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Wada N, Takagi S, Yoshikawa A, Itokawa T, Maruyama T, Hori Y. Multimodal Imaging of Optic Nerve Head in Retinitis Pigmentosa. Semin Ophthalmol 2024; 39:480-487. [PMID: 38851891 DOI: 10.1080/08820538.2024.2363849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND A pallor optic nerve head (ONH) is one of the three features of retinitis pigmentosa (RP). This study aimed to assess the ONH prospectively by color tone, presence of hyper-reflective tissue, blood flow, retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) and investigate the change in these parameters with and without ONH pallor. METHODS The presence of ONH pallor was assessed by three independent examiners through careful examination using fundus photographs. The presence of a hyper-reflective structure on the ONH was carefully evaluated using a volume scan optical coherence tomography (OCT). RNFL thickness and ellipsoid zone (EZ) width around the macula were also evaluated by OCT. Laser speckle flowgraphy was used to measure the mean blur rate of the entire ONH area, which was subsequently divided into the vessel area (MV) and tissue area (MT). RESULTS Twenty-eight eyes of 28 patients with RP (55.4 ± 16.23 years of age) were included. The pale ONH was observed in 10 (35%) eyes. Hyper-reflective structures were observed in seven (25%) eyes. No significant correlation was found between the pale ONH and the presence of a hyper-reflective structure (Pearson's chi-squared test, p = .364). The average of the ONH area, MV, and MT was 8.65 ± 3.08 AU, 17.81 ± 7.54 AU, and 6.4 ± 2.66 AU, respectively, which significantly decreased in patients with pallor ONH (all p < .05). The global RNFL thickness was 73.54 ± 18.82 μm. The nasal and superior quadrants and global RNFL thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH (all p < .05). The global and superior and inferior GCC thickness in patients with a pale ONH were significantly thinner than in patients without a pale ONH(all p < .05).There was no difference in the EZ width between patients with and without a pale ONH (p = .107). CONCLUSION We conducted multiple assessments of the ONH in RP patients and investigated its clinical significance. Our findings suggest that ONH pallor may indicate a comprehensive change that emerges alongside the progression of retinal degeneration in RP. TRIAL REGISTRATION This trial was retrospectively registered in the UMIN Clinical Trial Registry (UMIN ID: 000048168).
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Affiliation(s)
- Naoko Wada
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Seiji Takagi
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Akiko Yoshikawa
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Takashi Itokawa
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
| | - Takahiro Maruyama
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
- Department of Ophthalmology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine, Toho University, Tokyo, Japan
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Paez-Escamilla M, Alabek ML, Beale O, Prensky CJ, Lejoyeux R, Friberg TR, Sahel JA, Rosin B. An Optical Coherence Tomography-Based Measure as an Independent Estimate of Retinal Function in Retinitis Pigmentosa. Diagnostics (Basel) 2023; 13:3521. [PMID: 38066762 PMCID: PMC10706660 DOI: 10.3390/diagnostics13233521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND With the clinical advances in the field of gene therapy, the development of objective measures of visual function of patients with inherited retinal dystrophies (IRDs) is of utmost importance. Here, we propose one such measure. METHODS We retrospectively analyzed data from a cohort of 194 eyes of 97 genetically diagnosed patients with retinitis pigmentosa (RP), the most common IRD, followed at the UPMC Vision Institute. The analyzed data included the reflectivity ratio (RR) of the retinal nerve fiber layer (RNFL) to that of the entire retina, visual acuity (VA) and the thickness of the retinal outer nuclear layer (ONL) and the RNFL. RESULTS There was a strong positive correlation between the RR and VA. Both VA and the RR were negatively correlated with disease duration; VA, but not the RR, was negatively correlated with age. The RR correlated with the ONL but not with the RNFL thickness or the intraocular pressure. Age, RR, disease duration and ONL thickness were found to be independent predictors of VA by multivariate analysis. CONCLUSION The OCT RR could serve as an independent predictor of visual acuity, and by extension of retinal function, in genetically diagnosed RP patients. Such objective measures can be of great value in patient selection for therapeutic trials.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Department of Ophthalmology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Michelle L. Alabek
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Oliver Beale
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Colin J. Prensky
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Raphael Lejoyeux
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Rothschild Foundation Hospital, 75019 Paris, France
- Institut Oeil Paupiere, Viry-Chatillon, 91170 Paris, France
| | - Thomas R. Friberg
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Jose-Alain Sahel
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Boris Rosin
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
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Hirji SH. Clinical Evaluation of Patients with Retinitis Pigmentosa. Methods Mol Biol 2023; 2560:31-39. [PMID: 36481881 DOI: 10.1007/978-1-0716-2651-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter describes the clinical evaluation process of patients with retinitis pigmentosa (RP). The clinical evaluation consists of a complete history and ophthalmic examination. Here, we outline the aspects of the history and ophthalmic exam that are most important for the evaluation of RP patients. In addition, the expected findings of RP patients and the etiology of these findings are discussed.
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Affiliation(s)
- Sitara H Hirji
- Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA.
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Tan L, Long Y, Li Z, Ying X, Ren J, Sun C, Meng X, Li S. Ocular abnormalities in a large patient cohort with retinitis pigmentosa in Western China. BMC Ophthalmol 2021; 21:43. [PMID: 33461530 PMCID: PMC7812647 DOI: 10.1186/s12886-020-01797-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background To report the prevalence of ocular abnormalities and investigate visual acuity in a large cohort of retinitis pigmentosa (RP) patients in Western China. Methods The medical records and ophthalmic examination reports of 2127 eyes of 1065 RP patients at one eye hospital were retrospectively reviewed to determined the prevalence of ocular abnormalities and the relationship between best corrected visual acuity (BCVA) and macular abnormalities. Results Nyctalopia (58.2%) and blurred vision (27.1%) were the leading reasons for RP patients to request an ophthalmic examination. BCVA measurements in the better eyes at first clinical presentation showed that 304 patients (28.5%) were categorised as blind and 220 patients (20.7%) as low vision. The most common ocular abnormalities were macular abnormalities (59.7%) and cataracts (43.1%). The macular abnormalities included epiretinal membranes (51.1%), cystoid macular edema (18.4%), vitreomacular traction syndrome (2.4%), macular holes (2.3%) and choroidal neovascular membranes (0.05%). Glaucoma was found in 35 eyes (1.6%). The proportions of epiretinal membranes (p = 0.001) and macular holes (p = 0.008) increased significantly with age. Cystoid macular edema was significantly associated with poorer visual acuity in RP patients with clear lens (p = 0.002). Conclusion Cataracts and macular abnormalities are common in RP patients. Of the macular abnormalities, cystoid macular edema may have a negative effect on BCVA in RP patients with clear lens. Therefore, optical coherence tomography screening in RP patients is highly recommended for early detection and treatment of maculopathy. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-020-01797-z.
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Affiliation(s)
- Lian Tan
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Yanling Long
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Ziyang Li
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Xi Ying
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Jiayun Ren
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Cheng Sun
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China
| | - Xiaohong Meng
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China. .,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China.
| | - Shiying Li
- Southwest Eye Hospital/Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China. .,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, 400038, China.
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Zhang YS, Onishi AC, Zhou N, Song J, Samra S, Weintraub S, Fawzi AA. Characterization of Inner Retinal Hyperreflective Alterations in Early Cognitive Impairment on Adaptive Optics Scanning Laser Ophthalmoscopy. Invest Ophthalmol Vis Sci 2019; 60:3527-3536. [PMID: 31412112 PMCID: PMC6694736 DOI: 10.1167/iovs.19-27135] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose To examine inner retinal hyperreflective features on adaptive optics scanning laser ophthalmoscopy (AOSLO) in individuals with early cognitive impairment. Methods In this prospective, cross-sectional study, we enrolled 12 participants with either amnestic mild cognitive impairment (aMCI, n = 10) or early dementia due to Alzheimer's disease (eAD, n = 2) and 12 age-, sex-, and race-matched cognitively normal controls. All participants completed AOSLO imaging of the inner retina. AOSLO montages of the peripapillary area were graded for hyperreflective features including granular membranes, mottled membranes, and nummular features. Regions of interest on AOSLO were compared qualitatively to corresponding optical coherence tomography (OCT) cross sections. OCT was also used to analyze peripapillary retinal nerve fiber layer (RNFL) thickness. Results Cognitively impaired individuals had a significantly higher number of granular membranes with a larger overall area compared to controls. The proportion of cognitively impaired individuals with two or more granular membranes was 41.7% compared to none in the control group. Granular membrane area was also inversely correlated with cognitive performance on the Montreal Cognitive Assessment. There was no difference between the two groups in terms of other membrane types or RNFL thickness. Conclusions Individuals with early cognitive impairment related to Alzheimer's show hyperreflective granular membranes on high-resolution imaging, which we hypothesize to be manifestations of inner retinal gliosis. The presence of these subtle hyperreflective membranes may obscure underlying RNFL thinning in these eyes on OCT imaging. The distinctive phenotype of granular membranes surrounding the optic nerve on AOSLO may represent a new potential biomarker of early Alzheimer's.
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Affiliation(s)
- Yi Stephanie Zhang
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Alex C. Onishi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Nina Zhou
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Jessica Song
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Sahej Samra
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Amani A. Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
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Electronic retinal implant surgery. Eye (Lond) 2017; 31:191-195. [PMID: 28060358 DOI: 10.1038/eye.2016.280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/12/2016] [Indexed: 11/08/2022] Open
Abstract
Blindness due to outer retinal degeneration still remains largely untreatable. Photoreceptor loss removes light sensitivity, but the remaining inner retinal layers, the optic nerve, and indeed the physical structure of the eye itself may be unaffected by the degenerative processes. This provides the opportunity to restore some degree of vision with an electronic device in the subretinal space. In this lecture I will provide an overview of our experiences with the first-generation retinal implant Alpha IMS, developed by Retina Implant AG and based on the technology developed by Eberhart Zrenner as part of a multicentre clinical trial (NCT01024803). We are currently in the process of running a second NIHR-funded clinical trial to assess the next-generation device. The positive results from both studies to date indicate that the retinal implant should be included as a potential treatment for patients who are completely blind from retinitis pigmentosa. Evolution of the technology in future may provide further opportunities for earlier intervention or for other diseases.
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Dietrich M, Cruz-Herranz A, Yiu H, Aktas O, Brandt AU, Hartung HP, Green A, Albrecht P. Whole-body positional manipulators for ocular imaging of anaesthetised mice and rats: a do-it-yourself guide. BMJ Open Ophthalmol 2016; 1:e000008. [PMID: 29354694 PMCID: PMC5759402 DOI: 10.1136/bmjophth-2016-000008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background In vivo retinal imaging of rodents has gained a growing interest in ophthalmology and neurology. The bedding of the animals with the possibility to perform adjustments in order to obtain an ideal camera-to-eye angle is challenging. Methods We provide a guide for a cost-effective, do-it-yourself rodent holder for ocular imaging techniques. The set-up was tested and refined in over 2000 optical coherence tomography measurements of mice and rats. Results The recommended material is very affordable, readily available and easily assembled. The holder can be adapted to both mice and rats. A custom-made mouthpiece is provided for the use of inhalant anaesthesia. The holder is highly functional and assures that the rodent’s eye is the centre of rotation for adjustments in both the axial and the transverse planes with a major time benefit over unrestrained positioning of the rodents. Conclusion We believe this guide is very useful for eye researchers focusing on in vivo retinal imaging in rodents as it significantly reduces examination times for ocular imaging.
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Affiliation(s)
- Michael Dietrich
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Andrés Cruz-Herranz
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Hao Yiu
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Orhan Aktas
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ari Green
- Department of Neurology, University of California, San Francisco, San Francisco, California, United States
| | - Philipp Albrecht
- Department of Neurology, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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