Vitreoretinal Disease Imaging with 3D Annular-array Ultrasound

The team of Weill Cornell Medicine (WCM) Assistant Professor of Biomedical Engineering in Radiology Jeffrey Ketterling, Ph.D., has acquired a National Institutes of Health (NIH) R01 for a winning proposal to address, with exquisitely advanced technology, a garden-variety but increasingly devastating disease hitting patients at all stages of life. To be precise, the team is adding quantitative ultrasound (QUS) capabilities to a clinical ophthalmic ultrasound system to, more accurately than ever before, characterize vitreous inhomogeneity (i.e., clinically significant vitreous “floaters” called Vision Degrading Myodesopsia). 

Age-related changes due to collagen cross-linking and aggregation with liquefaction create inhomogeneities that appear non-uniformly throughout the eye's vitreous body. For patients with myopia, these processes occur earlier in life, when vitreoretinal adhesion is still strong. The processes destabilize the vitreous body before adhesion to the retina is weakened, resulting in multiple conditions impacting vision. The ability to properly visualize vitreoretinal organization will offer unique and long overdue early-stage detection, and assessment, of vitreoretinal disease in patients with myopia at risk for retinal detachment and vitreo-maculopathies resulting from traction. 

The impact could be substantial, given that 28% of the world’s population had myopia in 2010, and 50% may be afflicted by 2050. (In East Asia, rates can already climb as high as 90%.) Furthermore, more than 15% of those diagnosed with myopia develop more serious diseases, including retinal detachment, cataracts, and glaucoma.

Currently, no diagnostic method can make data-based decisions related to changes in the vitreous body before blinding pathologies develop, notes Ketterling. “The impending epidemic of myopia has created an urgent clinical need for technologies offering objective and sensitive means for early detection of macromolecular changes and structural precursors in the vitreous body directly related to vitreoretinal diseases,” he says. He posits that a diagnostic tool capable of quantitatively characterizing the entire vitreous body would assist in developing less invasive and affordable treatments for early intervention, like pharmacologic vitreolysis or laser therapy, and identify patients needing more aggressive interventions with vitrectomy.

“In collaboration with Quantel Medical,” explains Dr. Ketterling, “the ultimate goal of this project is to incorporate a new 3D probe and real-time QUS capabilities into a state-of-the-art, 20-MHz, annular-array-based clinical ophthalmic ultrasound system to quantify vitreous inhomogeneities. The early stages of the project will focus on emphasizing device enhancements of existing equipment to obtain necessary ultrasound data, which will allow us to demonstrate that QUS methods can be applied to any ultrasound system and extend our methods to more advanced QUS approaches. Dr. Sebag, our clinical partner, will recruit, followed by age-normal and myopic patients and collect patient data throughout the project collection and development of QUS algorithms to characterize the vitreous body in 2-D. The later stage of the project will utilize the new 3D ultrasound system to develop QUS methods of the whole vitreous body rather than just the 2D slices we now use.”

Dr. Ketterling concludes that the project's later stages will focus on developing and integrating a probe “capable of volumetric acquisition, further patient data collection, and QUS classification methods that take advantage of the new volumetric data. The final system will permit quantitative characterization of the vitreous body and allow for data-based treatment decisions for vitreoretinal diseases. While this investigation will focus on myopia, the resultant technology and approach will potentially be applied in many different clinical settings.”

Dr. Ketterling graduated from Yale University with a Ph.D. in electrical engineering. Before WCM, at Riverside Research, he served as research director for years, where he was a principal investigator for NIH-supported programs dealing with high-frequency annular arrays for small-animal and ophthalmic imaging, acoustic contrast agents for microcirculation imaging, vector-flow imaging of blood-flow patterns in animal models, high-speed plane-wave imaging, and hydrophone arrays for characterizing the instantaneous acoustic fields of lithotripters. He focused on high-frequency ultrasound technology and imaging applications, developing an annular-array transducer providing linear-array image quality with the simplicity of a single-element system. The annular-array technology was advanced to the point where his team obtained human-subject ophthalmic data with collaborators at Columbia University Irving Medical Center. 

Dr. Ketterling’s partners on the new grant include Dr. Jerry Sebag (Vitreo Macular Institute), a world expert on the vitreous body; Dr. Ronald Silverman (Columbia University Irving Medical Center), an expert in ophthalmic ultrasound; and Quantel Medical, a world leader in diagnostic ophthalmic ultrasound equipment. 

For more on this grant, number 7R01EB032082-02, see the NIH Reporter

Weill Cornell Medicine
Department of Radiology
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