Diagnostic Innovations in Glaucoma: Structural Assessment

描述（由申请人提供）：青光眼诊断创新研究（DIGS）：结构评估，自1995年以来资助，已导致我们检测青光眼视盘损伤的能力显着提高，并更好地了解视盘损伤和相应的视野损失之间的复杂关系。这种DIGS竞争性更新的总体目标是改善对脑水肿进展的检测和预测。纵向猴和人光谱域光学相干断层扫描（SDOCT）、共焦扫描激光检眼镜（CSL 0）和扫描激光偏振（GDx）数据和图像将用于解决以下3个特定目标：1）提高我们对正常老化和青光眼中黄斑、视网膜神经纤维层、视神经乳头、层前和层改变的认识，2）优化检测方案和成像分析技术，以检测变化，从而减少所需的检测，以及3）预测哪些个体处于进展的高风险中，以及哪些可能快速进展。 在具体目标1中，我们提出了几个假设，旨在确定如何最好地利用黄斑、视神经乳头、视网膜神经纤维层厚度以及前板层和板层测量来区分与年龄相关的微小生理性变化和与OAG相关的微小病理性变化。强调测量这些变化的速度。 我们的初步研究结果表明，计算和统计技术可以减少CSL 0图像的数量，可重复地检测变化。具体目标2的重点是假设这些技术应用于SDOCT时可以缩短验证变化所需的测试，从而降低青光眼管理和新青光眼治疗临床试验的成本。 为了解决具体目标3，将基线基于成像的结构参数和相关临床和人口统计学预测因素纳入多变量考克斯比例风险模型，以预测谁将发生基于照片和/或基于视野的进展以及谁将快速进展。 该项目解决了当前国家眼科研究所国家眼科和视力研究青光眼计划的目标，即“开发改进的诊断措施，以检测视神经疾病，进展和治疗效果。“通过确定最合适的结构措施，减少所需的测试数量，并开发预测模型，该提案将提高我们管理青光眼患者的能力，最终目标是降低视功能丧失的可能性和青光眼管理的成本。 公共卫生相关性：原发性开角型青光眼是美国和全世界失明的主要原因;超过220万美国人患有青光眼，超过130，000人因该疾病而合法失明。这项名为“青光眼诊断创新研究（DIGS）：结构评估”的竞争性更新的总体目标是改善青光眼进展的检测，以便早期识别因疾病失明风险最高的个体并开始治疗。具体来说，我们将继续跟踪一组健康个体、青光眼患者和具有最新一代眼科诊断成像仪器的高风险患者，以1）提高我们区分青光眼变化和正常衰老引起的变化的能力，2）缩短检测变化的时间并降低青光眼护理和新青光眼疗法临床试验的成本，以及3）预测哪些个体处于进展的高风险中，以及哪些个体可能快速进展。

DESCRIPTION (provided by applicant): The Diagnostic Innovations in Glaucoma Study (DIGS): Structural Assessment, funded since 1995, has led to significant improvements in our ability to detect glaucomatous optic disc damage, and a better understanding of the complex relationship between optic disc damage and corresponding visual field loss. The overall goal of this DIGS competitive renewal is to improve the detection and prediction of glaucomatous progression. Longitudinal monkey and human spectral domain optical coherence tomography (SDOCT), confocal scanning laser ophthalmoscopy (CSLO) and scanning laser polarimetry (GDx) data and images will be used to address the following 3 specific aims: 1) to improve our understanding of macular, retinal nerve fiber layer, optic nerve head, pre-laminar and laminar change in normal aging and glaucoma, 2) to optimize testing protocols and imaging analysis techniques for detecting change to reduce testing required, and 3) to predict which individuals are at a high risk of progression, and which are likely to progress rapidly. In Specific Aim 1, we address several hypotheses designed to determine how best to utilize macula, optic nerve head, retinal nerve fiber layer thickness and pre-lamina and laminar measurements to differentiate between small physiologic age-related change and small-pathologic OAG related change. Measuring the velocity of these changes is emphasized. Our preliminary results suggest that computational and statistical techniques can reduce the number of CSLO images required to reproducibly detect change. Specific Aim 2 focuses on the hypothesis that these techniques when applied to SDOCT can shorten the testing required to verify change, and thereby reduce the costs of glaucoma management and clinical trials for new glaucoma therapy. To address Specific Aim 3, baseline imaging-based structural parameters and relevant clinical and demographic predictive factors will be included in multivariable Cox proportional hazards models for predicting who will develop photograph based and/or visual field based progression and who will progress rapidly. This project addresses the current National Eye Institute National Plan for Eye and Vision Research glaucoma program objectives to "develop improved diagnostic measures to detect optic nerve disease, progression, and treatment effectiveness." By identifying the most appropriate structural measures, reducing the number of tests required, and developing prediction models, this proposal will improve our ability to manage glaucoma patients with the ultimate goals of reducing both the likelihood of visual function loss and the costs of glaucoma management. PUBLIC HEALTH RELEVANCE: Primary open angle glaucoma is a leading cause of blindness in the United States and worldwide; over 2.2 million Americans have glaucoma and that over 130,000 are legally blind from the disease. The overall goal of this competitive renewal entitled "Diagnostic Innovations in Glaucoma Study (DIGS): Structural Assessment is to improve the detection of glaucomatous progression so that the individuals that are at the highest risk of going blind from the disease are identified early and treatment initiated. Specifically, we will continue to follow a group of healthy individuals, individuals with glaucoma and those at high risk of developing the disease with the latest generation of ophthalmic diagnostic imaging instruments to 1) improve our ability to differentiate between glaucomatous changes and changes due to normal aging, 2) shorten the time to detect change and reduce costs of both glaucoma care and clinical trials of new glaucoma therapies, and 3) predict which individuals are at a high risk of progression, and which are likely to progress rapidly.