Retinal Nerve Fiber Layer Area in Aging and Glaucoma

描述（由申请人提供）：这个职业培训计划的主要目标是提供必要的教学和实验室培训的学术验光师是一个独立的研究人员。该项目的目的是提高视网膜神经纤维层（RNFL）的体内测量的精确度和准确度，RNFL是眼睛内神经节细胞含量的替代品，使用定制扫描进行青光眼的早期检测或进展。青光眼是一组疾病，如果不及时治疗，可能导致不可逆的失明。据估计，到2030年，全世界将有3700万人因这种疾病而失明，其中82%的人年龄超过50岁。在美国，青光眼是一个重要的公共卫生问题，影响220万人，并且是失明的主要原因。青光眼的诊断或进展通常通过直接评估视神经，评估视网膜神经纤维层（RNFL）的完整性和测量视野的敏感性来进行。成像技术的进步允许对视网膜和视神经进行客观评估。具体而言，谱域光学相干断层扫描（SD-OCT）允许高达75米的轴向分辨率。以视神经为中心的12度圆形扫描通常用于临床测量RNFL的厚度。为了对RNFL进行准确和精确的评估，重要的是要考虑诸如眼睛放大率和非神经元内容的贡献等因素。使用非侵入性方法来测量眼睛生物测量，可以计算眼睛放大率。虽然神经胶质组织和小的视网膜血管在SD-OCT扫描中不能被可视化，但是主要的视网膜血管在下面的组织上投射阴影，并且可以被解释。该项目的目标是调查RNFL厚度和面积的措施后，考虑眼睛放大和补偿主要的视网膜血管。特别地，这些方法将用于1）研究在非人灵长类动物模型中RNFL的厚度和横截面积随着青光眼疾病进展的变化; 2）研究RNFL测量和正常老化时发生的血管对RNFL的贡献; 3）研究RNFL测量和青光眼患者视野的功能关系。该技术的临床应用将提高青光眼患者的诊断准确性和治疗效果。 公共卫生相关性：青光眼是影响美国220万人的重大公共卫生问题，其中120，000人是法定盲人。据估计，治疗和管理这种疾病的直接财政负担为29亿美元，治疗晚期病例的费用高达早期病例的四倍。该项目的目标是提高视神经病变阶段的体内测量的准确性和精确性，以帮助这种视觉破坏性疾病的早期诊断。

DESCRIPTION (provided by applicant): The primary objective of this career training proposal is the provide an academic optometrist with the didactic and laboratory training necessary to be an independent researcher. The objective of this project is to improve the precision and accuracy of in vivo measures of the retinal nerve fiber layer (RNFL), a surrogate for the ganglion cell content within the eye, using customized scans for the early detection or progression of glaucoma. Glaucoma is a group of diseases that can lead to irreversible blindness if left untreated. It is estimated that by the year 2030, 37 million individuals worldwide will be blinded by this disease, with 82% of these individuals being over the age of 50. In the United States, glaucoma is a significant public health problem, affecting 2.2 million individuals, and being a leading cause of blindness. Having an elusive cause, the diagnosis or progression of glaucoma is often made by direct assessment of the optic nerve, evaluating the integrity of the retinal nerve fiber layer (RNFL) and measuring the sensitivity of the visual field. Advances in imaging technology allow for an objective assessment of the retina and optic nerve. Specifically, spectral domain optical coherence tomography (SD-OCT) allow for up to 75m axial resolution. A 12 degree circular scan centered on the optic nerve is often used clinically for measuring the thickness of the RNFL. For an accurate and precise assessment of the RNFL, it is important to account for factors such as ocular magnification and the contribution of the non-neuronal content. Using non-invasive methodologies to measure ocular biometry, ocular magnification can be computed. Although glial tissue and small retinal vessels cannot be visualized in SD-OCT scans, the major retinal vessels cast shadows on the underlying tissues, and can be accounted for. The goal of the project is to investigate RNFL thickness and area measures after consideration of ocular magnification and compensation for major retinal vasculature. In particular, these methodologies will be used to 1) investigate changes in the thickness and cross sectional area of the RNFL with glaucoma disease progression in the non-human primate model; 2) investigate RNFL measures and the vascular contribution to the RNFL that occur with normal ageing; 3) investigate RNFL measures and the functional relationship to visual fields in glaucoma patients. Clinical implementation of this technology will improve the diagnostic accuracy and treatment outcomes of patients with glaucoma. PUBLIC HEALTH RELEVANCE: Glaucoma is a significant public health problem affecting 2.2 million individuals in the United States, of which 120,000 are legally blind. The treatment and management of the disease is estimated to have a direct financial burden of $2.9 billion, with the care of more advanced cases costing up to four times those of early stages. The goal of this project is to improve the accuracy and precision of in vivo measures of the stage of optic neuropathy to aid in the early diagnosis of this visually devastating disease.