OCT Angiography for Neovascular Age-related Macular Degeneration

OCT 血管造影治疗新生血管性年龄相关性黄斑变性

• 批准号: 10242699
• 负责人: Steven T Bailey
• 金额: $ 47.16万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242699
• 关键词: 3-Dimensional; Address; Affect; Age related macular degeneration; Algorithmic Software; Algorithms; Angiography; Area; Astigmatism; Blindness; Blood Cells; Blood Vessels; Blood capillaries; Caliber; Choroidal Neovascularization; Clinical Research; Computer software; Cross-Sectional Studies; Defect; Detection; Development; Diabetic Retinopathy; Diagnosis; Diagnostic tests; Dose; Dyes; Enrollment; Ensure; Etiology; Evaluation; Exudative age-related macular degeneration; Eye; Fluorescein Angiography; Gold; Grant; Hemorrhage; Image; Label; Lasers; Location; Longitudinal Studies; Measurement; Measures; Morphologic artifacts; Motion; Optical Coherence Tomography; Optics; Outcome; Performance; Perfusion; Periodicity; Preventive treatment; Recurrence; Regimen; Resolution; Retina; Retinal Edemas; Retinal Vein Occlusion; Risk; Risk Factors; Role; Sampling; Scanning; Sensitivity and Specificity; Source; Speed; Structure of retinal pigment epithelium; System; Technology; Testing; Time; Visual; Visualization; base; bevacizumab; choroidal circulation; clinical application; cohort; density; follow-up; geographic atrophy; high risk; improved; innovation; insight; lens; longitudinal analysis; macula; macular edema; noninvasive diagnosis; novel; prevent; prototype; rapid growth; recruit; response; retina blood vessel structure; retina circulation; retinal imaging; routine screening; screening; two-dimensional

PROJECT SUMMARY Neovascular age-related macular degeneration (AMD), characterized by the presence of choroidal neovascularization (CNV), accounts for the majority of AMD related vision loss. Invasive dye-based fluorescein angiography (FA) remains the gold standard for CNV detection. Using high-speed OCT systems, we have developed novel OCT angiography (OCTA) technologies to image CNV as well as vascular plexuses associated with AMD. Our recent clinical studies have demonstrated that (1) 3×3-mm OCTA has a sensitivity for subfoveal CNV detection comparable to FA; (2) OCTA derived quantitative metrics provide novel insight into the CNV response to anti-VEGF treatment; and (3) routine screening OCTA can detect treatment naïve non-exudative CNV that carries high risk for progression and is invisible with FA. Currently, OCTA is limited by low transverse resolution, small field of view, and various artifacts. The current proposal will overcome these limitations by improving both the hardware platform and software algorithms to develop advanced OCTA. Its role in AMD evaluation and management will be tested in three clinical studies. 1. Develop high-resolution wide-field OCTA. We will develop a swept-source OCT prototype that is 4 times faster than current commercial OCT systems. A wide collimated beam will be used to improve transverse optical resolution. The high-speed and high-resolution OCTA will be able to image capillary-level details in a wide field of view. 2. Develop volumetric analysis of CNV and plexus-specific analysis of retinal and choroidal circulations. We will improve our algorithm to remove projection artifacts in the outer retina that arise from moving blood cells in superficial retinal vessels. Next, we will develop automated software to measure CNV volume and to detect defects in the choriocapillaris and retinal deep capillary plexus (DCP). 3. Evaluate advanced OCTA for AMD in clinical studies. Three studies will test the clinical applications of OCTA. Study 1: A cross-sectional analysis will compare the accuracy of OCTA versus FA to distinguish CNV as the etiology of macular edema versus control eyes with macular edema from retinal vein occlusion or diabetic retinopathy. Study 2: A longitudinal analysis of neovascular AMD under a treat-and-extend anti- VEGF regimen will determine if OCTA can predict recurrent exudation or hemorrhage. Study 3: An OCTA longitudinal screening of eyes with intermediate AMD will determine if choriocapillaris and retinal DCP defects presage CNV development. Non-exudative CNV detected with OCTA will be followed monthly and novel CNV volumetric analysis used to determine if rapid growth is a risk for development of exudation. If successful, OCTA will improve our capability to diagnose all macular CNVs, provide useful information to help determine appropriate anti-VEGF dosing intervals, and aid with surveillance of eyes at risk for development of neovascular AMD. OCTA is nearing its potential to replace the need for invasive FA.

项目摘要 新生血管相关的黄斑变性（AMD），其特征是存在脉络膜 新血管化（CNV）是AMD相关视力丧失的大部分。基于侵入性染料的荧光素 血管造影（FA）仍然是CNV检测的金标准。使用高速OCT系统，我们有 开发了新颖的OCT血管造影（八八）技术，以形象CNV以及血管丛 与AMD相关。我们最近的临床研究表明（1）3×3毫米八毫米具有灵敏度 用于与FA相当的叶片下CNV检测； （2）八八个衍生定量指标提供了新颖的见解 进入CNV对抗VEGF治疗的反应； （3）常规筛选八颗可以检测到幼稚的治疗 非估量性CNV具有高风险，并且与FA无形。目前，Octa受到限制 低横向分辨率，较小的视野和各种工件。当前的提议将克服这些 通过改进硬件平台和软件算法来开发高级八八颗局限性。 在三项临床研究中将测试AMD评估和管理中的作用。 1。发展高分辨率的宽场八八。我们将开发一个扫描源的OCT原型4次 比当前商业OCT系统快。宽的简洁光束将用于改善横向 光学分辨率。高速和高分辨率的八章将能够在 广阔的视野。 2。进行视网膜和脉络膜的CNV和丛特异性分析的体积分析 循环。我们将改进我们的算法以消除由外部视网膜中的投影伪像 在浅表残留视频中移动血细胞。接下来，我们将开发自动化软件来测量CNV 体积并检测脉络膜毛细血管和残留深毛细血管（DCP）的缺陷。 3。在临床研究中评估AMD的晚期八颗。三项研究将测试 八八。研究1：横截面分析将比较八八的准确性与FA的准确性 CNV作为黄斑水肿的病因与对照眼对照眼睛，具有残留静脉闭塞的黄斑水肿 或糖尿病性视网膜病。研究2：在治疗和扩张抗抗血管中的新血管AMD的纵向分析 VEGF治疗方案将确定八颗八粒是否可以预测复发性渗出或出血。研究3：八八 用中间AMD对眼睛的纵向筛查将确定脉络膜毛细血管和永久性DCP是否 缺陷Presage CNV开发。用八颗检测到的非陈述性CNV将每月遵循 新型的CNV体积分析用于确定快速生长是否是渗出量发展的风险。 如果成功，八八人将提高我们诊断所有黄斑CNV的能力，提供有用的信息 帮助确定适当的抗VEGF给药间隔，并帮助监视眼睛有风险 新血管AMD的发展。 Octa接近其替代入侵FA的需求的潜力。