Functional Testing for Glaucoma

青光眼功能测试

基本信息

批准号：
10227993
负责人：
Stuart Gardiner
金额：
$ 40.74万
依托单位：
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-01 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10227993
关键词：
Algorithms Anatomy Area Axon Blindness Characteristics Clinical Clinical Management Clinical Trials Cluster Analysis Data Data Collection Defect Detection Deterioration Disease Progression Eye Future Glaucoma Goals Individual Laboratories Light Location Longitudinal cohort Measurement Measures Monitor Neuroprotective Agents Pathway interactions Patients Perimetry Physiological Quality of life Reporting Research Research Personnel Retinal Ganglion Cells Scotoma Severity of illness Specificity Staging Stimulus Structure Techniques Test Result Testing Time Vision Visual Fields Work base clinical decision-making clinical practice cohort cost efficient design experience experimental study follow-up functional status glaucoma test improved indexing instrument neuromechanism next generation novel personalized management preservation primary endpoint rate of change treatment response trend analysis

项目摘要

Project Summary Glaucoma is a leading cause of blindness both in the US and worldwide. The long-term purpose of this project is to improve functional testing in glaucoma. Assessment and follow-up of patients currently relies on automated perimetry to provide functional testing of the visual field. However, the ability to assess progression and/or response to treatment using perimetry is hampered by high variability, especially in areas of moderate or severe glaucomatous damage. This proposal will build on previous work by our laboratory to reduce the variability, increase the dynamic range, and improve the analysis and interpretation, of these test results. Our experiments are explicitly designed so that their results and conclusions will be rapidly translatable to clinical practice. The project will improve the accuracy, efficiency and utility of functional testing, giving immediate impact in both research and clinical settings, and laying groundwork for the next generation of instruments and algorithms. The first Specific Aim is to use a novel stimulus to extend the effective dynamic range of perimetry and reduce its variability. Current clinical perimetry relies on the test subject pressing a button when they see a stimulus consisting of a small, stationary circle of brighter light on a white background. We propose to use a new stimulus, which we anticipate being easier to detect, allowing reliable measurements to be made in more damaged regions of the visual field than is currently possible, and reducing variability. The second Specific Aim is to better use data from current clinical perimetry. We anticipate being able to detect change sooner when looking for changes in anatomically-based clusters of test locations, rather than considering every location individually or considering all locations simultaneously. We will derive a measure of the rate of change based on this cluster analysis that corresponds with experienced clinicians’ opinions of the severity of disease progression, which would aid in the staging and monitoring of disease progression, and hence aid clinical decision making. The third Specific Aim is to perform high-accuracy testing of a subset of visual field locations. The current clinical standard is to instead perform low-accuracy testing of a wider selection of locations. We will compare the ability of these two approaches to detect functional change, and evaluate the effect on the strengths of the cross-sectional and longitudinal correlations with structural measures. The three aims are complementary. It is anticipated that these aims will improve data collection, analysis and interpretation when using perimetry. Such improvements in a test as commonly performed as perimetry will significantly impact future clinical practice.

项目摘要青光眼是美国和世界各地失明的主要原因。该项目的长期目的是为了改善青光眼的功能测试。当前患者的评估和随访依赖于自动化围场可提供视野的功能测试。但是，评估进展和/或的能力使用周期性对治疗的反应受到高变异性的阻碍，尤其是在中度或重度的领域青光眼损害。该提案将基于我们实验室以前的工作以降低可变性，增加动态范围，并改善这些测试结果的分析和解释。我们的实验经过明确的设计，以便他们的结果和结论将迅速转化为临床实践。项目将提高功能测试的准确性，效率和实用性，从而立即影响两者研究和临床环境，以及下一代仪器和算法的基础。第一个具体目的是使用新颖的刺激来扩展有效的周期性动态范围并减少其可变性。当前的临床时期依赖于测试受试者在看到刺激时按下按钮由一个小的固定圆圈组成，在白色背景上明亮。我们建议使用新的刺激，我们预计会更易于检测，可以在更大的损害区域进行可靠的测量视野的目前比目前可能的，并降低了可变性。第二个特定目的是更好地使用当前临床时期的数据。我们预计在寻找更改时能够早日检测到变化在基于解剖的测试地点集群中，而不是单独考虑每个位置或考虑所有位置。我们将根据此集群分析得出变更速率的度量与经验丰富的临床医生对疾病进展严重程度的看法相对应，这将有助于疾病进展的分期和监测，从而有助于临床决策。第三个具体目的是对视野位置的一部分进行高准确测试。当前的临床标准是对更广泛的位置选择进行低临界测试。我们将比较这两个的能力检测功能变化的方法，并评估对横截面强度的影响与结构措施的纵向相关性。这三个目标是完整的。预计这些使用期间时，目标将改善数据收集，分析和解释。测试中的这种改进由于时期通常会严重影响未来的临床实践。