Optom Vis Sci. 2023 Jun 1;100(6):354-375. doi: 10.1097/OPX.0000000000002029. Epub 2023 May 22.
Patient-based research plays a key role in probing basic visual mechanisms. Less-well recognized is the role of patient-based retinal imaging and visual function studies in elucidating disease mechanisms, which are accelerated by advances in imaging and function techniques and are most powerful when combined with the results from histology and animal models.A patient's visual complaints can be one key to patient management, but human data are also key to understanding disease mechanisms. Unfortunately, pathological changes can be difficult to detect. Before advanced retinal imaging, the measurement of visual function indicated the presence of pathological changes that were undetectable with existing clinical examination. Over the past few decades, advances in retinal imaging have increasingly revealed the unseen. This has led to great strides in the management of many diseases, particularly diabetic retinopathy and macular edema, and age-related macular degeneration. It is likely widely accepted that patient-based research, as in clinical trials, led to such positive outcomes. Both visual function measures and advanced retinal imaging have clearly demonstrated differences among retinal diseases. Contrary to initial thinking, sight-threatening damage in diabetes occurs to the outer retina and not only to the inner retina. This has been clearly indicated in patient results but has only gradually entered the clinical classifications and understanding of disease etiology. There is strikingly different pathophysiology for age-related macular degeneration compared with photoreceptor and retinal pigment epithelial genetic defects, yet research models and even some treatments confuse these. It is important to recognize the role that patient-based research plays in probing basic visual mechanisms and elucidating disease mechanisms, combining these findings with the concepts from histology and animal models. Thus, this article combines sample instrumentation from my laboratory and progress in the fields of retinal imaging and visual function.
基于患者的研究在探究基本视觉机制方面发挥着关键作用。但较少被认识到的是，基于患者的视网膜成像和视觉功能研究在阐明疾病机制方面的作用，这些研究得益于成像和功能技术的进步，并且当与组织学和动物模型的结果相结合时，其效果最为强大。患者的视觉主诉可以成为患者管理的一个关键，但人类数据对于理解疾病机制也至关重要。不幸的是，病理变化可能难以检测。在先进的视网膜成像出现之前，视觉功能的测量表明存在无法通过现有临床检查检测到的病理变化。在过去的几十年中，视网膜成像技术的进步越来越多地揭示了看不见的病变。这使得许多疾病的治疗取得了重大进展，特别是糖尿病性视网膜病变和黄斑水肿以及年龄相关性黄斑变性。人们普遍认为，基于患者的研究，如临床试验，导致了这些积极的结果。视觉功能测量和先进的视网膜成像都清楚地表明了视网膜疾病之间的差异。与最初的想法相反，糖尿病中的威胁视力的损害发生在外层视网膜，而不仅仅在内层视网膜。这在患者结果中得到了明确的表明，但仅逐渐进入疾病病因的临床分类和理解。与光感受器和视网膜色素上皮遗传缺陷相比，年龄相关性黄斑变性的病理生理学有明显的不同，但研究模型甚至一些治疗方法混淆了这些。认识到基于患者的研究在探究基本视觉机制和阐明疾病机制方面的作用非常重要，将这些发现与组织学和动物模型的概念相结合。因此，本文结合了我实验室的样本仪器以及视网膜成像和视觉功能领域的进展。
