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Title: Assessment and evaluation of visual function measurement in inherited retinal degeneration, focusing on optimisation
Author: Jolly, Jasleen Kaur
ISNI:       0000 0004 9355 3930
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2020
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Photoreceptors at the back of the eye are the first step in producing our sense of vision, able to capture photons of light of differing wavelength. These connect to retinal circuits, which feed into visual pathways and networks in the brain, where the responses from the eye are processed to provide rich visual perception. Loss of these photoreceptors leads to severe visual impairment, as light can no longer be detected. While degeneration has a direct effect on the photoreceptors, there are also secondary effects on retinal circuits, in addition to the pathways processing visual information in the brain. Recently there has been an increase in the development of novel interventions for the treatment of inherited retinal degenerations, with the first retinal gene therapy approved as an NHS treatment in 2019. Yet little work has been conducted on establishing the most appropriate outcome measures to quantify success. In this thesis I probe the practical impact of visual field loss on the conduct of visual function tests such as visual acuity and colour vision. I discuss factors affecting test reliability and propose solutions to improve measurement. I place emphasis on providing an understanding of the basis of the measurements to allow the appropriate measures to be chosen in trials, including for the first time a comprehensive assessment of local and global scotopic function. Beyond the retina, I show that the secondary changes in the inner retina can be detected with the use of ocular coherence tomography imaging and have an impact on visual function testing with microperimetry. I show changes in the integrity of the white matter in the visual brain pathways as a result of retinal disease. This could potentially pose a limiting factor in reversing visual deficits by treating the retina alone. Vision is a result of interconnecting circuits between the eye and the brain and therefore, changes from retinal disease must be considered in terms of their wider effects along the visual system.
Supervisor: Maclaren, Robert ; Bridge, Holly Sponsor: National Institute of Health Research
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Ophthalmology ; Neuroscience