Retinal Therapy Guided by 3-D OCT Image Analysis

描述（由申请人提供）：年龄相关性黄斑变性（AMD）是美国失明的主要原因之一。最近，大量强有力的新疗法，特别是抗vegf药物，可用于恢复脉络膜新生血管（CNV）的视觉功能，这是AMD最严重的形式。眼部不良事件的风险随着反复的玻璃体内治疗注射而增加。理想情况下，采用针对患者的给药策略，将抗vegf注射的数量降到最低。本研究将探讨视网膜内液和视网膜下液、囊肿和黄斑视网膜层的患者特异性特性（通过3D光谱域光学相干断层扫描或OCT获得）(i)与抗vgef治疗的个体反应相关，（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3D oct衍生的定量测量，视网膜对初始抗vegf治疗CNV的反应模型可以预测再治疗的时间。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方法，用于湿性AMD病理（症状性渗出相关紊乱或SEADs）存在的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。目标2：确定来自视网膜专家的标准2D Spectralis OCT临床读数与来自3D Cirrus OCT的定量SEAD和层衍生测量之间的关联。

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.