Diagnosis and Monitoring of Glaucoma with Optical Coherence Tomography Angiography

项目摘要 光学相干断层扫描血管造影术（OCTA）最近已被引入作为一种非- 一种侵入性的三维成像方法，用于可视化和量化整个微血管系统 视网膜。拟议的研究评价了OCTA测量的临床实用性， 视神经乳头（ONH）、视网膜神经纤维层（RNFL）的标准结构测量 使用当前的临床成像标准，光谱域光学相干性 断层扫描（SDOCT）。我们和其他人的研究表明， ONH区域和黄斑中的密度（由血管组成的测量面积的比例）是 原发性开角型青光眼（POAG）眼的密度低于健康眼。此外，诊断 准确性随着疾病严重程度的增加而提高。我们实验室的研究表明， 血管密度的诊断准确性与SDOCT测量的RNFL厚度相似， 在与局部视野（VF）缺陷相关的视网膜区域中血管密度降低。这些 横截面结果强烈表明，OCTA测量反映了相关组织的损伤， POAG的病理生理学此外，在一项纵向研究中， POAG眼睛中的黄斑血管密度明显快于青光眼可疑眼睛或健康眼睛。 目前的研究为延长长达8年的纵向OCTA数据提供了独特的机会 2年内收集了250只眼睛的血管密度，并研究血管密度变化 随着时间的推移，在青光眼怀疑和POAG的眼睛，以及比较它与其他成像方式 和青光眼相关的视野改变。本研究的目的是：（1）评估纵向 青光眼中视网膜表面血管密度丧失与青光眼发生时间和局部解剖学关系， RNFL厚度损失、神经视网膜边缘宽度损失和神经节细胞复合体（GCC）损失 怀疑青光眼和不同疾病严重程度的青光眼眼睛中的厚度，和2）评估 黄斑表浅缺损与ONH的纵向、时间和地形关系 视网膜血管密度、RNFL厚度损失、神经视网膜边缘宽度损失和GCC厚度损失 与青光眼中中央和外周VF缺陷的发展和进展有关。比较 血管密度变化相对于RNFL厚度变化的时间过程，神经视网膜 边缘宽度、神经节细胞层厚度和视觉功能将提供关于 青光眼的病理生理学，可以提高早期检测和准确监测先进的 与目前可用和广泛接受的方法相比，增强诊断和 检测到疾病进展应导致更早和更有效的治疗，从而降低 疾病恶化和预防视力相关生活质量的丧失（包括失明）。

Project Summary Optical coherence tomography angiography (OCTA) has been introduced recently as a non- invasive, 3-dimensional imaging method to visualize and quantify microvasculature throughout the retina. The proposed study evaluates the clinical utility of OCTA measurements compared to standard structural measurements of the optic nerve head (ONH), retinal nerve fiber layer (RNFL) and macula measured using the current clinical imaging standard, spectral domain optical coherence tomography (SDOCT). Our research, and that of others, has shown that superficial retinal vessel density (proportion of measured area composed of blood vessels) in the ONH region and macula is less dense in primary open angle glaucoma (POAG) eyes than in healthy eyes. Moreover, diagnostic accuracy is improved with increasing disease severity. Research from our laboratory suggests that the diagnostic accuracy of vessel density is similar to that of SDOCT-measured RNFL thickness, and that vessel density is reduced in retinal regions associated with localized visual field (VF) defects. These cross-sectional results strongly suggest that OCTA measurements reflect damage to tissues relevant to the pathophysiology of POAG. In a longitudinal study, moreover, the mean rate of change in macula vessel density is significantly faster in POAG eyes than in glaucoma suspect or healthy eyes. The current study provides a unique opportunity to extend for up to 8 years longitudinal OCTA data that has already been collected from 250 eyes over 2 years, and to investigate vessel density change over time in glaucoma suspect and POAG eyes, as well as to compare it to other imaging modalities and glaucoma-related visual field change. The aims of the study are 1) to assess the longitudinal temporal and topographic relationship in glaucoma between loss of superficial retinal vessel density, loss of RNFL thickness, loss of neuroretinal rim width, and loss of ganglion cell complex (GCC) thickness in glaucoma suspect and glaucoma eyes of varying disease severity, and 2) to assess the longitudinal temporal and topographic relationship between superficial loss of macula and ONH retinal vessel density, loss of RNFL thickness , loss of neuroretinal rim width, and loss GCC thickness with the development and progression of central and peripheral VF defects in glaucoma. Comparison of the time course of changes in vessel density relative to changes in RNFL thickness, neuroretinal rim width, ganglion cell layer thickness and visual function will provide information about the pathophysiology of glaucoma that can improve early detection and accurate monitoring of advanced disease compared to currently available and widely accepted methods. Enhanced diagnosis and detection of progression should lead to earlier and more effective treatment, thus reducing the rate of disease worsening and preventing loss of vision-related quality of life (including blindness).