Three-dimensional structure-function relationships in glaucoma from SD-OCT

描述(申请人提供)：此第二阶段方案旨在阐明青光眼患者视野阈值敏感度与视网膜层、视神经头和连接神经纤维束的结构特征之间的结构-功能关系。这项建议扩展了我们成功的I期研究，该研究建立了视网膜定量指标之间的结构-结构关系。在这一阶段中，光谱域光学相干断层扫描(SD OCT)图像分析的进一步进步将产生新的损伤度量，预计将与视野阈值灵敏度更好地对应。该项目是由一个重要的临床问题推动的-视野作为衡量青光眼视网膜神经节细胞及其轴突不可逆转损害的指标，可靠性和重复性较差。我们的长期视力仍然是通过OCT的客观结构测量来确定/预测青光眼的视觉功能。一旦实现，这种新的方法将提供一种客观和可重复的方法，补充青光眼损害的主观功能评估，减少由于视觉反应的长期波动而导致的频繁视野测试的需要，并基于可靠的进展标记来改进青光眼治疗。具体地说，我们将开发日益复杂的预测模型，产生针对患者的青光眼损害预测模型。激励这项研究的压倒一切的假设是，利用神经纤维束轨迹对整个视网膜神经节细胞-轴突复合体形态进行新的量化测量，可以可靠地预测视觉功能。我们确定了以下具体目标：目标1：通过比较24-2阈值与青光眼和正常受试者登记的多视野SD-OCT扫描得出的相应结构指数，建立Humphrey 24-2视野检查(24度半径视野)所覆盖的视网膜局部结构-功能相关性的基线。根据由视网膜神经节细胞和神经纤维层组成的视网膜内层的结构特性，推导出功能的基线预测模型。目的2：证明在基于SD-OCT图谱的视网膜神经节细胞-轴突复合体(RGC-AC)轨迹中加入结构参数可以改善预测结构-功能模型的性能。目的3：评估24-2阈值的预测是否通过基于个体的RGC-AC轨迹而不是来自RGC-AC图谱来改进。这项拟议的工作将在同一天使用来自100名青光眼患者和40名年龄匹配的正常受试者的7视野3D SD-OCT图像和24-2个视野测试数据进行。

DESCRIPTION (provided by applicant): This Phase-II proposal seeks to elucidate the structure-function relationships between visual field threshold sensitivity and the structural features of the retinal layers, the optic nerve head, and the connecting nerve fiber bundles in glaucoma. This proposal extends our successful Phase-I research that established structure- structure relationships among retinal quantitative indices. In this Phase II, further advancements of spectral domain optical coherence tomography (SD OCT) image analysis will yield new damage metrics expected to correspond much better with visual field threshold sensitivity. The project is driven by an important clinical problem - the poor reliability and reproducibility of th visual field as a measure of irreversible damage to the retinal ganglion cells and their axons in glaucoma. Our long-term vision remains to determine/predict glaucoma visual function from objective structure measurements by OCT. Once achieved, this new approach will provide an objective and reproducible measure, complementing subjective functional assessment of glaucoma damage, decrease the need for frequent visual field testing resulting from long-term fluctuation of visual response, and improve glaucoma treatment based on reliable progression markers. Specifically, we will develop predictive models of increasing complexity yielding a patient- specific predictive model of glaucomatous damage. The overriding hypothesis motivating the proposed research is that novel quantitative metrics of the entire retinal ganglion cell-axonal complex morphology utilizing the nerve fiber bundle trajectories allow reliable prediction of visual function. We have identified the following specific aims: Aim 1: Establish a baseline for the focal structural-functional correlation in the retina covered by the Humphrey 24-2 perimetry test (24 degree radius visual field) by comparing 24-2 thresholds with their corresponding structural indices derived from registered multi-field SD-OCT scans in glaucoma and normal subjects. Derive a baseline predictive model of function from structural properties of the inner retinal layers, comprised of retinal ganglion cell and nerve fiber layers. Aim 2: Demonstrate that incorporating structural parameters along SD-OCT atlas-based retinal ganglion cell- axonal complex (RGC-AC) trajectories improves the performance of the predictive structure-function model. Aim 3: Evaluate whether prediction of 24-2 thresholds is improved by deriving individual-based RGC-AC trajectories instead of from an RGC-AC atlas. The proposed work will be performed using 7-field per eye 3D SD-OCT images accompanied by 24-2 visual field test data on the same day from 100 patients with glaucoma and 40 age-matched normal subjects.