Novel Assessment of Early Changes in Diabetic Retinopathy

糖尿病视网膜病变早期变化的新评估

• 批准号: 7373314
• 负责人: QUAN DONG NGUYEN
• 金额: $ 44.94万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-02-01 至 2011-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7373314
• 关键词: Adult; Age; Blindness; Blood; Blood flow; Calibration; Characteristics; Choroid; Clinical; Clinical Trials; Coupled; Data; Databases; Development; Diabetes Mellitus; Diabetic Retinopathy; Discrimination; Disease; Disease Progression; Disease regression; Early Diagnosis; Early treatment; Edema; Eye; Eye diseases; Fluorescein Angiography; Fundus; Fundus photography; Future; Generations; Goals; Guidelines; Image; Imagery; Individual; Intervention; Invasive; Lasers; Lighting; Location; Maps; Measurement; Measures; Methodology; Methods; Metric; Modality; Monitor; National Eye Institute; Optical Coherence Tomography; Optics; Outcome; Oxygen; Oxygen saturation measurement; Patients; Persons; Population; Prevention; Prevention strategy; Preventive Intervention; Process; Purpose; Range; Recruitment Activity; Relative (related person); Reliance; Research; Research Project Grants; Retina; Retinal; Retinal Diseases; Series; Staging; Standards of Weights and Measures; Structure; System; Techniques; Technology; Testing; Thick; Time; Tissues; United States National Institutes of Health; Vascular Endothelial Growth Factors; Visual Fields; Visual impairment; Work; base; data acquisition; diabetic; functional restoration; macular edema; novel; pre-clinical; prevent; retina blood vessel structure; success; technique development; tool

DESCRIPTION (provided by applicant): Diabetic retinopathy (DR) is a leading cause of visual impairment in the working age population. Treatment for severe retinopathy and macular edema has relied on the presence of clinical signs visible through fundus photography or invasive fluorescein angiography. However, advances are being made in the early treatment that should prevent such proliferative changes or edema from occurring. Implementation of such preventive strategies will require the early detection of the onset of diabetic eye disease, such as changes in retinal blood flow, retinal thickness and volume, and decreases in retinal oxygenation. Current techniques are not able to provide detailed retinal structures, retinal map, or summary of the blood flow or oxygenation within the retina that might trigger such an intervention. In anticipation of the imaging needs required by the treatment advances, this research grant proposes to develop, test, and provide normative data on parameters of retinal tissue structures, blood flow, and oxygenation. Quantitative flow measurements will be made using laser speckle tracking approaches while oxygen saturation will be determined by spectral techniques within the visible and near-infrared range. Retinal oxygenation is established using laser illumination at a series of carefully chosen wavelengths. Each of these illumination wavelengths used for oxygenation also provides a separate flow estimate. Choice of the particular wavelength for flow assessment will provide a degree of discrimination between vasculature in the retina and in the fundus. These retinal maps of flow and oxygenation will be perfectly registered as the same camera is used for each assessment. In addition, the Stratus Optical Coherence Tomography system will be employed to evaluate retinal thickness and volume. The assessment of retinal thickness and volume, blood flow, and oxygenation, as well as standard fundus photography, will be performed in 100 diabetic patients identified from the Wilmer Retina Division: 50 with early signs of DR and 50 without signs of DR. In addition, 150 patients without diabetes will be recruited to provide normative data. Correlations of early changes in the absence of signs of DR, as well as in early signs of DR, will be evaluated. The proposed project will provide clinicians with invaluable tools, using relevant clinical measures of tissue structures, blood flow, and oxygenation, to guide early treatment of DR, with the ultimate goal of halting progression of early signs of the disease and preventing vision loss. Diabetic retinopathy is the leading cause of vision loss in working age adults. New treatment modalities to prevent the onset of eye disease and clinical trial outcomes that monitor these treatments are a high priority for the National Institutes of Health and the National Eye Institute. The proposed project seeks to create and test novel methods of assessing retinal oxygenation and blood flow, coupled with retinal thickness and volume, that can be used to determine the earliest signs of diabetic eye disease. Such methods will be critically important to assessment of preventive interventions and monitoring diabetic eye disease in the future.

描述（由申请人提供）：糖尿病视网膜病变（DR）是工作年龄人群视力障碍的主要原因。严重视网膜病变和黄斑水肿的治疗依赖于通过眼底照相或侵入性荧光素血管造影可见的临床体征的存在。然而，早期治疗正在取得进展，应该可以防止这种增殖性变化或水肿的发生。实施此类预防策略需要及早发现糖尿病眼病的发作，例如视网膜血流、视网膜厚度和体积的变化以及视网膜氧合的减少。目前的技术无法提供详细的视网膜结构、视网膜图或可能触发此类干预的视网膜内血流或氧合的摘要。考虑到治疗进展所需的成像需求，这项研究拨款建议开发、测试并提供有关视网膜组织结构、血流和氧合参数的规范数据。将使用激光散斑跟踪方法进行定量流量测量，而氧饱和度将通过可见光和近红外范围内的光谱技术确定。使用一系列精心选择的波长的激光照射来建立视网膜氧合。用于氧合的每个照明波长还提供单独的流量估计。选择用于血流评估的特定波长将在一定程度上区分视网膜和眼底的脉管系统。由于每次评估都使用同一台相机，这些血流和氧合的视网膜图将被完美记录。此外，Stratus光学相干断层扫描系统将用于评估视网膜厚度和体积。将从 Wilmer 视网膜部门确定的 100 名糖尿病患者中进行视网膜厚度和体积、血流量和氧合的评估以及标准眼底摄影：其中 50 名有早期 DR 迹象，50 名没有 DR 迹象。此外，还将招募150名非糖尿病患者来提供规范数据。将评估无 DR 迹象以及 DR 早期迹象时早期变化的相关性。拟议的项目将为临床医生提供宝贵的工具，利用组织结构、血流和氧合的相关临床测量，指导 DR 的早期治疗，最终目标是阻止疾病早期症状的进展并防止视力丧失。糖尿病视网膜病变是工作年龄成年人视力丧失的主要原因。预防眼病发作的新治疗方式以及监测这些治疗的临床试验结果是美国国立卫生研究院和国家眼科研究所的首要任务。该项目旨在创建和测试评估视网膜氧合和血流以及视网膜厚度和体积的新方法，可用于确定糖尿病眼病的最早迹象。这些方法对于评估未来的预防干预措施和监测糖尿病眼病至关重要。