Functional Testing for Glaucoma

青光眼功能测试

• 批准号: 8500302
• 负责人: Stuart Gardiner
• 金额: $ 29.07万
• 依托单位: LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8500302
• 关键词: Algorithms; Area; Blindness; Clinical; Contrast Sensitivity; Data; Data Collection; Data Set; Defect; Detection; Disease; Frequencies; Functional disorder; Future; Glaucoma; Laboratories; Location; Measurement; Measures; Noise; Optic Disk; Patients; Perimetry; Probability; Quality of life; Reporting; Research; Retinal Ganglion Cells; Source; Stimulus; Structure; Techniques; Testing; Time; Vision; Visual Fields; Visual system structure; Work; base; central visual field; clinical practice; cost; design; follow-up; functional status; glaucoma test; improved; indexing; instrument; luminance; next generation; novel; prevent; prognostic; response

DESCRIPTION (provided by applicant): 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. Recent findings by our laboratory and others have advanced our understanding of perimetry by challenging key assumptions about the test. This proposal aims to use these advances to explain and reduce the test variability. This will improve the accuracy, efficiency and utility of current 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 produce an accurate and physiologically justified measure of the Effective Dynamic Range (EDR) of perimetry. It is postulated that the very high contrast stimuli used by perimetry in glaucomatous defects saturate the response of the visual system. The resultant nonlinearity in the contrast-response function would cause the detection probability to asymptote below 100%, explaining the high variability in sensitivities in damaged areas. The limit of the EDR will be defined as the contrast beyond which response linearity cannot be assumed. This will be measured by collecting frequency-of-seeing curves in subjects with moderate or advanced glaucoma. The same technique will be used to determine whether the EDR is extended by use of an increased stimulus size. The second Specific Aim is to derive and test a spatial filter to reduce the variability. This will be the first filter to be based both on sensitivities at other locations in the visual field and on the structure of the optic nerve head. The third Specific Aim is to assess the potential utility of using a linear scale for sensitivity, rather than the current logarithmic decibel scale. First, an efficient linear-scaled thresholding algorithm will be derived and tested, to determine whether it will reduce variability both between tests and in the structure-function relation. Second, linear-scaled global indices of the central visual field will be examined, to determine whether they offer improved prognostic value compared with current decibel-scaled indices when assessing progression. The three aims are complementary. It is anticipated that by combining these aims, variability in perimetry will be better understood, and significantly reduced. Such an improvement in a test as commonly performed as perimetry will significantly impact future clinical practice.

描述（由申请人提供）：青光眼是美国和全球范围内失明的主要原因。该项目的长期目的是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围场来提供视野的功能测试。但是，高变异性会妨碍评估使用围场治疗的进展和/或反应的能力，尤其是在中度或重度青光眼损伤的区域。我们的实验室和其他人的最新发现通过挑战对测试的关键假设来提高我们对围场的理解。该建议旨在利用这些进步来解释和减少测试变异性。这将提高当前功能测试的准确性，效率和实用性，在研究和临床环境中立即产生影响，并为下一代工具和算法奠定基础。第一个具体目的是产生对圆锥体有效动态范围（EDR）的准确和生理合理的衡量标准。据推测，在青光眼缺陷中使用的极高的对比度刺激使视觉系统的响应饱和。对比响应函数中最终的非线性将导致渐近线以下100％以下的检测概率，从而解释了受损区域敏感性的高度差异。 EDR的限制将定义为无法假定响应线性的对比。这将通过收集中等或晚期青光眼受试者的观察曲线来衡量。将使用相同的技术来确定是否使用增加的刺激大小来扩展EDR。第二个特定目的是得出和测试空间过滤器以降低变异性。这将是第一个基于视野其他位置和视神经头结构的敏感性的过滤器。第三个具体目的是评估使用线性尺度提高灵敏度的潜在效用，而不是当前的对数分贝量表。首先，将得出和测试有效的线性刻度阈值算法，以确定它是否会在测试和结构函数函数关系之间降低可变性。其次，将检查中央视野的线性尺度全局指数，以确定与当前分贝级尺度指数相比，在评估进展时，它们是否提供了提高的预后价值。这三个目标是互补的。可以预料，通过结合这些目标，将更好地理解外围的变异性，并大大降低。通常执行的测试中的这种改善将对未来的临床实践产生重大影响。