VISUAL FUNCTION IN GLAUCOMA AND OCULAR HYPERTENSION

本申请描述了一项为期五年的青光眼视功能前瞻性纵向研究，该研究建立在前两个资助期在该领域的工作基础上。本研究将使用各种视觉功能的心理物理测试来确定昏迷性视力丧失的性质和程度，并将讨论视力丧失与疾病进展、遗传标记和临床管理的关系。具体目标。A.继续采用这种多变量方法分析青光眼相关的视觉功能变化，并进一步描述这些变化与潜在生理机制的关系。B。提高诊断和分析技术，包括视觉功能的几个措施。C.改善评估进展的技术，以便更好地监测当前和新疗法的有效性。D.描述青光眼相关的视功能丧失与某些分子遗传标记存在或不存在之间的关系。科目本研究包括正在进行的入组。我们将对450例同意完成5年研究的患者眼睛进行标准、SWAP、FDP和MAP视野测试。此外，我们有一个广泛的数据库，所有受试者的总n为1295，其中超过569与SWAP。我们还与Jeffrey Liebmann博士合作，在本提案的5年内提供500只非洲裔美国人的眼睛进行分析。这些患者的临床特征很好，我们的数据库包括风险因素、病史、其他影响疾病、青光眼亚型、立体影像分级、所有视力测试、视神经结构测量、眼内压史、药物治疗、手术等信息。据我们所知，这个广泛的数据库是独一无二的，在比任何其他实验室更长的时间范围内包含更多的视觉功能和视神经结构测量。方法.心理物理测试旨在隔离各种视觉功能。我们将使用各种统计学方法（信号检测理论、考克斯比例风险模型、生存分析、进展算法）来确定每种方法的灵敏度和特异性、缺陷率和模式、结果再现性和临床效用的最佳参数。此外，还将确定与遗传和种族群体的关系。 结论从拟议的实验结果应该提供一个更好的理解潜在的损害与青光眼相关的视力，随着时间的推移损失的比较进展，并预测哪些患者是最危险的可能性，由于遗传，种族或其他因素。

This application describes a five-year prospective longitudinal study of visual function in glaucoma, which builds upon prior work in this area during two previous grant periods. This study will use a variety of psychophysical tests of visual function to determine the nature and extent of glaucomatous vision loss, and will address the relationship of vision loss to progression of disease, genetic markers, and clinical management. Specific Aims. A. To continue this multivariate approach for analysis of the functional changes in vision associated with glaucoma and to delineate further the relationship of these changes to underlying physiological mechanisms. B. To improve diagnostic and analysis techniques encompassing several measures of visual function. C. To improve techniques for evaluating progression in order to better monitor effectiveness of current and new therapies. D. To delineate the relationship between visual function loss associated with glaucoma and the presence or absence of certain molecular genetic markers. Subjects. The study includes ongoing enrollment. We will have 450 patient eyes tested on standard, SWAP, FDP and MAP fields, who agree to complete the five year study. In addition, we have an extensive database for all subjects with total n of 1295, over 569 of these with SWAP. We have also developed a collaboration with Dr. Jeffrey Liebmann to provide 500 African-American eyes for analysis over the 5 years of this proposal. These patients are clinically well-characterized and our database includes information such as risk factors, medical history, other influencing disease, subtypes of glaucoma, stereophoto grades, all vision testing, measures of optic nerve structure, intraocular pressure history, medications, surgeries, and more. To our knowledge, this extensive database is unique, encompassing more measures of visual function and optic nerve structure over a considerably longer time frame than any other laboratory. Methods. The psychophysical tests are designed to isolate various visual functions. We will use a variety of statistical methods (signal detection theory, Cox proportional hazard modeling, survival analysis, progression algorithms) to determine best parameters for sensitivity and specificity of each, rate and pattern of defect, reproducibility of results and clinical utility. In addition, the relationship to genetics and ethnic group will be determined. Conclusion. The results from the proposed experiments should provide a greater understanding of the underlying damage to vision associated with glaucoma, the comparative progression of loss over time, and the likelihood of predicting which patients are most at risk due to genetic, ethnic or other factors.