Retinal Therapy Guided by 3-D OCT Image Analysis

描述(申请人提供)：年龄相关性黄斑变性(AMD)是美国致盲的主要原因之一。最近有大量有效的新疗法，特别是抗血管内皮生长因子药物，可用于恢复脉络膜新生血管(CNV)的视觉功能，脉络膜新生血管(CNV)是AMD最严重的形式。反复玻璃体内注射会增加发生眼部不良事件的风险。理想情况下，应采用抗血管内皮生长因子注射次数最少的针对患者的给药策略。这项研究将解决黄斑部视网膜内和视网膜下液体、囊肿和视网膜层的哪些患者特有的特性(通过3D光谱域光学相干断层扫描或OCT获得)(I)与个体对抗血管内皮生长因子治疗的反应有关，以及(Ii)可以预测适当的治疗时机和反应。这项研究的主要假设是，基于定量3D OCT测量的CNV初始抗VEGF治疗的视网膜反应模型可以预测退缩的时间。我们确定了以下具体目标：目标1：进一步完善和验证一套全面的分析方法和途径，用于在存在湿性AMD病理(症状性渗出相关错乱或SEAD)的情况下进行3D光谱OCT图像分析，并通过与专家分析的比较来评估其性能。目的2：确定来自视网膜专家的标准2D SpectralisOCT临床读数与3D CirrusOCT的定量SEAD和层衍生测量之间的关联。 目的3：确定3D OCT的SEAD定量和层析测量对CNV患者诱导后抗血管内皮生长因子治疗反应的患者特定结果参数的预测能力，以预测再次治疗的时间。这项工作将在CNV疾病治疗过程中获得的体内光谱域OCT图像中进行。我们将在治疗前、治疗中和一年的随访期内重复对200名脉络膜新生血管患者进行成像。 与公众健康相关：三维光谱OCT成像提供了关于人类视网膜的形态和组织特征的丰富信息。我们建议使用这种新的三维OCT成像设备来研究黄斑视网膜内层的结构和功能关系，并将有关患者特定视网膜成分和结构的信息与年龄相关性黄斑变性的治疗结果联系起来。这项研究对影像引导治疗这种致盲疾病具有潜在的重要意义。

DESCRIPTION (provided by applicant): Age related macular degeneration (AMD) is one of the primary causes of blindness in the U.S. A wealth of powerful new treatments, especially anti-VEGF agents, has recently become available to restore visual function in choroidal neovascularization (CNV), the most severe form of AMD. The risk of ocular adverse events increases with repeated intravitreal treatment injections. Ideally a patient-specific dosing strategy with the minimally necessary number of anti-VEGF injections would be employed. This study will address which patient-specific properties of the intra- and sub-retinal fluid, cysts, and retinal layers of the macula (obtained from 3D spectral domain optical coherence tomography or OCT) (i) are associated with individual response to anti-VGEF treatment, and (ii) can predict proper treatment timing and response. The main hypothesis motivating the proposed research is that a model of retinal response to initial anti-VEGF treatment for CNV, based on quantitative 3D OCT-derived measures, can predict the timing of retreatment.We have identified the following specific aims: Aim 1: Further refine and validate a comprehensive set of analysis methods and approaches for 3D spectral OCT image analysis in the presence of wet AMD pathology (Symptomatic Exudate Associated Derangements or SEADs) and assess its performance by comparison to expert analyses. Aim 2: Determine associations between standard 2D Spectralis OCT clinical readings from retinal specialists and quantitative SEAD- and layer-derived measures from 3D Cirrus OCT. Aim 3: Determine how well the quantitative SEAD- and layer-derived measures from 3D OCT predict the patient-specific outcome parameters in response to post-induction anti-VEGF treatment in patients with CNV, in order to predict the timing of retreatment. The work will be performed prospectively in in-vivo spectral-domain OCT images acquired during the course of CNV disease treatment. We will repeatedly image 200 patients with choroidal neovascularization before and during treatment and during the 1-year follow-up phase. PUBLIC HEALTH RELEVANCE: Three dimensional spectral OCT imaging provides a wealth of information about the morphology and tissue characteristics of human retinal. We propose to study structural and functional relationships of the macular intraretinal layers using this new 3-D OCT imaging device and relate the information about patient-specific retinal composition and structure with treatment outcome in age-related macular degeneration. This study has potentially important consequences for image guided treatment of this blindness-causing disease.