Psychophysical Correlates of Neurodegeneration in Glaucoma

描述(申请人提供)：青光眼是发达国家第二大致盲原因，可导致周边视野进行性丧失。虽然青光眼造成的视力损失目前是不可逆转的，但如果在疾病的早期发现，可以避免灾难性的视野损失，临床干预是最有效的。不幸的是，现有的筛查技术只能在视力严重受损的情况下才能检测到青光眼。虽然青光眼的视力障碍被认为是由于视网膜神经节细胞(RGC)的程序性细胞死亡(凋亡)所致，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，而必须衡量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。这一点，加上筛查敏感性差，对有效管理一种日益流行的疾病具有长期影响。这项建议评估了一种更有效、更灵敏的运动筛查技术，该技术可能有助于及早发现RGC功能障碍，促进迅速的临床干预，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，这些可能会掩盖进行性视力损害的检测，并阻止患者在疾病的早期阶段自我诊断。这项建议的总体目标是识别青光眼的迹象，这些迹象可能有助于在灾难性的青光眼视野丧失发生之前将患者带到临床。这样的早期干预可以使青光眼的临床治疗最有效，从而减轻视力损害的负担。公共卫生相关性：青光眼是发达国家导致失明的第二大原因，随着人口老龄化，其发病率将会上升。虽然青光眼造成的视力损失目前是不可逆转的，但如果及早发现并治疗这种疾病，可以避免灾难性的视野损失，临床干预是最有效的。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.