A New Technique for Central Visual Field Analysis

描述(由申请人提供)：快速、准确和负担得起的视野缺陷(暗点)评估为诊断眼部疾病、选择适当的医疗干预措施、监测治疗程序的有效性和预测康复需求的目的提供关键信息。自动视野检查费时费力，不适合频繁监测老年性黄斑变性(AMD)等疾病的快速发展。当不能保持稳定的中心固定时，它就变得不可靠了。阿姆斯勒网格测试已被证明是不敏感和不可靠的。这项拟议研究的目的是评估一种新的视野测试在评估中央视野方面的有效性。在此常规点阵测试(RDAT)中，直线点阵短暂闪烁，而暗点则表现为规则点图案的中断，通常是一些缺失的点。患者通过报告异常点的数量来描述中断的即时感觉。RDAT与现有的视野测试有以下特点：1)它使用空间扩展的规则点阵来同时检查大范围的视野。2)点阵的规律性使受试者可以立即对感知到的视野缺陷的大小做出定量报告，因此测试结果并不严重依赖于受试者保持稳定注视的能力。3)可以调整点阵密度以减少感知填充(PFI)，从而可以检测到小的和长期存在的暗点。4)可以考虑点阵PFI的影响，从而可以更准确地确定暗点的大小。5)测试可以在个人计算机上进行，因此可以广泛使用。这些特点的结合使RDAT成为现有现场测试的重要补充。在现有的现场测试被证明无效或不可靠的情况下(例如，与AMD相关的中心暗点)，或者需要对视野进行快速且低成本的评估(筛查、初级保健设置或自我管理监测)时，它可能是有用的。实现五个具体目标。1)确定RDAT的最佳测试参数和程序。2)评价RDAT检测黄斑暗点的敏感性和特异性。3)评估RDAT量化暗点大小和位置的能力。4)对照现有视野检查，评估RDAT的测试/重测可靠性、对注视稳定性的依赖程度和效率。5)建立RDAT结果与现有现场测试之间的关系。长期目标是开发一种低成本、易于使用和广泛使用的临床工具来评估黄斑。

DESCRIPTION (provided by applicant): Quick, accurate and affordable assessment of visual field defects (scotomas) provides crucial information for the purposes of diagnosing eye diseases, selecting appropriate medical interventions, monitoring the effectiveness of therapeutic procedures, and predicting rehabilitation needs. Automated perimetry is time-consuming and unsuitable for frequent monitoring of rapid development of diseases such as age-related macular degeneration (AMD). It becomes unreliable when steady central fixation cannot be maintained. The Amsler grid test has been shown to be insensitive and unreliable. The goal of the proposed research is to evaluate the efficacy of a new visual field test for assessing the central visual field. In this Regular Dot-Array Test (RDAT) a rectilinear dot-array is flashed briefly, and a scotoma manifests itself as an interruption of the regular dot pattern, typically, some missing dots. The patient describes the immediate percept of the interruption by reporting the number of abnormal dots. The following characteristics distinguish the RDAT from existing visual field tests: 1) It uses spatially extended regular dot-arrays to examine a large area of the visual field simultaneously. 2) The regularity of a dot-array allows subjects to make quantitative reports about the sizes of perceived field defects instantly, and thus the test result doesn't depend critically on the subject's ability to maintain steady fixation. 3) The dot-array density can be adjusted to reduce perceptual filling-in (PFI) so that small and long-standing scotomas can be detected. 4) It is possible to account for the effect of dot-array PFI, so that the sizes of scotomas can be more accurately determined. 5) The test can be conducted on personal computers, and thus is widely accessible. The combination of these characteristics makes the RDAT an important addition to existing field tests. It can be useful in situations where existing field tests have been shown to be ineffective or unreliable (central scotomas associated with AMD, for example), or where a quick and low-cost assessment of visual field is desired (screening, primary care settings, or self-administered monitoring). Five specific aims will be accomplished. 1) Determine the optimal testing parameters and procedure for the RDAT. 2) Assess the sensitivity and specificity of the RDAT for detecting macular scotomas. 3) Assess the ability of the RDAT to quantify the sizes and locations of scotomas. 4) Assess the test/retest reliability, the dependence on fixation stability and the efficiency of the RDAT, in relation to existing visual field tests. 5) Establish the relationship between the findings of the RDAT and existing field tests. The long-term goal is to develop a low-cost, easy-to-use, and widely accessible clinical tool for evaluating the macula.