Novel ultrahigh speed swept source OCT angiography methods in diabetic retinopathy

糖尿病视网膜病变的新型超高速扫源 OCT 血管造影方法

• 批准号: 10656644
• 负责人: JAMES G FUJIMOTO
• 金额: $ 50.07万
• 依托单位: MASSACHUSETTS INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10656644
• 关键词: 3-Dimensional; Acceleration; Address; Age; Aging; Angiography; Area; Artificial Intelligence; Assessment tool; Background Diabetic Retinopathy; Biological Markers; Blindness; Blood Vessels; Blood capillaries; Blood flow; Clinical; Clinical Management; Clinical Trials; Complications of Diabetes Mellitus; Computer software; Cross-Sectional Studies; Data; Data Set; Detection; Diabetic Retinopathy; Disease; Disease Progression; Early Diagnosis; Extravasation; Eye; Generations; Goals; Image; Individual; Intervention; Ischemia; Lasers; Location; Measures; Mediating; Medical; Methods; Microaneurysm; Monitor; Motion; Noise; Optical Coherence Tomography; Outcome; Papillary; Pathogenesis; Patients; Performance; Peripheral; Prediction of Response to Therapy; Protocols documentation; Research; Resolution; Retina; Retinal Diseases; Risk; Role; Sampling; Scanning; Severities; Severity of illness; Signal Transduction; Source; Speed; Structure; Surface; Surrogate Markers; Techniques; Technology; Thrombosis; Time; Vascular Endothelial Growth Factors; Vascular Permeabilities; Vision; Visit; Visualization; age group; aging population; biomarker identification; cohort; deep learning; diabetes management; diabetic; diabetic patient; disease mechanisms study; drug development; glycemic control; high risk; image processing; imaging biomarker; imaging modality; improved; inhibitor therapy; innovation; macula; macular edema; multidisciplinary; neovascular; neovascularization; next generation; novel; predicting response; predictive marker; preservation; prevent; programs; proliferative diabetic retinopathy; response; risk prediction; tool; treatment response; vascular abnormality; vessel regression

Diabetic retinopathy (DR) is a leading cause of blindness in working age populations. Glycemic control remains the best strategy for preventing or slowing disease progression. However, early detection of vision threatening retinal changes and prompt treatment is necessary for preserving visual function in more advanced stages. Clinical management of DR also requires objective tools for assessing retinal structure and microvascular abnormalities, as well as methods to evaluate treatment response. The goal of this multidisciplinary program is to develop novel optical coherence tomography (OCT) imaging methods and biomarkers that can identify and characterize retinal microvasculature and blood flow alterations in DR, which can be used for early disease detection, predicting progression, monitoring treatment response, and improving clinical trial efficiency. We will develop next generation OCT angiography (OCTA) technology and analysis frameworks (Aim 1). This hardware- software innovation will develop ultrahigh speed swept-source OCT (SS-OCT) to enable increased dynamic range OCTA characterization of retinal blood flow, higher definition volumetric data to visualize vasculature at the capillary level, and enable wide field structural and vascular imaging. These advances will develop a quantitative surrogate marker for capillary level blood flow speeds in retinal microvasculature. The ability to assess blood flow speeds at the capillary level represents a paradigm shift in OCTA imaging, enabling detection of subtle vascular flow alterations that occur at earlier disease stages, which are related to pathogenesis of diabetic macular edema (DME), capillary non-perfusion and neovascularization. New software motion correction technology can correct volumetric OCT/OCTA data for eye motion in three dimensions and artificial intelligence / deep learning techniques can generate reliable layer segmentations for OCTA, to facilitate tracking longitudinal changes across multiple patient visits. Using ultrahigh speed SS-OCT and OCTA blood flow biomarkers, we will perform a cross-sectional study in a cohort of diabetic patients and age-matched healthy controls (Aim 2). The study will evaluate repeatability of OCTA-driven VISTA flow markers, investigate if OCTA blood flow biomarkers are correlated with DR severity, and if they are associated with DME, capillary non-perfusion or neovascularization. Finally, we will monitor DR eyes longitudinally to investigate the role of subtle blood flow alterations in disease progression and predicting treatment response (Aim 3). The hypothesis is that OCTA blood flow biomarkers can identify regions with abnormal blood flow, which are at increased risk of thrombosis and leakage, and hence DME, as well as regions that are ischemic, and at increased risk of neovascularization. Similarly, we will also investigate if OCTA blood flow biomarkers can be used to predict response to anti-VEGF (vascular endothelial growth factor) therapy, including DME resolution, neovascular regression, and/or treatment durability. If successful, this program has the potential to improve clinical DR management and help DR patients to achieve better vision outcomes.

糖尿病性视网膜病（DR）是工作年龄人群失明的主要原因。血糖控制仍然存在 预防或放缓疾病进展的最佳策略。但是，早期发现视力威胁 在更高级的阶段保持视觉功能是必要的视网膜变化和及时处理。 DR的临床管理还需要评估视网膜结构和微血管的客观工具 异常以及评估治疗反应的方法。这个多学科计划的目标是 开发可以识别和 特征是视网膜微举行和DR中的血流改变，可用于早期疾病 检测，预测进展，监测治疗反应以及提高临床试验效率。我们将 开发下一代OCT血管造影（OCTA）技术和分析框架（AIM 1）。这个硬件 - 软件创新将开发超高速度扫描源OCT（SS-OCT），以使动态增加 视网膜血流的范围八八体表征，更高清晰度的体积数据可视化脉管系统 毛细管水平，并实现广阔的田间结构和血管成像。这些进步将发展 视网膜微脉管系统中毛细血管水平流速的定量替代标记。能力 评估毛细管水平上的血流速度代表八八片成像的范式转移，使检测能够检测 在早期疾病阶段发生的细微血管流动改变，这与 糖尿病性黄斑水肿（DME），毛细血管非灌注和新血管形成。新软件运动校正 技术可以在三个维度和人工智能上校正大量的OCT/OCTA数据，以进行眼部运动 /深度学习技术可以生成可靠的层分段，以促进跟踪纵向 多次访问的变化。使用Ultrahigh Speed SS-OCT和Octa血流生物标志物，我们将 在糖尿病患者和年龄匹配的健康对照组中进行横断面研究（AIM 2）。这 研究将评估八八驱动的远景流量标记的可重复性，研究八角血流生物标志物是否 与DR的严重程度相关，如果与DME相关 新血管形成。最后，我们将纵向监测眼睛，以研究微妙的血液的作用 疾病进展和预测治疗反应的改变（AIM 3）。假设是八达血 流动生物标志物可以识别血流异常的区域，血栓形成的风险增加，并且 泄漏，因此DME以及缺血性的区域，并具有新生血管形成的风险。 同样，我们还将调查八八血流生物标志物是否可以用于预测对抗VEGF的反应 （血管内皮生长因子）治疗，包括DME分辨率，新血管回归和/或治疗 耐用性。如果成功，该计划有可能改善临床博士管理并帮助DR患者 取得更好的视力结果。