Assessment of episcleral vasculature for glaucoma management

ABSTRACT Glaucoma is one of the leading causes of irreversible blindness globally and is caused by retinal ganglion cell death or loss associated with elevated intra-ocular pressure (IOP). Current treatment strategies revolve around reduction of IOP, but are limited by poor adherence and potentially blinding surgical complications. Microinvasive glaucoma surgery (MIGS) has offered a promising solution to reduce IOP, however results have been inconsistent in part due to the lack of real-time assessment of aqueous outflow. This has limited the success of MIGS. Our project proposes to develop an optical imaging-based solution to quantify aqueous humor outflow and blood flow in the episcleral veins to provide crucial insight to ophthalmic surgeons performing MIGS in real- time to support optimal surgical approach. During Phase I, we will develop a hardware-software system for estimating flow of blood and aqueous humor, optimize and characterize its performance in vitro using standard imaging targets and flow phantoms (Aim 1), and subsequently validate its performance in vivo using rabbit models of anterior segment imaging and glaucoma (Aim 2). If successful, we anticipate undertaking a Phase II effort comprising clinical studies to validate the clinical performance of the system before and after MIGS (Aim 1) and the demonstration of improvement in outcomes of MIGS outcomes with real-time availability of feedback from our technology (Aim 2). This project, thereby, aims to the lay the foundation of a data-driven approach for MIGS, or smart MIGS.RELEVANCE TO PUBLIC HEALTH Surgeons performing microinvasive glaucoma surgery (MIGS) to reduce intraocular pressure in the eye could benefit from real-time information pertaining to the outflow of aqueous humor and blood flow in the episcleral veins of the eye. Our project seeks to develop a system and methods for obtaining such information.