Novel ultrahigh speed swept source OCT angiography methods in diabetic retinopathy

糖尿病视网膜病变的新型超高速扫源 OCT 血管造影方法

• 批准号: 10656644
• 负责人: JAMES G FUJIMOTO
• 金额: $ 50.07万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656644
• 关键词: 3-Dimensional; Acceleration; Address; Age; Aging; Angiography; Area; Artificial Intelligence; Assessment tool; Background Diabetic Retinopathy; Biological Markers; Blindness; Blood Vessels; Blood capillaries; Blood flow; Clinical; Clinical Management; Clinical Trials; Complications of Diabetes Mellitus; Computer software; Cross-Sectional Studies; Data; Data Set; Detection; Diabetic Retinopathy; Disease; Disease Progression; Early Diagnosis; Extravasation; Eye; Generations; Goals; Image; Individual; Intervention; Ischemia; Lasers; Location; Measures; Mediating; Medical; Methods; Microaneurysm; Monitor; Motion; Noise; Optical Coherence Tomography; Outcome; Papillary; Pathogenesis; Patients; Performance; Peripheral; Prediction of Response to Therapy; Protocols documentation; Research; Resolution; Retina; Retinal Diseases; Risk; Role; Sampling; Scanning; Severities; Severity of illness; Signal Transduction; Source; Speed; Structure; Surface; Surrogate Markers; Techniques; Technology; Thrombosis; Time; Vascular Endothelial Growth Factors; Vascular Permeabilities; Vision; Visit; Visualization; age group; aging population; biomarker identification; cohort; deep learning; diabetes management; diabetic; diabetic patient; disease mechanisms study; drug development; glycemic control; high risk; image processing; imaging biomarker; imaging modality; improved; inhibitor therapy; innovation; macula; macular edema; multidisciplinary; neovascular; neovascularization; next generation; novel; predicting response; predictive marker; preservation; prevent; programs; proliferative diabetic retinopathy; response; risk prediction; tool; treatment response; vascular abnormality; vessel regression

Diabetic retinopathy (DR) is a leading cause of blindness in working age populations. Glycemic control remains the best strategy for preventing or slowing disease progression. However, early detection of vision threatening retinal changes and prompt treatment is necessary for preserving visual function in more advanced stages. Clinical management of DR also requires objective tools for assessing retinal structure and microvascular abnormalities, as well as methods to evaluate treatment response. The goal of this multidisciplinary program is to develop novel optical coherence tomography (OCT) imaging methods and biomarkers that can identify and characterize retinal microvasculature and blood flow alterations in DR, which can be used for early disease detection, predicting progression, monitoring treatment response, and improving clinical trial efficiency. We will develop next generation OCT angiography (OCTA) technology and analysis frameworks (Aim 1). This hardware- software innovation will develop ultrahigh speed swept-source OCT (SS-OCT) to enable increased dynamic range OCTA characterization of retinal blood flow, higher definition volumetric data to visualize vasculature at the capillary level, and enable wide field structural and vascular imaging. These advances will develop a quantitative surrogate marker for capillary level blood flow speeds in retinal microvasculature. The ability to assess blood flow speeds at the capillary level represents a paradigm shift in OCTA imaging, enabling detection of subtle vascular flow alterations that occur at earlier disease stages, which are related to pathogenesis of diabetic macular edema (DME), capillary non-perfusion and neovascularization. New software motion correction technology can correct volumetric OCT/OCTA data for eye motion in three dimensions and artificial intelligence / deep learning techniques can generate reliable layer segmentations for OCTA, to facilitate tracking longitudinal changes across multiple patient visits. Using ultrahigh speed SS-OCT and OCTA blood flow biomarkers, we will perform a cross-sectional study in a cohort of diabetic patients and age-matched healthy controls (Aim 2). The study will evaluate repeatability of OCTA-driven VISTA flow markers, investigate if OCTA blood flow biomarkers are correlated with DR severity, and if they are associated with DME, capillary non-perfusion or neovascularization. Finally, we will monitor DR eyes longitudinally to investigate the role of subtle blood flow alterations in disease progression and predicting treatment response (Aim 3). The hypothesis is that OCTA blood flow biomarkers can identify regions with abnormal blood flow, which are at increased risk of thrombosis and leakage, and hence DME, as well as regions that are ischemic, and at increased risk of neovascularization. Similarly, we will also investigate if OCTA blood flow biomarkers can be used to predict response to anti-VEGF (vascular endothelial growth factor) therapy, including DME resolution, neovascular regression, and/or treatment durability. If successful, this program has the potential to improve clinical DR management and help DR patients to achieve better vision outcomes.

糖尿病视网膜病变（DR）是导致工作年龄人群失明的主要原因。血糖控制仍然有效