青光眼患者福音 用手機測眼壓

When it comes to treating glaucoma, the goal of eye doctors is assuring their patient don’t go blind.

在治療青光眼上，眼科醫生的目標通常是確保病人不會失明。

That would seem relatively easy. Give them eye drops or refer them to surgery, which helps relieve what is known as intraocular pressure (IOP) inside the eye. But with current technology, it can often be difficult to measure this pressure because it fluctuates so much and those measurements have to be done in a doctor’s office.

這個目標看似不難，只要給他們開點眼藥水或讓他們去做手術就行了，手術主要是爲了降低眼壓。但是憑藉現有技術，測量眼壓是有難度的，因爲眼壓的波動比較大，而且測眼壓的過程必須要在醫生的辦公室裏完成。

That soon could change, thanks to a new device described in Nature Medicine.

但是藉助於《自然醫學》雜誌描述的一種新設備，這種情況可能很快就會改變。

A team of researchers from Stanford University and Bar-Ilan University in Israel has designed an implantable sensor that can be read with a smartphone camera. This allows the patient to take readings themselves and should improve the accuracy of pressure data.

美國斯坦福大學（Stanford University）和以色列巴伊蘭大學（Bar-Ilan University）的研究團隊設計了一款可植入式的傳感器，通過智能手機攝像頭就可以獲得它的讀數。因此患者完全可以自行讀取讀數，同時它也提高了眼壓數據的準確性。

“We believe this self-monitoring capabilities of the implant can significantly enhance the treatment and make it significantly better for the patient,” said Bar-Ilan’s Yossi Mandel, who co-authored the paper with Ismail Araci, Baolong Su and Stephen R. Quake of Stanford.

巴伊蘭大學的約西o曼德爾表示：“我們認爲，這款可植入眼壓傳感器帶來的自我監測能力，可以顯著提高青光眼的治療，並改善患者的處境。”《自然醫學》雜誌上的這篇論文就是曼德爾與斯坦福大學的伊斯梅爾o阿拉西、蘇寶龍（音譯）和史蒂芬oRo奎克合作撰寫的。

“Today, we think we are not treating them good enough,” he added. “They come once in a while and we take a single point in time of measurement. This probably is not good enough and we know from other studies that there is large variation in the IOP. In the same day, it can vary a lot.”

曼德爾補充道：“現在，我認爲我們對青光眼治療得還不夠好。患者偶爾到醫院來一趟，然後我們測量到的是他們在某個時間點上的眼壓。這可能不夠好。我們從其它研究得知，眼壓會有很大變化。哪怕在同一天裏，眼壓也會有很大的變化。”

Glaucoma is a group of eye diseases that in most cases produces increased pressure within the eye and affects more than 65 million people worldwide. When the eye pressure is increased, the optic nerve becomes damaged, resulting in the death of the retinal cells, degeneration of the nerve fibers and eventually permanent loss of vision.

青光眼是一系列眼科疾病的統稱，在大多數情況下會導致眼內壓增高，全球青光眼患者超過6500萬人。一旦眼壓升高，視神經就會受到損傷，導致視網膜細胞死亡，神經纖維退化，最終直至永久失明。

There are several good methods to diagnosing glaucoma but only one that monitors the disease to ensure the prescribed treatments are working. Called the Goldman applanationtonometery, or GAT, the method requires that the eye be anesthetized in a physician’s office and then a plastic prism makes contact with the cornea to measure the pressure. Not only is this uncomfortable and complex but this technique has been found in several studies to be inaccurate.

青光眼有好幾種不錯的診斷方法，但是能對病情進行監測，以瞭解治療是否有效的辦法只有一種——它叫做Goldman壓平眼壓計測量法或GAT。用這種方法測量眼壓，首先需要在醫生的辦公室裏將患者的眼部麻醉，然後用一根塑料棱鏡按壓患者的角膜來測量眼壓。這種方法不僅難受、複雜，而且根據多項研究顯示，並不是非常精確。

“Unfortunately, the patient can’t today measure his own IOP like he would with hypertension where you can measure your own blood pressure. Glaucoma patients have to go to their physicians,” Mandel said in a phone interview. “In one study, they measured IOP over 24 hours and saw there were large variations. In about 80 percent of the patients, they changed the treatment.”

曼德爾在接受電話採訪時表示：“可惜的是，現在病人還不能像量血壓一樣自行監測自己的眼壓。青光眼病人必須到醫院去。在一項研究中，研究人員測量了患者24小時內的眼壓，發現患者一天內的眼壓有很大波動。所以他們對80%的患者改變了治療方法。”

The self-monitoring device, Mandel said, is about 50 microns in diameter and a few millimeters long. Looking much like a small tube, Mandel said the device developed in Quake’s lab is implanted in the eye.

曼德爾表示，這款自測試備的直徑只有50微米，長度只有幾毫米，看起來像一根極微小的管子。曼德爾稱，這款在奎克的實驗室開發出來的設備可以植入人的眼中。

“It looks very simple,” Mandel said. “The pressure in the eye causes a shift in the position of the fluid column in the device which then can be read much like the temperature in a thermometer.”

曼德爾解釋道：“它的原理非常簡單。眼內壓會導致設備內的液柱位置變化，然後讀取它的讀數即可，原理很像溫度計。”

Glaucoma experts welcomed news of the device, saying it offers several advantages over the current methods including that it reads the pressure and does it around the clock.

青光眼專家們都對這款設備表示歡迎，並表示它與以往的測量方法相比有很多優點，包括它可以顯示讀數，而且可以隨時監測。

“If patient comes in for cataract surgery and, if at the same time you can implant the device that would allow monitoring IOP more accurately and remotely, that has a huge benefit,” Dr. Andrew Iwach, chairman of board for the Glaucoma Research Foundation and executive director Glaucoma Center of San Francisco said. He also founded the foundation’s annual event, Glaucoma 360, which brings together researchers, industry executives and philanthropist to find a cure for glaucoma.

美國青光眼研究基金會（Glaucoma Research Foundation）的董事會主席、舊金山青光眼中心常務主任安德魯o伊瓦施表示：“如果患者做了白內障手術的話，如果在做手術的同時，你把這款設備植入進去，那麼就能更精確地監測眼壓，這是有巨大好處的。”伊瓦施還是青光眼基金會“青光眼360”活動的發起人，這個活動旨在召集青光眼研究專家、行業高管和慈善人士來尋找治療青光眼的方法。

“So if you look at the risk benefit ratio the question wouldn’t be why did you put it in but why you didn’t put it in,” he said.

他表示：“因此，如果你看看風險收益比，問題就不會是你爲什麼要植入，而是你爲什麼不植入。”

There is a similar device available in Europe to measure pressure around the clock called the Sensimed Triggerfish. But this contact lens sensor doesn’t measure the eye pressure directly, which makes it less accurate and, according to a 2012 study in Arch of Ophthalmol, caused blurred vision and other adverse reactions in over 80 percent of the patients.

歐洲也有一款類似的可以隨時測量眼壓的設備，名叫Sensimed Triggerfish。不過這款接觸式鏡片傳感器並非直接測量眼壓，導致測量結果精確度不高。另外根據《眼科學報》（Arch of Ophthalmol）2012年的一份研究顯示，它會導致80%的患者出現視覺模糊和其它負作用。

Iwach said the lack of a reliable device to measure pressure in the American market has prompted a competition of sorts with at least five companies vying to be the first to get a device inserted into the eye, which transmits an electronic signal out onto the American market.

伊瓦施指出，由於美國市場缺乏一款可以測量眼壓的可靠設備，現在至少有五家以上的公司都在這個領域進行競爭，他們都希望能第一個在美國市場上推出植入式眼壓測量設備。

“This is an exciting a horse race,” Iwach said. “Different camps realize the first to market, the one who figures out how to do this best, is going to potentially revolutionize how we manage glaucoma and ultimately patients will be better for it.”

伊瓦施表示：“這是一場令人興奮的競爭。大家都意識到，第一個進入市場、第一個知道怎樣最好地測量眼壓的公司，可能會給青光眼的治療帶來革命性的效果，而且最終會造福患者。”

While showing promise to be the first, the latest device still is several years away from being commercially feasible. It has only been tested in pigs so the next step, Mandel said, is to do further research to ensure the device is safe in humans and can remain in the eye for an extended period of time.

雖然上文提到的這款微傳感器還是該領域的第一款設備，但它離正式商用還有好幾年。目前它只在豬身上測試過。因此曼德爾表示，下一步重點是要進一步深入研究，以確保它對人體的安全性，並且確保它能長期妥善地存在於眼部。

“As scientist we are always skeptical about what we and others do,” Mandel said. “There are challenges that have to overcome but this device shows a lot of promise.”

曼德爾表示：“作爲科學家，我們總是對我們和其他人做的事感到懷疑。不過雖然前路還有一些挑戰需要克服，但這款設備的確帶給我們很多希望。”