Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology. 2017 Dec;124(12S):S66-S70. doi: 10.1016/j.ophtha.2017.05.006.
The relationship between functional vision loss and structural changes of the optic nerve head and retinal ganglion cells is the hallmark of glaucoma diagnosis. Understanding and measuring this relationship has been the focus of numerous studies, the goal of which have been to improve glaucoma diagnosis and detection of glaucoma worsening. In this review, a historical perspective is used to understand structure-function relationships in glaucoma and their application to improve glaucoma diagnosis and monitoring. Initially, histologic studies that link visual field sensitivity to retinal ganglion cell count are discussed. Additionally, those studies that determined the mathematical relationship between visual field sensitivity and ganglion cell number are reviewed. Next, those studies that attempt to create a map of the structure-function relationship using fundus photography and visual field sensitivity are examined. Subsequently, studies that use more recent imaging technology, such as optical coherence tomography, confocal scanning laser ophthalmoscopy, or scanning laser perimetry, to measure structure quantitatively in vivo and to correlate these measures with automated perimetry are explored. Among these studies that use advanced imaging, those that use cross-sectional data to explore structure-function relationships to improve glaucoma diagnosis first are discussed. Second, those studies that use longitudinal data to improve detection of worsening are reviewed. Finally, areas of further research and steps needed to implement structure-function relationships clinically are explored.
功能性视力丧失与视神经头和视网膜神经节细胞结构变化之间的关系是青光眼诊断的标志。理解和测量这种关系一直是许多研究的重点，目的是改善青光眼的诊断和检测青光眼的恶化。在这篇综述中，我们从历史的角度来理解青光眼的结构-功能关系及其在改善青光眼诊断和监测中的应用。首先，我们讨论了将视野敏感性与视网膜神经节细胞计数联系起来的组织学研究。此外，还回顾了那些确定视野敏感性与神经节细胞数量之间数学关系的研究。接下来，我们研究了那些试图使用眼底照相和视野敏感性创建结构-功能关系图的研究。随后，我们探讨了使用更现代的成像技术（如光学相干断层扫描、共焦扫描激光检眼镜或扫描激光眼压计）来定量测量体内结构，并将这些测量结果与自动视野计相关联的研究。在这些使用先进成像技术的研究中，我们首先讨论了那些使用横截面数据来改善青光眼诊断的结构-功能关系的研究。其次，我们回顾了那些使用纵向数据来提高恶化检测的研究。最后，我们探讨了进一步研究的领域以及将结构-功能关系临床应用所需的步骤。
