Light deprivation and retinitis pigmentosa

Evaluation of outer nuclear layer overshadowed by retinal vessels in retinitis pigmentosa

OBJECTIVES

We investigated in vivo light-induced photoreceptor damage in retinitis pigmentosa (RP) using spectral-domain optical coherence tomography (SD-OCT) images.

METHODS

We retrospectively reviewed patients with genetic diagnosis of EYS-associated RP. The outer nuclear layer (ONL) thickness under retinal vessels was measured on SD-OCT vertical scans. As a control, we measured adjacent ONL thickness 100 μm superior and inferior from the vessel. Same measurements were performed in healthy subjects. We calculated the ratio of ONL thickness under vessel divided by the average of adjacent ONL thickness and defined as ONL preservation ratio. In patients with RP, the length of ellipsoid zone (EZ) from the fovea was also measured with SD-OCT vertical scans.

RESULTS

Thirty EYS-associated RP patients and 25 healthy subjects were included. In both groups, ONL thickness overshadowed by retinal vessels was not significantly different from that of adjacent area. However, ONL preservation ratio of RP was larger than that of healthy control in both superior and inferior retina (1.03 vs 0.97; p < 0.01, 1.15 vs 0.95; p < 0.01, respectively). In RP, ONL preservation ratio was significantly larger in the inferior retina than superior retina (p < 0.01). Furthermore, in RP patients, the EZ length from the fovea was always shorter in the inferior than superior retina and there was a significant difference (p < 0.01).

CONCLUSIONS

Patients with EYS-associated RP exhibited inferior-dominant photoreceptor death and the relative ONL preservation under retinal vessels. These results suggest that longitudinal environment light exposure may be correlated with the photoreceptor death.

Influence of eye pigmentation on retinal degeneration in P23H and S334ter mutant rhodopsin transgenic rats

Dark-rearing has been found to slow the rate of retinal degeneration in albino P23H but not S334ter mutant rhodopsin transgenic (Tg) rats. Since eye pigmentation has the same protective slowing effect as dark-rearing in RCS rats, we examined whether eye pigmentation has a comparable slowing effect in the different mutant rhodopsin Tg rats. Different lines of albino P23H and S334ter Tg rats on the Sprague-Dawley (SD) background were bred to Long-Evans (LE) rats to produce pigmented Tg rats. These were compared to albino Tg rats at postnatal days of different ages using the outer nuclear layer (ONL) as a morphological measure of photoreceptor number and electroretinogram (ERG) a- and b-wave amplitudes as a measure of retinal function. When compared to albino P23H rats, pigmented P23H rats had a slower rate of degeneration as measured by greater ONL thicknesses and greater ERG a- and b-wave amplitudes. By contrast, pigmented S334ter rats showed no difference in ONL thicknesses or ERG a- and b-wave amplitudes when compared to their albino equivalents. Thus, degeneration of photoreceptors in P23H Tg rats is slowed by eye pigmentation as measured by ONL thickness, while it is not in the S334ter Tg rats. Eye pigmentation also protects functional changes in ERG a- and b-waves for the P23H lines, but not for the S334ter lines.

Retinitis pigmentosa

Hereditary degenerations of the human retina are genetically heterogeneous, with well over 100 genes implicated so far. This Seminar focuses on the subset of diseases called retinitis pigmentosa, in which patients typically lose night vision in adolescence, side vision in young adulthood, and central vision in later life because of progressive loss of rod and cone photoreceptor cells. Measures of retinal function, such as the electroretinogram, show that photoreceptor function is diminished generally many years before symptomic night blindness, visual-field scotomas, or decreased visual acuity arise. More than 45 genes for retinitis pigmentosa have been identified. These genes account for only about 60% of all patients; the remainder have defects in as yet unidentified genes. Findings of controlled trials indicate that nutritional interventions, including vitamin A palmitate and omega-3-rich fish, slow progression of disease in many patients. Imminent treatments for retinitis pigmentosa are greatly anticipated, especially for genetically defined subsets of patients, because of newly identified genes, growing knowledge of affected biochemical pathways, and development of animal models.

Light and inherited retinal degeneration

Light deprivation has long been considered a potential treatment for patients with inherited retinal degenerative diseases, but no therapeutic benefit has been demonstrated to date. In the few clinical studies that have addressed this issue, the underlying mutations were unknown. Our rapidly expanding knowledge of the genes and mechanisms involved in retinal degeneration have made it possible to reconsider the potential value of light restriction in specific genetic contexts. This review summarises the clinical evidence for a modifying role of light exposure in retinal degeneration and experimental evidence from animal models, focusing on retinitis pigmentosa with regional degeneration, Oguchi disease, and Stargardt macular dystrophy. These cases illustrate distinct pathophysiological roles for light, and suggest that light restriction may benefit carefully defined subsets of patients.

Multiple vulnerability of photoreceptors to mesopic ambient light in the P23H transgenic rat

The P23H transgenic rat was engineered to mimic a human form of retinal degeneration caused by a mutation in rhodopsin. We have tested whether the P23H transgene influences the vulnerability of photoreceptors to modest variations in ambient light, well within the physiological range. P23H-3 (P23H line 3) and control Sprague-Dawley (SD) rats were raised in cyclic light (12 h light, 12 h dark), with the light phase set at either 5 lx ('scotopic-reared') or 40-60 lx ('mesopic-reared'). Mesopic rearing reduced the length of outer segments (OSs) in both SD and P23H-3 strains, but the shortening was more marked in the P23H-3 strain. Mesopic rearing was associated with thinning of the ONL, again more prominently in the P23H-3. Correspondingly, mesopic rearing increased the rate of photoreceptor death (assessed by TUNEL labelling), the increase occurring during early postnatal life. Mesopic rearing upregulated FGF-2 (basic fibroblast growth factor) levels in photoreceptors and glial fibrillary acidic protein (GFAP) in Müller cells in both SD and P23H-3 strains; again the changes were more marked in the P23H-3. Finally, mesopic rearing decreased the amplitude of the a-wave of the ERG in both strains; again the effect was greater in the P23H-3 strain. The ERG decline induced in both strains by mesopic-rearing can be explained by a reduction of functional OS membrane, due to a combination of photoreceptor death and OS shortening. The P23H-3 transgene makes photoreceptors abnormally vulnerable to modest levels of ambient light, their vulnerability being evident in multiple ways. In humans suffering photoreceptor degeneration from comparable genetic causes, light restriction may preserve the number and the function of photoreceptors.

Blue light dose distribution and retinitis pigmentosa visual field defects: an hypothesis

The hypothesis that retinitis pigmentosa (RP) is worsened by blue light has been raised a century ago. In order to check this hypothesis we calculated the theoretical dose distribution of light on the retinal surface. The relative dose to the different parts of the retina was calculated using a Monte-Carlo method. The changes in the peripheral isopters were calculated both degrading at a constant rate and degrading proportionally to light exposure. There is a considerably greater exposure to the superior compared to the inferior visual field. The maximum dose of UV and blue light is located on the superior field about 4mm above the macula. The dose received by the peripheral retina is markedly lower than the dose received by the central retina. The visual field defects most commonly described in RP are concentric, centered by the macula. These defects cannot, therefore, be explained by the impact of light on the retina. But some regional form of RP with a superior field defect can result from an abnormal genetically encoded sensitivity to ultraviolet and blue light.

Expression of a mutant opsin gene increases the susceptibility of the retina to light damage

The question of whether the expression of mutant opsin predisposes the retina to light damage was addressed using transgenic mice that express rhodopsin with three point mutations near the N-terminus of the molecule. The mutations involve the substitution of histidine for proline at position 23 (P23H), glycine for valine at position 20 (V20G), and leucine for proline at position 27 (P27L). These mice express equal amounts of mutant and wild-type transcripts, and develop a progressive photoreceptor degeneration that is similar to that seen in human retinitis pigmentosa (RP). The P23H mutation is associated with the most frequently occurring form of human autosomal dominant retinitis pigmentosa (ADRP) in the United States. Transgenic and normal littermates were exposed to illuminance of 300 foot-candles (ft-c) for 24 h, then placed in darkness for either 6 h, 6 days, or 14 days. Histological and biochemical techniques were used to evaluate the outer retina in light-exposed and control animals reared on 12-h light/12-h dark cycle. The results indicate that light exposure accelerates the pathological changes associated with the transgene expression. Compared with transgenic animals reared in ambient cyclic light, retinas from light-exposed mice had a reduced rhodopsin content, fewer photoreceptor cell bodies, and less preservation of retinal structure. Data obtained from normal mice did not differ for the lighting regimens used. These findings suggest that the expression of VPP mutations in the opsin gene predisposes the transgenic photoreceptors to be more susceptible to light damage. The data also suggest that reducing photic exposure may be beneficial to any patient with RP mediated by an opsin mutation.