在治療青光眼上，眼科醫生的目標通常是確保病人不會(huì )失明。

    這個(gè)目標看似不難，只要給他們開(kāi)點(diǎn)眼藥水或讓他們去做手術(shù)就行了，手術(shù)主要是為了降低眼壓。但是憑借現有技術(shù)，測量眼壓是有難度的，因為眼壓的波動(dòng)比較大，而且測眼壓的過(guò)程必須要在醫生的辦公室里完成。

    但是借助于《自然醫學(xué)》雜志描述的一種新設備，這種情況可能很快就會(huì )改變。

    美國斯坦福大學(xué)（Stanford University）和以色列巴伊蘭大學(xué)（Bar-Ilan University）的研究團隊設計了一款可植入式的傳感器，通過(guò)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(shí)它也提高了眼壓數據的準確性。

    巴伊蘭大學(xué)的約西?曼德?tīng)柋硎荆骸拔覀冋J為，這款可植入眼壓傳感器帶來(lái)的自我監測能力，可以顯著(zhù)提高青光眼的治療，并改善患者的處境?！薄蹲匀会t學(xué)》雜志上的這篇論文就是曼德?tīng)柵c斯坦福大學(xué)的伊斯梅爾?阿拉西、蘇寶龍（音譯）和史蒂芬?R?奎克合作撰寫(xiě)的。

    曼德?tīng)栄a充道：“現在，我認為我們對青光眼治療得還不夠好?；颊吲紶柕结t院來(lái)一趟，然后我們測量到的是他們在某個(gè)時(shí)間點(diǎn)上的眼壓。這可能不夠好。我們從其它研究得知，眼壓會(huì )有很大變化。哪怕在同一天里，眼壓也會(huì )有很大的變化?！?/span>

    青光眼是一系列眼科疾病的統稱(chēng)，在大多數情況下會(huì )導致眼內壓增高，全球青光眼患者超過(guò)6500萬(wàn)人。一旦眼壓升高，視神經(jīng)就會(huì )受到損傷，導致視網(wǎng)膜細胞死亡，神經(jīng)纖維退化，最終直至永久失明。

    青光眼有好幾種不錯的診斷方法，但是能對病情進(jìn)行監測，以了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里將患者的眼部麻醉，然后用一根塑料棱鏡按壓患者的角膜來(lái)測量眼壓。這種方法不僅難受、復雜，而且根據多項研究顯示，并不是非常精確。

    曼德?tīng)栐诮邮茈娫?huà)采訪(fǎng)時(shí)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(shí)內的眼壓，發(fā)現患者一天內的眼壓有很大波動(dòng)。所以他們對80%的患者改變了治療方法?！?/span>

    曼德?tīng)柋硎?，這款自測試備的直徑只有50微米，長(cháng)度只有幾毫米，看起來(lái)像一根極微小的管子。曼德?tīng)柗Q(chēng)，這款在奎克的實(shí)驗室開(kāi)發(fā)出來(lái)的設備可以植入人的眼中。

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

    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.

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

    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.

    “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.

    “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.”

    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.

    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.

    “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.”

    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?tīng)柦忉尩溃骸八脑矸浅：?jiǎn)單。眼內壓會(huì )導致設備內的液柱位置變化，然后讀取它的讀數即可，原理很像溫度計?！?/span>

    青光眼專(zhuān)家們都對這款設備表示歡迎，并表示它與以往的測量方法相比有很多優(yōu)點(diǎn)，包括它可以顯示讀數，而且可以隨時(shí)監測。

    美國青光眼研究基金會(huì )（Glaucoma Research Foundation）的董事會(huì )主席、舊金山青光眼中心常務(wù)主任安德魯?伊瓦施表示：“如果患者做了白內障手術(shù)的話(huà)，如果在做手術(shù)的同時(shí)，你把這款設備植入進(jìn)去，那么就能更精確地監測眼壓，這是有巨大好處的?！币镣呤┻€是青光眼基金會(huì )“青光眼360”活動(dòng)的發(fā)起人，這個(gè)活動(dòng)旨在召集青光眼研究專(zhuān)家、行業(yè)高管和慈善人士來(lái)尋找治療青光眼的方法。

    他表示：“因此，如果你看看風(fēng)險收益比，問(wèn)題就不會(huì )是你為什么要植入，而是你為什么不植入?！?/span>

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

    伊瓦施指出，由于美國市場(chǎng)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(gè)領(lǐng)域進(jìn)行競爭，他們都希望能第一個(gè)在美國市場(chǎng)上推出植入式眼壓測量設備。

    伊瓦施表示：“這是一場(chǎng)令人興奮的競爭。大家都意識到，第一個(gè)進(jìn)入市場(chǎng)、第一個(gè)知道怎樣最好地測量眼壓的公司，可能會(huì )給青光眼的治療帶來(lái)革命性的效果，而且最終會(huì )造?；颊??！?/span>

    雖然上文提到的這款微傳感器還是該領(lǐng)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(guò)。因此曼德?tīng)柋硎?，下一步重點(diǎn)是要進(jìn)一步深入研究，以確保它對人體的安全性，并且確保它能長(cháng)期妥善地存在于眼部。

    曼德?tīng)柋硎荆骸白鳛榭茖W(xué)家，我們總是對我們和其他人做的事感到懷疑。不過(guò)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?！保ㄘ敻恢形木W(wǎng)）

    譯者：樸成奎

    “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.”

    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.

    “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.

    “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.

    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.

    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.

    “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.”

    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.

    “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.”