青光眼是一种脑部疾病吗?

San Antonio – Findings from a new study published in Translational Vision Science & Technology (TVST) show the brain, not the eye, controls the cellular process that leads to glaucoma. The results may help develop treatments for one of the world’s leading causes of irreversible blindness, as well as contribute to the development of future therapies for preserving brain function in other age-related disorders like Alzheimer’s.

在TVST的报纸上, Refined Data Analysis Provides Clinical Evidence for Central Nervous System Control of Chronic Glaucomatous Neurodegeneration, vision scientists and ophthalmologists describe how they performed a data and symmetry analysis of 47 patients with moderate to severe glaucoma in both eyes. 在青光眼中，每只眼睛的视力丧失似乎是偶然的. 相反, neural damage within the brain caused by strokes or tumors produces visual field loss that is almost identical for each eye, supporting the idea that the entire degenerative process in glaucoma must occur at random in the individual eye — without brain involvement.

然而, the team of investigators discovered during their analysis that as previously disabled optic nerve axons — that can lead to vision loss — recover, the remaining areas of permanent visual loss in one eye coincide with the areas that can still see in the other eye. The team found that the visual field of the two eyes fit together like a jigsaw puzzle, resulting in much better vision with both eyes open than could possibly arise by chance.

“随着年龄和其他对眼部健康的损害对每只眼睛造成伤害, discrete bundles of the small axons within the larger optic nerve are sacrificed so the rest of the axons can continue to carry sight information to the brain,作家William Eric Sponsel解释道, MD, Professor of Vision Science at the 道成肉身的大学 罗森博格验光学院. “这种安静的故意牺牲一些电线来拯救其余的电线, when there are decreasing resources to support them all (called apoptosis), is analogous to pruning some of the limbs on a stressed fruit tree so the other branches can continue to bear healthy fruit.”

据研究人员称, the cellular process used for pruning small optic nerve axons in glaucoma is “remarkably similar to the apoptotic mechanism that operates in the brains of people afflicted with Alzheimer’s disease.”

“The extent and statistical strength of the jigsaw effect in conserving the binocular visual field among the clinical population turned out to be remarkably strong,Sponsel说. “The entire phenomenon appears to be under the meticulous control of the brain.”

The TVST paper is the first evidence in humans that the brain plays a part in pruning optic nerve axon cells. 在之前的一项研究中, Failure of Axonal Transport Induces a Spatially Coincident Increase in Astrocyte BDNF Prior to Synapse Loss in a Central Target, a mouse model suggested the possibility that following injury to the optic nerve cells in the eye, 大脑控制着神经末端那些细胞的修剪. 这最终导致受伤的细胞死亡.

“Our basic science work has demonstrated that axons undergo functional deficits in transport at central brain sites well before any structural loss of axons,大卫说。. Calkins, 博士学位, of the Vanderbilt Eye Institute and author of the previous study. “Indeed, we found no evidence of actual pruning of axon synapses until much, much later. Similarly, projection neurons in the brain persisted much longer, as well.”

“这是视觉科学的突破性进展.  这项研究是我们对青光眼认识的一个突破, 一种使数百万人失明的疾病,”医生说。. Andrew Buzzelli, dean of the 道成肉身的大学 罗森博格验光学院 (UIWRSO).  “我们很荣幸邀请到. 赞助我们学院的教员.”

Sponsel has already seen how these findings have positively affected surgically stabilized patients who were previously worried about going blind. “When shown the complementarity of their isolated right and left eye visual fields, 他们不再那么困惑，而是更加放心,他说. “It would be relatively straightforward to modify existing equipment to allow for the performance of simultaneous binocular visual fields in addition to standard right eye and left eye testing.”

Authors of the TVST paper suggest their findings can assist in future research with cellular processes similar to the one used for pruning small optic nerve axons in glaucoma, 比如阿尔茨海默氏症患者的大脑.

“如果大脑积极地试图保持最佳的双眼视野, 而不是偶然地产生了拼图效应, that would imply some neuro-protective substance is at work preventing unwanted pruning,TVST论文的合著者泰德·马迪斯说, 博士学位, ARC视觉科学卓越中心的主任, 澳大利亚国立大学. “Since glaucoma has much in common with other important neurodegenerative disorders, our research may say something generally about connections of other nerves within the brain and what controls their maintenance.”

The scope of this work will be expanded into the current UIWRSO research program, 在博士的协调下. 理查德·特维诺，助理教授兼住院医师项目主任.

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CONTACT:    Margaret Garcia, associate director public relations, (210) 829-6001, mlgarci2@uiwtx.edu

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