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

项目摘要/摘要 视网膜脱离可导致严重的视力丧失，通常始于视网膜上的小裂口 周边视网膜(从眼球赤道到锯齿缘)。这些裂隙允许液体进入视网膜下 空间，脱离视网膜，导致视网膜缺血和功能障碍。激光光凝(LP) 治疗可以在临床上使用，将后续脱离的风险降低10倍(50%到5%)，但只有在以下情况下 早在视网膜下积聚过多的液体之前就能检测到破损。长期目标是 开发一种系统，提供360度的外周视网膜可视化，取代目前的护理标准 评估视网膜周边是否有裂孔：间接检眼镜检查合并巩膜压低的一种方法 要求检查人员在多个位置机械地缩进眼睛，并使用间接检眼镜 以及聚光透镜，试图在周边和360度以上显示视网膜。这个项目的基本原理是 除了让病人感到极度不适外，这项技术还需要相当高的技巧 受过专门训练。此外，考试不会直接记录调查结果--主考人 必须说明来自记忆的指南地图，以便后续使用相同的手动技术进行LP治疗。 这些目标将通过追求两个具体目标来实现：1)采用定制的锥面镜隐形眼镜 以及机器人对准平台，用于通过OCT和激光光凝光学访问外围视网膜 治疗；以及2)验证周边视网膜机器人对齐OCT与巩膜压抑检查 而且没有需要治疗的周围性视网膜裂孔。在第一个目标下，圆锥镜隐形眼镜和 机器人对准平台将被重新设计，将OCT和LP治疗光传送到外围视网膜。 将验证该系统的视野和分辨率，并评估其提供LP治疗的能力 在活体猪眼中，通过实时OCT图像引导，在整个周边视网膜产生裂隙。 在第二个目标下，机器人对准OCT成像系统将在体内使用。首先，一项试点研究将 在健康受试者身上执行，以优化机器人与操作员的交互。完成后，一项由动力驱动的研究 将检验零假设，即在每一次中断次数的配对差异之间没有差异 周围性视网膜RAOCT检查与临床对照研究 骨折需要治疗。申请人认为，拟议的研究在技术上具有创新性， 因为它直接解决了通过使用 专为OCT和LP治疗而设计的定制圆锥镜接触器，结合3D跟踪和 补偿。申请人认为，拟议的研究在临床上进一步具有创新性，因为它 提供第一个360度全面的周边视网膜评估。这是一条直接提供真正的- 时间影像引导下全视网膜周边的LP治疗。

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.