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[ARVO2013]OCT应用前景展望
——美国俄勒冈健康与科学大学D.Huang教授专访

青光眼 玻璃体视网膜  作者:  D.Huang  2013/7/2 15:41:00
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内容概要:《国际眼科时讯》:黄博士,您今天在ARVO会议上作了关于“利用OCT对视盘与视网膜血流的检查来早期诊断 青光眼”的报告,您能否为我们讲一讲OCT技术的视盘扫描,以及为什么您将视网膜血流列入到青光眼早期诊断的标准之中?

 

  <International Ophthalmology Times>:Dr. Huang, you today at ARVO had a talk titled OCT-Based ONH and Retinal Blood Flow for Early Diagnosis of Glaucoma. Could you discuss the technique of OCT-based ONH and why you are looking for retinal blood flow for the early diagnosis of glaucoma?

  《国际眼科时讯》:黄博士,您今天在ARVO会议上作了关于“利用OCT对视盘与视网膜血流的检查来早期诊断 青光眼”的报告,您能否为我们讲一讲OCT技术的视盘扫描,以及为什么您将视网膜血流列入到青光眼早期诊断的标准之中?

  Dr. Huang:I am interested in these areas because they are novel. The structural OCT has been in use since 1995 to look at glaucoma, people have looked at nerve fiber layer, we pioneer looking at ganglion cells by measuring ganglion cell complex, and all these are very good tools for diagnosing and tracking glaucoma. But, they still have limits, for example, every time you look at the structural measures and their correlation with visual field function, you will find that they are moderately correlated. But there are certainly a lot of eyes where function is much worse than structure or visual field is much worse than the structure or structure is much worse than visual field. So, measuring ganglion cells and nerve fibers may not be the end of all {phonetic}.

  Several years ago, we figured out that OCT now is fast enough that it’s feasible to measure circulation either on a global level looking at retinal blood flow, total retinal blood flow or at a regional level looking at either peripheral blood flow or optic disk blood flow. And these may certainly give you independent information and even better information than structural measurements.

  What we have found so far are very encouraging in that total retinal blood flow has much higher correlation with visual field and nerve fiber layer thickness or retinal thickness, and same with disk circulation as measured by OCT angiography. Not only that, with OCT angiography we found that the measurement is very precise, much more precise than blood flow measurement that were taken before with say Heidelberg flowmetry or the Color Doppler ultrasound. So, now you really have a very precise repeatable method of measuring blood flow. I think it will really open up a whole new area of investigation.

  黄博士:这一领域非常新颖,我非常感兴趣。1995年时,OCT技术就开始被应用于青光眼领域,人们利用OCT技术观测视网膜神经纤维层,我们则利用OCT技术测量神经节细胞复合体,开创了OCT的神经节细胞监测,发现OCT是一个诊断和随访青光眼的好工具。但是,OCT也有局限性,例如我们发现OCT的结构检测结果与视野缺损仅表现为为中度相关,但是许多青光眼患者的视功能比其视网膜结构损害要严重得多,视野损害比结构损害要更糟一些,或者结构损害很严重,而视野改变却没有那么严重。所以,OCT的神经节细胞和神经纤维层测量检测并不是青光眼监测的最终选择。

  几年前,我们发现OCT的扫描速度足以用来测量视神经、视网膜的血液循环,既可以用于在全局水平上观察视网膜总体血流,也可以检查局部周边血流或视盘血流。这些测量必然为我们提供独立的信息,甚至是比结构测量更为有意义的信息。

  我们目前的发现非常令人鼓舞,视网膜总体血流与视野及神经纤维层厚度、视网膜厚度的相关性更高,OCT血管造影的视盘血流检查结果同样与视野损害和神经纤维层厚度相关。不仅仅如此,我们发现OCT血管造影检查非常精确,比海德堡血流计或者彩色多普勒超声的检测结果要精确得多。所以,现在我们真正地掌握了一种精确而可重复的血流测量方法,它将为我们的研究开创一片全新的领域。

  <International Ophthalmology Times>:I heard in your talk you mentioned that all irreversible blindness has some sort of root in blood flow problems, so this could be applied beyond just glaucoma?

  《国际眼科时讯》:在您的报告中,您提到所有不可逆性盲多多少少都与眼部血流有些联系,那是不是说OCT技术也可以应用到青光眼以外的领域之中?

  Dr. Huang:That’s right. Tomorrow in the Friedenwald lecture, I am going to show some choroidal neurovascular nets image with OCT angiography, and they were really quite stunning. You can see detailed flow patterns within these neurovascular nets. You can look at the area and you can measure the average flow index within them. We only have a very few cases but they seem to go with the clinical status and amount of edema, the CLB activity pretty well in these few cases. And if non-invasive, you can look through hemorrhages pretty well. So, it’s just the beginning but I think it’s very promising.

  黄博士:对。明天在 Friedenwald lecture上,我会展示一些脉络膜新生血管网的OCT血管造影图像,这些图片很让人震惊。你可以看到神经纤维层内血管网络的精密血流图像,你可以观察这一区域,并可测量该区域内平均血流指数。我们所获得的病例数不多,但所获得的数据与与临床表现、视网膜水肿的程度以及CLB活性十分相符。这是一项无创性检查,你可以透过出血清楚地观察视网膜。所以,这仅仅是一个开始,它的前景十分光明。

  <International Ophthalmology Times>:Where do you see this technology going? What do you see will be the ultimate end product of this new technology in the research that you are doing?

  《国际眼科时讯》:您认为OCT技术未来的发展方向如何?在您的研究领域内,您觉得OCT技术发展的终极产品是什么样子?

  Dr. Huang:The main limitation now for function of OCT whether it’s measurement of total retinal blood flow or angiography is that we are measuring relatively small regions. I picked target that’s easy to do for this. With a 3 mm area, it’s adequate to measure uptake disk. It’s adequate to measure a subfoveal choroidal neovascular net but if you want to use it on all macular and optic nerve cases, you will really want to image it over a wide area. So, there is a lot of hardware and algorithm improvement that could enable that and I think that would be what’s coming up.

  For example with diabetic retinopathy, you would really ideally want wide area angiography just like Fluorescein. The technology is almost there actually. It maybe just more years so that the cost can come down, so that clinicians can actually afford these instruments with the limits in reimbursement. Tomorrow I am also going to talk about kind of the Moore’s Law for OCT technology. And if you plot OCT speed since 1994 to 2012, you’ll find that the speed doubles every 1.6 years, pretty much like the number of transistors on integrated circuit chip.

  At this rate by 2019, you should be able to buy a commercial OCT system at the same price where the acquisition rate would be in megahertz and who knows when it’s going to start. With that kind of speed, we should be able to get quantitative 3D wide field angiography like we are doing with Fluorescein now but in three dimension instead of two and without getting people nauseous and actually at a lower cost.

  黄博士:现在OCT技术的主要局限是,无论是OCT视网膜总血流测量,还是OCT血管造影,它所检查的区域相对来说都很小。OCT技术很容易找到观察目标. 在一个3mm2的区域内,完全可以涵盖视盘。3mm2的范围足够测量黄斑中心凹下方的脉络膜新生血管网,但是如果你打算用OCT同时检查黄斑和视神经,就会希望检查范围能够扩大一些。所以,还有很多硬件和软件需要改进来实现检查范围扩大,我想这将是OCT技术接下来的发展方向。

  比如说,在对糖尿病视网膜患者进行检测时,理想的OCT造影检查范围应该跟荧光素钠血管造影一样,该项技术实际上已经比较成熟,也许只需要再过几年仪器设备的价格下降一些之后,临床医生能够负担得起设备的费用。明天,我还要讲一些关于OCT技术的Moore法则的内容,如果你给OCT扫描速度画一个曲线出来,你就会发现,从1994年到2012年,平均每1.6年扫描的速度就会增加一倍,简直就像集成电路板上晶体管数量增长的速度。

  按着这个速度,到2019年时,你就可以买一套物有所值的,图像获取速度为兆赫的商业OCT系统,这件事已经开始发生。高速扫描可以帮助我们获得如同我们现在正在使用的荧光素钠血管造影一样的定量3D广角血管造影,而且是三维图像,并不是我们现在看到的二维图像,而且患者不会出现荧光素钠血管造影过程中的恶心症状,且花费低廉。

 


 
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