Functional and Structural Optical Coherence Tomography for Glaucoma

项目摘要 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， 视力丧失的高风险。这允许合理使用药物、激光和手术治疗。电流 评估青光眼的方法具有明显的局限性。视野（VF）测试对以下因素的敏感性较低： 检测早期疾病，其可重复性在晚期阶段下降，降低了其可靠性， 监测疾病进展。光学相干断层扫描（OCT）精确测量视乳头周围 神经纤维层（NFL）厚度，是客观青光眼最常用的技术 评价然而，NFL厚度在检测早期青光眼方面的敏感性有限， 在中度青光眼中的价值，这可以防止它跟踪青光眼进展到后期阶段。的目标 该研究计划开发先进的OCT技术，以提高早期青光眼的检测， 提高检测显著疾病进展的灵敏度，并提高测量的准确性 前进速度具体目标是： 1.开发定向高分辨率OCT和OCT血管造影原型，以改善 结构和灌注。原型将实时控制光束方向， 垂直入射的NFL准确的反射率分析，这已显示出非常有希望的 早期青光眼的敏感检测。无传感器自适应光学像差校正将使高 横向分辨率，以增强对神经纤维束和毛细血管缺陷的检测。超高轴向 分辨率将使得能够评估内丛状层的五层结构。 2.宽视野OCT和OCT血管造影分析和视野模拟。广泛的乳头周围和 黄斑扫描，使用下一代商业光谱域OCT系统，将允许可视化 从椎间盘边缘到颞中缝的神经纤维和灌注缺陷，从而改善早期青光眼 侦测将进行VF模拟，以将OCTA灌注测量值转换为VF等效dB- 临床医生熟悉的用于监测进展的量表。模拟结果的重现性比实际结果高 VF，改善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 提出的新技术可以改善视野前青光眼的检测， 进展，以及测量进展速度的准确性。 本研究有可能通过开发新的客观功能，改变青光眼的临床实践 以及可在下一代临床OCT系统上实际实施的结构测试。这 通过对早期青光眼的准确诊断和对快速进展者的及时干预，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.