Adaptive optics parallel confocal scanning ophthalmoscope (AO-PCSO)

描述（由申请人提供）：年龄相关性黄斑变性（AMD）是发达国家50岁或以上人群失明的主要原因。最突出的临床和组织学损伤包括视网膜色素上皮（RPE）、布鲁氏膜和绒毛膜毛细血管；但正是光感受器的退化、功能障碍和死亡导致了视力丧失。解剖和功能研究发现，在RPE/Bruch膜复合体发展为晚期AMD之前，光感受器变性和丧失就已经发生。虽然视锥细胞的光感受器变性继发于视杆细胞死亡，但视锥细胞的丧失才是导致主要视觉障碍的原因。因此，在临床环境中发现早期锥体变性对于预防视力丧失具有重要的战略意义。锥体内节变宽、变形；我们假设中央凹旁锥体的扩大和变形可以作为AMD诊断的早期临床体征。高分辨率和高保真视网膜成像可能有助于识别这些迹象。人眼细胞尺度视网膜图像只有在自适应光学辅助下才能获得。但目前的AO视网膜成像存在图像采集速度慢、图像保真度低等问题。在本应用中，我们将开发一种高速，高分辨率的AO平行共聚焦扫描检眼镜（AO- pcso），以促进AMD的早期诊断。在这个应用程序中开发的仪器是“现实世界”的病人导向。AO- pcso超越了目前的AO视网膜成像方式，显著提高了数据收集效率和图像保真度。该应用程序打破了AMD研究的障碍，通过提供视网膜退行性疾病的细胞诊断，寻求将当前的临床实践范例从宏观尺度转变为微观尺度。这项研究的成功将显著提高我们在发病时诊断AMD的能力和我们对疾病进展的认识。高速图像采集是共聚焦视网膜成像的一个标志性进展；它不仅对老年受试者的成像很重要，而且对涉及早发性视网膜疾病的儿童的研究同样重要。

DESCRIPTION (provided by applicant): Age-related macular degeneration (AMD) is the leading cause of blindness in people 50 years of age or older in the developed world. The most prominent clinical and histological damage involves retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillaris; but it is the degeneration, dysfunction, and death of photoreceptors that accounts for the vision loss. Anatomical and functional studies have found that photoreceptor degeneration and loss occur before disease in the RPE/Bruch's membrane complex progresses to late AMD. Although the cone photoreceptor degeneration is secondary to rod death, it is the cone loss that causes major visual handicap. As such detecting early cone degeneration in a clinical setting is strategically critical to prevent vision loss. Cone inner segments become widened and misshapen during the degeneration; we hypothesize that enlargement and deformation of the parafoveal cones could be used as an early clinical sign for the diagnosis of AMD. Identifying these signs may be facilitated by high-resolution and high-fidelity retinal imaging. The cellular scale retinal image in the living human eye can only be achieved by adaptive optics (AO) assisted ophthalmoscopy. But current AO retinal imaging is hampered by insufficient image acquisition speed and inadequate image fidelity. In this application, we will develop a high- speed, high-resolution AO parallel confocal scanning ophthalmoscope (AO-PCSO) to facilitate diagnosis of AMD at an earlier stage. The instrument developed in this application is 'real-world' patient oriented. The AO-PCSO exceeds current AO retinal imaging modalities with significantly improved data collection efficiency and image fidelity. This application breaks the barrier to the study of AMD, seeking to shift current clinical practice paradigms from macro-scale to micro-scale by providing cellular diagnosis of retinal degenerative disease. The success of this research will significantly improve our ability to diagnose AMD at its onset and our knowledge of disease progression. High-speed image acquisition is a signature advance in confocal retinal imaging; it is not only important for imaging the elderly subjects but also equally important for studies involving children with early onset retinal disease.