Medical College research holds promise for preemies

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Every Wednesday morning at Children’s Hospital Neonatal Intensive Care Unit, Deborah Costakos, MD, spends time making sure one less premature infant goes through life without the gift of sight.

The pediatric ophthalmologist studies retinas of babies born as early as 23 weeks and weighing as little as 1 pound to see if certain abnormalities are present that might lead to retinopathy of prematurity. ROP, abnormal blood vessel development that can lead to blindness, affects 80 to 90 percent of preemies but causes blindness in one of every 100. Costakos heads up Children’s ROP program and has conducted most of the screenings in Milwaukee over the past decade.

But with the current standard technology, subtle details can easily be missed. In fact, Costakos said, 20 percent of the time doctors fail to catch the issue and seek appropriate treatment in time. Blindness is the result. She feels that simply is unacceptable, particularly for babies who already have the odds stacked against them so early in life.

“Premature babies have everything stacked against them. If their vision turns out not to be one of them, then I have made a difference,” Costakos said.

Right next door, Joseph Carroll, Ph.D., co-director of the Medical College of Wisconsin’s Advanced Ocular Imaging Program, studies how the retina develops. The Eye Institute, where the program is housed, is one of few places nationwide with imaging technology capable of capturing high resolution images in these infants. What he was missing was a clinical partner with whom he could translate this application into meaningful patient care.

Costakos’ frustration, Carroll’s curiosity and the technology’s capabilities, combined with chance and circumstance, led to an imaging-based screening research project that aims to give physicians a more detailed view of the eye, lead to improved treatment and ultimately reduce the chances of vision loss for preemies. A $300,000 grant from the Russell J. and Betty Jane Shaw Fund allowed the pair to take their collaboration to the next level.

“It is one of these things where you look at the pieces that have to be in place and if you remove any one of them, it is not going to work,” Carroll said. “If we were doing this anywhere else and didn’t have a physician who was receptive and passionate about this and in a city that didn’t have something like the Greater Milwaukee Foundation, none of this would happen.”

They are creating a database of retinal images that will help them study signs leading to ROP. Central to building that database is introducing the optical coherence tomography technology to neonatal intensive care units. They are creating relationships with area hospitals to build up the volume of data and ultimately hope to impact the standard of care. In other words, their research would help provide the evidence that proves that all hospitals should invest in the imaging technology.

“Why should where you are born dictate whether you might benefit from having access to this technology,” Carroll said. “Our job is to provide the evidence to say this is what people should be doing.”

It might take years to make that kind of paradigm shift. But both remain confident and committed.

“Even if I don’t get to the answer first, if it inspires someone to get the answer first, I’m OK with that,” Costakos said.

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