We propose to develop a method for selective RPE photocoagulation with minimal damage to the overlying photoreceptors. The technique will be applied to address a long standing question of how much retinal tissue one needs to photocoagulate in order to elicit a useful therapeutic outcome. While the answer will depend on the specific disorder being treated, our hypothesis is that selective killing of diseased RPE cells will stimulate surrounding RPE cells to proliferate and form a new, functional RPE layer. The proposed technique may be useful for treating diseases thought to be associated with the RPE, including central serous retinopathy, diabetic macular edema, and drusen. Two major technical challenges need to be overcome in order to implement the selective RPE targeting scheme. First, a suitable laser source has to be developed, with the desired treatment parameters which confine laser damage to the RPE. Second, a feedback system needs to be implemented to ensure that reproducible lesions are being created, since RPE damage alone without neuroretina coagulation is not visible ophthalmoscopically. This proposal aims to address both of these issues, as well as to understand the mechanism for RPE cell killing.
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