Diagnostic Innovations in Glaucoma: Clinical Electrophysiology

描述（由申请人提供）：本申请旨在研究临床电生理测量（视网膜电图（PERG）和多焦视觉诱发电位（mfVEP））检测青光眼的诊断精度，该技术被2004年国家眼科研究所（NEI）国家计划确定为近期眼科研究中与青光眼相关的重要发展。目标1:将对青光眼、可疑眼和健康眼的电生理反应进行表征，并将这些商业上可用的技术的诊断准确性与当前的参考标准（视盘立体照片评估和标准自动视野测量）和最近开发的诊断技术进行比较，包括视盘和视网膜神经纤维层的光学成像(共聚焦扫描激光眼科检查，光学相干层析成像（光学相干层析成像，扫描激光偏振法）和视功能专用视距测量（短波自动视距测量和倍频技术视距测量）。目标2：将机器学习分类器技术（例如相关向量机，支持向量机，高斯混合技术，独立分量分析）的新用途应用于电生理数据，以提高其诊断准确性，并将来自不同诊断技术（如上所述）的数据结合起来，以提高整体诊断准确性。目的3：通过检查青光眼和疑似青光眼患者的电生理异常与视盘和RNFL损伤的关系，验证电生理测量作为视神经损伤的功能指标。210名患者（105名青光眼患者，105名疑似青光眼患者）和105名健康参与者将被纳入横断面研究。该提案的具体目的是解决当前NEI青光眼和视神经病变项目的目标，即发展改进的诊断措施，以表征和检测视神经疾病的发作，确定视神经损伤的功能相关性，并在结构和功能水平上表征视觉通路中的青光眼神经变性。关于电生理测量、光学成像技术和神经节细胞特异性视距测量在青光眼检测中的相对有用性的信息，对于确定未来青光眼诊断和监测护理标准的循证变化至关重要。这些研究将证明电生理测量（视网膜电图，PERG；多焦视觉诱发电位，mfVEP）相对于光学成像技术（共聚焦扫描眼科检查，光学相干断层扫描，扫描激光偏振法）和神经节细胞特异性视距测量（短波和倍频视距测量）在青光眼检测中的相对有用性。该提案解决了当前NEI青光眼和视神经病变项目的目标，即发展改进的诊断措施，以表征和检测视神经疾病的发作，确定视神经损伤的功能相关性，并在结构和功能水平上表征视觉通路中的青光眼神经变性。研究结果对于确定未来青光眼诊断和监测护理标准的循证变化具有重要意义。

DESCRIPTION (provided by applicant): This application proposes to investigate the diagnostic precision for detecting glaucoma of clinical electrophysiological measurement (pattern electroretinogram, PERG; and multifocal visual evoked potentials, mfVEP), a technique identified as an important recent glaucoma- related development in eye research by the 2004 National Eye Institute (NEI) National Plan. Aim 1: Electrophysiological responses will be characterized in glaucoma, suspect and healthy eyes and the diagnostic accuracy of these commercially available techniques will be compared to current reference standards (evaluation of stereoscopic photographs of the optic disc and standard automated perimetry) and to recently developed diagnostic techniques including optical imaging of the optic disc and retinal nerve fiber layer (RNFL) (confocal scanning laser ophthalmoscopy, optical coherence tomography, and scanning laser polarimetry) and visual function-specific perimetry (short-wavelength automated perimetry and frequency doubling technology perimetry). Aim 2: Novel use of machine learning classifier techniques (e.g. relevance vector machines, support vector machines, mixture of Gaussian techniques, independent components analysis) will be applied to electrophysiological data to improve its diagnostic accuracy and data from different diagnostic techniques (named above) will be combined to improve overall diagnostic accuracy. Aim 3: Electrophysiological measurements will be validated as functional indicators of optic nerve damage by examining the relationship between electrophysiological abnormality and optic disc and RNFL damage in glaucoma and glaucoma suspect patients. 210 patients (105 glaucoma's, 105 glaucoma suspects) and 105 healthy participants will be enrolled and studied cross-sectionally. The specific aims of this proposal address the current NEI Glaucoma and Optic Neuropathies Program objectives of developing improved diagnostic measures to characterize and detect optic nerve disease onset, determining functional correlates of optic nerve damage, and characterizing glaucomatous neurodegeneration within the visual pathways at structural and functional levels. Information about the relative usefulness of electrophysiological measurement, optical imaging techniques, and ganglion cell-specific perimetry for glaucoma detection is important to the clinical community for determining future evidence-based changes in standard of care for glaucoma diagnosis and monitoring. These studies will demonstrate the relative usefulness of electrophysiological measurement (pattern electroretinogram, PERG; multi-focal visual evoked potential, mfVEP) compared to optical imaging techniques (confocal scanning ophthalmoscopy, optical coherence tomography, scanning laser polarimetry) and ganglion cell-specific perimetry (short wavelength and frequency doubling perimetry) for glaucoma detection. The proposal addresses the current NEI Glaucoma and Optic Neuropathies Program objectives of developing improved diagnostic measures to characterize and detect optic nerve disease onset, determining functional correlates of optic nerve damage, and characterizing glaucomatous neurodegeneration within the visual pathways at structural and functional levels. Findings will be important to the clinical community for determining future evidence-based changes in standard of care for glaucoma diagnosis and monitoring.