Imaging of Retinal Oxygen Metabolism in Diabetic Retinopathy

摘要 糖尿病视网膜病变(DR)是目前工作年龄成年人视力丧失的主要原因。与 糖尿病人口的预期增长，不能工作的视力受损的糖尿病人的数量 否则，照顾自己将继续是一个主要的公共卫生问题。预防DR导致的视力损失 需要早期诊断、定期监测和及时的治疗干预。目前，未满足的临床 需求是能够前瞻性地确定哪些糖尿病患者将发展为DR，进展为视力- 威胁阶段，或对治疗有积极反应。一个公认的因素，有助于 由于DR而导致的威胁视力的病理是视网膜缺氧，这可能随后损害 氧气代谢。维持氧气代谢对能量的产生至关重要，而能量的产生对细胞至关重要 以求生存并进行视觉处理。视网膜内的氧代谢是由 视网膜内氧输送和氧摄取分数。尽管视网膜组织和微血管系统 已经从解剖学的角度进行了广泛的研究，但关于血管内皮细胞的改变的信息有限 视网膜氧代谢功能和能量产生由Dr.博士提出的研究提案将克服这一点 通过创新、定量和全面的多模式成像方法来阐明 发生在进展期的氧代谢改变和调节机制缺陷 DR与治疗的应用以及与视网膜毛细血管丛形态的关系。具体目标是 要：1)确定与DR分期相关的视网膜内部氧代谢指标，并指示 过去的血糖控制；2)确定治疗前视网膜内氧代谢指标可预测 治疗结果；3)阐明视网膜内部氧代谢指标、毛细血管丛之间的关系 DR分期的形态和细胞层厚度这些发现将拓宽对DR的认识 病理生理学，改进诊断和预后评估，并推动寻找新的预防和治疗方法 治疗性干预。这项研究性研究可能会改变对DR的临床评估，从而 显著影响糖尿病患者的生活质量和视障人士的护理成本 个人。

Abstract Diabetic retinopathy (DR) is currently the leading cause of vision loss in working age adults. With the anticipated growth of the diabetic population, the number of visually impaired diabetic people who cannot work or care for themselves will continue to be a major public health concern. Vision loss prevention due to DR requires early diagnosis, regular monitoring, and timely therapeutic intervention. Currently, the unmet clinical needs are the ability to prospectively identify which diabetic individuals will develop DR, progress to vision- threatening stages, or respond favorably to therapy. A generally recognized factor that contributes to the development of vision-threatening pathologies due to DR is retinal hypoxia, which can subsequently impair oxygen metabolism. Maintenance of oxygen metabolism is essential for energy production that is vital for cells to survive and perform visual processing. Inner retinal oxygen metabolism is maintained by the balance of inner retinal oxygen delivery and oxygen extraction fraction. Although the retinal tissue and microvasculature have been extensively studied from an anatomical perspective, there is limited information about alterations in retinal oxygen metabolic function and energy production due to DR. The research proposal will overcome this limitation by an innovative, quantitative, and comprehensive multimodal imaging approach to elucidate alterations in oxygen metabolism and defects in regulatory mechanisms that occur at progressive stages of DR, with application of treatment, and in relation to retinal capillary plexus morphology. The specific aims are to: 1) identify inner retina oxygen-metabolic metrics that are associated with stages of DR and indicative of past glycemic control; 2) determine pre-treatment inner retina oxygen-metabolic metrics that are predictive of treatment outcome; 3) elucidate associations among inner retina oxygen-metabolic metrics, capillary plexus morphology and cell layer thickness at stages of DR. The findings will broaden knowledge of DR pathophysiology, improve diagnostic and prognostic evaluation, and propel search for new preventative and therapeutic interventions. The research study can potentially transform clinical assessment of DR, thereby significantly impacting the quality of life of diabetic people and the cost of caring for visually impaired individuals.