Diagnostic Innovations in Glaucoma: Structural Assessment

青光眼诊断创新：结构评估

基本信息

批准号：
8520600
负责人：
LINDA M ZANGWILL
金额：
$ 23.66万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-01 至 2013-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8520600
关键词：
Accounting Address Affect Age Aging Agreement American Blindness Caring Clinical Clinical Trials Complex Computing Methodologies Cornea Cox Proportional Hazards Models Data Data Analyses Data Collection Detection Diagnostic Diagnostic Imaging Disease Disease Progression Early treatment Eye Funding Future Generations Genetic Glaucoma Goals Human Image Image Analysis Individual Lasers Lead Length Measurement Measures Methods Modeling Monkeys National Eye Institute Open-Angle Glaucoma Ophthalmoscopes Ophthalmoscopy Optic Disk Optical Coherence Tomography Pathologic Patients Phenotype Physiological Predictive Factor Primary Open Angle Glaucoma Property Protocols documentation Reproducibility Resolution Retina Risk Factors Scanning Schedule Science Staging Statistical Methods Structure Techniques Testing Thick Time Treatment Effectiveness United States Vision Vision research Visit Visual Fields age related base blind clinical care cost data sharing design follow-up functional disability ganglion cell genetic variant genome wide association study high risk improved innovation instrument legally blind macula normal aging optic nerve disorder polarimetry programs public health relevance research study retinal nerve fiber layer

项目摘要

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.

描述（由申请人提供）：青光眼诊断创新研究 (DIGS)：结构评估自 1995 年起资助，使我们检测青光眼视神经盘损伤的能力显着提高，并更好地理解视神经盘之间的复杂关系损伤和相应的视野丧失。此次 DIGS 竞争性更新的总体目标是改善青光眼进展的检测和预测。纵向猴子和人类谱域光学相干断层扫描 (SDOCT)、共焦扫描激光检眼镜 (CSLO) 和扫描激光偏振测量 (GDx) 数据和图像将用于解决以下 3 个具体目标：1）提高我们对黄斑、视网膜神经纤维层、视神经乳头、正常衰老和青光眼中的前层状和层状变化，2) 优化测试方案和成像分析技术，以检测变化减少所需的检测，以及 3) 预测哪些个体处于进展高风险，以及哪些个体可能进展迅速。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层和层状测量来区分与年龄相关的微小生理变化和与 OAG 相关的微小病理变化。强调测量这些变化的速度。我们的初步结果表明，计算和统计技术可以减少可重复检测变化所需的 CSLO 图像数量。具体目标 2 侧重于以下假设：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疗法临床试验的成本。为了实现具体目标 3，基于基线成像的结构参数以及相关的临床和人口预测因素将包含在多变量 Cox 比例风险模型中，用于预测谁将出现基于照片和/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睛和视力研究青光眼计划的目标，即“开发改进的诊断措施来检测视神经疾病、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以及开发预测模型，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成本。公众健康相关性：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 13 万美国人因这种疾病而失明。这项名为“青光眼研究（DIGS）的诊断创新：结构评估”的竞争性更新的总体目标是改进对青光眼进展的检测，以便尽早识别因该疾病而失明风险最高的个体并开始治疗具体来说，我们将继续使用最新一代的眼科诊断成像仪器跟踪一组健康个体、青光眼患者和高风险人群，以 1) 提高我们区分青光眼的能力。青光眼变化和正常衰老引起的变化，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高风险，哪些个体可能有进展风险才能快速进步。