Retinal Therapy Guided by 3-D OCT Image Analysis

摘要： 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，可以恢复脉络膜新生血管(CNV)的视觉功能，脉络膜新生血管是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 研究将解决黄斑部视网膜内和视网膜下液体、囊泡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。 激励这项研究的主要假设是，基于定量3D OCT衍生测量的视网膜对初始抗血管内皮生长因子治疗CNV的反应模型可以预测再次治疗的时间。 我们确定了以下具体目标： 目标1：进一步提炼和验证一套全面的3D分析方法和途径 湿性AMD病变(症状性渗出液)的OCT光谱图像分析 关联错位或SEAD)，并通过与专家进行比较来评估其性能 分析。 目的2：确定来自视网膜的标准2D光谱OCT临床读数之间的关联 专家和来自3D Cirrus OCT的定量SEAD和层派生测量。 目标3：确定来自3DOCT的定量SEAD和层衍生测量的预测效果如何 诱导后抗血管内皮生长因子治疗对患者特定预后参数的影响 CNV患者，以预测再次治疗的时间。 这项工作将在体内光谱域OCT图像中前瞻性地执行 CNV病的治疗疗程。我们将反复对200名脉络膜患者进行成像 治疗前、治疗中和1年随访期间的新生血管形成。

Abstract: 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, have 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.