Point-of-care ophthalmic diagnostic imaging of retinopathy of prematurity

早产儿视网膜病变的护理点眼科诊断成像

• 批准号: 10587600
• 负责人: Ipek Oguz
• 金额: $ 58.3万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10587600
• 关键词: 3-Dimensional; Adult; Affect; Algorithms; Angiography; Area; Blindness; Blood Vessels; Childhood; Clinical; Clinical Research; Computer software; Coupled; Custom; Data; Data Set; Development; Devices; Diagnosis; Diagnostic; Diagnostic Imaging; Dilatation - action; Ensure; Eye; Eye diseases; Fluorescein; Image; Image Analysis; Image Enhancement; Incidence; Infant; Intervention; Manuals; Measures; Morphologic artifacts; Motion; Operative Surgical Procedures; Ophthalmology; Ophthalmoscopy; Optical Coherence Tomography; Optics; Outcome; Patients; Performance; Peripheral; Premature Infant; Protocols documentation; Quality Control; Reproducibility; Research; Resolution; Retina; Retinal Detachment; Retinopathy of Prematurity; Sampling; Signal Transduction; Source; Speed; Staging; System; Technology; Time; Translating; Translations; Vascular Diseases; Vascularization; Vertebral column; Vision; Visual; Visualization; Weight; analysis pipeline; anterior chamber; awake; clinical diagnostics; clinical examination; clinically relevant; design; detection limit; detection sensitivity; diagnostic biomarker; ergonomics; feature extraction; image processing; image registration; imaging platform; imaging system; improved; in vivo imaging; insight; interest; kinematics; multimodality; neovascularization; novel; pharmacologic; point of care; prognostic; programs; prototype; quantitative imaging; retinal imaging; sample fixation; serial imaging; standard of care; structural imaging; tomography; tractography; vascular abnormality

Retinopathy of prematurity (ROP) is a proliferative retinal vascular disease that affects preterm infants and a major cause of childhood blindness. ROP is diagnosed and staged under indirect ophthalmoscopy at the junction between the vascularized and avascular retina (i.e., periphery) using features such as retinal detachment (RD) and increased vascular dilatation and tortuosity. While surgical and pharmacologic therapies exist, poor structural and visual outcomes (<20/200 vision or blindness) occur in >50% of severe cases because RD, schisis, and vascular abnormalities are often missed on clinical examination. Conventional ophthalmoscopic examination in infants is performed using fundoscopy. However, retinal microvasculature is poorly visualized even when combined with exogenous fluorescein contrast. Optical coherence tomography (OCT) is currently the gold- standard for ophthalmic diagnostic imaging in adults and developments in OCT angiography (OCT-A) have enabled in vivo imaging of retinal vasculature without the need for exogenous contrast. While several research groups have developed handheld OCT/OCTA imaging systems and demonstrated imaging in ROP patients, longitudinal quantitative imaging of retinal vasculature to track ROP progression remains limited by several key challenges: 1) infants cannot fixate, making repeated imaging of regions-of-interest (ROIs) impossible; 2) handheld imaging coupled with infant motion results in significant artifacts and poor OCTA contrast; 3) OCT/OCTA quality is severely degraded by vitreous/anterior chamber haze, which is common in ROP; 4) peripheral retinal vascular changes are important for ROP staging but aiming of OCT/OCTA at these ROIs is difficult; 5) vascular volumes provide clinically relevant features such as dilatation and tortuosity, but OCTA is conventionally assessed using only en face projections. To overcome these limitations, we have developed a combination of hardware and image-processing technologies for handheld OCT/OCTA built around a multimodal spectrally encoded coherence tomography and reflectometry (SECTR) ophthalmic imaging platform. SECTR simultaneously acquires orthogonal en face reflectance and cross-sectional OCT images that uniquely benefits volumetric registration for motion-correction and multi-volumetric mosaicking. We hypothesize that the translation of these technologies into a point-of-care ophthalmic imaging system will allow for robust, reproducible, and quantitative longitudinal tracking of retinal vascular changes, which will improve the diagnostic and staging accuracy of ROP in preterm infants. We aim to develop custom hardware (AIM 1) and image analysis pipelines (AIM 2) optimized for handheld SECTR imaging in infant eyes. These technologies will be validated in longitudinal imaging of structural and functional changes in ROP (AIM 3) and provide quantitative insight on the viability of SECTR imaging to benefit treatment decisions. The proposed device and quantitative analysis pipeline are not limited to ROP cases and can be broadly applied in any area of ophthalmology where a robust point-of- care OCT/OCTA may improve current clinical standard-of-care.

预性早产（ROP）是一种增殖性视网膜血管疾病，影响着早产儿和A 儿童失明的主要原因。在交界处的间接眼镜检查下诊断和上演了ROP 使用视网膜脱离（RD）在血管化和血管视网膜（即外围）之间 并增加了血管扩张和曲折。尽管存在手术和药理疗法，但差 在> 50％的严重病例中，结构和视觉结果（<20/200视力或失明）出现，因为RD，Schisis， 在临床检查中通常会错过血管异常。常规眼镜检查 在婴儿中使用基础镜检查进行。但是，即使在 结合外源性荧光素对比。光学相干断层扫描（OCT）目前是金 - OCT血管造影（OCT-A）的成人和发展的眼科诊断成像的标准 启用了视网膜脉管系统的体内成像，而无需外源对比度。而几个研究 小组已经开发了手持式OCT/OCTA成像系统，并在ROP患者中展示了成像， 视网膜脉管系统的纵向定量成像是跟踪ROP进展的限制 挑战：1）婴儿无法固定，使不可能的利益区域（ROI）重复成像； 2） 手持式成像加上婴儿运动会导致明显的伪影和八八颗的对比。 3） 玻璃体/前室雾度严重降解了OCT/OCTA质量，这在ROP中很常见。 4） 外围视网膜血管变化对于ROP分期很重要，但OCT/OCTA对这些ROI的瞄准是 难的; 5）血管量提供临床相关的特征，例如扩张和曲折，但八 通常仅使用面部预测进行评估。为了克服这些局限性，我们已经开发了 围绕多模式构建的手持式OCT/OCTA的硬件和图像处理技术的组合 频谱编码的相干断层扫描和反射仪（SECTR）眼科成像平台。 sectr 同时获得正交的脸反射率和横截面OCT图像，这些图像具有独特的好处 体积登记，用于运动更正和多弹药镶嵌。我们假设 这些技术将这些技术转换为护理点眼镜成像系统将允许强大， 视网膜血管变化的可再现和定量纵向跟踪，这将改善诊断 和早产儿ROP的分期精度。我们旨在开发自定义硬件（AIM 1）和图像分析 针对婴儿眼中的手持式SECTR成像优化的管道（AIM 2）。这些技术将在 ROP结构和功能变化的纵向成像（AIM 3），并提供了定量的见解 SECTR成像的生存能力使治疗决策受益。提出的设备和定量分析管道 不仅限于ROP病例，并且可以广泛地应用于任何稳健点的眼科领域 Care Oct/Octa可能会改善当前的临床标准护理。