Assistive Robotically Aligning Optical Coherence Tomography and Laser Photocoagulation Therapy of the Retinal Periphery

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PROJECT SUMMARY/ABSTRACT Retinal detachments can cause significant vision loss and frequently begin as small breaks in the peripheral retina (from ocular globe equator to the ora serrata). These breaks allow fluid to enter the sub-retinal space, detaching the retina and leading to retinal ischemia and dysfunction. Laser photocoagulation (LP) therapy can be utilized in the clinic reducing the risk of subsequent detachment tenfold (50% to 5%) but only if breaks are detected early and before excess fluid has accumulated under the retina. The long-term goal is to develop a system that provides 360° visualization of the peripheral retina replacing the current standard of care for evaluation of the retinal periphery for breaks: indirect ophthalmoscopy with scleral depression, a procedure requiring the examiner to mechanically indent the eye at multiple locations and use an indirect ophthalmoscope and condensing lens to attempt to visualize the retina peripherally and over 360°. The rationale for this project is that in addition to being extremely uncomfortable for the patient, this technique requires considerable skill with specialized training. Furthermore, the exam does not create a direct record of the findings – the examiner must illustrate a guide map from memory for subsequent LP therapy utilizing this same manual technique. These objectives will be achieved by pursuing two specific aims: 1) Adapt a custom conical mirror contact lens and robotically aligning platform to optically access the peripheral retina with OCT and laser photocoagulation therapy; and 2) Validate peripheral retina robotically aligning OCT against scleral depressed exam in eyes with and without peripheral retinal breaks requiring treatment. Under the first aim the conical mirror contact lens and robotically aligning platform will be redesigned to deliver both OCT and LP therapy light to the peripheral retina. The system will be validated for field-of-view and resolution and evaluated for the ability to deliver LP therapy in ex vivo porcine eyes to created breaks throughout the peripheral retinal with real-time OCT image guidance. Under the second aim, the robotically aligning OCT imaging system will be used in vivo. First a pilot study will be performed on healthy subjects optimizing for robot-operator interactions. Upon completion, a powered study will test the null hypothesis that there is no difference between paired differences in the number of breaks per eye as observed by peripheral retina RAOCT versus clinical exam in eyes with and without peripheral retinal breaks requiring treatment. The proposed research is technically innovative, in the applicant’s opinion, because it directly addresses optical issues for accessing and aligning to the retinal periphery by using a custom conical mirror contact designed for use with OCT and LP therapy coupled with 3D tracking and compensation. The proposed research is further clinically innovative, in the applicant’s opinion, because it provides the first 360° comprehensive assessment of the peripheral retina. This is a direct path to provide real- time image guided LP therapy to the full retinal periphery.