Analyzing retinal microanatomy in retinopathy of prematurity to improve care

 描述（由申请方提供）：早产儿视网膜病变（ROP）是一种神经视网膜及其血管系统发育障碍，可能会影响脆弱早产儿的视力。对ROP婴儿的临床护理可以降低失明的可能性，但视力异常很常见，特别是那些疾病严重到需要治疗的婴儿。由于无法区分影响特定视网膜细胞和/或中枢神经系统（CNS）的疾病和/或发育不良是否导致视力丧失，尤其是当其不太严重时，因此没有预防大多数治疗ROP的婴儿中低于正常的敏锐度的策略。 早产儿出生的时间间隔 在重症监护室（ICN）中度过的ROP风险是视网膜快速发育的时间。临床医生和研究人员不知道局部、中枢神经系统和全身的发育和疾病过程如何反映在视网膜显微解剖结构中。婴儿期视网膜的异常可能是后期视力问题和发育迟缓的早期预测因素。通过对早产儿视网膜亚结构、脑解剖、连通性和功能网络以及神经炎症生物标志物的研究，本研究将阐明局部视网膜解剖变化影响的途径，并可能预测后期视力和CNS功能低于正常。这项研究的结果将使我们能够：区分眼睛和非眼睛对视力丧失的贡献，指导未来的治疗，以改变视网膜异常，如水肿;并确定哪些微解剖视网膜生物标志物最适合监测ROP的影响，以及全身治疗对眼睛和大脑的影响。与间接检眼镜检查或摄影相比，床边的新型非接触式眼部成像将能够在多个托儿所中对ROP和神经发育进行直接远程医疗筛查。 我们的长期目标是通过客观的床边成像和分析来帮助改善早产儿的健康护理，这些成像和分析表征了视力不良、神经发育和ROP的早期关键指标。这将迅速转化为早期干预和改善未来的视力保健。这项研究的具体目标有三个方面：实施技术创新，以改善ICN中非镇静婴儿的光学相干断层扫描（OCT）成像;区分视网膜显微解剖学的要素，这些要素预测视觉通路发育不良和可能影响早产儿视力的神经发育不良;并描绘出哪些元素和区域（后部和外周）早产儿OCT-衍生的视网膜显微解剖最能告诉我们ROP婴儿的疾病严重程度和视力结果。 除了为极早产儿（VPT）婴儿后部和外周视网膜的床边分析提供突破性方法外，本研究还将为儿科眼科和远程医疗界提供区分预测婴儿视力异常、视觉通路损伤、功能发育不良和ROP进展（及其组合）风险的微解剖标志物的方法。这些生物标志物将可用于确定眼科和CNS治疗干预，并监测其对视觉通路的影响，因此可能与其他婴儿眼部和脑部疾病相关。

 DESCRIPTION (provided by applicant): Retinopathy of prematurity (ROP) is a disorder of development of the neural retina and its vasculature that may impact vision in vulnerable preterm neonates for a lifetime. Clinical care of infants with ROP decreases the likelihood of blindness, but abnormal vision is common, especially in those with disease severe enough to require treatment. Because it has not been possible to distinguish whether disease and/or maldevelopment that affects specific retinal cells and/or the central nervous system (CNS) cause the vision loss, especially when it is less severe, there has been no strategy to prevent subnormal acuity in the majority of infants treated for ROP. The interval that a preterm infant at risk for ROP spends in an intensive care nursery (ICN) is a time of rapid retinal development. Clinicians and researchers do not know how local, CNS and systemic development and disease processes are reflected in the retinal microanatomy. Abnormalities in the retina during infancy are likely early predictors of later vision problems and developmental delay. From study of preterm retinal substructures, brain anatomy, connectivity and functional networks and neuroinflammatory biomarkers this study will elucidate the pathway by which local retinal anatomic changes impact and may predict later subnormal vision and CNS function. The results of this research will enable us to: distinguish ocular from non-ocular contributions to vision loss guide future treatment directed to modify retinal anomalies such as edema; and determine which microanatomic retinal biomarkers are best to monitor effects of ROP, and effects of systemic therapies on the eye and brain. In contrast to indirect ophthalmoscopy or photography, novel non-contact ocular imaging at the bedside would enable direct telemedicine screening for ROP and for neural development in multiple nurseries. Our long-term goal is to help improve preterm infant health care via objective bedside imaging and analysis that characterizes early critical indicators of poor vision, neurological development and ROP. This will rapidly translate t early intervention and improved future vision care. Specific goals of this research are threefold: to implement technological innovations to improve optical coherence tomography (OCT) imaging in non-sedated infants in the ICN; to distinguish elements of retinal microanatomy which predict maldevelopment of visual pathway and poor neurodevelopment that may impact vision in preterm infants; and to delineate which elements and regions (posterior and peripheral) of preterm infant OCT-derived retinal microanatomy best inform us about severity of disease and visual outcomes in infants with ROP. In addition to providing a breakthrough method for bedside analysis of the very preterm (VPT) infant posterior and peripheral retina, this study will provide the pediatric ophthalmologic and telemedicine community with methods to distinguish microanatomic markers that predict infants at risk for abnormal vision, visual pathway injury, poor functional development and progression of ROP (and combinations thereof). These biomarkers will be useful for determining ophthalmic and CNS therapeutic interventions and monitoring their impact on the visual pathway and will thus likely cross over with relevance to other infant eye and brain disease.