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Update on Pediatric Retina Retina Subspecialty Day AAO 2010

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

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Update on Pediatric Retina Retina Subspecialty Day AAO 2010

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  1. Update on Pediatric RetinaRetina Subspecialty DayAAO 2010 Kimberly Drenser, MD, PhD Associated Retinal Consultants kdrenser@arcpc.net

  2. Financial Disclosures • Retinal Innovations, O; FocusROP, O; Retinal Soultions, O

  3. Current Issues • ROP remains the leading cause of blindness in infants • Untreated threshold ROP = 50% blindness • Treatment reduces blindness <1%

  4. 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

  5. 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

  6. 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…

  7. These Results Are Based On: ROP requiring laser ROP requiring VTX

  8. 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

  9. 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

  10. Hypoxia-Mimetics • Hypoxia Inducible Factor (HIF) • Promotes vascular growth • Dimethyl Oxyl Glutamate (DMOG) • HIF mimetic • Oxygen induced retinopathy model demonstrates decreased retinopathy

  11. Prevention of ROP:Dr. Drenser • Wnt signaling and Norrin in treatment of retinal disease

  12. ANGIOGENESIS NDP * LRP Fzd4 ABERRANT ANGIOGENESIS CAMK2 PKC -CATENIN

  13. Can Norrin Rescue Retinopathy • Standard OIR mouse model (p5-p12) • Intravitreal injection at p14 • Sacrificed at p17

  14. Norrin Treated Untreated Fellow Eye

  15. 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

  16. How Would Digital Imaging Help? Training Vigilance Longitudinal Viewing Second opinion

  17. Why Move To Image-Based Screening? Which image is better?

  18. Safety Net Components Hospital infrastructure Expertise Image management software Parent education/participation in care

  19. 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)

  20. FocusROPTM Homepage

  21. RIGHT EYE

  22. LEFT EYE

  23. 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

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