Update on Pediatric Retina
Retina Subspecialty Day
AAO 2010
Kimberly Drenser, MD, PhD
Associated Retinal Consultants
kdrenser@arcpc.net
Financial Disclosures
 Retinal Innovations, O; FocusROP, O;
Retinal Soultions, O
Current Issues
 ROP remains the leading cause of blindness
in infants
 Untreated threshold ROP = 50% blindness
 Treatment reduces blindness <1%
Incidence of ROP in the US
 Unchanged over last 20 years
 See increased survival of infants <26 weeks
 Increased number of Zone 1 disease
 Requires more diligent screening and early
intervention
Incidence of ROP in other
countries
 Intermediate Development
 Highest increase in the incidence of ROP
 Improved survival of premature infants with
variable/poor neonatal care
 3rd World
 Low incidence of ROP
 Poor survival of premature infants
ROP Care - The State of the Art
 With current ROP care techniques the
theoretical failure rate for ROP is about 1%
 These results are based on…
These Results Are Based On:
 ROP requiring laser
 ROP requiring VTX
ROP Care - The State of the Art
 The actual success rate in ROP management
is nowhere near 99%
 Infants are still going blind who should not
 Reason: in the US we are facing an epidemic
of poor ROP care
Prevention of ROP:
Dr. Sears
 Relative hypoxia is normal in utero
 Strict monitoring of O2 Sats
 85%-92%
 Until PMA 34 weeks
 Statistically significant decrease in ROP
Hypoxia-Mimetics
 Hypoxia Inducible Factor (HIF)
 Promotes vascular growth
 Dimethyl Oxyl Glutamate (DMOG)
 HIF mimetic
 Oxygen induced retinopathy model
demonstrates decreased retinopathy
Prevention of ROP:
Dr. Drenser
 Wnt signaling and Norrin in treatment of
retinal disease
ANGIOGENESIS
NDP
*
LRP
Fzd4
ABERRANT
ANGIOGENESIS
CAMK2
PKC
-CATENIN
Can Norrin Rescue Retinopathy
 Standard OIR mouse model (p5-p12)
 Intravitreal injection at p14
 Sacrificed at p17
Norrin Treated
Untreated Fellow
Eye
The Challenge
 How can we do better for infants and their
families?
 We need a more effective safety net
 Telemedecine for ROP was presented by Drs.
Trese and Vinekar
How Would Digital Imaging Help?
 Training
 Vigilance
 Longitudinal Viewing
 Second opinion
Why Move To Image-Based Screening?
Which image is better?
Safety Net Components
1 Hospital infrastructure
2 Expertise
3 Image management software
4 Parent education/participation in care
Ideal ROP Software
 Internet features
 Secure
 Rapid return of report within 12 hours
 Printable or seamless electronic record entry
 Instantly access to “experts” as needed
 Education about ROP (free)
FocusROPTM Homepage
RIGHT EYE
LEFT EYE
Benefit for the Baby
 Examination image available to
 Ophthalmologist
 Neonatologist and NICU nurses
 Parents
 Demands explanation and action in regard to
interval changes in fundus
 Improves parent understanding/participation