Clinical glaucoma management enabled by visible-light OCT

项目摘要 这个以协作技术为重点的项目致力于开发、表征和验证可见光光学 相干断层扫描(VIS-OCT)作为一种功能工具来改变青光眼的临床治疗。我们会 解决临床青光眼诊断和进展检测中未满足的两个需求：(1)测量 视网膜亚层结构和(2)准确评估局部视网膜血氧饱和度(SO2)。这个 青光眼最早的结构变化被认为是视网膜神经节细胞(RGC)树突的回缩 内部网状层(IPL)。具体地说，这将发生在RGC“关闭”细胞突触的外侧IPL。 通过减少散射或通过IPL亚层厚度的变化来识别突触的丢失， 可以作为青光眼的早期和更敏感的生物标志物。测量视网膜SO2和 特定的小动脉-小静脉偶联可以决定这些血管所服务的区域的氧摄取。 我们的初步数据显示，青光眼患者眼睛受损区域的氧摄取率较低。 比健康眼睛中的相似区域。我们的观察表明，这种氧提取异常可能是 测量结果远远超过传统OCT记录的“地板效应”阈值，从而能够评估疾病 超过传统结构OCT变得不敏感的时间点。为了实现我们的长期目标，我们 将专注于新的VIS-OCT光学系统设计、成像协议和数据处理方法，以 确定早期青光眼的代谢改变和超精细解剖改变，这两者都超出了 现有成像技术的能力。

Project Summary This collaborative technology focused project seeks to develop, characterize, and validate visible-light optical coherence tomography (vis-OCT) as a functional tool to transform the clinical management of glaucoma. We will address two unmet needs in clinical glaucoma diagnosis and detection of progression: (1) the ability to measure retinal sublayer structure and (2) to accurately assess local retinal hemoglobin oxygen saturation (sO2). The earliest structural changes in glaucoma are thought to be a retraction of retinal ganglion cell (RGC) dendrites in the inner plexiform layer (IPL). Specifically, this would occur in the outer IPL, where RGC “off” cells synapse. Identification of loss of synapses, either by decreased scattering or by the change in IPL sublayers’ thicknesses, could serve as an earlier and more sensitive biomarker for glaucoma than any other. Measuring retinal sO2 and specific arteriole-venule couplets can determine the oxygen extraction in the regions served by those vessels. Our preliminary data indicate that regions showing damage in glaucomatous eyes have lower oxygen extraction than similar areas in healthy eyes. Our observation suggests that such oxygen extraction abnormalities can be measured well beyond the “floor effect” threshold noted with conventional OCT, allowing assessment of disease beyond the time point that conventional structural OCT becomes insensitive. To achieve our long-term goal, we will focus on new vis-OCT optical system design, imaging protocols, and data processing methodologies to identify both metabolic and ultra-fine anatomical alternations in early glaucoma, both of which are beyond the capabilities of existing imaging technologies.