Ultra-wide field optical coherence tomography based angiography for imaging diabetic retinopathy

项目摘要 美国人口中糖尿病发病率的增加和美国人老龄化的惯性浪潮将 确保糖尿病视网膜病变(DR)仍然是成人患者视力的主要威胁之一， 对于临床社区来说，这是一个重大的管理挑战。现在很清楚，外周视网膜就是这个部位 许多威胁视力的眼病的病理学研究，包括视网膜外周的医生评估， 因此，对疾病表现的筛查、诊断、监测和治疗具有重要意义。 从历史上看，外周视网膜的成像一直是有限的，很难获得；最近在 然而，广域摄影极大地提高了对视网膜前部成像的能力。揭示 外周视网膜血管受累，侵入性成像技术，如荧光素血管造影术(FA) 和吲哚菁绿血管造影术(ICGA)，目前正在使用。这两种技术在传统上都是 用于做出诊断和治疗决策，但它们仅提供二维(2D)图像和 需要有并发症风险的血管内注射。如果能够进行3D操作将是非常有利的 用毛细血管水平分辨率显示周围血管的血流灌注，两者都能显示详细的 微血管网络的功能结构，并允许量化血流灌注状态 视网膜。这些信息将是更好地理解具有外周的视网膜疾病的基础 血管受累，例如DR，导致更知情和更有针对性的治疗决定。 在这个项目中，我们建议开发一种临床适用的3D超宽带光学微血管成像技术。 (UW-OMAG)系统，能够在~180度视野内对神经视网膜进行成像。我们设想这一点 新型、非侵入性和无标记的光学成像方法将量化血管的形态和 允许在3D中评估它们的空间关系，不仅在中央黄斑区，而且在外围 视网膜。同时，视网膜总血流量(RBF)和视网膜血管体积可以定量 评估过了。为了实现这一目标，我们将首先设计和构建一个新颖的、基于SCREPT的UW-OMAG系统 源光学相干层析成像能够以400 kHz的A扫描速率。重点将放在解决挑战上 与创建能够提供成像范围的UW-OMAG视网膜成像系统相关联 &gt；12 mm，具有最小的系统灵敏度滚降特性，因此它能够适应和成像弯曲的 后段，获得了前所未有的成像视场~180o。然后我们将利用这一点 临床适用的原型，以验证其对周围视网膜微血管系统可视化的准确性， 与超宽视野眼底照相和FA进行比较。最后，我们将执行UW-OMAG试验成像 160例正常受试者和糖尿病视网膜病变受试者的研究，以证明这一新的临床可行性和有效性 血管结构和功能的无标记三维超宽视野显微血管成像。这项研究将作为 为下一代OCT血管成像和未来UW-OMAG数据的解释奠定了基础。

Project Summary The increasing incidence of diabetes in the US population and the inertial wave of aging in Americans will ensure that diabetic retinopathy (DR) remains one of the principal threats to the sight of adult patients and a significant management challenge for the clinical community. It is now clear that the peripheral retina is the site of pathology in many vision-threatening eye diseases, including DR. Evaluation of the retinal periphery, therefore, is important for screening, diagnosis, monitoring, and treatment of disease manifestations. Historically, imaging of the peripheral retina has been limited and difficult to obtain; recent advancements in wide-field photography, however, have dramatically improved the ability to image the anterior retina. To reveal vascular involvements in the peripheral retina, invasive imaging techniques, e.g., fluorescein angiography (FA) and indo-cyanine green angiography (ICGA), are currently used. Both techniques have traditionally been utilized to make diagnoses and treatment decisions, but they only provide two-dimensional (2D) images and require intravascular injections that risk complications. It would be highly advantageous to be capable of 3D visualization of peripheral vascular perfusion with capillary-level resolution, both to reveal the detailed functional architecture of the microvascular network and to permit quantification of the perfusion status of the retina. This information would be fundamental to better understanding of retinal diseases that has peripheral vascular involvements, e.g. DR, resulting in more informed and targeted treatment decisions. In this project, we propose to develop a clinically applicable 3D ultra widefield optical microangiography (UW-OMAG) system capable of imaging the neural retina at ~180-degree field of view. We envision that this novel, non-invasive, and label-free optical imaging method will quantify the morphology of blood vessels and permit assessment of their spatial relations in 3D, not only in the central macular region, but in the peripheral retina. Concurrently, total retinal blood flow (RBF) and vascular volumes of the retina can be quantitatively assessed. To achieve this goal, we will first design and construct a novel, UW-OMAG system based on swept source optical coherence tomography capable of 400 kHz A-scan rate. The focus will be on solving challenges associated with creating an UW-OMAG retinal imaging system that is capable of providing an imaging range of >12mm with minimal system sensitivity roll-off characteristics so that it is able to adapt and image the curved posterior segment, and achieving an unprecedented imaging field of view ~180o. We will then utilize this clinically applicable prototype to validate its accuracy for visualizing the peripheral retinal microvasculature, compared to ultra widefield fundus photography and FA. Finally, we will perform UW-OMAG pilot imaging studies in 160 subjects of normal and DR subjects to demonstrate clinical feasibility and usefulness of this new label-free 3D ultra widefield microangiography of vascular structure and function. This study will serve as the foundation for next generation of OCT angiography and for interpretation of UW-OMAG data in future.