Functional and Structural Optical Coherence Tomography for Glaucoma

项目总结 在美国，青光眼是导致失明的主要原因。青光眼的治疗是基于早期 检测，然后进行仔细的评估和监测，以确定那些疾病进展迅速和 视力丧失的风险很高。这允许合理地使用内科、激光和外科治疗。当前 评估青光眼的方法有很大的局限性。视野(VF)检测的敏感度较低 检测早期疾病，其重复性在晚期恶化，降低了其对 监测疾病进展。光学相干断层扫描(OCT)精确测量乳头周围 神经纤维层(NFL)厚度，是目前治疗青光眼最常用的技术 评估。然而，NFL厚度在检测早期青光眼方面的敏感性有限，并达到了最低点 在中度青光眼中的价值，这阻止了它跟踪青光眼的进展到后期。的目标是 这项拟议的研究旨在开发先进的OCT技术，以增强对早期青光眼的检测， 提高检测重大疾病进展的灵敏度，并提高测量的准确性 前进的速度。具体目标是： 1.研制了一种定向高分辨率OCT和OCT血管成像样机，以提高对脑血管成像的质量 结构和灌注量。样机将对光束方向进行实时控制以保持 垂直入射在NFL上进行精确的反射率分析，这已经显示出非常有希望 对早期青光眼的敏感检测。无传感器自适应光学像差校正将实现高 横向分辨率，以提高对神经纤维束和毛细血管缺陷的检测。超高轴向 分辨率将使评估内网状层的五层结构成为可能。 2.广域OCT和OCT血管成像分析及视野模拟。广泛的乳头状肌周围和 黄斑扫描，使用下一代商业光谱域OCT系统，将允许可视化 从盘缘到颞缝的神经纤维和灌注缺陷，从而改善早期青光眼 侦测。将执行VF模拟，以将OCTA灌注测量转换为VF等效的分贝- 临床医生熟悉的用于监测进展的标尺。模拟的重现性比实际高。 VF，它改进了疾病进展的检测和进展速度的测量。 3.青光眼诊断和监测的临床研究。这项临床研究将测试是否有 提出的新技术可以改善对周围性青光眼的检测，疾病的检测 进程，以及测量进程速度的准确性。 这项研究很可能通过开发新的目标函数来改变青光眼的临床实践 以及可以在下一代临床OCT系统上实际实施的结构测试。这 通过对冰胶瘤的早期准确诊断和对进展迅速的患者进行及时干预，将挽救视力。

PROJECT SUMMARY Glaucoma is a leading cause of blindness in the US. The management of glaucoma is based on early detection, followed by careful evaluation and monitoring to identify those with rapid disease progression and high risk for vision loss. This allows for the rational use of medical, laser, and surgical treatments. Current methods of assessing glaucoma have significant limitations. Visual field (VF) testing has a low sensitivity for detecting early disease, and its reproducibility worsens in advanced stages, reducing its reliability for monitoring disease progression. Optical coherence tomography (OCT) precisely measure the peripapillary nerve fiber layer (NFL) thickness and is the most commonly used technology for objective glaucoma evaluation. However, NFL thickness has limited sensitivity in detecting early glaucoma, and reaches a floor value in moderate glaucoma, which prevents it from tracking glaucoma progress into later stages. The goal of the proposed research is to develop advanced OCT technology that will enhance detection of early glaucoma, improve the sensitivity of detecting significant disease progression, and increase the accuracy of measuring progression speed. The Specific Aims are: 1. Develop a directional high-resolution OCT and OCT angiography prototype to improve imaging of structure and perfusion. The prototype will have real-time control of beam direction to maintain perpendicular incidence on the NFL for accurate reflectance analysis, which has shown promise for very sensitive detection of early glaucoma. Sensorless adaptive-optics aberration correction will enable high transverse resolution to enhance the detection of nerve fiber bundle and capillary defects. Ultrahigh axial resolution will enable assessment of the pentalaminar structure of the inner plexiform layer. 2. Wide-field OCT and OCT angiography analyses and visual field simulation. Wide peripapillary and macular scans, using a next-generation commercial spectral-domain OCT system, will allow visualization of nerve fiber and perfusion defects from the disc margin to temporal raphe, thus improving early glaucoma detection. VF simulation will be performed to convert OCTA perfusion measurement to a VF-equivlaent dB- scale familiar to clinicians for monitoring progression. The simulation has higher reproducibility than actual VF, which improves detection of disease progression and measurement of progression speed. 3. Clinical studies in glaucoma diagnosis and monitoring. The clinical study will test whether the proposed new technologies can improve the detection of pre-perimetric glaucoma, detection of disease progression, and the accuracy of measuring the speed of progression. This research is likely to transform the clinical practice of glaucoma by developing novel objective functional and structural tests that can be practically implemented on the next generation of clinical OCT systems. This will save vision by achieving accurate diagnosis in early glacuoma and timely intervention in rapid progressors.