Advanced imaging for diabetic retinopathy

描述（由申请人提供）：糖尿病视网膜病变（DR）是糖尿病患者视力丧失的主要原因，对诊断提出了重大挑战。由于对DR的机制和视网膜神经组织与视网膜脉管系统之间关系的改变了解有限，阻碍了预防这些个体视力丧失的进展。因此，需要一种客观的测试方法来早期诊断和评估DR治疗，以识别视力威胁问题的高危人群。我们的目标是通过先进的成像技术，多普勒傅里叶域光学相干断层扫描（多普勒FD-OCT）来预防糖尿病患者的视力丧失，该技术可以更好地了解DR潜在的视力威胁并发症以及神经视网膜和血管之间关系的改变。我们的目的是验证视网膜结构改变先于视网膜血流动力学紊乱和视觉功能障碍的假设。我们将完成以下目标：先进的多普勒FD-OCT成像和新型定量功能解剖测量相结合的诊断能力可以为正常健康受试者和伴有或不伴有dr的糖尿病患者的视网膜血流动力学和结构形态学的无创和体内定量提供客观的方法。我们的假设预测视网膜结构改变先于视网膜血流动力学紊乱和视觉功能缺陷，并且在进行性DR的每个阶段，视网膜结构恶化的程度将大于血流动力学紊乱和视觉功能缺陷的程度。我们将通过比较解剖学变量、血流动力学参数和视觉功能测量来确定视网膜病变不同阶段视网膜结构改变和血流动力学紊乱的比例。我们的研究结果将提供糖尿病患者视网膜血流的定量信息，并将改善dr的早期诊断和治疗。我们的预期结果将促进视网膜病变不同阶段的视觉功能障碍与视网膜结构改变和血流动力学紊乱的比例。我们将描述视网膜结构和血流动力学参数的特征，并将研究结果与不同程度DR的糖尿病患者分层组的控制和并发症的系统测量相关联。我们的影响将影响临床实践，为DR临床试验提供一种识别更好的临床终点的方法，这些临床试验对早期疾病进展比视力更敏感，并定义血液循环异常在DR中的确切作用进展。

DESCRIPTION (provided by applicant): Diabetic retinopathy (DR) is a major cause of visual loss in diabetic individuals that presents a significant diagnostic challenge. Advances in preventing vision loss in these individuals are hindered by limited understanding of mechanisms underlying DR and the altered relationships between the retinal neural tissue and retinal vasculature. Therefore, an objective test for the early diagnosis and evaluation of DR treatment is certainly needed in order to identify the individuals at great risk for vision-threatening problems. Our goal is to prevent visual loss in diabetic patients with an advanced imaging technique, Doppler Fourier Domain Optical Coherence Tomography (Doppler FD-OCT) that can facilitate a better understanding of the underlying sight- threatening complications of DR and the altered relationships between the neural retina and blood vessels. Our objective is to test the hypothesis that retinal structure alteration precedes disturbances in retinal hemodynamics and visual function deficit in DR. We will accomplish the following aims: Aim 1: Test the hypothesis the diagnostic power of the combination of advanced Doppler FD-OCT imaging and novel quantitative functional-anatomical measures can provide an objective methodology for non-invasive and in vivo quantification of retinal hemodynamics and structure morphology in normal healthy subjects and diabetic patients with and without DR. Aim 2: Test the hypothesis that retinal structure alteration precedes disturbances in retinal hemodynamics and visual function deficit in DR. Our hypothesis predicts that retinal structure alteration precedes disturbance of retinal hemodynamics, and at each stage of progressive DR the magnitude of structure deterioration will be larger than the magnitude of hemodynamic disturbance and visual function deficit. We will define the ratio of dysfunction to retinal structure alterations and hemodynamic disturbances at different stages of retinopathy by comparing anatomical variables, hemodynamic parameters and visual function measures. Our results will provide quantitative information about retinal blood flow in diabetic patients with and without retinopathy, and will improve the early diagnosis and treatment of DR. Our expected outcome will be to facilitate a ratio of visual dysfunction to retinal structure alterations and hemodynamic disturbances at different stages of retinopathy. We will characterize the retinal structure and hemodynamic parameters and relate the findings to systemic measures of control and complications in defined stratified groups of diabetic patients with varying levels of DR. Our impact will influence clinical practice by providing a means of identifying better clinical endpoints for DR clinical trials that are more sensitive to early disease progression than visual acuity and define the exact role of the blood circulation abnormalities in the DR progression. PUBLIC HEALTH RELEVANCE: Diabetic retinopathy is a major public health concern, and efforts should be focused on its prevention. An understanding of the mechanism of diabetic retinopathy is important for elucidating its pathogenesis for early detection and identification of potential future therapies. It will be helpful for healthcare providers and the public to be able to estimate a person's risk of diabetic retinopathy.