Advanced imaging for diabetic retinopathy

糖尿病视网膜病变的先进成像

• 批准号: 8444056
• 负责人: Delia Cabrera DeBuc
• 金额: $ 14.48万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8444056
• 关键词: Area Under Curve; Blindness; Blood Circulation; Blood Vessels; Blood flow; Caliber; Classification; Clinic; Clinical; Clinical Trials; Deterioration; Development; Diabetic Retinopathy; Diagnostic; Diagnostic Procedure; Discrimination; Disease Progression; Early Diagnosis; Early identification; Early treatment; Eye; Functional disorder; Fundus; Future; Goals; Health Personnel; Human; Image; Imaging Techniques; Individual; Intervention; Measurement; Measures; Methodology; Monitor; Morphology; Nerve Degeneration; Neural Retina; Optic Disk; Optical Coherence Tomography; Outcome; Pathogenesis; Pathology; Persons; Prevention; Public Health; Receiver Operating Characteristics; Retina; Retinal; Retinal Diseases; Risk; Role; Staging; Structure; System; Testing; Thick; Tissues; Venous; Vision; Visual; Visual Acuity; clinical practice; diabetic; diabetic patient; diagnosis evaluation; hemodynamics; improved; in vivo; novel; prevent; relating to nervous system; retina blood vessel structure; tool

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.

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，这对诊断提出了重大挑战。由于对 DR 机制的了解有限以及视网膜神经组织和视网膜脉管系统之间关系的改变，阻碍了预防这些人视力丧失的进展。因此，当然需要对 DR 治疗进行早期诊断和评估的客观测试，以识别出现视力威胁问题的高风险人群。我们的目标是利用先进的成像技术——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，该技术可以帮助更好地了解糖尿病视网膜病变潜在的威胁视力的并发症以及神经视网膜和血管之间关系的改变。我们的目的是检验以下假设：视网膜结构改变先于视网膜血流动力学紊乱和 DR 视功能缺陷。我们将实现以下目标： 目标 1：测试假设，先进的多普勒 FD-OCT 成像和新颖的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患有或不患有 DR 的糖尿病患者的视网膜血流动力学和结构形态的无创和体内定量提供客观的方法。目标 2：检验 DR 中视网膜结构改变先于视网膜血流动力学紊乱和视功能缺陷的假设。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，并且在进行性 DR 的每个阶段，结构恶化的程度将大于血流动力学紊乱和视功能缺陷的程度。我们将通过比较解剖变量、血流动力学参数和视功能测量来定义视网膜病变不同阶段功能障碍与视网膜结构改变和血流动力学紊乱的比率。我们的结果将提供有关患有或不患有视网膜病变的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。我们的预期结果将是提高视网膜病变不同阶段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，并将研究结果与具有不同 DR 水平的糖尿病患者分层的系统控制和并发症测量结果联系起来。我们的影响将通过提供一种确定更好的 DR 临床试验临床终点的方法来影响临床实践，这些临床试验对早期疾病进展比视力更敏感，并确定血液循环异常在 DR 进展中的确切作用。 公共卫生相关性：糖尿病视网膜病变是一个主要的公共卫生问题，应重点关注其预防。了解糖尿病视网膜病变的机制对于阐明其发病机制、早期检测和识别未来潜在的治疗方法非常重要。能够估计一个人患糖尿病视网膜病变的风险将有助于医疗保健提供者和公众。