Point-of-care ophthalmic diagnostic imaging of retinopathy of prematurity

早产儿视网膜病变的护理点眼科诊断成像

• 批准号: 10587600
• 负责人: Ipek Oguz
• 金额: $ 58.3万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10587600
• 关键词: 3-Dimensional; Adult; Affect; Algorithms; Angiography; Area; Blindness; Blood Vessels; Childhood; Clinical; Clinical Research; Computer software; Coupled; Custom; Data; Data Set; Development; Devices; Diagnosis; Diagnostic; Diagnostic Imaging; Dilatation - action; Ensure; Eye; Eye diseases; Fluorescein; Image; Image Analysis; Image Enhancement; Incidence; Infant; Intervention; Manuals; Measures; Morphologic artifacts; Motion; Operative Surgical Procedures; Ophthalmology; Ophthalmoscopy; Optical Coherence Tomography; Optics; Outcome; Patients; Performance; Peripheral; Premature Infant; Protocols documentation; Quality Control; Reproducibility; Research; Resolution; Retina; Retinal Detachment; Retinopathy of Prematurity; Sampling; Signal Transduction; Source; Speed; Staging; System; Technology; Time; Translating; Translations; Vascular Diseases; Vascularization; Vertebral column; Vision; Visual; Visualization; Weight; analysis pipeline; anterior chamber; awake; clinical diagnostics; clinical examination; clinically relevant; design; detection limit; detection sensitivity; diagnostic biomarker; ergonomics; feature extraction; image processing; image registration; imaging platform; imaging system; improved; in vivo imaging; insight; interest; kinematics; multimodality; neovascularization; novel; pharmacologic; point of care; prognostic; programs; prototype; quantitative imaging; retinal imaging; sample fixation; serial imaging; standard of care; structural imaging; tomography; tractography; vascular abnormality

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease that affects preterm infants and a major cause of childhood blindness. ROP is diagnosed and staged under indirect ophthalmoscopy at the junction between the vascularized and avascular retina (i.e., periphery) using features such as retinal detachment (RD) and increased vascular dilatation and tortuosity. While surgical and pharmacologic therapies exist, poor structural and visual outcomes (<20/200 vision or blindness) occur in >50% of severe cases because RD, schisis, and vascular abnormalities are often missed on clinical examination. Conventional ophthalmoscopic examination in infants is performed using fundoscopy. However, retinal microvasculature is poorly visualized even when combined with exogenous fluorescein contrast. Optical coherence tomography (OCT) is currently the gold- standard for ophthalmic diagnostic imaging in adults and developments in OCT angiography (OCT-A) have enabled in vivo imaging of retinal vasculature without the need for exogenous contrast. While several research groups have developed handheld OCT/OCTA imaging systems and demonstrated imaging in ROP patients, longitudinal quantitative imaging of retinal vasculature to track ROP progression remains limited by several key challenges: 1) infants cannot fixate, making repeated imaging of regions-of-interest (ROIs) impossible; 2) handheld imaging coupled with infant motion results in significant artifacts and poor OCTA contrast; 3) OCT/OCTA quality is severely degraded by vitreous/anterior chamber haze, which is common in ROP; 4) peripheral retinal vascular changes are important for ROP staging but aiming of OCT/OCTA at these ROIs is difficult; 5) vascular volumes provide clinically relevant features such as dilatation and tortuosity, but OCTA is conventionally assessed using only en face projections. To overcome these limitations, we have developed a combination of hardware and image-processing technologies for handheld OCT/OCTA built around a multimodal spectrally encoded coherence tomography and reflectometry (SECTR) ophthalmic imaging platform. SECTR simultaneously acquires orthogonal en face reflectance and cross-sectional OCT images that uniquely benefits volumetric registration for motion-correction and multi-volumetric mosaicking. We hypothesize that the translation of these technologies into a point-of-care ophthalmic imaging system will allow for robust, reproducible, and quantitative longitudinal tracking of retinal vascular changes, which will improve the diagnostic and staging accuracy of ROP in preterm infants. We aim to develop custom hardware (AIM 1) and image analysis pipelines (AIM 2) optimized for handheld SECTR imaging in infant eyes. These technologies will be validated in longitudinal imaging of structural and functional changes in ROP (AIM 3) and provide quantitative insight on the viability of SECTR imaging to benefit treatment decisions. The proposed device and quantitative analysis pipeline are not limited to ROP cases and can be broadly applied in any area of ophthalmology where a robust point-of- care OCT/OCTA may improve current clinical standard-of-care.

早产儿视网膜病变 (ROP) 是一种影响早产儿的增殖性视网膜血管疾病， 儿童失明的主要原因。 ROP 在交界处通过间接检眼镜进行诊断和分期 使用视网膜脱离 (RD) 等特征在有血管和无血管视网膜（即周边）之间进行区分 并增加血管扩张和弯曲度。虽然存在手术和药物治疗，但效果不佳 超过 50% 的严重病例会出现结构和视觉结果（<20/200 视力或失明），因为 RD、分裂、 临床检查时经常会漏掉血管异常。常规检眼镜检查 婴儿的检查是使用眼底镜检查进行的。然而，即使在 结合外源性荧光素对比。光学相干断层扫描（OCT）是目前的黄金技术 成人眼科诊断成像标准和 OCT 血管造影 (OCT-A) 的发展 无需外源对比即可实现视网膜脉管系统的体内成像。虽然多项研究 研究小组开发了手持式 OCT/OCTA 成像系统，并在 ROP 患者中展示了成像效果， 视网膜脉管系统纵向定量成像追踪 ROP 进展仍然受到几个关键因素的限制 挑战：1）婴儿无法注视，无法对感兴趣区域（ROI）进行重复成像； 2） 手持成像与婴儿运动相结合会导致明显的伪影和较差的 OCTA 对比度； 3） OCT/OCTA 质量因玻璃体/前房混浊严重降低，这在 ROP 中很常见； 4） 周边视网膜血管变化对于 ROP 分期很重要，但 OCT/OCTA 的目标是这些 ROI 难的; 5) 血管体积提供临床相关特征，例如扩张和扭曲度，但 OCTA 是 传统上仅使用正面投影进行评估。为了克服这些限制，我们开发了 围绕多模态构建的手持式 OCT/OCTA 的硬件和图像处理技术的组合 光谱编码相干断层扫描和反射测量 (SECTR) 眼科成像平台。 SECTR 同时获取正交正面反射率和横截面 OCT 图像，这具有独特的优势 用于运动校正和多体积镶嵌的体积配准。我们假设 将这些技术转化为即时眼科成像系统将能够实现稳健、 可重复、定量地纵向追踪视网膜血管变化，这将改善诊断 以及早产儿 ROP 分期的准确性。我们的目标是开发定制硬件 (AIM 1) 和图像分析 针对婴儿眼部手持式 SECTR 成像进行优化的管道 (AIM 2)。这些技术将在 ROP (AIM 3) 结构和功能变化的纵向成像，并提供有关 SECTR 成像的可行性有利于治疗决策。所提出的装置和定量分析管道 不限于 ROP 病例，可以广泛应用于眼科的任何领域，只要有一个强大的点 护理 OCT/OCTA 可以改善当前的临床护理标准。