Ocular Fundus Abnormalities for Acute Risk Stratification in TIA and Minor Stroke

描述（由申请人提供）：短暂性脑缺血发作（TIA）和轻微中风每年影响数十万美国人。高达20%的TIA和轻微中风患者将在90天内出现新的，通常是致残的中风或心血管事件，其中大多数新事件发生在初始事件发生后的最初几个小时和几天。重要的研究集中在创建有效的、易于使用的工具，为临床医生提供TIA和轻微中风后中风风险的准确估计，但仍有很大的改进空间。眼科有一个重要的机会来帮助解决这个难题，因为眼底是唯一可以直接无创地观察部分中枢神经系统（CNS）及其相关微血管的地方。基于我们的初步数据，我们假设眼底（视神经和视网膜）的急性视网膜病变和血管病变不仅是急性中枢神经系统组织损伤的生物标志物，而且还提供了其他重要卒中危险因素（如高血压和糖尿病）的严重程度信息。我们提出一项前瞻性、观察性队列研究，在760名受试者的全动力研究中验证和重复我们的早期结果。我们将使用非散瞳摄影来评估眼底异常，这种摄影可以在不扩大瞳孔的情况下拍摄视神经和视网膜的高质量照片。我们的目的是：(1)确定眼底异常是否是一个独立的预测因素，超越其他临床特征和神经影像学研究，短期（即90岁以内）

DESCRIPTION (provided by applicant): Transient ischemic attack (TIA) and minor strokes affect hundreds of thousands of Americans each year. Up to 20% of patients affected by TIA and minor stroke will have a new, often disabling, stroke or cardiovascular event within 90 days, with the majority of these new events occurring in the first few hours and days after the initial events. Significant research has been focused on creating validated, easy-to-use tools that provide clinicians with accurate estimates of stroke risk after TIA and minor stroke, but there is substantial room for improvement. Ophthalmology has an important opportunity to assist with this difficult problem because the ocular fundus is the only place where part of the central nervous system (CNS) and its associated microvasculature can be directly visualized non-invasively. Based on our preliminary data, we hypothesize that acute retinopathic and vasculopathic changes in the ocular fundus (optic nerve and retina) are not only biomarkers of acute CNS tissue injury, but provide severity information about other important stroke risk factors (e.g., hypertension and diabetes). We propose a prospective, observational cohort study to validate and replicate our early results in a fully-powered study of 760 subjects. We will assess ocular fundus abnormalities using non-mydriatic photography, which allows high quality photographs of the optic nerve and retina to be taken without dilation of the pupils. Our aims are (1) to determine whether abnormalities of the ocular fundus are an independent predictor, above and beyond that of other clinical features and neuroimaging studies, of short-term (i.e., within 90 days) clinical outcomes (new stroke, cardiovascular events, and death) in patients presenting with TIA and minor stroke, and (2) to determine whether abnormalities of the ocular fundus among patients with suspected TIA differentiate patients with cerebrovascular diagnoses vs. those with non- cerebrovascular diagnoses. We will conduct the project at three Emory University-affiliated hospital's emergency departments and stroke services. Our project has the potential to translate our preliminary epidemiological findings into clinical care and improve the evaluation of TIA and minor stroke with a low-cost, universally available, but underutilized, aspect of the physical examination that when augmented by non- mydriatic fundus photography provides improved diagnostic capabilities and the potential for telemedical consultation when additional expertise is required.