Assessment of Retinal Capillary Density, Morphology and Function in Retinal Vascular Disease Using Novel OCT Angiography Based Metrics

使用基于 OCT 血管造影的新型指标评估视网膜血管疾病中的视网膜毛细血管密度、形态和功能

• 批准号: 10460809
• 负责人: Amir H Kashani
• 金额: $ 49万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460809
• 关键词: Assessment; Retinal; Capillary; Density; Morphology

Abstract Diabetes mellitus (DM) and hypertension (HTN) are two prototypical vascular diseases associated with microscopic pathological changes in retinal capillary structure. These changes ultimately lead to capillary dysfunction, capillary closure, ischemia and vision loss. Current clinical methods and diagnostics for staging these diseases are neither effective in detecting the earliest capillary changes nor in detecting incremental capillary changes (improvement or worsening) in later stages of the disease. For example, clinical detection of capillary loss is generally not possible by clinical examination alone. Fluorescein angiography (FA) is an invasive test that has been traditionally used to assess retinal perfusion but human studies show that the resolution and technical limitations of FA is only effective in detecting capillary loss after ~50% or more of capillaries are already non-perfused. In addition, FA is not clinically indicated unless there are already clinical signs of late stage disease and neovascularization. Therefore, reliably detecting and characterizing subclinical retinal capillary changes in DM and HTN represents an important opportunity to decrease disease burden and cost by enabling early diagnosis, clinical trials and interventions before irreversible tissue damage. Optical coherence tomography angiography (OCTA) is a safe, non-invasive and FDA approved method that provides a unique opportunity to achieve these goals. Our group of physicians, scientists and engineers have been pioneers in the development and application of OCTA technology. In this proposal, we seek to shift the current research and clinical practice paradigms in assessment of retinal vascular disease by utilizing cutting-edge commercially available OCTA technology and novel image acquisition methods to identify and measure subclinical changes in capillary structure and function. Our preliminary data shows that subclinical capillary loss occurs in all stages of DR. In this proposal we will (1) further characterize capillary changes in well controlled, non-interventional clinical trial of human subjects across race, age, gender and other possible confounding variables by taking advantage of well-characterized subjects from NIH-funded population based studies. (2) Assess the feasibility and reliability of novel OCTA measures of retinal capillary function. (3) To further characterize the magnitude and physiological relevance of these capillary changes we will use a custom built functional swept-source OCTA (FOCTA) to assess real time and in vivo retinal vascular responses during a focal physiologic light stimulus. The successful outcome of this proposal will develop and implement novel SD- and SS-OCTA based technology in human subjects to identify novel biomarkers of capillary loss or closure in DM and HTN. Application of these biomarkers will improve the diagnosis and management of disease by allowing direct evaluation of capillary changes and ischemia in a clinical setting. Our proposal uses spectral domain (SD) and swept-source (SS)-OCTA devices that are FDA approved so our results will be directly transferable to patient care.

摘要 糖尿病(DM)和高血压(HTN)是两种典型的与 视网膜毛细血管结构的微观病理变化。这些变化最终导致毛细血管 功能障碍、毛细血管闭合、缺血和视力丧失。目前临床分期的方法和诊断方法 这些疾病既不能有效检测最早的毛细血管改变，也不能检测增量 疾病后期的毛细血管改变(改善或恶化)。例如，临床检测 仅凭临床检查一般不可能出现毛细血管丢失。荧光素血管造影(FA)是一种 传统上用来评估视网膜血流的侵入性测试，但人体研究表明 FA的分辨率和技术限制仅在检测约50%或更多的毛细血管丢失时有效 毛细血管已经是非灌注型。此外，FA没有临床指征，除非已经有临床 晚期疾病和新生血管的迹象。因此，可靠地检测和表征亚临床 糖尿病和HTN的视网膜毛细血管改变是减轻疾病负担和 在不可逆转的组织损伤之前，能够进行早期诊断、临床试验和干预，从而降低成本。光学 相干断层血管成像(OCTA)是一种安全、无创的FDA批准的方法，它提供了一种 实现这些目标的独特机会。我们的医生、科学家和工程师团队一直在 是OCTA技术开发和应用的先驱。在这项提案中，我们寻求将当前的 利用前沿技术评估视网膜血管疾病的研究和临床实践范式 商业化的OCTA技术和用于识别和测量的新型图像采集方法 毛细血管结构和功能的亚临床改变。我们的初步数据显示，亚临床毛细血管 在本提案中，我们将(1)进一步描述油井中的毛细血管变化 对不同种族、年龄、性别和其他可能的受试者进行的受试者对照、非干预性临床试验 利用美国国立卫生研究院资助人群中具有良好特征的受试者的优势来混淆变量 学习。(2)评价视网膜毛细血管功能OCTA新指标的可行性和可靠性。(3)至 为了进一步表征这些毛细血管变化的大小和生理相关性，我们将使用 建立功能性扫描源OCTA(FOCTA)以评估实时和在体视网膜血管反应 一种焦点生理性光刺激。这一提议的成功结果将发展和实施小说 基于SD和SS-OCTA的人体毛细血管丢失或闭合新生物标志物识别技术 在DM和HTN中。这些生物标志物的应用将通过以下方式改善疾病的诊断和管理 允许在临床环境中直接评估毛细血管变化和缺血。我们的建议使用光谱 域(SD)和扫频源(SS)-FDA批准的OCTA设备，因此我们的结果将直接 可转移到病人护理。