A Blueprint for Saving the Sight of Infants in Thailand — and Beyond

Neil Bressler, center, discusses retina images being obtained in a premature infant by Atchareeya Wiwatwongwana, right center, while the baby is soothed by Benja Yatikul, far right, (the head nurse in the ROP clinic), and Kwanhathai Kantaroj, left center (a neonatal nurse specialist), as Jun Kong, far left, prepares communication with retina experts in Shanghai.
Across Thailand, a primary cause of childhood blindness is retinopathy of prematurity (ROP), an eye disease in some premature babies that occurs when their early birth disrupts the growth of blood vessels in the retina. While ROP can be countered with proper treatment, research has shown the condition too often goes underdiagnosed, says Neil Bressler, M.D., the James P. Gills Professor of Ophthalmology at the Wilmer Eye Institute.
A recently launched collaboration that Bressler is leading — between physician-scientists at Johns Hopkins University and Chiang Mai University in Thailand — aims to change that. Atchareeya Wiwatwongwana, M.D., is leading the study in Thailand with her colleague and former Wilmer research fellow, Voraporn Chaikitmongkol,M.D., now at Chiang Mai University. The initiative is made possible through funding from a prominent Thai businessman, Chalerm Yoovidhya.
“I learned that one in 1,000 children [in Thailand] could develop blindness, and this could be prevented by early detection and treatment, and I was very surprised by that,” says Yoovidhya.
While laser surgery or injections of anti-growth factor medications have been shown effective in treating ROP, Bressler says, “these treatments are only effective if you know which premature infants need treatment. And doctors in NICUs throughout Thailand may not have the equipment needed to facilitate its recognition, so the babies go blind before you can treat them.”
Proper diagnosis requires high-end imaging of the retina and specialized skill in interpreting the images, which simply do not exist in many places. Bressler and his collaborators, supported by Yoovidhya, have developed a feasibility study to address these challenges.
The researchers have purchased and set up a sophisticated camera in Chiang Mai University’s Neonatal Intensive Care Unit and begun training providers on how to obtain outstanding images of the retina. The physicians will confirm their interpretation of the images by sharing them with world experts in ROP who are based in Shanghai, China.
The Hopkins/Chiang Mai collaboration is working with the group in Shanghai because of a fortuitous connection. Another former Wilmer research fellow and currently a co-investigator on the project at Hopkins, Jun Kong,M.D., Ph.D., completed retina surgical training with one of the leading pediatric retina surgeons in China, Peiquan Zhao, M.D., Ph.D., who happens to be an expert in imaging infants as well.
“Zhao has an image reading center in Shanghai of experts in ROP who have trained people to obtain great images of these premature infants’ eyes. He and his investigators will look at the images the providers in Thailand obtain and give them feedback about how to make the images better. In addition, the Shanghai group will see if its interpretations of the images match the interpretations of the providers in Chiang Mai,” says Kong. “The doctors in Chiang Mai also will get feedback as to whether an infant might need the expertise of a health care provider for laser treatment or eye injections or referral for sophisticated surgery, as well as to determine proper monitoring.”
If this system works successfully, Bressler plans to approach hospital systems in other regions that may not have pediatric retina expertise with a cost-effective blueprint for improving the diagnosis of ROP by sending images to a central image reading center for interpretation and disease management. “There will be broad implications for trying to reduce childhood blindness in similar locales,” says Bressler.
For his part, Yoovidhya is excited about what lies ahead. “Three countries are collaborating on this project. If the program by Chiang Mai University helps reduce childhood blindness in Thailand, I believe further donations from donors and foundations could go a long way to help reduce childhood blindness in other parts of the world,” he says.
“If we could save one child from blindness, this is more than well worth it.”