Adaptive optics parallel confocal scanning ophthalmoscope (AO-PCSO)

描述(申请人提供)：老年性黄斑变性(AMD)是发达国家50岁或以上人群失明的主要原因。最显著的临床和组织学损伤涉及视网膜色素上皮(RPE)、Bruch膜和脉络膜毛细血管；但导致视力丧失的原因是光感受器的退化、功能障碍和死亡。解剖学和功能研究发现，在疾病进展到晚期AMD之前，RPE/Bruch膜复合体中的光感受器退化和丢失就已经发生了。虽然视锥感光细胞变性继发于视杆细胞死亡，但视锥细胞的丧失是导致主要视力障碍的原因。因此，在临床环境中检测早期视锥细胞变性对于预防视力丧失具有重要的战略意义。视锥内段在退变过程中变宽畸形，我们推测视乳头旁视锥的增大和变形可作为AMD的早期临床征象。通过高分辨率和高保真的视网膜成像可以帮助识别这些征兆。只有通过自适应光学(AO)辅助眼底镜才能获得活体人眼的细胞尺度视网膜图像。但目前的视网膜声学成像存在图像采集速度不快、图像保真度不高等问题。在这一应用中，我们将开发一种高速、高分辨率的AO平行共焦扫描眼底镜(AO-PCSO)，以便于AMD的早期诊断。在这一应用中开发的仪器是以病人为导向的。在数据采集效率和图像保真度方面，AO-PCSO超过了目前的AO视网膜成像设备。这一应用打破了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式从宏观尺度转移到微观尺度。这项研究的成功将显著提高我们在AMD发病时诊断AMD的能力和我们对疾病进展的了解。高速图像采集是共焦视网膜成像的一项标志性进步；它不仅对老年受试者成像很重要，而且对涉及早发性视网膜疾病的儿童的研究也同样重要。

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.