Ultra-wide field optical coherence tomography based angiography for imaging diabetic retinopathy

项目摘要 美国人口中糖尿病发病率的增加和美国人老龄化的惯性波将 确保糖尿病视网膜病变（DR）仍然是成年患者视力的主要威胁之一， 对临床社区的重大管理挑战。现在很清楚周边视网膜是 在许多威胁视力的眼部疾病中的病理学，包括DR。视网膜周边的评价， 因此对于疾病表现的筛查、诊断、监测和治疗是重要的。 从历史上看，周边视网膜的成像一直是有限的，并且难以获得;最近的进展， 然而，宽视场摄影已经显著地提高了对前部视网膜成像的能力。揭示 周边视网膜中的血管受累，侵入性成像技术，例如，荧光素血管造影（FA） 和吲哚花青绿色血管造影术（ICGA）。这两种技术传统上都是 用于做出诊断和治疗决策，但它们仅提供二维（2D）图像， 需要血管内注射，有并发症的风险如果能够进行3D打印， 具有毛细血管水平分辨率的外周血管灌注的可视化，两者都揭示了详细的 微血管网络的功能结构，并允许定量的灌注状态的微血管网络的功能结构， 视网膜。这些信息将是基础，以更好地了解视网膜疾病，有周边 血管受累，例如DR，导致更明智和更有针对性的治疗决策。 在本计画中，我们提出发展一种可应用于临床的三维超宽视野光学微血管造影系统 （UW-OMAG）系统，其能够在~180度视野下对神经视网膜进行成像。我们设想， 一种新的、非侵入性的、无标记的光学成像方法将量化血管的形态， 允许在3D中评估它们的空间关系，不仅在中央黄斑区，而且在周边 视网膜。同时，可以定量地测量视网膜的总视网膜血流量（RBF）和血管体积。 评估。为了实现这一目标，我们将首先设计和构建一个新的，UW-OMAG系统的基础上扫 源光学相干断层扫描能够400 kHz的A-扫描速率。重点将放在解决挑战上 与创建能够提供成像范围的UW-OMAG视网膜成像系统相关 具有最小的系统灵敏度滚降特性，以便能够适应和成像弯曲的 后段，并实现了前所未有的成像视野~ 180 o。我们将利用这个 临床上可应用的原型，以验证其可视化周边视网膜微血管的准确性， 与超宽视野眼底照相和FA相比。最后，我们将进行UW-OMAG飞行员成像 在160名正常受试者和DR受试者中进行的研究，以证明这种新的 血管结构和功能的无标记3D超宽视野微血管造影。这项研究将作为 为下一代OCT血管造影和未来UW-OMAG数据的解释奠定了基础。

Project Summary The increasing incidence of diabetes in the US population and the inertial wave of aging in Americans will ensure that diabetic retinopathy (DR) remains one of the principal threats to the sight of adult patients and a significant management challenge for the clinical community. It is now clear that the peripheral retina is the site of pathology in many vision-threatening eye diseases, including DR. Evaluation of the retinal periphery, therefore, is important for screening, diagnosis, monitoring, and treatment of disease manifestations. Historically, imaging of the peripheral retina has been limited and difficult to obtain; recent advancements in wide-field photography, however, have dramatically improved the ability to image the anterior retina. To reveal vascular involvements in the peripheral retina, invasive imaging techniques, e.g., fluorescein angiography (FA) and indo-cyanine green angiography (ICGA), are currently used. Both techniques have traditionally been utilized to make diagnoses and treatment decisions, but they only provide two-dimensional (2D) images and require intravascular injections that risk complications. It would be highly advantageous to be capable of 3D visualization of peripheral vascular perfusion with capillary-level resolution, both to reveal the detailed functional architecture of the microvascular network and to permit quantification of the perfusion status of the retina. This information would be fundamental to better understanding of retinal diseases that has peripheral vascular involvements, e.g. DR, resulting in more informed and targeted treatment decisions. In this project, we propose to develop a clinically applicable 3D ultra widefield optical microangiography (UW-OMAG) system capable of imaging the neural retina at ~180-degree field of view. We envision that this novel, non-invasive, and label-free optical imaging method will quantify the morphology of blood vessels and permit assessment of their spatial relations in 3D, not only in the central macular region, but in the peripheral retina. Concurrently, total retinal blood flow (RBF) and vascular volumes of the retina can be quantitatively assessed. To achieve this goal, we will first design and construct a novel, UW-OMAG system based on swept source optical coherence tomography capable of 400 kHz A-scan rate. The focus will be on solving challenges associated with creating an UW-OMAG retinal imaging system that is capable of providing an imaging range of >12mm with minimal system sensitivity roll-off characteristics so that it is able to adapt and image the curved posterior segment, and achieving an unprecedented imaging field of view ~180o. We will then utilize this clinically applicable prototype to validate its accuracy for visualizing the peripheral retinal microvasculature, compared to ultra widefield fundus photography and FA. Finally, we will perform UW-OMAG pilot imaging studies in 160 subjects of normal and DR subjects to demonstrate clinical feasibility and usefulness of this new label-free 3D ultra widefield microangiography of vascular structure and function. This study will serve as the foundation for next generation of OCT angiography and for interpretation of UW-OMAG data in future.