College of Optometry, University of Houston, 505 J. Davis Armistead Building, Houston, TX 77204-2020, USA.
Prog Retin Eye Res. 2010 Jul;29(4):249-71. doi: 10.1016/j.preteyeres.2010.02.001. Epub 2010 Mar 11.
The glaucomas are a group of relatively common optic neuropathies, in which the pathological loss of retinal ganglion cells causes a progressive loss of sight and associated alterations in the retinal nerve fiber layer and optic nerve head. The diagnosis and management of glaucoma are often dependent on methods of clinical testing that either, 1) identify and quantify patterns of functional visual abnormality, or 2) quantify structural abnormality in the retinal nerve fiber layer, both of which are caused by loss of retinal ganglion cells. Although it is evident that the abnormalities in structure and function should be correlated, propositions to link losses in structure and function in glaucoma have been formulated only recently. The present report describes an attempt to build a model of these linking propositions using data from investigations of the relationships between losses of visual sensitivity and thinning of retinal nerve fiber layer over progressive stages of glaucoma severity. A foundation for the model was laid through the pointwise relationships between visual sensitivities (behavioral perimetry in monkeys with experimental glaucoma) and histological analyses of retinal ganglion cell densities in corresponding retinal locations. The subsequent blocks of the model were constructed from clinical studies of aging in normal human subjects and of clinical glaucoma in patients to provide a direct comparison of the results from standard clinical perimetry and optical coherence tomography. The final formulation is a nonlinear structure-function model that was evaluated by the accuracy and precision of translating visual sensitivities in a region of the visual field to produce a predicted thickness of the retinal nerve fiber layer in the peripapillary sector that corresponded to the region of reduced visual sensitivity. The model was tested on two independent patient populations, with results that confirmed the predictive relationship between the retinal nerve fiber layer thickness and visual sensitivities from clinical perimetry. Thus, the proposed model for linking structure and function in glaucoma has provided information that is important in understanding the results of standard clinical testing and the neuronal losses caused by glaucoma, which may have clinical application for inter-test comparisons of the stage of disease.
青光眼是一组较为常见的视神经病变，其病理特征是视网膜神经节细胞的进行性丧失，导致视力逐渐下降，并伴有视网膜神经纤维层和视盘的改变。青光眼的诊断和管理通常依赖于临床测试方法，这些方法可以：1）识别和量化功能视觉异常的模式，或 2）量化视网膜神经纤维层的结构异常，这两者都是由视网膜神经节细胞的丧失引起的。尽管结构和功能的异常应该是相关的，这一点是显而易见的，但将青光眼的结构和功能损失联系起来的命题直到最近才被提出。本报告描述了一种使用从青光眼严重程度进展的各个阶段的视觉敏感性损失和视网膜神经纤维层变薄的关系研究中获得的数据，构建这些联系命题模型的尝试。该模型的基础是通过在猴子的实验性青光眼的视觉敏感性（行为视野检查）和相应视网膜位置的视网膜神经节细胞密度的组织学分析之间的点关系建立的。模型的后续部分是从正常人类受试者的年龄和患者的临床青光眼研究中构建的，以提供标准临床视野检查和光学相干断层扫描结果的直接比较。最终的模型是一个非线性的结构-功能模型，通过将视野区域的视觉敏感性转换为预测视盘周围区域视网膜神经纤维层厚度的准确性和精度来评估。该模型在两个独立的患者群体中进行了测试，结果证实了视网膜神经纤维层厚度与临床视野检查的视觉敏感性之间的预测关系。因此，该模型为青光眼的结构和功能联系提供了信息，对于理解标准临床测试结果和青光眼引起的神经元丧失具有重要意义，这可能对疾病阶段的测试间比较具有临床应用价值。
