫选择。在目标1中，我们将 自适应光学校正的PVT视觉显示和用于视网膜成像的NIR照明。成像光是 舒适且足够暗，不会干扰视觉任务。专利近红外成像技术项目 视网膜上的一系列光栅状条纹，为成像提供线扫描。检测是通过 带滚动快门的2D CMOS检测器，行的串行读出与 照明或时间上的偏移。这提供了在计算机控制下的柔性电子孔径。两 共焦和多重散射光图像是可用的，揭示玻璃疣和其他视网膜下增厚。 我们将在10名受试者中优化图像质量，这些受试者具有一系列屈光不正、眼部色素沉着和年龄。在 目的2，我们将量化和验证Hartmann-Shack波前测量的PVT在20名患者 有视网膜疾病的患者与无视网膜疾病的患者对比，以确定对波前测量的影响。在目标3中， 使用目标1的数据优化算法，以有效测试和衡量潜在视力（PVA） 和2，报告集中趋势（期望值）和可变性，包括光学误差和注视数据，以 这位患者通过视网膜治疗所能达到的视力目的4：20例渗出型AMD患者 和20例糖尿病性黄斑水肿患者，我们将通过与标准对照来评估PVA的重现性和有效性。 VA和基线预测值与随访时实际治疗后测量的VA和PVA。

Project Summary Age-related macular degeneration (AMD) remains the most common cause of permanent vision loss in the US and many industrialized countries. Diabetic retinopathy and diabetic macular edema are the leading cause of visual acuity loss in working age Americans. Visual function is a key component in almost all of the 1,861 US clinical trials for AMD and 262 for diabetic retinopathy and macular edema. If outcome measures, including visual acuity, could be made more accurate and cost-effective and with decreased test-retest variability, then clinical trials could use smaller sample sizes, giving savings in cost and time to bring therapies to market. By building a new device, the Potential Vision Tester™ (PVT), we will improve measurements by minimizing the issues from the optics of the aging eye. Simultaneous retinal imaging will clarify fixation locus and fixation stability of the patient’s eye. The optical errors of a patient’s eye will be measured as wavefront aberrations, and the target display will be corrected with moderately priced adaptive optics to overcome retinal elevation from exudation as well as refractive error. Reporting out of wavefront errors distinguishes between neural damage vs. optical issues. A high resolution display, suitable for visual acuity testing, will project stimuli onto the eye in Maxwellian view to minimize pupil size effects found in older eyes. Competing devices for microperimetry lack the resolution needed for visual acuity. We will use psychophysical techniques that are rapid, accurate, and provide better measures of variability: 4 alternative forced choice. In Aim 1, we will build an adaptive optics-corrected PVT visual display and NIR illumination for retinal imaging. The imaging light is comfortable and dim enough not to interfere with visual tasks. The patented NIR imaging technology projects a series of stripes onto the retina in a raster pattern, providing line scanning for imaging. The detection is via a 2D CMOS detector with a rolling shutter, with the serial read-out of the lines either synchronized with the illumination or offset in time. This provides a flexible electronic aperture under computer control. Both confocal and multiply scattered light images are available, revealing drusen and other subretinal thickening. We will optimize image quality in 10 subjects with a range of refractive error, ocular pigmentation, and age. In Aim 2, we will quantify and validate the Hartmann-Shack wavefront measurements of the PVT in 20 patients with retinal disease vs. 20 without to determine the effect on wavefront measurements. In Aim 3 we will optimize the algorithm for efficient testing and metric for Potential Visual Acuity (PVA), using data from Aims 1 and 2, reporting central tendency (expected value) and variability, including optical errors and fixation data, to address the acuity this patient could reach with retinal treatment. In Aim 4, for 20 patients with exudative AMD and 20 with diabetic macular edema, we will assess PVA reproducibility and validity by comparison to standard VA and the prediction at baseline to actual post-treatment measured VA and PVA at follow up.