Prediction and treatment of ROP: Emerging strategies

Abstract

Retinopathy of Prematurity(ROP) is a leading cause of childhood visual impairment and blindness in developed countries, and is increasingly prevalent in developing countries. Ablative therapy for Type 1 ROP usually allows favorable outcomes, but less destructive and preventative treatment strategies would be optimal. We need ways to predict early those infants who will develop ROP, particularly for locales where ophthalmologists are not readily available. Low IGF-1 levels and poor post-natal weight gain are important predictors in ROP development, and weight surveillance alone may help identify infants at highest risk of severe ROP development. We developed an algorithm (WINROP) that predicts significant ROP early (median time to development of ROP, 9 weeks, and treatable ROP, 8 weeks) with very high specificity and sensitivity. A multicenter trial to evaluate this method is underway, and we will discuss results to date and discuss expanding the use of this method in more US and world NICUs. Dietary supplementation has also been a topic of ROP research, and since composition of parenteral nutrition and breast milk plays an important role in brain and eye development, recognition of deficiencies with supplementation to normal levels could play an important role in ROP prevention. VEGF inhibitors for ROP treatment offer promise and will also be discussed, though current use in the US is limited to compassionate use or as part of a clinical trial such as BLOCK-ROP. The panel will discuss recent clinical research in these areas and how this information may be used in the clinical setting.