Psychophysical Correlates of Neurodegeneration in Glaucoma

描述（由申请人提供）：青光眼是发达国家的第二大致盲原因，并导致周边视野的逐渐丧失。虽然目前由青光眼引起的视力丧失是不可逆转的，但如果在早期发现这种疾病，临床干预是最有效的，此时可以避免灾难性的视野丧失。不幸的是，现有的筛查技术只能检测青光眼一旦显着的视觉障碍已经发生。虽然青光眼中的视觉缺陷被认为可归因于视网膜神经节细胞（RGC）的程序性细胞死亡（凋亡），但现在清楚的是，细胞死亡是RGC功能逐渐恶化的终点。有效的诊断不能等待细胞死亡，而必须测量RGC功能障碍的行为影响。当筛查失败时，临床医生特别依赖患者的自我诊断。不幸的是，超过50%的可诊断青光眼患者并没有意识到这一点，这沿着筛查灵敏度差，对有效管理日益流行的疾病具有长期影响。该提案评估了一种更有效、更灵敏的运动筛查技术，该技术可能有助于更早地检测RGC功能障碍，促进及时的临床干预以减缓青光眼的进展。我们检查双眼视觉，填充和代偿性眼球运动，可能会掩盖检测进行性视力障碍，并防止患者在疾病的早期阶段自我诊断。该提案的总体目标是识别青光眼的体征，这可能有助于在发生灾难性青光眼性视野丧失之前将患者带到诊所。这种早期干预使得青光眼的临床管理最有效，从而减轻视力损害的负担。公共卫生相关性：青光眼是发达国家的第二大致盲原因，其发病率随着人口老龄化而上升。虽然由青光眼引起的视力丧失目前是不可逆的，但如果在早期阶段发现和治疗该疾病，则临床干预是最有效的，此时可以避免灾难性的视野丧失。拟议的研究计划开发了对青光眼神经变性早期阶段敏感的新诊断方法。

DESCRIPTION (provided by applicant): Glaucoma is the second leading cause of blindness in the developed world and causes progressive loss of the peripheral visual field. While visual loss caused by glaucoma is currently irreversible, clinical intervention is most effective if the disease is caught at an early stage, when catastrophic field loss can be averted. Unfortunately existing screening techniques can only detect glaucoma once significant visual impairment has occurred. Although visual deficits in glaucoma are thought to be attributable to programmed cell death (apoptosis) of retinal ganglion cells (RGCs) it is now clear that cell-death is the endpoint of a gradual deterioration in RGC-function. Effective diagnostics cannot wait for cell death, but must measure a behavioral impact of RGC dysfunction. When screening fails, the clinician is particularly reliant on the patients self-diagnosing. Unfortunately more than 50% of people who have diagnosable glaucoma are unaware of it. This, along with poor screening sensitivity has long-term implications for the effective management of an increasingly prevalent disease. This proposal assesses a more efficient and more sensitive motion screening technique that may help detect RGC dysfunction earlier, facilitating prompt clinical intervention to slow the progression of glaucoma. We examine binocular vision, filling-in and compensatory eye movements that may obscure detection of progressive visual impairment and prevent patients from self-diagnosing at an earlier stage of the disease. The overall aim of this proposal is to identify signs of glaucoma that may help bring patients to clinic before catastrophic glaucomatous visual field loss has occurred. Such early intervention allows clinical management of glaucoma to be most effective and so relieves the burden of visual impairment. PUBLIC HEALTH RELEVANCE: Glaucoma is the second leading cause of blindness in the developed world and its incidence is set to rise as the population ages. While visual loss caused by glaucoma is currently irreversible, clinical intervention is most effective if the disease is detected and treated at an early stage, when catastrophic field loss can be averted. The proposed program of research develops new diagnostics that are sensitive to the early stages of neuro-degeneration in glaucoma.