Detection of Glaucoma Progression with Macular OCT Imaging

利用黄斑 OCT 成像检测青光眼进展

• 批准号: 8866409
• 负责人: Kouros Nouri-Mahdavi
• 金额: $ 22.91万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8866409
• 关键词: Age; Area; Award; Biological Markers; Biometry; Blindness; Bruch' s basal membrane structure; Caring; Clinical Research; Complement; Complex; Computer Vision Systems; Cornea; Data; Detection; Diagnosis; Diagnostic Imaging; Disease; Early Diagnosis; Enrollment; Epidemiology; Ethical Issues; Evaluation; Eye; Foundations; Functional Imaging; Future; Glaucoma; Goals; Gold; Human; Image; Image Analysis; Individual; Inner Plexiform Layer; K-Series Research Career Programs; Knowledge; Lead; Legal Blindness; Length; Longitudinal Studies; Master of Science; Measurement; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Morbidity - disease rate; Nerve Fibers; Noise; Ophthalmologist; Optic Disk; Optical Coherence Tomography; Outcome; Outcome Measure; Patients; Performance; Process; Proxy; Quality of life; Race; Research; Research Personnel; Retinal; Role; Scientist; Signal Transduction; Societies; Solid; Specialist; Staging; Structure of retinal pigment epithelium; Testing; Thick; Time; Vision; Visual; Visual Fields; advanced disease; biomathematics; central visual field; clinical investigation; disability; experience; follow-up; ganglion cell; image processing; improved; interest; macula; next generation; programs; retina outer nuclear layer; retinal nerve fiber layer; skills

DESCRIPTION (provided by applicant): This application is a formal request for a career development award (K23) for an academic glaucoma specialist with a serious interest in the role of imaging in glaucoma using optical coherence tomography (OCT). This will allow the candidate to establish a clinical research program with the main goal of improving detection of glaucoma progression through macular imaging with spectral-domain OCT. By the time the proposed research is accomplished, the candidate will have preliminary data for continuing his research as an independent investigator and will have collected longitudinal structural and functional data in a group of advanced glaucoma patients that will serve as a platform for further improving detection of glaucoma progression with macular OCT imaging. The data will help the candidate provide preliminary results for a subsequent R01 that would potentially allow the PI to continue follow-up of the patients enrolled in the K23 award period. I have a Master's of Science degree in Clinical Investigation under my belt and intend to deepen my skills in the field of imaging and biostatistics (to be used for enhancing and handling OCT images and for analyzing longitudinal data) by completing the proposed didactic program. By the end of the award period, I expect that I will have gained additional experience, knowledge, and mentorship required to prosper as an independent clinician-scientist in the field of glaucoma. My long-term goal is to carry out longitudinal studies of glaucoma patients where current and upcoming imaging and functional tests can be applied and their utility for detection of glaucoma progression can be investigated. I am confident that the combined skills and experience of my mentors will lead to a successful outcome for the proposed K award. I also envisage myself mentoring candidates like myself in future so that our collective knowledge and wisdom can be passed along to the next generation of aspiring clinician-scientists. My objectives during the award period are as follows: 1) To develop an individual research program in glaucoma diagnostic imaging; 2) to successfully complete credited coursework in biomathematics, advanced biostatistics, computer vision (image processing), epidemiology, and ethical issues in research. The main goal of the research component of this proposal is to better delineate the role of macular SD- OCT imaging for detection of glaucoma progression in advanced glaucoma. The specific aims through which this goal will be accomplished are as follows: (1) To compare the performance of various global and regional macular measures to detect glaucoma. The potential factors influencing the performance of various macular outcome measures will be explored. Such covariates include age, race, axial length, disc size, central corneal thickness, OCT signal strength, and outer retinal thickness among others. I hypothesize that the thickness of the outer retina (outer nuclear layer to retinal pigment epithelium-Bruch's membrane complex) may be the most important factor explaining the measurement variability of the inner retinal layer thickness (GCC or ganglion cell/inner plexiform layers). (2) To determine and compare the utility of the candidate macular measures, detected through the first aim, for detection of glaucoma progression in moderately advanced to severe glaucoma. Moderately advanced to severe glaucoma will be defined as eyes with visual field mean deviation worse than -6 dB or eyes with involvement of the central 10 degrees on the 24-2 visual field. It is widely accepted that measurement of the optic nerve head or RNFL parameters in advanced glaucoma does not provide clinicians with much useful information. In contrast, the central macular ganglion cells are the last to die in glaucoma. Macular imaging in advanced glaucoma is directed towards this area where detection of change may still be possible. I hypothesize that macular OCT parameters are valid structural outcome measures (biomarkers) that can be used to follow the course of the disease in advanced glaucoma and that such measures are significantly correlated with changes in the central visual field. Changes in the macular measures over time will be first correlated with the corresponding visual field change (functional progression) over time in eyes with moderately advanced to severe glaucoma. The utility of the best candidate macular measures for predicting subsequent glaucoma progression will also be explored and compared. I hypothesize that there may be a lag period between progressive loss of macular ganglion cells and subsequent visual field progression in advanced glaucoma, and therefore, detection of worsening in one or more macular outcome measures can be used as a proxy for subsequent visual field progression. Collectively, these studies will provide a solid foundation for better understanding and integration of macular OCT imaging in the care of glaucoma patients. Timely detection of glaucoma progression in the later stages can significantly reduce visual disability and blindness through earlier aggressive treatment and will potentially reduce glaucoma's financial burden to society.

描述（由申请人提供）：本申请是为学术青光眼专家提供职业发展奖（K23）的正式请求，对成像在青光眼中使用光学连贯性层析成像（OCT）的作用非常感兴趣。这将使候选人能够建立一个临床研究计划，其主要目的是通过使用光谱域OCT来改善通过黄斑成像检测青光眼进展。到拟议的研究完成时，候选人将拥有继续作为独立研究者的研究的初步数据，并将在一组晚期青光眼患者中收集纵向结构和功能数据，这些数据将作为进一步改善通过黄斑OCT成像进一步改善青光眼进展的平台。这些数据将帮助候选人为随后的R01提供初步结果，这有可能使PI继续对K23奖项期间入学的患者进行随访。 我拥有临床研究的科学硕士学位，并打算加深我在成像和生物统计学领域的技能（用于增强和处理OCT图像，用于分析纵向数据），通过完成拟议的教学计划。在奖励期结束时，我希望我将获得一些繁荣的经验，知识和指导，以作为青光眼领域的独立临床医生 - 科学家。我的长期目标是对青光眼患者进行纵向研究，其中可以应用当前和即将进行的成像和功能测试，并可以研究其检测青光眼进展的实用性。我相信，导师的综合技能和经验将为拟议的K奖带来成功的结果。我还设想自己将来对像我这样的候选人进行指导，以便我们的集体知识和智慧可以传递给下一代有抱负的临床医生。 在奖励期间，我的目标如下：1）制定青光眼诊断成像中的个别研究计划； 2）成功完成了生物学，高级生物统计学，计算机视觉（图像处理），流行病学和研究中的道德问题的学分课程。 该提案的研究组成部分的主要目标是更好地描述黄斑SD-OCT成像在晚期青光眼中检测青光眼进展的作用。实现该目标的具体目的如下：（1）比较各种全球和区域黄斑测量的性能以检测青光眼。 将探讨影响各种黄斑结局度量表现的潜在因素。这样的协变量包括年龄，种族，轴向长度，圆盘尺寸，中央角膜厚度，OCT信号强度和视网膜外厚度。我假设外视网膜的厚度（外部核层与视网膜色素上皮 - 布鲁克的膜复合物）可能是解释内部视网膜层厚度（GCC或神经节细胞/内部丛生层）的测量变异性的最重要因素。 （2）确定和比较通过第一个目的检测到的候选黄斑测量的效用，以检测中等先进至严重青光眼的青光眼进展。 中度高级至严重的青光眼将被定义为视野平均偏差比-6 dB差的眼睛，或者在24-2视野上涉及中央10度。人们普遍认为，晚期青光眼中视神经头或RNFL参数的测量不会为临床医生提供太多有用的信息。相反，中央黄斑神经节细胞是青光眼中最后死亡的细胞。晚期青光眼中的黄斑成像针对该区域，在该区域可能仍可能发生变化。我假设黄斑OCT参数是有效的结构性结果度量（生物标志物），可用于遵循晚期青光眼中疾病的过程，并且此类措施与中央视野的变化显着相关。随着时间的推移，黄斑测量的变化将首先与相应的视野变化相关（功能 随着时间的流逝，进展是在中度向严重青光眼的眼睛中。还将探索和比较最佳候选黄斑测量方法，以预测随后的青光眼进展。我假设在黄斑神经节细胞的进行性丧失与晚期青光眼的后续视野进程之间可能存在滞后，因此可以将检测一种或多种黄斑结局测量中的恶化，以作为随后的视野进展的代理。 总的来说，这些研究将为黄斑患者的护理中更好地理解和整合黄斑OCT成像。及时发现青光眼进展的后期可以通过早期的积极治疗大大降低视觉障碍和失明，并有可能减轻青光眼对社会的财务负担。