Characterization of Exudative Macular Degeneration and Diabetic Retinopathy Using

描述（由申请人提供）：自1961年首次在视网膜中使用以来，荧光素血管造影（FA）一直是视网膜血管疾病客观表征的金标准（例如糖尿病视网膜病变、视网膜静脉闭塞和与年龄相关性黄斑变性（AMD）相关的脉络膜新生血管）。尽管其广泛使用，但FA是昂贵的，侵入性的，耗时的，限制了作为筛查工具的有效性。光学相干断层扫描（OCT）及其更快的变化称为光谱域OCT （SDOCT）是干涉成像技术，可以对视网膜结构进行三维成像。该技术使视网膜形态和病理改变的临床成像分辨率几乎与组织学切片相当。由于OCT不能显示大多数视网膜血管异常，因此经常与FA一起诊断和治疗黄斑疾病患者。作为一种潜在的替代FA诊断视网膜血管疾病的方法，我们开发了一种称为相位对比光学相干断层扫描（PC-OCT）的成像方法，该方法使用从临床可用的SDOCT成像系统获得的数据进行专门的软件分析，以提供视网膜血管和脉络膜新生血管的高分辨率成像的附加功能。为了发展PC-OCT成像作为荧光素血管造影的非侵入性替代方法，我们有以下目标：(1)提高PC-OCT成像的速度、准确性和自动化程度，以允许一般临床使用，并将这种开发的技术应用于(2)糖尿病视网膜病变的视网膜毛细血管不灌注和(3)年龄相关性黄斑变性（AMD）的脉络膜新生血管（CNV）的疾病目标。PC-OCT成像的可视化能力将直接与目标疾病受试者的荧光素血管造影图像进行比较。I期目标的成功完成将导致PC-OCT成像技术和分析的进一步发展，用于检测血管渗漏和筛查无症状同伴眼睛的亚临床CNV。发展PC-OCT的运动对比能力，与临床可用的SDOCT系统一起使用，可以为视网膜血管诊断建立一种新的无创筛查工具。通过非侵入性筛查对AMD患者进行早期检测，可以在中心视力丧失之前更早发现亚临床CNV并开始治疗。

DESCRIPTION (provided by applicant): Since its first use in the retina in 1961, fluorescein angiography (FA) has been the gold standard for objective characterization of retinovascular disease (e.g. diabetic retinopathy, retinal vein occlusions, and choroidal neovascularization associated with age-related macular degeneration (AMD)). Despite its widespread use, FA is costly, invasive, and time consuming, limiting the usefulness as a screening tool. Optical coherence tomography (OCT) and its faster variation called spectral domain OCT (SDOCT) are interferometric imaging techniques which allow three-dimensional imaging of the retinal structure. This technique has enabled clinical imaging of retinal morphology and pathologic alteration with resolution nearly comparable to histologic sections. Because OCT is not capable of rendering most retinovascular abnormalities, it is frequently performed with FA to diagnose and manage patients with macular disease. As a potential alternative to FA in diagnosing retinovascular disease, we have developed an imaging method called phase contrast optical coherence tomography (PC-OCT) which uses specialized software analysis of data acquired from clinically available SDOCT imaging systems to provide the additional functionality of high resolution imaging of retinal vessels and choroidal neovascularization. To develop PC-OCT imaging as a non-invasive alternative for fluorescein angiography, we have the following goals: (1) improve the speed, accuracy and automation of PC-OCT imaging to allow for general clinical usage, and apply this developed technique towards disease targets of (2) retinal capillary non- perfusion in diabetic retinopathy and (3) choroidal neovascularization (CNV) in age-related macular degeneration (AMD). The visualization capabilities of PC-OCT imaging will be compared directly against fluorescein angiography images for subjects of the target diseases. Successful completion of the Phase I aims will lead to further development of PC-OCT imaging techniques and analysis for detection of vascular leakage and screening for sub-clinical CNV in asymptomatic fellow eyes. Developing motion contrast capabilities of PC-OCT to be used with clinically available SDOCT systems can establish a new non-invasive screening tool for retinovascular diagnosis. Earlier detection through non-invasive screening of AMD patients may enable earlier detection of subclinical CNV and initiation of therapy before central vision is lost. PUBLIC HEALTH RELEVANCE: This proposal describes a new software product that enhances the diagnostic capability of optical coherence tomography (OCT), the most commonly performed retinal diagnostic test used in the US for evaluation of macular degeneration and diabetic retinopathy. By non-invasively providing high resolution retinovascular imaging, the product, phase contrast OCT (PC-OCT), may potentially replace fluorescein angiography, the current invasive and costly gold standard for retinovascular imaging. The proposed research plan improves the capabilities of PC-OCT and then does a head-to-head comparison with fluorescein angiography in evaluation of patients with wet macular degeneration and diabetic retinopathy.