101
|
Guduru A, Lupidi M, Gupta A, Jalali S, Chhablani J. Comparative analysis of autofluorescence and OCT angiography in Stargardt disease. Br J Ophthalmol 2017; 102:1204-1207. [DOI: 10.1136/bjophthalmol-2017-311000] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/13/2017] [Accepted: 10/13/2017] [Indexed: 12/29/2022]
Abstract
AimsTo characterise the vasculature of the retina in patients with Stargardt disease (STGD) using optical coherence tomography angiography (OCTA) and to compare these functional findings with fundus autofluorescence (FAF) imaging.MethodsThis observational study included consecutive patients with STGD. The choriocapillaris (CC) layer was analysed on OCTA and retinal pigment epithelium (RPE) changes were assessed on FAF. Areas of CC and RPE impairment were quantified and correlated.ResultsTwenty-two patients suffering from different stages of STGD were enrolled. OCTA revealed a vascular rarefaction with vascular prominence in 15 (35%) eyes while the remaining cases had pure vascular rarefaction. On FAF imaging, 25 (58%) eyes had a peripapillary halo, a hypofluorescent lesion in foveal area and the presence of both hypofluorescent and hyperfluorescent changes. On FAF imaging, the average area of RPE impairment was 6.7±4.4 mm2 while on OCTA a hypointense area of 4.2±3.6 mm2 was shown at the level of the CC layer. Mann-Whitney U test showed a statistically significant difference in terms of lesion extension between these two findings (p=0.004).ConclusionRPE damage on FAF appears to be significantly larger than CC layer vessel loss on OCTA, which suggests that RPE damage might precede that of CC.
Collapse
|
102
|
Charng J, Tan R, Luu CD, Sadigh S, Stambolian D, Guymer RH, Jacobson SG, Cideciyan AV. Imaging Lenticular Autofluorescence in Older Subjects. Invest Ophthalmol Vis Sci 2017; 58:4940-4947. [PMID: 28973367 PMCID: PMC5627676 DOI: 10.1167/iovs.17-22540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose To evaluate whether a practical method of imaging lenticular autofluorescence (AF) can provide an individualized measure correlated with age-related lens yellowing in older subjects undergoing tests involving shorter wavelength lights. Methods Lenticular AF was imaged with 488-nm excitation using a confocal scanning laser ophthalmoscope (cSLO) routinely used for retinal AF imaging. There were 75 older subjects (ages 47–87) at two sites; a small cohort of younger subjects served as controls. At one site, the cSLO was equipped with an internal reference to allow quantitative AF measurements; at the other site, reduced-illuminance AF imaging (RAFI) was used. In a subset of subjects, lens density index was independently estimated from dark-adapted spectral sensitivities performed psychophysically. Results Lenticular AF intensity was significantly higher in the older eyes than the younger cohort when measured with the internal reference (59.2 ± 15.4 vs. 134.4 ± 31.7 gray levels; P < 0.05) as well as when recorded with RAFI without the internal reference (10.9 ± 1.5 vs. 26.1 ± 5.7 gray levels; P < 0.05). Lenticular AF was positively correlated with age; however, there could also be large differences between individuals of similar age. Lenticular AF intensity correlated well with lens density indices estimated from psychophysical measures. Conclusions Lenticular AF measured with a retinal cSLO can provide a practical and individualized measure of lens yellowing, and may be a good candidate to distinguish between preretinal and retinal deficits involving short-wavelength lights in older eyes.
Collapse
Affiliation(s)
- Jason Charng
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rose Tan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Sadigh
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dwight Stambolian
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Victoria, Australia
| | - Samuel G Jacobson
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Artur V Cideciyan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| |
Collapse
|
103
|
The Rapid-Onset Chorioretinopathy Phenotype of ABCA4 Disease. Ophthalmology 2017; 125:89-99. [PMID: 28947085 DOI: 10.1016/j.ophtha.2017.07.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To characterize patients affected by a uniquely severe, rapid-onset chorioretinopathy (ROC) phenotype of ABCA4 disease. DESIGN Comparative cohort study. PARTICIPANTS Sixteen patients were selected from a large clinically diagnosed and genetically confirmed cohort (n = 300) of patients diagnosed with ABCA4 disease. MAIN OUTCOME MEASURES Phenotypic characteristics were assessed on color fundus photographs, short-wavelength autofluorescence (488-nm), and near-infrared autofluorescence (NIR-AF, 787-nm) images. Subfoveal thickness measurements were obtained from enhanced-depth imaging OCT. Generalized retinal function was determined with full-field electroretinogram (ffERG) testing, and lipofuscin accumulation was assessed by quantitative autofluorescence (qAF). RESULTS All patients exhibited advanced disease features, including pigment migration in the macula and retinal vessel attenuation at an early age, and reported a symptomatic onset, on average, at 7.4 years (average for ABCA4 disease is 21.9 years, P < 0.0001). Deterioration of the macula was observed to begin with an intense, homogeneous signal on short-wavelength autofluorescence, which corresponds to an attenuated NIR-AF signal and progresses to a patchy, coalescing pattern of chorioretinal atrophy within the subsequent decade. Measurement of choroidal thickness revealed a more rapid thinning of choriocapillaris with age of Sattler's layer compared with the rate in most other patients with ABCA4 disease (P < 0.001). Levels of qAF in the macula before atrophy were above both the 95% confidence intervals for healthy individuals and patients with Stargardt disease (STGD1) (>1000 qAF units). Severe attenuation of cone responses and notable decreases in rod responses were detected by ffERG. Sequencing of the ABCA4 gene revealed exclusively deleterious, null mutations, including stop codons; frameshift deletions; variants in canonical splice sites, which completely abolish splicing; and known deleterious missense alleles. CONCLUSIONS The ROC phenotype is a unique classification of ABCA4 disease, which is caused by deleterious null biallelic ABCA4 mutations and is characterized by the rapid deterioration of retinal pigment epithelium and photoreceptor layers in the macula and significant choroidal thinning within the first 2 decades of life.
Collapse
|
104
|
Sears AE, Bernstein PS, Cideciyan AV, Hoyng C, Charbel Issa P, Palczewski K, Rosenfeld PJ, Sadda S, Schraermeyer U, Sparrow JR, Washington I, Scholl HPN. Towards Treatment of Stargardt Disease: Workshop Organized and Sponsored by the Foundation Fighting Blindness. Transl Vis Sci Technol 2017; 6:6. [PMID: 28920007 PMCID: PMC5599228 DOI: 10.1167/tvst.6.5.6] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 01/13/2023] Open
Abstract
Accumulation of fluorescent metabolic byproducts of the visual (retinoid) cycle is associated with photoreceptor and retinal pigment epithelial cell death in both Stargardt disease and atrophic (nonneovascular) age-related macular degeneration (AMD). As a consequence of this observation, small molecular inhibitors of enzymes in the visual cycle were recently tested in clinical trials as a strategy to protect the retina and retinal pigment epithelium in patients with atrophic AMD. To address the clinical translational needs for therapies aimed at both diseases, a workshop organized by the Foundation Fighting Blindness was hosted by the Department of Pharmacology at Case Western Reserve University on February 17, 2017, at the Tinkham Veale University Center, Cleveland, OH, USA. Invited speakers highlighted recent advances in the understanding of the pathophysiology of Stargardt disease, in terms of its clinical characterization and the development of endpoints for clinical trials, and discussed the comparability of therapeutic strategies between atrophic age-related macular degeneration (AMD) and Stargardt disease. Investigators speculated that reducing the concentrations of visual cycle precursor substances and/or their byproducts may provide valid therapeutic options for the treatment of Stargardt disease. Here we review the workshop's presentations in the context of published literature to help shape the aims of ongoing research endeavors and aid the development of therapies for Stargardt disease.
Collapse
Affiliation(s)
- Avery E Sears
- Department of Pharmacology, School of Medicine, Cleveland Center for Membrane and Structural Biology, Case Western Reserve University, Cleveland, OH, USA
| | | | - Artur V Cideciyan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carel Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and the Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Krzysztof Palczewski
- Department of Pharmacology, School of Medicine, Cleveland Center for Membrane and Structural Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Philip J Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA, USA
| | - Ulrich Schraermeyer
- Institute of Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Janet R Sparrow
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Ilyas Washington
- Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Hendrik P N Scholl
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
105
|
Dysli C, Wolf S, Berezin MY, Sauer L, Hammer M, Zinkernagel MS. Fluorescence lifetime imaging ophthalmoscopy. Prog Retin Eye Res 2017; 60:120-143. [PMID: 28673870 PMCID: PMC7396320 DOI: 10.1016/j.preteyeres.2017.06.005] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 12/17/2022]
Abstract
Imaging techniques based on retinal autofluorescence have found broad applications in ophthalmology because they are extremely sensitive and noninvasive. Conventional fundus autofluorescence imaging measures fluorescence intensity of endogenous retinal fluorophores. It mainly derives its signal from lipofuscin at the level of the retinal pigment epithelium. Fundus autofluorescence, however, can not only be characterized by the spatial distribution of the fluorescence intensity or emission spectrum, but also by a characteristic fluorescence lifetime function. The fluorescence lifetime is the average amount of time a fluorophore remains in the excited state following excitation. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an emerging imaging modality for in vivo measurement of lifetimes of endogenous retinal fluorophores. Recent reports in this field have contributed to our understanding of the pathophysiology of various macular and retinal diseases. Within this review, the basic concept of fluorescence lifetime imaging is provided. It includes technical background information and correlation with in vitro measurements of individual retinal metabolites. In a second part, clinical applications of fluorescence lifetime imaging and fluorescence lifetime features of selected retinal diseases such as Stargardt disease, age-related macular degeneration, choroideremia, central serous chorioretinopathy, macular holes, diabetic retinopathy, and retinal artery occlusion are discussed. Potential areas of use for fluorescence lifetime imaging ophthalmoscopy will be outlined at the end of this review.
Collapse
Affiliation(s)
- Chantal Dysli
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Mikhail Y Berezin
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Lydia Sauer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Martin Hammer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Martin S Zinkernagel
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| |
Collapse
|
106
|
Insights into autofluorescence patterns in Stargardt macular dystrophy using ultra-wide-field imaging. Graefes Arch Clin Exp Ophthalmol 2017; 255:1917-1922. [DOI: 10.1007/s00417-017-3736-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022] Open
|
107
|
Zhao J, Kim HJ, Sparrow JR. Multimodal Fundus Imaging of Sodium Iodate-Treated Mice Informs RPE Susceptibility and Origins of Increased Fundus Autofluorescence. Invest Ophthalmol Vis Sci 2017; 58:2152-2159. [PMID: 28395299 PMCID: PMC5389744 DOI: 10.1167/iovs.17-21557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose By multimodal imaging, and the use of mouse and in vitro models, we have addressed changes in fundus autofluorescence (488 and 790 nm) and observed interactions between the photooxidative stress imposed by RPE bisretinoid lipofuscin and the oxidative impact of systemic sodium iodate (NaIO3). Methods Abca4−/−, wild-type, and Rpe65rd12 mice were given systemic injections of NaIO3 (30 mg/kg). Analysis included noninvasive imaging of fundus autofluorescence (short-wavelength [SW-AF]; near-infrared excitation [NIR-AF]), quantitative fundus AF (qAF; 488 nm); light microscopy, RPE flat-mounts and measurements of outer nuclear layer (ONL) thickness. NaIO3 also was studied by using in vitro assays. Results In SW-AF and NIR-AF images, fundus mottling was visible 3 and 7 days after NaIO3 injection with changes being more pronounced in Abca4−/− mice that are characterized by an abundance of RPE bisretinoid lipofuscin. In Abca4−/− mice, qAF was elevated 3 and 7 days after NaIO3 administration. In light micrographs and RPE flat-mounts stained to reveal tight junctions (ZO-1) and nuclei, the RPE monolayer was disorganized, and clumping and loss of RPE was visible. ONL thinning was most pronounced in Abca4−/− mice. Treatment of ARPE-19 cells with NaIO3 together with the photooxidation of the bisretinoid A2E by exposure to 430-nm light produced an additive effect whereby loss of cell viability was greater than with either perturbation alone. Conclusions Elevations in SW-AF intensity can occur due to photoreceptor cell dysfunction as induced secondarily by NaIO3. Photooxidative stress associated with RPE cell bisretinoid lipofuscin may confer increased susceptibility to the oxidant NaIO3.
Collapse
Affiliation(s)
- Jin Zhao
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Hye Jin Kim
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States 2Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| |
Collapse
|
108
|
Schuerch K, Woods RL, Lee W, Duncker T, Delori FC, Allikmets R, Tsang SH, Sparrow JR. Quantifying Fundus Autofluorescence in Patients With Retinitis Pigmentosa. Invest Ophthalmol Vis Sci 2017; 58:1843-1855. [PMID: 28358950 PMCID: PMC5377994 DOI: 10.1167/iovs.16-21302] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose Using quantitative fundus autofluorescence (qAF), we analyzed short-wavelength autofluorescent (SW-AF) rings in RP. Methods Short-wavelength autofluorescent images (486 nm excitation) of 40 patients with RP (69 eyes) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference. Mean qAF was measured in eight preset segments (qAF8) and in region of interest (ROI)-qAF (200–700 μm) within and external to the borders of the rings at superior, temporal, and inferior sites relative to the ring. For both groups, qAF in patients with RP was compared to age-similar and race/ethnicity-matched healthy eyes at equivalent retinal locations. Results In 71% of eyes of RP patients, qAF8 acquired internal to the inner border of the ring, was within the 95% confidence interval (CI) for healthy eyes, while in the remaining RP eyes qAF8 was either higher or lower than the CI. Measured external to the ring, qAF8 values were within the CI in 47% of RP eyes with the other eyes being higher or lower. In 28% of sites measured by ROI-qAF within the SW-AF ring, values were above the 95% CI of healthy controls. Region of interest-qAF measured just external to the ring was within the CI of healthy eyes in 74% of locations. The average local elevation in qAF within the ring was approximately 15%. In SD-OCT scans, photoreceptor-attributable reflectivity bands were thinned within and external to the ring. Conclusions Increased fluorophore production may be a factor in the formation of the SW-AF rings in RP.
Collapse
Affiliation(s)
- Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Russell L Woods
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - François C Delori
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
109
|
Lee W, Schuerch K, Xie Y, Zernant J, Tsang SH, Sparrow JR, Allikmets R. Simultaneous Expression of ABCA4 and GPR143 Mutations: A Complex Phenotypic Manifestation. Invest Ophthalmol Vis Sci 2017; 57:3409-15. [PMID: 27367509 PMCID: PMC4961055 DOI: 10.1167/iovs.16-19621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose To describe the complex, overlapping phenotype expressed in a two generation family harboring pathogenic mutations in the ABCA4 and GPR143 genes. Methods Clinical evaluation of a two generation family included quantitative autofluorescence imaging (qAF, 488-nm excitation) using a modified confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference to account for varying laser power detector sensitivity, spectral-domain optical coherence tomography, and full-field ERG testing. Complete sequencing of the ABCA4 and GPR143 genes was carried out in each individual. Results Affected individuals presented with bull's eye lesions and qAF levels above the 95% confidence interval for healthy eyes; full-field ERG revealed no generalized rod dysfunction but mild implicit time delays in cone responses. Complete sequencing of the ABCA4 gene revealed two disease-causing mutations, p.L541P and p.G1961E; and mutational phase was confirmed in each unaffected parent. Further examination in the affected patients revealed a peripheral “mud-splattered” pattern of hypopigmented RPE after which sequencing of GPR143 revealed a novel missense variant, p.Y157C. The GPR143 variant segregated from the father who did not exhibit any indications of retinal disease with the exception of an abnormal near-infrared autofluorescence (NIR-AF) signal distribution in the macula. Conclusions An individual carrying both ABCA4 and GPR143 disease-causing mutations can express a complex, overlapping phenotype associated with both Stargardt disease and X-linked ocular albinism (OA1). The absence of OA1-related disease changes (with the exception of NIR-AF changes associated with melanin distribution) in the father may be indicative of mild expressivity or variable gene penetrance.
Collapse
Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Yajing Xie
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
110
|
Jimenez-Rolando B, Noval S, Rosa-Perez I, Mata Diaz E, Del Pozo A, Ibañez C, Silla JC, Montaño VEF, Martin-Arenas R, Vallespin E. Next generation sequencing in the diagnosis of Stargardt's disease. ACTA ACUST UNITED AC 2017; 93:119-125. [PMID: 28571903 DOI: 10.1016/j.oftal.2017.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/22/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Stargardt's disease is the most frequent form of inherited macular dystrophy in children and adults. It is a genetic eye disorder caused by mutations in ABCA4 gene with an autosomal recessive inheritance. ABCA4 is a very polymorphic and large gene containing 50 exons. The development of next generation sequencing (NGS) can be used for the genetic diagnosis of this disease. PATIENTS AND METHODS A report is presented on two patients with a clinical diagnosis of Stargardt's disease whose genetic confirmation was performed by a NGS panel of 298 genes. RESULTS Clinically, the patients showed bull's eye maculopathy and absence of flecks, and genetically they shared the Gly1961Glu mutation that could explain their common phenotype, together with c.C3056T:p.T1019M for case 1, and c.287del:p.Asn96Thrfs*19 for case 2. CONCLUSIONS NGS is particularly useful in the diagnosis of Stargardt's disease as ABCA4 is a large gene with a high allelic heterogeneity that causes a wide range of clinical manifestations.
Collapse
Affiliation(s)
- B Jimenez-Rolando
- Servicio Oftalmología, Hospital Central de la Cruz Roja, Madrid, España.
| | - S Noval
- Servicio Oftalmología, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - I Rosa-Perez
- Servicio Oftalmología, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - E Mata Diaz
- Servicio Oftalmología, Hospital Central de la Cruz Roja, Madrid, España
| | - A Del Pozo
- Sección de Bioinformática, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| | - C Ibañez
- Sección de Bioinformática, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| | - J C Silla
- Sección de Bioinformática, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| | - V E F Montaño
- Sección de Genómica Estructural y Funcional, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| | - R Martin-Arenas
- Sección de Genómica Estructural y Funcional, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| | - E Vallespin
- Sección de Genómica Estructural y Funcional, Servicio Genética INGEMM-IdiPAZ-CIBERER, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
111
|
Jolly JK, Edwards TL, Moules J, Groppe M, Downes SM, MacLaren RE. A Qualitative and Quantitative Assessment of Fundus Autofluorescence Patterns in Patients With Choroideremia. Invest Ophthalmol Vis Sci 2017; 57:4498-4503. [PMID: 27750291 PMCID: PMC5860725 DOI: 10.1167/iovs.15-18362] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose We set out to characterize the pattern of fundus autofluorescence (AF) loss in choroideremia (CHM) patients of varying ages and disease severity in order to determine the average rate of progression of this potential disease biomarker. Methods Fifty consecutive CHM patients (100 eyes) attending outpatient clinics at Oxford Eye Hospital underwent analysis with the Heidelberg OCT Spectralis with autofluorescence capabilities. The area of residual AF was traced using Heidelberg Eye Explorer. Bland-Altman analysis was used to calculate the coefficient of repeatability (CR). The degree of AF loss was correlated to different ages and the pattern of residual AF constructed into color-coded maps in order to gain insight into the mechanism of disease progression. Results The CR for measurement of AF area is <1%, indicating that a small change is likely to be significant. Correlation of patient age and area of residual AF produced a clinically relevant index of expected anatomic disease. Progression is 7.7% of the residual area each year (95% confidence intervals 7.0%–8.2%) and follows a logarithmic pattern with age (r = 0.95, P < 0.001). From this we derived the mean half-life of AF as 9 years. Qualitatively, the pattern of remaining AF centered on a point temporal to the fovea. Conclusions The area of residual AF in CHM can be measured reproducibly and shows a distinct pattern of loss. The measured residual area is inversely correlated to age. The ratio of the two variables may provide useful information regarding the rate of progression for any one individual at a given point in time.
Collapse
Affiliation(s)
- Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford Biomedical Research Centre, Oxford, United Kingdom 2Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom 3Moorfields Eye Hospital-UCL Institute of Ophthalmology, National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| | - Thomas L Edwards
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford Biomedical Research Centre, Oxford, United Kingdom 2Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Markus Groppe
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Susan M Downes
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford Biomedical Research Centre, Oxford, United Kingdom 2Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford Biomedical Research Centre, Oxford, United Kingdom 2Oxford Eye Hospital, John Radcliffe Hospital, Oxford, United Kingdom 3Moorfields Eye Hospital-UCL Institute of Ophthalmology, National Institute for Health Research Biomedical Research Centre, London, United Kingdom
| |
Collapse
|
112
|
Verdina T, Greenstein VC, Sodi A, Tsang SH, Burke TR, Passerini I, Allikmets R, Virgili G, Cavallini GM, Rizzo S. Multimodal analysis of the Preferred Retinal Location and the Transition Zone in patients with Stargardt Disease. Graefes Arch Clin Exp Ophthalmol 2017; 255:1307-1317. [PMID: 28365912 DOI: 10.1007/s00417-017-3637-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/29/2016] [Accepted: 03/13/2017] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of our study was to investigate morpho-functional features of the preferred retinal location (PRL) and the transition zone (TZ) in a series of patients with recessive Stargardt disease (STGD1). METHODS Fifty-two STGD1 patients with at least one ABCA4 mutation, atrophy of the central macula (MA) and an eccentric PRL were recruited for the study. Microperimetry, fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) were performed. The location and stability of the PRL along with the associated FAF pattern and visual sensitivities were determined and compared to the underlying retinal structure. RESULTS The mean visual sensitivity of the PRLs for the 52 eyes was 10.76 +/- 3.70 dB. For the majority of eyes, PRLs were associated with intact ellipsoid zone (EZ) bands and qualitatively normal FAF patterns. In 17 eyes (32.7%) the eccentric PRL was located at the edge of the MA. In 35 eyes (67.3%) it was located at varying distances from the border of the MA with a TZ between the PRL and the MA. The TZ was associated with decreased sensitivity values (5.92 +/- 4.69 dB) compared to PRLs (p<0.05), with absence/disruption of the EZ band and abnormal FAF patterns (hyper or hypo-autofluorescence). CONCLUSIONS In STGD1 eccentric PRLs are located away from the border of MA and associated with intact EZ bands and normal FAF. The TZ is characterized by structural and functional abnormalities. The results of multimodal imaging of the PRL and TZ suggest a possible sequence of retinal and functional changes with disease progression that may help in the planning of future therapies; RPE dysfunction appears to be the primary event leading to photoreceptor degeneration and then to RPE loss.
Collapse
Affiliation(s)
- Tommaso Verdina
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy.
| | | | - Andrea Sodi
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Barbara & Donald Jonas Stem Cell & Regenerative Medicine Laboratory, and Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Tomas R Burke
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Ilaria Passerini
- Department of Genetic Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Barbara & Donald Jonas Stem Cell & Regenerative Medicine Laboratory, and Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Gianni Virgili
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - Gian Maria Cavallini
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - Stanislao Rizzo
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| |
Collapse
|
113
|
Lee W, Schuerch K, Zernant J, Collison FT, Bearelly S, Fishman GA, Tsang SH, Sparrow JR, Allikmets R. Genotypic spectrum and phenotype correlations of ABCA4-associated disease in patients of south Asian descent. Eur J Hum Genet 2017; 25:735-743. [PMID: 28327576 DOI: 10.1038/ejhg.2017.13] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 11/09/2022] Open
Abstract
Variants in the ABCA4 gene are the most common cause of juvenile-onset blindness affecting close to 1 in 10 000 people worldwide. Disease severity varies largely according to genotype, which can be specific to ethnic and racial groups. Here we investigate the spectrum of ABCA4 variation and its phenotypic expression in 38 patients of South Asian descent, notably from India, Pakistan, Bangladesh and Sri Lanka. Sequencing of all exons and flanking intronic sequences of ABCA4 revealed disease-causing variants in all patients: 3 in 2.6%, 2 in 81.6% and 1 in 15.8%. Altogether, 36 distinct variants were identified, including 9 previously not described. The most frequent variant c.5882G>A, p.(G1961E) was found in half the patients, the highest ever reported in a single study cohort. The South Asian founder variant c.859-9T>C was identified along with other founder variants ascribed to Danish, Chinese, Mexican and African patients. Patients carrying c.5882G>A, p.(G1961E) exhibited a consistently confined disease phenotype, normal quantitative autofluorescence (qAF) levels and preserved full-field ERG (ffERG) while c.859-9T>C resulted in widespread disease, significantly elevated qAF and reduced to non-detectable ffERG. South Asian patients present with a relatively unique ABCA4 profile comprised of various ethnic founder variants resulting in two or three major retinal phenotypes.
Collapse
Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Frederick T Collison
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | | | - Gerald A Fishman
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| |
Collapse
|
114
|
Teussink MM, Lambertus S, de Mul FF, Rozanowska MB, Hoyng CB, Klevering BJ, Theelen T. Lipofuscin-associated photo-oxidative stress during fundus autofluorescence imaging. PLoS One 2017; 12:e0172635. [PMID: 28235055 PMCID: PMC5325292 DOI: 10.1371/journal.pone.0172635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/07/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Current standards and guidelines aimed at preventing retinal phototoxicity during intentional exposures do not specifically evaluate the contribution of endogenous photosensitizers. However, certain retinal diseases are characterized by abnormal accumulations of potential photosensitizers such as lipofuscin bisretinoids in the retinal pigment epithelium (RPE). We sought to determine these contributions by a numerical assessment of in-vivo photo-oxidative stress during irradiation of RPE lipofuscin. Methods Based on the literature, we calculated the retinal exposure levels, optical filtering of incident radiation by the ocular lens, media, photoreceptors, and RPE melanin, light absorption by lipofuscin, and photochemical effects in the RPE in two situations: exposure to short-wavelength (λ = 488 nm) fundus autofluorescence (SW-AF) excitation light and exposure to indirect (diffuse) sunlight. Results In healthy persons at age 20, 40, and 60, respectively, the rate of oxygen photoconsumption by lipofuscin increases by 1.3, 1.7, and 2.4 fold during SW-AF-imaging as compared to diffuse sunlight. In patients with STGD1 below the age of 30, this rate was 3.3-fold higher compared to age-matched controls during either sunlight or SW-AF imaging. Conclusions Our results suggest that the RPE of patients with STGD1 is generally at increased risk of photo-oxidative stress, while exposure during SW-AF-imaging amplifies this risk. These theoretical results have not yet been verified with in-vivo data due to a lack of sufficiently sensitive in-vivo measurement techniques.
Collapse
Affiliation(s)
- Michel M. Teussink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stanley Lambertus
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frits F. de Mul
- Department of Applied Physics, University of Twente, Enschede, the Netherlands
| | | | - Carel B. Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B. Jeroen Klevering
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas Theelen
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| |
Collapse
|
115
|
Abstract
Fundus autofluorescence (FAF) is a relatively new imaging technique that can be used to study retinal diseases. It provides information on retinal metabolism and health. Several different pathologies can be detected. Peculiar AF alterations can help the clinician to monitor disease progression and to better understand its pathogenesis. In the present article, we review FAF principles and clinical applications.
Collapse
Affiliation(s)
| | | | - Paolo Lanzetta
- Department of Medical and Biological Sciences - Ophthalmology, University of Udine, Udine; Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| |
Collapse
|
116
|
Jolly JK, Wagner SK, Moules J, Gekeler F, Webster AR, Downes SM, MacLaren RE. A Novel Method for Quantitative Serial Autofluorescence Analysis in Retinitis Pigmentosa Using Image Characteristics. Transl Vis Sci Technol 2016; 5:10. [PMID: 27933220 PMCID: PMC5142716 DOI: 10.1167/tvst.5.6.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/13/2016] [Indexed: 01/13/2023] Open
Abstract
Purpose Identifying potential biomarkers for disease progression in retinitis pigmentosa (RP) is highly relevant now that gene therapy and other treatments are in clinical trial. Here we report a novel technique for analysis of short-wavelength autofluorescence (AF) imaging to quantify defined regions of AF in RP patients. Methods Fifty-five–degree AF images were acquired from 12 participants with RP over a 12-month period. Of these, five were identified as having a hyperfluorescent annulus. A standard Cartesian coordinate system was superimposed on images with the fovea as the origin and eight bisecting lines traversing the center at 45 degrees to each other. Spatial extraction software was programmed to highlight pixels corresponding to varying degrees of percentile fluorescence such that the parafoveal AF ring was mapped. Distance between the fovea and midpoint of the AF ring was measured. Percentage of low luminance areas was utilized as a measure of atrophy. Results The hyperfluorescent ring was most accurately mapped using the 70th percentile of fluorescence. Both the AF ring and peripheral hypofluorescence showed robust repeatability at all time points noted (P = 0.93). Conclusions Both a hypofluorescent ring and retinal pigment epithelium atrophy were present on a significant proportion of RP patients and were consistently mapped over a 12-month period. There is potential extrapolation of this methodology to wide-field imaging as well as other retinal dystrophies. This anatomical change may provide a useful anatomical biomarker for assessing treatment end points in RP. Translational Relevance Spatial extraction software can be a valuable tool in the assessment of ophthalmic imaging data.
Collapse
Affiliation(s)
- Jasleen K Jolly
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Siegfried K Wagner
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | | | | | - Andrew R Webster
- Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| | - Susan M Downes
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - Robert E MacLaren
- Nuffield Department of Clinical Neurosciences, Oxford Biomedical Research Centre, University of Oxford, Oxford, UK ; Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK ; Moorfields Eye Hospital-UCL Institute of Ophthalmology NIHR Biomedical Research Centre, London, UK
| |
Collapse
|
117
|
Calvo-Maroto AM, Esteve-Taboada JJ, Domínguez-Vicent A, Pérez-Cambrodí RJ, Cerviño A. Confocal scanning laser ophthalmoscopy versus modified conventional fundus camera for fundus autofluorescence. Expert Rev Med Devices 2016; 13:965-978. [PMID: 27634136 DOI: 10.1080/17434440.2016.1236678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Fundus autofluorescence (FAF) is a noninvasive imaging method to detect fundus endogenous fluorophores, mainly lipofuscin located in the retinal pigment epithelium (RPE). The FAF provides information about lipofuscin distribution and RPE health, and consequently an increased accumulation of lipofuscin has been correlated with ageing and development of certain retinal conditions. Areas covered: An exhaustive literature search in MEDLINE (via OVID) and PUBMED for articles related to ocular FAF in retinal diseases and different devices used for acquiring FAF imaging was conducted. Expert commentary: This review aims to show an overview about autofluorescence in the RPE and the main devices used for acquiring these FAF images. The knowledge of differences in the optical principles, acquisition images and the image post-processing between confocal scanning laser ophthalmoscopy and modified conventional fundus camera will improve the FAF images interpretation when are used as a complementary diagnosis and monitoring tool of retinal diseases.
Collapse
Affiliation(s)
- Ana M Calvo-Maroto
- a Optometry Research Group, Department of Optics & Optometry & Vision Sciences , University of Valencia , Valencia , Spain
| | - Jose J Esteve-Taboada
- a Optometry Research Group, Department of Optics & Optometry & Vision Sciences , University of Valencia , Valencia , Spain
| | - Alberto Domínguez-Vicent
- a Optometry Research Group, Department of Optics & Optometry & Vision Sciences , University of Valencia , Valencia , Spain
| | | | - Alejandro Cerviño
- a Optometry Research Group, Department of Optics & Optometry & Vision Sciences , University of Valencia , Valencia , Spain
| |
Collapse
|
118
|
Kaluzny J, Purta P, Poskin Z, Rogers JD, Fawzi AA. Ex Vivo Confocal Spectroscopy of Autofluorescence in Age-Related Macular Degeneration. PLoS One 2016; 11:e0162869. [PMID: 27631087 PMCID: PMC5024989 DOI: 10.1371/journal.pone.0162869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/30/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigated the autofluorescence (AF) signature of the microscopic features of retina with age-related macular degeneration (AMD) using 488 nm excitation. Methods The globes of four donors with AMD and four age-matched controls were embedded in paraffin and sectioned through the macula. Sections were excited using a 488 nm argon laser, and the AF emission was captured using a laser scanning confocal microscope (496–610 nm, 6 nm resolution). The data cubes were then analyzed to compare peak emission spectra between the AMD and the controls. Microscopic features, including individual lipofuscin and melanolipofuscin granules, Bruch’s Membrane, as well macroscopic features, were considered. Results Overall, the AMD eyes showed a trend of blue-shifted emission peaks compared with the controls. These differences were statistically significant when considering the emission of the combined RPE/Bruch’s Membrane across all the tissue cross-sections (p = 0.02). Conclusions The AF signatures of ex vivo AMD RPE/BrM show blue-shifted emission spectra (488 nm excitation) compared with the control tissue. The magnitude of these differences is small (~4 nm) and highlights the potential challenges of detecting these subtle spectral differences in vivo.
Collapse
Affiliation(s)
- Joel Kaluzny
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Patryk Purta
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Zach Poskin
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Jeremy D Rogers
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| |
Collapse
|
119
|
Tanna P, Strauss RW, Fujinami K, Michaelides M. Stargardt disease: clinical features, molecular genetics, animal models and therapeutic options. Br J Ophthalmol 2016; 101:25-30. [PMID: 27491360 PMCID: PMC5256119 DOI: 10.1136/bjophthalmol-2016-308823] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/20/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023]
Abstract
Stargardt disease (STGD1; MIM 248200) is the most prevalent inherited macular dystrophy and is associated with disease-causing sequence variants in the gene ABCA4. Significant advances have been made over the last 10 years in our understanding of both the clinical and molecular features of STGD1, and also the underlying pathophysiology, which has culminated in ongoing and planned human clinical trials of novel therapies. The aims of this review are to describe the detailed phenotypic and genotypic characteristics of the disease, conventional and novel imaging findings, current knowledge of animal models and pathogenesis, and the multiple avenues of intervention being explored.
Collapse
Affiliation(s)
- Preena Tanna
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Rupert W Strauss
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK.,Departments of Ophthalmology, Medical University Graz and Johannes Kepler University, Linz, Austria
| | - Kaoru Fujinami
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK.,National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Centre, Tokyo, Japan
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| |
Collapse
|
120
|
Gelman R, Smith RT, Tsang SH. DIAGNOSTIC ACCURACY EVALUATION OF VISUAL ACUITY AND FUNDUS AUTOFLUORESCENCE MACULAR GEOGRAPHIC ATROPHY AREA FOR THE DISCRIMINATION OF STARGARDT GROUPS. Retina 2016; 36:1596-601. [PMID: 26818478 PMCID: PMC4961576 DOI: 10.1097/iae.0000000000000960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate diagnostic accuracy of visual acuity and fundus autofluorescence (FAF) macular geographic atrophy (GA) area for the discrimination of autosomal recessive Stargardt groups. METHODS Subjects aged <50 years old with confirmed molecular diagnoses were classified to Groups 1, 2, or 3 according to a full-field electroretinogram reference standard. Diagnostic accuracy of visual acuity and the FAF macular GA area was assessed with generalized estimating equations, receiver operating characteristic curve area under the curve, and support vector machines. RESULTS Ten eyes were classified as Group 1 and 7 as Group 2. The mean log minimum angle resolution (Snellen equivalent) was 0.64 (20/87) for group 1 and 0.96 (20/182) for group 2. Mean FAF macular GA area was 0.96 mm for Group 1 and 3.23 mm for Group 2. The generalized estimating equation analysis showed an 8.3% increase in odds of Group 2 classification with each 0.1-unit increase in log minimum angle resolution and a 24% increase with each 1-mm increase in FAF macular GA area. Multivariate generalized estimating equation analysis showed that only the FAF macular GA area was significant. Area under the curve was 0.79 for log minimum angle resolution and 0.89 for FAF macular GA area. The support vector machine classification accuracy was 71% for log minimum angle resolution and 82% for FAF macular GA area. CONCLUSION Visual acuity and FAF macular GA area had good independent accuracy for the discrimination of groups 1 and 2, indicating that they may serve as useful diagnostic parameters.
Collapse
Affiliation(s)
- Rony Gelman
- Bernard & Shirlee Brown Glaucoma Laboratory and Barbara & Donald Jonas Stem Cell Laboratory, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY
| | - R. Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, NY
| | - Stephen H. Tsang
- Bernard & Shirlee Brown Glaucoma Laboratory and Barbara & Donald Jonas Stem Cell Laboratory, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY
- Institute of Human Nutrition, Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY
| |
Collapse
|
121
|
McGill TJ, Renner LM, Neuringer M. Elevated Fundus Autofluorescence in Monkeys Deficient in Lutein, Zeaxanthin, and Omega-3 Fatty Acids. Invest Ophthalmol Vis Sci 2016; 57:1361-9. [PMID: 27002296 PMCID: PMC4811180 DOI: 10.1167/iovs.15-18596] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We quantified fundus autofluorescence (FAF) in the nonhuman primate retina as a function of age and diets lacking lutein and zeaxanthin (L/Z) and omega-3 fatty acids. Methods Quantitative FAF was measured in a cross-sectional study of rhesus macaques fed a standard diet across the lifespan, and in aged rhesus macaques fed lifelong diets lacking L/Z and providing either adequate or deficient levels of omega-3 fatty acids. Macular FAF images were segmented into multiple regions of interest, and mean gray values for each region were calculated using ImageJ. The resulting FAF values were compared across ages within the standard diet animals, and among diet groups and regions. Results Fundus autofluorescence increased with age in the standard diet animals, and was highest in the perifovea. Monkeys fed L/Z-free diets with either adequate or deficient omega-3 fatty acids had significantly higher FAF overall than age-matched standard diet monkeys. Examined by region, those with adequate omega-3 fatty acids had higher FAF in the fovea and superior regions, while monkeys fed the diet lacking L/Z and omega-3 fatty acids had higher FAF in all regions. Conclusions Diets devoid of L/Z resulted in increased retinal autofluorescence, with the highest values in animals also lacking omega-3 fatty acids. The increase was equivalent to a 12- to 20-year acceleration in lipofuscin accumulation compared to animals fed a standard diet. Together these data add support for the role of these nutrients as important factors in lipofuscin accumulation, retinal aging, and progression of macular disease.
Collapse
Affiliation(s)
- Trevor J McGill
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States 2Department of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon; United States
| | - Lauren M Renner
- Department of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon; United States
| | - Martha Neuringer
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, United States 2Department of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, Oregon; United States
| |
Collapse
|
122
|
Pallitto P, Ablonczy Z, Jones EE, Drake RR, Koutalos Y, Crouch RK, Donello J, Herrmann J. A2E and lipofuscin distributions in macaque retinal pigment epithelium are similar to human. Photochem Photobiol Sci 2016. [PMID: 26223373 DOI: 10.1039/c5pp00170f] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The accumulation of lipofuscin, an autofluorescent aging marker, in the retinal pigment epithelium (RPE) has been implicated in the development of age-related macular degeneration (AMD). Lipofuscin contains several visual cycle byproducts, most notably the bisretinoid N-retinylidene-N-retinylethanolamine (A2E). Previous studies with human donor eyes have shown a significant mismatch between lipofuscin autofluorescence (AF) and A2E distributions. The goal of the current project was to examine this relationship in a primate model with a retinal anatomy similar to that of humans. Ophthalmologically naive young (<10 years., N = 3) and old (>10 years., N = 4) Macaca fascicularis (macaque) eyes, were enucleated, dissected to yield RPE/choroid tissue, and flat-mounted on indium-tin-oxide-coated conductive slides. To compare the spatial distributions of lipofuscin and A2E, fluorescence and mass spectrometric imaging were carried out sequentially on the same samples. The distribution of lipofuscin fluorescence in the primate RPE reflected previously obtained human results, having the highest intensities in a perifoveal ring. Contrarily, A2E levels were consistently highest in the periphery, confirming a lack of correlation between the distributions of lipofuscin and A2E previously described in human donor eyes. We conclude that the mismatch between lipofuscin AF and A2E distributions is related to anatomical features specific to primates, such as the macula, and that this primate model has the potential to fill an important gap in current AMD research.
Collapse
Affiliation(s)
- Patrick Pallitto
- Department of Ophthalmology, Storm Eye Institute, Medical University of South Carolina, USA.
| | | | | | | | | | | | | | | |
Collapse
|
123
|
Garcia MD, Salomao DR, Marmorstein AD, Pulido JS. Histopathologic Findings in the Areas of Orange Pigment Overlying Choroidal Melanomas. Transl Vis Sci Technol 2016; 5:4. [PMID: 27190699 PMCID: PMC4867953 DOI: 10.1167/tvst.5.3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/06/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Orange pigment is an important sign of malignancy in melanocytic tumors. There is a question as to whether the pigment accumulation is inside of macrophages or retinal pigment epithelial (RPE) cells. We investigated which cells are involved with this color alteration. METHODS We examined enucleated specimens from two patients with choroidal melanoma and dense orange pigment on fundus examination. Color fundus and fundus autofluorescence (FAF) photographs were reviewed followed by examination with fluorescent microscopy, electron microscopy, and immunohistochemistry of enucleated eyes for the specific areas corresponding to the orange pigment. RESULTS Orange pigment was observed on color fundus photography and correlated with areas of hyperautofluorescence on FAF. Fluorescent microscopy of sections of the enucleated eyes showed autofluorescence in the RPE, which were most pronounced where there was a localized retinal detachment and reactive hyperplasia of the RPE. Immunohistochemical studies were done with keratin (OSCAR and AE1/AE3) and S-100 stained RPE cells, which still were attached to Bruch's membrane. Histiocytes present in the detached retina stained with anti-CD163 antibody and did not show autofluorescence. Electron microscopy studies of the same areas showed the presence of lipofuscin and melanolipofuscin within the clustered RPE cells. CONCLUSIONS Orange pigment in choroidal melanocytic lesions originates from the RPE cells, rather than macrophages, and is most abundant where there is proliferation of the RPE. TRANSLATIONAL RELEVANCE The orange pigment tumoral biomarker arises and is in the retinal pigment epithelium.
Collapse
Affiliation(s)
- Maria D Garcia
- Department of Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Diva R Salomao
- Department of Anatomic Pathology, , Mayo Clinic, Rochester, MN, USA
| | | | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA ; Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
124
|
Morgan JIW. The fundus photo has met its match: optical coherence tomography and adaptive optics ophthalmoscopy are here to stay. Ophthalmic Physiol Opt 2016; 36:218-39. [PMID: 27112222 PMCID: PMC4963017 DOI: 10.1111/opo.12289] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/20/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE Over the past 25 years, optical coherence tomography (OCT) and adaptive optics (AO) ophthalmoscopy have revolutionised our ability to non-invasively observe the living retina. The purpose of this review is to highlight the techniques and human clinical applications of recent advances in OCT and adaptive optics scanning laser/light ophthalmoscopy (AOSLO) ophthalmic imaging. RECENT FINDINGS Optical coherence tomography retinal and optic nerve head (ONH) imaging technology allows high resolution in the axial direction resulting in cross-sectional visualisation of retinal and ONH lamination. Complementary AO ophthalmoscopy gives high resolution in the transverse direction resulting in en face visualisation of retinal cell mosaics. Innovative detection schemes applied to OCT and AOSLO technologies (such as spectral domain OCT, OCT angiography, confocal and non-confocal AOSLO, fluorescence, and AO-OCT) have enabled high contrast between retinal and ONH structures in three dimensions and have allowed in vivo retinal imaging to approach that of histological quality. In addition, both OCT and AOSLO have shown the capability to detect retinal reflectance changes in response to visual stimuli, paving the way for future studies to investigate objective biomarkers of visual function at the cellular level. Increasingly, these imaging techniques are being applied to clinical studies of the normal and diseased visual system. SUMMARY Optical coherence tomography and AOSLO technologies are capable of elucidating the structure and function of the retina and ONH noninvasively with unprecedented resolution and contrast. The techniques have proven their worth in both basic science and clinical applications and each will continue to be utilised in future studies for many years to come.
Collapse
Affiliation(s)
- Jessica I W Morgan
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
125
|
Müller PL, Gliem M, Mangold E, Bolz HJ, Finger RP, McGuinness M, Betz C, Jiang Z, Weber BHF, MacLaren RE, Holz FG, Radu RA, Charbel Issa P. Monoallelic ABCA4 Mutations Appear Insufficient to Cause Retinopathy: A Quantitative Autofluorescence Study. Invest Ophthalmol Vis Sci 2016; 56:8179-86. [PMID: 26720470 DOI: 10.1167/iovs.15-17629] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the effect of ABCA4 mutation status on lipofuscin-related quantitative autofluorescence (qAF) in humans and on bisretinoid accumulation in mice. METHODS Genotyped parents (n = 26; age 37-64 years) of patients with biallelic ABCA4-related retinopathy underwent in-depth retinal phenotyping including qAF imaging as a surrogate measure for RPE lipofuscin accumulation. In addition, bisretinoids as the main components of autofluorescent lipofuscin at the ocular fundus were quantified in Abca4-/-, Abca4+/-, and wild-type mice. RESULTS Index patients showed a retinal phenotype characteristic for ABCA4-related retinopathy, including increased qAF levels. In contrast, qAF measures in carriers of only one ABCA4 mutation were not different from age-matched controls in this sample, and there was no difference between truncating and missense mutations. Also, none of these carriers presented an abnormal phenotype on conventional imaging. One parent with ABCA4-related retinopathy and increased qAF carried an additional ABCA4 mutation, explaining the phenotype under a recessive disease model (pseudodominance). Biochemical analysis in the mouse model revealed direct downstream products (A2PE-H2, at-RALdimer-PE) of the ABCA4 substrate N-Ret-PE to be similar in wild-type and Abca4+/- mice. Both bisretinoids were 12- to 18-fold increased in Abca4-/- mice. Levels of A2E and A2PE in Abca4+/- mice were in between those measured in wild-type and Abca4-/- mice. CONCLUSIONS This study indicates that carriers of monoallelic ABCA4 mutations are phenotypically normal. However, biochemical analysis in the Abca4-deficient mouse model suggests detectable effects of one mutation in ABCA4 on the molecular level. The findings may have implications for therapeutic approaches such as gene replacement therapy.
Collapse
Affiliation(s)
- Philipp L Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany 2Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany
| | - Martin Gliem
- Department of Ophthalmology, University of Bonn, Bonn, Germany 2Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany
| | | | - Hanno J Bolz
- Bioscientia Center for Human Genetics, Ingelheim, Germany 5Institute of Human Genetics, University Hospital of Cologne, Cologne, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany 6Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Myra McGuinness
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Christian Betz
- Bioscientia Center for Human Genetics, Ingelheim, Germany
| | - Zhichun Jiang
- Stein Eye Institute, Department of Ophthalmology, University of California-Los Angeles School of Medicine, Los Angeles, California, United States
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Robert E MacLaren
- The Nuffield Laboratory of Ophthalmology & Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany 2Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany
| | - Roxana A Radu
- Stein Eye Institute, Department of Ophthalmology, University of California-Los Angeles School of Medicine, Los Angeles, California, United States
| | - Peter Charbel Issa
- Department of Ophthalmology, University of Bonn, Bonn, Germany 2Center for Rare Diseases Bonn (ZSEB), University Hospital of Bonn, Bonn, Germany
| |
Collapse
|
126
|
Yung M, Klufas MA, Sarraf D. Clinical applications of fundus autofluorescence in retinal disease. Int J Retina Vitreous 2016; 2:12. [PMID: 27847630 PMCID: PMC5088473 DOI: 10.1186/s40942-016-0035-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/15/2016] [Indexed: 12/30/2022] Open
Abstract
Fundus autofluorescence (FAF) is a non-invasive retinal imaging modality used in clinical practice to provide a density map of lipofuscin, the predominant ocular fluorophore, in the retinal pigment epithelium. Multiple commercially available imaging systems, including the fundus camera, the confocal scanning laser ophthalmoscope, and the ultra-widefield imaging device, are available to the clinician. Each offers unique advantages for evaluating various retinal diseases. The clinical applications of FAF continue to expand. It is now an essential tool for evaluating age related macular degeneration, macular dystrophies, retinitis pigmentosa, white dot syndromes, retinal drug toxicities, and various other retinal disorders. FAF may detect abnormalities beyond those detected on funduscopic exam, fluorescein angiography, or optical coherence tomography, and can be used to elucidate disease pathogenesis, form genotype-phenotype correlations, diagnose and monitor disease, and evaluate novel therapies. Given its ease of use, non-invasive nature, and value in characterizing retinal disease, FAF enjoys increasing clinical relevance. This review summarizes common ocular fluorophores, imaging modalities, and FAF findings for a wide spectrum of retinal disorders.
Collapse
Affiliation(s)
- Madeline Yung
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
| | - Michael A. Klufas
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
- Greater Los Angeles VA Healthcare Center, Los Angeles, CA 90024 USA
| |
Collapse
|
127
|
Armenti ST, Greenberg JP, Smith RT. Quantitative Fundus Autofluorescence for the Evaluation of Retinal Diseases. J Vis Exp 2016. [PMID: 27023389 DOI: 10.3791/53577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The retinal pigment epithelium (RPE) is juxtaposed to the overlying sensory retina, and supports the function of the visual system. Among the tasks performed by the RPE are phagocytosis and processing of outer photoreceptor segments through lysosome-derived organelles. These degradation products, stored and referred to as lipofuscin granules, are composed partially of bisretinoids, which have broad fluorescence absorption and emission spectra that can be detected clinically as fundus autofluorescence with confocal scanning laser ophthalmoscopy (cSLO). Lipofuscin accumulation is associated with increasing age, but is also found in various patterns in both acquired and inherited degenerative diseases of the retina. Thus, studying its pattern of accumulation and correlating such patterns with changes in the overlying sensory retina are essential to understanding the pathophysiology and progression of retinal disease. Here, we describe a technique employed by our lab and others that uses cSLO in order to quantify the level of RPE lipofuscin in both healthy and diseased eyes.
Collapse
|
128
|
Duncker T, Stein GE, Lee W, Tsang SH, Zernant J, Bearelly S, Hood DC, Greenstein VC, Delori FC, Allikmets R, Sparrow JR. Quantitative Fundus Autofluorescence and Optical Coherence Tomography in ABCA4 Carriers. Invest Ophthalmol Vis Sci 2016; 56:7274-85. [PMID: 26551331 DOI: 10.1167/iovs.15-17371] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess whether carriers of ABCA4 mutations have increased RPE lipofuscin levels based on quantitative fundus autofluorescence (qAF) and whether spectral-domain optical coherence tomography (SD-OCT) reveals structural abnormalities in this cohort. METHODS Seventy-five individuals who are heterozygous for ABCA4 mutations (mean age, 47.3 years; range, 9-82 years) were recruited as family members of affected patients from 46 unrelated families. For comparison, 57 affected family members with biallelic ABCA4 mutations (mean age, 23.4 years; range, 6-67 years) and two noncarrier siblings were also enrolled. Autofluorescence images (30°, 488-nm excitation) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference. The gray levels (GLs) of each image were calibrated to the reference, zero GL, magnification, and normative optical media density to yield qAF. Horizontal SD-OCT scans through the fovea were obtained and the thicknesses of the outer retinal layers were measured. RESULTS In 60 of 65 carriers of ABCA4 mutations (age range, 9-60), qAF levels were within normal limits (95% confidence level) observed for healthy noncarrier subjects, while qAF levels of affected family members were significantly increased. Perifoveal fleck-like abnormalities were observed in fundus AF images in four carriers, and corresponding changes were detected in the outer retinal layers in SD-OCT scans. Thicknesses of the outer retinal layers were within the normal range. CONCLUSIONS With few exceptions, individuals heterozygous for ABCA4 mutations and between the ages of 9 and 60 years do not present with elevated qAF. In a small number of carriers, perifoveal fleck-like changes were visible.
Collapse
Affiliation(s)
- Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Gregory E Stein
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Donald C Hood
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Psychology, Columbia University, New York, New York, United States
| | | | - François C Delori
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
129
|
Bowrey HE, Anderson DM, Pallitto P, Gutierrez DB, Fan J, Crouch RK, Schey KL, Ablonczy Z. Imaging mass spectrometry of the visual system: Advancing the molecular understanding of retina degenerations. Proteomics Clin Appl 2016; 10:391-402. [PMID: 26586164 DOI: 10.1002/prca.201500103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 08/15/2015] [Accepted: 11/11/2015] [Indexed: 11/08/2022]
Abstract
Visual sensation is fundamental for quality of life, and loss of vision to retinal degeneration is a debilitating condition. The eye is the only part of the central nervous system that can be noninvasively observed with optical imaging. In the clinics, various spectroscopic methods provide high spatial resolution images of the fundus and the developing degenerative lesions. However, the currently utilized tools are not specific enough to establish the molecular underpinnings of retinal diseases. In contrast, mass spectrometric imaging (MSI) is a powerful tool to identify molecularly specific disease indicators and classification markers. This technique is particularly well suited to the eye, where molecular information can be correlated with clinical data collected via noninvasive diagnostic imaging modalities. Recent studies during the last few recent years have uncovered a plethora of new spatially defined molecular information on several vision-threatening diseases, including age-related macular degeneration, Stargardt disease, glaucoma, cataract, as well as lipid disorders. Even though MS inside the eye cannot be performed noninvasively, by linking diagnostic and molecular information, these studies are the first step toward the development of smart ophthalmic diagnostic and surgical tools. Here, we provide an overview of current approaches applying MSI technology to ocular pathology.
Collapse
Affiliation(s)
- Hannah E Bowrey
- Brain Health Institute, Rutgers University, New Brunswick, NJ, USA
| | - David M Anderson
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Patrick Pallitto
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Danielle B Gutierrez
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jie Fan
- Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA
| | - Rosalie K Crouch
- Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA
| | - Kevin L Schey
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Zsolt Ablonczy
- Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
130
|
|
131
|
Duncker T, Tsang SH, Woods RL, Lee W, Zernant J, Allikmets R, Delori FC, Sparrow JR. Quantitative Fundus Autofluorescence and Optical Coherence Tomography in PRPH2/RDS- and ABCA4-Associated Disease Exhibiting Phenotypic Overlap. Invest Ophthalmol Vis Sci 2015; 56:3159-70. [PMID: 26024099 DOI: 10.1167/iovs.14-16343] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess whether quantitative fundus autofluorescence (qAF), a measure of RPE lipofuscin, and spectral-domain optical coherence tomography (SD-OCT) can aid in the differentiation of patients with fundus features that could either be related to ABCA4 mutations or be part of the phenotypic spectrum of pattern dystrophies. METHODS Autofluorescence images (30°, 488-nm excitation) from 39 patients (67 eyes) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference and were quantified as previously described. In addition, horizontal SD-OCT images through the fovea were obtained. Patients were screened for ABCA4 and PRPH2/RDS mutations. RESULTS ABCA4 mutations were identified in 19 patients (mean age, 37 ± 12 years) and PRPH2/RDS mutations in 8 patients (mean age, 48 ± 13 years); no known ABCA4 or PRPH2/RDS mutations were found in 12 patients (mean age, 48 ± 9 years). Differentiation of the groups using phenotypic SD-OCT and AF features (e.g., peripapillary sparing, foveal sparing) was not reliable. However, patients with ABCA4 mutations could be discriminated reasonably well from other patients when qAF values were corrected for age and race. In general, ABCA4 patients had higher qAF values than PRPH2/RDS patients, while most patients without mutations in PRPH2/RDS or ABCA4 had qAF levels within the normal range. CONCLUSIONS The high qAF levels of ABCA4-positive patients are a hallmark of ABCA4-related disease. The reason for high qAF among many PRPH2/RDS-positive patients is not known; higher RPE lipofuscin accumulation may be a primary or secondary effect of the PRPH2/RDS mutation.
Collapse
Affiliation(s)
- Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Russell L Woods
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - François C Delori
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
132
|
Sparrow JR, Marsiglia M, Allikmets R, Tsang S, Lee W, Duncker T, Zernant J. Flecks in Recessive Stargardt Disease: Short-Wavelength Autofluorescence, Near-Infrared Autofluorescence, and Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2015; 56:5029-39. [PMID: 26230768 DOI: 10.1167/iovs.15-16763] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We evaluated the incongruous observation whereby flecks in recessive Stargardt disease (STGD1) can exhibit increased short-wavelength autofluorescence (SW-AF) that originates from retinal pigment epithelium (RPE) lipofuscin, while near-infrared AF (NIR-AF), emitted primarily from RPE melanin, is usually reduced or absent at fleck positions. METHODS Flecks in SW- and NIR-AF images and spectral-domain optical coherence tomography (SD-OCT) scans were studied in 19 STGD1 patients carrying disease-causing ABCA4 mutations. Fleck spatial distribution and progression were recorded in serial AF images. RESULTS Flecks observed in SW-AF images typically colocalized with darkened foci in NIR-AF images; the NIR-AF profiles were larger. The decreased NIR-AF signal from flecks preceded apparent changes in SW-AF. Spatiotemporal changes in fleck distribution usually progressed centrifugally, but in one case centripetal expansion was observed. Flecks in SW-AF images corresponded to hyperreflective deposits that progressively traversed photoreceptor-attributable bands in SD-OCT images. Outer nuclear layer (ONL) thickness negatively correlated with expansion of flecks from outer to inner retina. CONCLUSIONS In the healthy retina, RPE lipofuscin fluorophores form in photoreceptor cells but are transferred to RPE; thus the SW-AF signal from photoreceptor cells is negligible. In STGD1, NIR-AF imaging reveals that flecks are predominantly hypofluorescent and larger and that NIR-AF darkening occurs prior to heightened SW-AF signal. These observations indicate that RPE cells associated with flecks in STGD1 are considerably changed or lost. Spectral-domain OCT findings are indicative of ongoing photoreceptor cell degeneration. The bright SW-AF signal of flecks likely originates from augmented lipofuscin formation in degenerating photoreceptor cells impaired by the failure of RPE.
Collapse
Affiliation(s)
- Janet R Sparrow
- Department of Ophthalmology Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Marcela Marsiglia
- Department of Ophthalmology Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Stephen Tsang
- Department of Ophthalmology Columbia University, New York, New York, United States 2Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology Columbia University, New York, New York, United States
| | - Tobias Duncker
- Department of Ophthalmology Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology Columbia University, New York, New York, United States
| |
Collapse
|
133
|
Cideciyan AV, Swider M, Jacobson SG. Autofluorescence imaging with near-infrared excitation:normalization by reflectance to reduce signal from choroidal fluorophores. Invest Ophthalmol Vis Sci 2015; 56:3393-406. [PMID: 26024124 DOI: 10.1167/iovs.15-16726] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We previously developed reduced-illuminance autofluorescence imaging (RAFI) methods involving near-infrared (NIR) excitation to image melanin-based fluorophores and short-wavelength (SW) excitation to image lipofuscin-based flurophores. Here, we propose to normalize NIR-RAFI in order to increase the relative contribution of retinal pigment epithelium (RPE) fluorophores. METHODS Retinal imaging was performed with a standard protocol holding system parameters invariant in healthy subjects and in patients. Normalized NIR-RAFI was derived by dividing NIR-RAFI signal by NIR reflectance point-by-point after image registration. RESULTS Regions of RPE atrophy in Stargardt disease, AMD, retinitis pigmentosa, choroideremia, and Leber congenital amaurosis as defined by low signal on SW-RAFI could correspond to a wide range of signal on NIR-RAFI depending on the contribution from the choroidal component. Retinal pigment epithelium atrophy tended to always correspond to high signal on NIR reflectance. Normalizing NIR-RAFI reduced the choroidal component of the signal in regions of atrophy. Quantitative evaluation of RPE atrophy area showed no significant differences between SW-RAFI and normalized NIR-RAFI. CONCLUSIONS Imaging of RPE atrophy using lipofuscin-based AF imaging has become the gold standard. However, this technique involves bright SW lights that are uncomfortable and may accelerate the rate of disease progression in vulnerable retinas. The NIR-RAFI method developed here is a melanin-based alternative that is not absorbed by opsins and bisretinoid moieties, and is comfortable to view. Further development of this method may result in a nonmydriatic and comfortable imaging method to quantify RPE atrophy extent and its expansion rate.
Collapse
|
134
|
Ach T, Tolstik E, Messinger JD, Zarubina AV, Heintzmann R, Curcio CA. Lipofuscin redistribution and loss accompanied by cytoskeletal stress in retinal pigment epithelium of eyes with age-related macular degeneration. Invest Ophthalmol Vis Sci 2015; 56:3242-52. [PMID: 25758814 DOI: 10.1167/iovs.14-16274] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Lipofuscin (LF) and melanolipofuscin (MLF) of the retinal pigment epithelium (RPE) are the principal sources of autofluorescence (AF) signals in clinical fundus-AF imaging. Few details about the subcellular distribution of AF organelles in AMD are available. We describe the impact of aging and AMD on RPE morphology revealed by the distribution of AF LF/MLF granules and actin cytoskeleton in human tissues. METHODS Thirty-five RPE-Bruch's membrane flatmounts from 35 donors were prepared (postmortem: ≤4 hours). Ex vivo fundus examination at the time of accession revealed either absence of chorioretinal pathologies (10 tissues; mean age: 83.0 ± 2.6 years) or stages of AMD (25 tissues; 85.0 ± 5.8 years): early AMD, geographic atrophy, and late exudative AMD. Retinal pigment epithelium cytoskeleton was labeled with AlexaFluor647-Phalloidin. Tissues were imaged on a spinning-disk fluorescence microscope and a high-resolution structured illumination microscope. RESULTS Age-related macular degeneration impacts individual RPE cells by (1) lipofuscin redistribution by (i) degranulation (granule-by-granule loss) and/or (ii) aggregation and apparent shedding into the extracellular space; (2) enlarged RPE cell area and conversion from convex to irregular and sometimes concave polygons; and (3) cytoskeleton derangement including separations and breaks around subretinal deposits, thickening, and stress fibers. CONCLUSIONS We report an extensive and systematic en face analysis of LF/MLF-AF in AMD eyes. Redistribution and loss of AF granules are among the earliest AMD changes and could reduce fundus AF signal attributable to RPE at these locations. Data can enhance the interpretation of clinical fundus-AF and provide a basis for future quantitative studies.
Collapse
Affiliation(s)
- Thomas Ach
- University of Alabama at Birmingham Department of Ophthalmology, Birmingham, Alabama, United States 2University Hospital Würzburg, Department of Ophthalmology, Würzburg, Germany
| | - Elen Tolstik
- Leibniz Institute of Photonic Technology, Jena, Germany 5King's College London, Randall Division of Cell & Molecular Biophysics, London, United Kingdom
| | - Jeffrey D Messinger
- University of Alabama at Birmingham Department of Ophthalmology, Birmingham, Alabama, United States
| | - Anna V Zarubina
- University of Alabama at Birmingham Department of Ophthalmology, Birmingham, Alabama, United States
| | - Rainer Heintzmann
- Leibniz Institute of Photonic Technology, Jena, Germany 5King's College London, Randall Division of Cell & Molecular Biophysics, London, United Kingdom
| | - Christine A Curcio
- University of Alabama at Birmingham Department of Ophthalmology, Birmingham, Alabama, United States
| |
Collapse
|
135
|
Greenstein VC, Schuman AD, Lee W, Duncker T, Zernant J, Allikmets R, Hood DC, Sparrow JR. Near-infrared autofluorescence: its relationship to short-wavelength autofluorescence and optical coherence tomography in recessive stargardt disease. Invest Ophthalmol Vis Sci 2015; 56:3226-34. [PMID: 26024107 DOI: 10.1167/iovs.14-16050] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE We compared hypoautofluorescent (hypoAF) areas detected with near-infrared (NIR-AF) and short-wavelength autofluorescence (SW-AF) in patients with recessive Stargardt disease (STGD1) to retinal structure using spectral domain optical coherence tomography (SD-OCT). METHODS The SD-OCT volume scans, and SW-AF and NIR-AF images were obtained from 15 eyes of 15 patients with STGD1 and registered to each other. Thickness maps of the total retina, receptor-plus layer (R+, from distal border of the RPE to outer plexiform/inner nuclear layer boundary), and outer segment-plus layer (OS+, from distal border of the RPE to ellipsoid zone [EZ] band) were created from SD-OCT scans. These were compared qualitatively and quantitatively to the hypoAF areas in SW-AF and NIR-AF images. RESULTS All eyes showed a hypoAF area in the central macula and loss of the EZ band in SD-OCT scans. The hypoAF area was larger in NIR than SW-AF images and it exceeded the area of EZ band loss for 12 eyes. The thickness maps showed progressive thinning towards the central macula, with the OS+ layer showing the most extensive and severe thinning. The central hypoAF areas on NIR corresponded to the OS+ thinned areas, while the hypoAF areas on SW-AF corresponded to the R+ thinned areas. CONCLUSIONS Since the larger hypoAF area on NIR-AF exceeded the region of EZ band loss, and corresponded to the OS+ thinned area, RPE cell loss occurred before photoreceptor cell loss. The NIR-AF imaging may be an effective tool for following progression and predicting loss of photoreceptors in STGD1.
Collapse
Affiliation(s)
| | - Ari D Schuman
- Columbia College, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States 3Department of Ophthalmology, Charité University Medicine, Berlin, Germany
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States 4Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Donald C Hood
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States 4Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
136
|
Nõupuu K, Lee W, Zernant J, Greenstein VC, Tsang S, Allikmets R. Recessive Stargardt disease phenocopying hydroxychloroquine retinopathy. Graefes Arch Clin Exp Ophthalmol 2015; 254:865-72. [PMID: 26311262 DOI: 10.1007/s00417-015-3142-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe a series of patients with Stargardt disease (STGD1) exhibiting a phenotype usually associated with hydroxychloroquine (HCQ) retinopathy on spectral domain-optical coherence tomography (SD-OCT). METHODS Observational case series from Columbia University Medical Center involving eight patients with genetically-confirmed STGD1. Patients selected for the study presented no history of HCQ use. Horizontal macular SD-OCT scans and accompanying 488-nm autofluorescence (AF) images, color fundus photographs, and full-field electroretinograms were analyzed. RESULTS All study patients exhibited an abrupt thinning of the parafoveal region or disruption of the outer retinal layers on SD-OCT resembling the transient HCQ retinopathy phenotype. Funduscopy and AF imaging revealed variations of bull's eye maculopathy (BEM). Five patients exhibited local fleck-like deposits around the lesion. Genetic screening confirmed two disease-causing ABCA4 mutations in five patients and one mutation in three patients. CONCLUSIONS A transient SD-OCT phenotype ascribed to patients with HCQ retinopathy is associated with an early subtype of STGD1. This finding may also present with HCQ retinopathy-like BEM lesions on AF imaging and funduscopy. A possible phenotypic overlap is unsurprising, given certain shared mechanistic disease processes between the two conditions. A thorough work-up, including screening of genes that are causal in retinal dystrophies associated with foveal sparing, may prevent misdiagnosis of more ambiguous cases.
Collapse
Affiliation(s)
- Kalev Nõupuu
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA.,Department of Ophthalmology, University of Tartu, Tartu, Estonia
| | - Winston Lee
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA
| | - Vivienne C Greenstein
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA
| | - Stephen Tsang
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA.,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, Eye Research Annex Rm 202, 160 Ft Washington Ave, New York, NY, 10032, USA. .,Department of Pathology & Cell Biology, Columbia University, New York, NY, USA.
| |
Collapse
|
137
|
Teussink MM, Lee MD, Smith RT, van Huet RA, Klaver CC, Klevering BJ, Theelen T, Hoyng CB. The effect of light deprivation in patients with Stargardt disease. Am J Ophthalmol 2015; 159:964-72.e2. [PMID: 25681002 DOI: 10.1016/j.ajo.2015.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/02/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether long-term protection from light exposure affects the rate of disease progression in patients with autosomal recessive Stargardt disease (STGD1), measured using fundus autofluorescence imaging. DESIGN Longitudinal, retrospective, interventional case series. METHODS Five patients with Stargardt disease protected 1 eye from light exposure by applying a black contact lens during waking hours for ≥12 months. Disease progression was followed by performing autofluorescence imaging at semi-regular intervals. Longitudinal changes in autofluorescence were studied by evaluating areas of decreased autofluorescence and areas of increased autofluorescence as a measure of retinal pigment epithelium damage and lipofuscin accumulation, respectively. RESULTS We observed less progression of decreased autofluorescence in 4 out of 5 light-protected eyes relative to their respective nonprotected eyes. The progression of increased autofluorescence, on the other hand, was highly variable and did not respond consistently to treatment. CONCLUSIONS Areas of decreased autofluorescence may serve as a useful biomarker for measuring the progression of Stargardt disease. The reduced progression of decreased autofluorescence in the light-protected eyes suggests that light deprivation might be beneficial in patients with Stargardt disease.
Collapse
|
138
|
Marsiglia M, Lee W, Mahajan VB, Zernant J, Delori FC, Tsang SH, Sparrow JR. Quantitative autofluorescence as a clinical tool for expedited differential diagnosis of retinal degeneration. JAMA Ophthalmol 2015; 133:219-20. [PMID: 25375877 DOI: 10.1001/jamaophthalmol.2014.4507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Marcela Marsiglia
- Department of Ophthalmology, Columbia University, New York, New York
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York
| | - Vinit B Mahajan
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York
| | - François C Delori
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts4Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York
| |
Collapse
|
139
|
Duncker T, Marsiglia M, Lee W, Zernant J, Tsang SH, Allikmets R, Greenstein VC, Sparrow JR. Correlations among near-infrared and short-wavelength autofluorescence and spectral-domain optical coherence tomography in recessive Stargardt disease. Invest Ophthalmol Vis Sci 2014; 55:8134-43. [PMID: 25342616 DOI: 10.1167/iovs.14-14848] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Short-wavelength (SW) fundus autofluorescence (AF) is considered to originate from lipofuscin in retinal pigment epithelium (RPE) and near-infrared (NIR) AF from melanin. In patients with recessive Stargardt disease (STGD1), we correlated SW-AF and NIR-AF with structural information obtained by spectral-domain optical coherence tomography (SD-OCT). METHODS Twenty-four STGD1 patients (45 eyes; age 8 to 61 years) carrying confirmed disease-associated ABCA4 mutations were studied prospectively. Short-wavelength AF, NIR-AF, and SD-OCT images were acquired. RESULTS Five phenotypes were identified according to features of the central lesion and extent of fundus change. Central zones of reduced NIR-AF were typically larger than areas of diminished SW-AF and reduced NIR-AF usually approximated areas of ellipsoid zone (EZ) loss identified by SD-OCT (group 1; r, 0.93, P < 0.0001). In patients having a central lesion with overlapping parafoveal rings of increased NIR-AF and SW-AF (group 3), the extent of EZ loss was strongly correlated with the inner diameter of the NIR-AF ring (r, 0.89, P < 0.0001) and the eccentricity of the outer border of the NIR-AF ring was greater than that of the SW-AF ring. CONCLUSIONS Lesion areas were more completely delineated in NIR-AF images than with SW-AF. In most cases, EZ loss was observed only at locations where NIR-AF was reduced or absent, indicating that RPE cell atrophy occurs in advance of photoreceptor cell degeneration. Because SW-AF was often increased within the central area of EZ disruption, degenerating photoreceptor cells may produce lipofuscin at accelerated levels. Consideration is given to mechanisms underlying hyper-NIR-AF in conjunction with increased SW-AF.
Collapse
Affiliation(s)
- Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany
| | - Marcela Marsiglia
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| | | | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology and Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|
140
|
Duncker T, Tsang SH, Lee W, Zernant J, Allikmets R, Delori FC, Sparrow JR. Quantitative fundus autofluorescence distinguishes ABCA4-associated and non-ABCA4-associated bull's-eye maculopathy. Ophthalmology 2014; 122:345-55. [PMID: 25283059 DOI: 10.1016/j.ophtha.2014.08.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Quantitative fundus autofluorescence (qAF) and spectral-domain optical coherence tomography (SD OCT) were performed in patients with bull's-eye maculopathy (BEM) to identify phenotypic markers that can aid in the differentiation of ABCA4-associated and non-ABCA4-associated disease. DESIGN Prospective cross-sectional study at an academic referral center. SUBJECTS Thirty-seven BEM patients (age range, 8-60 years) were studied. All patients exhibited a localized macular lesion exhibiting a smooth contour and qualitatively normal-appearing surrounding retina without flecks. Control values consisted of previously published data from 277 healthy subjects (374 eyes; age range, 5-60 years) without a family history of retinal dystrophy. METHODS Autofluorescence (AF) images (30°, 488-nm excitation) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference to account for variable laser power and detector sensitivity. The grey levels (GLs) from 8 circularly arranged segments positioned at an eccentricity of approximately 7° to 9° in each image were calibrated to the reference (0 GL), magnification, and normative optical media density to yield qAF. In addition, horizontal SD OCT images through the fovea were obtained. All patients were screened for ABCA4 mutations using the ABCR600 microarray, next-generation sequencing, or both. MAIN OUTCOME MEASURES Quantitative AF, correlations between AF and SD OCT, and genotyping for ABCA4 variants. RESULTS ABCA4 mutations were identified in 22 patients, who tended to be younger (mean age, 21.9±8.3 years) than patients without ABCA4 mutations (mean age, 42.1±14.9 years). Whereas phenotypic differences were not obvious on the basis of qualitative fundus AF and SD OCT imaging, with qAF, the 2 groups of patients were clearly distinguishable. In the ABCA4-positive group, 37 of 41 eyes (19 of 22 patients) had qAF8 of more than the 95% confidence interval for age. Conversely, in the ABCA4-negative group, 22 of 26 eyes (13 of 15 patients) had qAF8 within the normal range. CONCLUSIONS The qAF method can differentiate between ABCA4-associated and non-ABCA4-associated BEM and may guide clinical diagnosis and genetic testing.
Collapse
Affiliation(s)
- Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York; Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York; Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - François C Delori
- Schepens Eye Research Institute and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York; Department of Pathology and Cell Biology, Columbia University, New York, New York.
| |
Collapse
|
141
|
Lee W, Nõupuu K, Oll M, Duncker T, Burke T, Zernant J, Bearelly S, Tsang SH, Sparrow JR, Allikmets R. The external limiting membrane in early-onset Stargardt disease. Invest Ophthalmol Vis Sci 2014; 55:6139-49. [PMID: 25139735 DOI: 10.1167/iovs.14-15126] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To describe pathologic changes of the external limiting membrane (ELM) in young patients with early-onset Stargardt (STGD1) disease. METHODS Twenty-six STGD1 patients aged younger than 20 years with confirmed disease-causing adenosine triphosphate-binding cassette, subfamily A, member 4 (ABCA4) alleles and 30 age-matched unaffected individuals were studied. Spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence (AF), and color fundus photography (CFP) images, as well as full-field electroretinograms were obtained and analyzed for one to four visits in each patient. RESULTS The ELM in all patients exhibited a distinct thickening that was not observed in unaffected individuals. In addition, accumulations of reflective deposits were noted in the outer nuclear layer in every patient. Four patients exhibited a concave protuberance or bulging of a thickened and hyperreflective ELM band within the fovea containing preserved photoreceptors. Longitudinal SD-OCT data in several patients revealed the persistence of this ELM abnormality over a period of time (1-4 years). Furthermore, the edges of the inner segment ellipsoid band appeared to recede earlier than the ELM band in active lesions. CONCLUSIONS Structural changes seen in the ELM of this cohort may reflect a gliotic response to cellular stress at the photoreceptor level in early-onset STGD1.
Collapse
Affiliation(s)
- Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Kalev Nõupuu
- Department of Ophthalmology, Columbia University, New York, New York, United States Eye Clinic, Tartu University Hospital, Tartu, Estonia
| | - Maris Oll
- Department of Ophthalmology, Columbia University, New York, New York, United States Eye Clinic, Tartu University Hospital, Tartu, Estonia
| | - Tobias Duncker
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Tomas Burke
- Department of Ophthalmology, Royal United Hospital, Bath, United Kingdom
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Srilaxmi Bearelly
- Department of Ophthalmology, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, New York, United States Department of Pathology & Cell Biology, Columbia University, New York, New York, United States
| |
Collapse
|