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Momin SZ, Le JT, Miranda RC. Vascular Contributions to the Neurobiological Effects of Prenatal Alcohol Exposure. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2023; 3:10924. [PMID: 37205306 PMCID: PMC10191416 DOI: 10.3389/adar.2023.10924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Fetal alcohol spectrum disorders (FASD) are often characterized as a cluster of brain-based disabilities. Though cardiovascular effects of prenatal alcohol exposure (PAE) have been documented, the vascular deficits due to PAE are less understood, but may contribute substantially to the severity of neurobehavioral presentation and health outcomes in persons with FASD. Methods We conducted a systematic review of research articles curated in PubMed to assess the strength of the research on vascular effects of PAE. 40 pertinent papers were selected, covering studies in both human populations and animal models. Results Studies in human populations identified cardiac defects, and defects in vasculature, including increased tortuosity, defects in basement membranes, capillary basal hyperplasia, endarteritis, and disorganized and diminished cerebral vasculature due to PAE. Preclinical studies showed that PAE rapidly and persistently results in vasodilation of large afferent cerebral arteries, but to vasoconstriction of smaller cerebral arteries and microvasculature. Moreover, PAE continues to affect cerebral blood flow into middle-age. Human and animal studies also indicate that ocular vascular parameters may have diagnostic and predictive value. A number of intervening mechanisms were identified, including increased autophagy, inflammation and deficits in mitochondria. Studies in animals identified persistent changes in blood flow and vascular density associated with endocannabinoid, prostacyclin and nitric oxide signaling, as well as calcium mobilization. Conclusion Although the brain has been a particular focus of studies on PAE, the cardiovascular system is equally affected. Studies in human populations, though constrained by small sample sizes, did link pathology in major blood vessels and tissue vasculature, including brain vasculature, to PAE. Animal studies highlighted molecular mechanisms that may be useful therapeutic targets. Collectively, these studies suggest that vascular pathology is a possible contributing factor to neurobehavioral and health problems across a lifespan in persons with a diagnosis of FASD. Furthermore, ocular vasculature may serve as a biomarker for neurovascular health in FASD.
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Affiliation(s)
| | | | - Rajesh C. Miranda
- Corresponding author to whom correspondence should be addressed: Rajesh C. Miranda, PhD, , Texas A&M University Health Science Center, School of Medicine, Department of Neuroscience & Experimental Therapeutics, Medical Research and Education Building, 8447 Riverside Parkway, Bryan, TX 77807-3260, Phone: 979-436-0332, Fax: 979-436-0086
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Pitkänen J, Leiviskä I, Liinamaa J, Saarela V. Antenatal and neonatal factors and morphology of the optic nerve head in the Northern Finland birth cohort. Acta Ophthalmol 2022; 100:e1657-e1664. [PMID: 35535519 PMCID: PMC9790595 DOI: 10.1111/aos.15164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/27/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The optic nerve head (ONH) is a part of the brain that can be evaluated through the transparent medium of the eye. The purpose of this study was to explore the possible correlations among the properties of the optic nerve head, maternal factors during pregnancy and neonatal parameters in a randomized sample of a birth cohort. METHODS The Northern Finland 1966 Birth Cohort has been prospectively monitored since their antenatal period. Data on pregnancy and neonatal period were collected during gestation and right after birth in 1966. A randomized sample of 3070 subjects underwent an ophthalmic assessment at the age of 46-48 years. The examination protocol included scanning laser ophthalmoscopy with the Heidelberg Retina Tomograph. The ophthalmological parameters assessed were the disc area and the neuroretinal rim volume of the ONH. RESULTS We found that chronic pulmonary disease of the mother (p = 0.007), the number of gestational weeks (p = 0.030) and the mother's highest measured systolic blood pressure (p = 0.035) during pregnancy had a statistically significant effect on the disc area. Smaller disc size was associated with pulmonary disease and early gestation. There was a significant difference in rim volume between genders (p < 0.001). Women had larger neuroretinal rim volumes compared to men. CONCLUSION In this population-based study, the vast majority of antenatal and neonatal factors showed no correlation with optic disc area or rim volume. Furthermore, even the factors with statistically significant correlation with ONH morphology had limited predictive value.
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Affiliation(s)
- Joel Pitkänen
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Ilmari Leiviskä
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Johanna Liinamaa
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
| | - Ville Saarela
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research CenterUniversity of Oulu and Oulu University HospitalOuluFinland
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Lubinsky M, Encha-Razavi F. Delineating septo-optic dysplasia. Birth Defects Res 2022; 114:1343-1353. [PMID: 36200678 DOI: 10.1002/bdr2.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Septo-optic dysplasia (SOD), once a variable triad of septum pellucidum defects (SPDs), optic nerve hypoplasia (ONH), and hypopituitarism, has had multiple findings added, with uncertain causes, definitions, and limits. METHOD Literature review. RESULTS SOD is a complex vascular sequence with confounders. CONCLUSIONS Proximal anterior cerebral artery trunk disruptions cause overlapping primary effects, giving ONH alone most often, and isolated SPD less. ONH disruptions can spread to pituitary, SPD disruptions to the cerebral cortex, causing schizencephaly and related anomalies. Pituitary defects are rare without ONH, and cortical findings are rare without SPD. Extensions are unidirectional, so isolated pituitary or cortical defects are separate from SOD. Micro- an- ophthalmia, a suggested ONH variant, is not part of SOD. Disruption by-products can affect development, causing cognitive and endocrine issues, and structural anomalies such as corpus callosum thinning, ventriculomegaly, and hippocampal and olfactory findings. Limbic extensions may also contribute to the same structural defects as by-products. Midline CNS developmental anomalies can act as disruptive foci, most likely through vascular variants, but have separate pathogenesis. Relative frequencies of specific pituitary hormone defects change as SOD rates increase. Increasing relative rates of midline CNS developmental defects and cortical anomalies are consistent with rising levels of exogenous exposures sensitizing to midline predispositions.
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Tsang TW, Finlay-Jones A, Perry K, Grigg JR, Popova S, Cheung MMY, Bower C, Tam P, Jamieson RV, Elliott EJ. Eye Abnormalities in Children with Fetal Alcohol Spectrum Disorders: A Systematic Review. Ophthalmic Epidemiol 2022:1-12. [DOI: 10.1080/09286586.2022.2123004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tracey W Tsang
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - Amy Finlay-Jones
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
- Curtin University, West Perth, Australia
| | - Kerrin Perry
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Melissa Mei Yin Cheung
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
| | - Carol Bower
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
| | - Patrick Tam
- Embryology Research Unit, Children’s Medical Research Institute, the University of Sydney, Westmead, NSW, Australia; and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn V Jamieson
- Sydney Eye Hospital, Sydney, Australia
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, NSW, Australia, and Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Westmead, Australia
| | - Elizabeth J Elliott
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
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Pitkänen J, Veijola J, Barnett J, Liinamaa J, Saarela V. Optic Nerve Parameters and Cognitive Function in the Northern Finland Birth Cohort Eye Study. Ophthalmic Epidemiol 2021; 29:189-197. [PMID: 33877002 DOI: 10.1080/09286586.2021.1910317] [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: 10/21/2022]
Abstract
PURPOSE The optic nerve head (ONH) is a part of the brain that can be easily studied through the transparent medium of the eye. We explored the relationship between the properties of the optic nerve head, the retinal nerve fiber layer (RNFL) and cognitive function. METHODS Participants of the Northern Finland Birth Cohort (NFBC) 1966 underwent an ophthalmic and cognitive assessment after randomization at age 46. The ophthalmological parameters obtained were the disc area and the neuroretinal rim volume of the ONH and the average RNFL thickness. The surrogates used for cognitive function were the paired associates learning test (PAL), level of education, grade point average (GPA) and Humphrey 24-2 perimetric test time (HFA). We did exploratory research between the ophthalmological parameters and the surrogates for cognition and the correlations between the surrogates for cognition. RESULTS We found that a larger disc area was associated with a higher level of education, faster accomplishment of the HFA (R = -0.065) but a lower GPA (R = -0.084). An increase in neuroretinal rim volume was associated with fewer errors in the PAL test (R = -0.056), higher level of education, higher GPA (R = 0.072) and faster accomplishment of the HFA (R = -0.047). A thicker RNFL was associated with faster accomplishment of the HFA (R = -0.047). CONCLUSION We were able to find statistically significant associations between the parameters of the optic nerve head, the RNFL and cognition in the NFBC Eye study. However, the correlations were negligible at best and of limited predictive value.
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Affiliation(s)
- Joel Pitkänen
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience and Medical Research Center, University of Oulu and Oulu University Hospital, Finland
| | - Jennifer Barnett
- Department of Psychiatry, University of Cambridge, Cambridge Cognition Ltd, Cambridge, UK
| | - Johanna Liinamaa
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Ville Saarela
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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6
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Affiliation(s)
- Denize Atan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Eye Hospital, University Hospitals NHS Foundation Trust, Bristol, UK
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Martín-Begué N, Saint-Gerons M. Congenital optic nerve anomalies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:577-588. [PMID: 27378455 DOI: 10.1016/j.oftal.2016.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To update the current knowledge about congenital optic disc anomalies. METHODS A comprehensive literature search was performed in the major biomedical databases. RESULTS Patients with these anomalies usually have poor vision in infancy. Refractive errors are common, and serous retinal detachment may develop in some of these anomalies. It is critically important to clinically differentiate between these congenital optic disc anomalies, as central nervous system malformations are common in some, whereas others may be associated with systemic anomalies. CONCLUSIONS Congenital optic disc anomalies are a heterogeneous group of pathologies with characteristic fundus appearance and systemic associations. We should always try to make a correct diagnosis, in order to ask for specific tests, as well as to provide an adequate follow-up.
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Affiliation(s)
- N Martín-Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - M Saint-Gerons
- Servicio de Oftalmología, Hospital Mútua de Terrassa , Terrassa, Barcelona, España
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Kahn BM, Corman TS, Lovelace K, Hong M, Krauss RS, Epstein DJ. Prenatal ethanol exposure in mice phenocopies Cdon mutation by impeding Shh function in the etiology of optic nerve hypoplasia. Dis Model Mech 2016; 10:29-37. [PMID: 27935818 PMCID: PMC5278523 DOI: 10.1242/dmm.026195] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/16/2016] [Indexed: 01/01/2023] Open
Abstract
Septo-optic dysplasia (SOD) is a congenital disorder characterized by optic nerve, pituitary and midline brain malformations. The clinical presentation of SOD is highly variable with a poorly understood etiology. The majority of SOD cases are sporadic, but in rare instances inherited mutations have been identified in a small number of transcription factors, some of which regulate the expression of Sonic hedgehog (Shh) during mouse forebrain development. SOD is also associated with young maternal age, suggesting that environmental factors, including alcohol consumption at early stages of pregnancy, might increase the risk of developing this condition. Here, we address the hypothesis that SOD is a multifactorial disorder stemming from interactions between mutations in Shh pathway genes and prenatal ethanol exposure. Mouse embryos with mutations in the Shh co-receptor, Cdon, were treated in utero with ethanol or saline at embryonic day 8 (E8.0) and evaluated for optic nerve hypoplasia (ONH), a prominent feature of SOD. We show that both Cdon-/- mutation and prenatal ethanol exposure independently cause ONH through a similar pathogenic mechanism that involves selective inhibition of Shh signaling in retinal progenitor cells, resulting in their premature cell-cycle arrest, precocious differentiation and failure to properly extend axons to the optic nerve. The ONH phenotype was not exacerbated in Cdon-/- embryos treated with ethanol, suggesting that an intact Shh signaling pathway is required for ethanol to exert its teratogenic effects. These results support a model whereby mutations in Cdon and prenatal ethanol exposure increase SOD risk through spatiotemporal perturbations in Shh signaling activity.
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Affiliation(s)
- Benjamin M Kahn
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Tanya S Corman
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Korah Lovelace
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Mingi Hong
- Department of Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Robert S Krauss
- Department of Developmental and Regenerative Biology, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - Douglas J Epstein
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Ghate D, Vedanarayanan V, Kamour A, Corbett JJ, Kedar S. Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin. J Neurol Sci 2016; 368:25-31. [DOI: 10.1016/j.jns.2016.06.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/07/2016] [Accepted: 06/12/2016] [Indexed: 11/29/2022]
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Creavin AL, Williams C, Tilling K, Timpson N, Higgins JPT. The range of peripapillary retinal nerve fibre layer and optic disc parameters in children aged up to but not including 18 years of age, as measured by optical coherence tomography: protocol for a systematic review. Syst Rev 2016; 5:71. [PMID: 27138009 PMCID: PMC4853851 DOI: 10.1186/s13643-016-0247-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The parameters of the optic disc and peripapillary retinal nerve fibre layer (pRNFL) in children may vary with disease processes that contribute to visual impairment and blindness and so could be useful as an objective measure in at-risk children. There is no standardised reference for the normal parameters of the optic disc and pRNFL in children; however, there are a large number of small individual studies that have been undertaken to look at these measures. METHODS A systematic review of current literature on the range of pRNFL and optic disc parameters in children aged less than 18 years will be performed. Studies will be considered for review if they report numerical data on optic disc and pRNFL parameters, measured using optical coherence tomography. Outcome measures will include mean pRNFL thickness and cup-disc ratio. The bibliographic databases Medline, CINAHL, EMBASE, Scopus and Web of Science will be systematically searched from 1991. Screening of search results will be conducted by two authors working independently, as will extraction of primary and secondary outcome data. Ten per cent of all other data extraction will be checked by a second author. Results will be compiled and presented in evidence tables. Where possible and appropriate, study-specific estimates will be combined to obtain an overall summary estimate of pRNFL thickness and cup-disc ratio across studies and results will be presented by age of population. Subgroup analyses will be undertaken for children of different ethnicities. DISCUSSION This review aims to provide an overview of the parameters of the optic disc and pRNFL in children of different ages in order to identify gaps in knowledge and to improve understanding of what might be considered within/outside the range of normality. The findings will be presented in peer-reviewed journals and will be presented at conferences. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033068.
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Affiliation(s)
- Alexandra L. Creavin
- />MRC Integrative Epidemiology Unit and Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol, BS8 2BN UK
| | - Cathy Williams
- />Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- />MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicholas Timpson
- />MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Oyama J, Mori K, Imamura M, Mizushima Y, Tateishi U. Size of the intracranial optic nerve and optic tract in neonates at term-equivalent age at magnetic resonance imaging. Pediatr Radiol 2016; 46:527-33. [PMID: 26646150 DOI: 10.1007/s00247-015-3495-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/21/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The expected MRI-based dimensions of the intracranial optic nerve and optic tract in neonates are unknown. OBJECTIVE To evaluate the sizes of the intracranial optic nerve and optic tract in neonates at term-equivalent age using MRI. MATERIALS AND METHODS We retrospectively analyzed brain MRI examinations in 62 infants (28 boys) without intracranial abnormalities. The images were obtained in infants at term-equivalent age with a 1.5-tesla MRI scanner. We measured the widths and heights of the intracranial optic nerve and optic tract and calculated the cross-sectional areas using the formula for an ellipse. RESULTS The means ± standard deviation of the width, height and cross-sectional area of the intracranial optic nerve were 2.7 ± 0.2 mm, 1.7 ± 0.2 mm and 3.5 ± 0.5 mm(2), respectively. The width, height and cross-sectional area of the optic tract were 1.5 ± 0.1 mm, 1.6 ± 0.1 mm and 2.0 ± 0.2 mm(2), respectively. Using univariate and multivariate analyses, we found that postmenstrual age showed independent intermediate positive correlations with the width (r = 0.48, P < 0.01) and cross-sectional area (r = 0.40, P < 0.01) of the intracranial optic nerve. The lower bounds of the 95% prediction intervals for the width and cross-sectional area of the intracranial optic nerve were 0.07 × (postmenstrual age in weeks) - 0.46 mm, and 0.17 × (postmenstrual age in weeks) - 4.0 mm(2), respectively. CONCLUSION We identified the sizes of the intracranial optic nerve and optic tract in neonates at term-equivalent age. The postmenstrual age at MRI independently positively correlated with the sizes.
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Affiliation(s)
- Jun Oyama
- Department of Radiology, Tsuchiura Kyodo General Hospital, 11-7 Manabeshinmachi, Tsuchiura, Ibaraki, 300-0053, Japan.
| | - Kouichi Mori
- Department of Radiology, Tsuchiura Kyodo General Hospital, 11-7 Manabeshinmachi, Tsuchiura, Ibaraki, 300-0053, Japan
| | - Masatoshi Imamura
- Department of Neonatology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Yukiko Mizushima
- Department of Ophthalmology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Ukihide Tateishi
- Departments of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Zhao L, Zevallos SE, Rizzoti K, Jeong Y, Lovell-Badge R, Epstein DJ. Disruption of SoxB1-dependent Sonic hedgehog expression in the hypothalamus causes septo-optic dysplasia. Dev Cell 2012; 22:585-96. [PMID: 22421044 DOI: 10.1016/j.devcel.2011.12.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 10/26/2011] [Accepted: 12/28/2011] [Indexed: 11/29/2022]
Abstract
Septo-optic dysplasia (SOD) is a congenital brain anomaly that results in pituitary, optic nerve, and midline forebrain defects. The etiology of SOD is poorly understood, with the majority of cases being sporadic. In rare instances, SOD is caused by mutations in Sox2, Sox3, or Hesx1, but how this manifests in disease is not entirely certain. We demonstrate here that mouse embryos lacking Sonic hedgehog (Shh) in the prospective hypothalamus exhibit key features of SOD, including pituitary hypoplasia and absence of the optic disc. The hypothalamic source of Shh is required to maintain gene expression boundaries along the anteroposterior and mediolateral neural axes that are important for proper pituitary and eye development, respectively. We further reveal that Sox2 and Sox3 are dose-dependent regulators of Shh transcription that directly bind and activate a long-range Shh forebrain enhancer. These data indicate that reduced levels of Shh expression in the hypothalamus cause SOD.
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Affiliation(s)
- Li Zhao
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Lempert P. Anomalous Vascular Patterns of the Optic Disc in Amblyopia. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:158-61. [PMID: 26107332 DOI: 10.1097/apo.0b013e318255969a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the presence of anomalies of the optic disc vascular patterns in subjects with amblyopia. DESIGN Case controlled study. The outcome measure is temporal deviation of central retinal vessels and / or vascular pattern asymmetry. METHODS A total of 342 hyperopic amblyopic patients were evaluated. An additional 88 subjects with equal visual acuity with strabismus, and 108 subjects with equal visual acuity and anisometropia were evaluated. RESULTS In this study, more than 50% of amblyopic patients had optic disc deformities. Sixty-five percent of subjects with amblyopia, orthophoria, and anisometropia exceeding 1.5 D had these anomalies compared with less than 7% of the groups without amblyopia or strabismus. CONCLUSIONS These disc anomalies may be associated with disorganization of optic nerve axons. This finding indicates the possibility of a peripheral cause for impaired vision and could provide an explanation for the variability in visual defects associated with amblyopia. Optic nerve imaging should be incorporated into clinical protocols for amblyopia research.
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Abstract
PURPOSE To report a porencephalic cyst in a child with large optic disc cup but normal-sized discs. METHODS Case report with figures. RESULTS Clinical findings of a patient with porencephaly presenting with large cups in normal-sized optic discs are discussed. CONCLUSIONS Optic disc morphology is not a reliable indicator of the timing of ischemic brain injury. Intracranial pathology should be suspected in children with disc cupping but no other features of glaucoma.
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Hellgren K, Hellström A, Martin L. Visual fields and optic disc morphology in very low birthweight adolescents examined with magnetic resonance imaging of the brain. Acta Ophthalmol 2009; 87:843-8. [PMID: 18811637 DOI: 10.1111/j.1755-3768.2008.01365.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to evaluate visual fields (VFs) and optic disc morphology in very low birthweight (VLBW) adolescents compared with age- and gender-matched controls, and to relate the findings to magnetic resonance imaging (MRI) results. METHODS Fifty-nine VLBW adolescents and 55 age- and gender-matched controls with normal birthweight were examined. Visual fields were tested using computerized rarebit perimetry (RB). Optic nerve and retinal vessel morphology were evaluated by digital image analysis of fundus photographs. Brain MRI was conducted in the VLBW subjects. RESULTS Ten of the 57 VLBW subjects (p = 0.022) had subnormal VF results defined as a mean hit rate below the fifth percentile of the controls (i.e. < 89%). All of these also had significantly lower mean hit rates (p = 0.039) in the inferior hemifield. Sixteen of 57 (28%) VLBW subjects had white matter damage of immaturity (WMDI) on MRI. Six of 15 subjects with WMDI (who underwent VF testing) also had subnormal RB results, compared with four of 39 with normal MRI findings (p = 0.02). The mean neural retinal rim area was 9% smaller (p = 0.018) in the VLBW group than in the control group. The VLBW adolescents had a significantly higher index for tortuosity of arterioles than the controls (p < 0.001). CONCLUSIONS In the present study, 18% of all VLBW adolescents and 40% of those with WMDI had subnormal RB VF findings. The VLBW group had increased arterial tortuosity and a somewhat smaller (9%) mean neural retinal rim area than the control group. Thus sequels to VLBW appear to persist in adolescence.
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Affiliation(s)
- Kerstin Hellgren
- Department of Clinical Neuroscience, Karolinska Institutet, St Erik's Eye Hospital, Stockholm, Sweden.
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Abstract
Developmental anomalies of the optic nerve are an important and growing cause of lifelong visual handicap and they are often associated with systemic abnormalities. This review focuses on the ocular and systemic aspects of developmental anomalies arising from defects of fetal fissure closure and retinal ganglion cell development, and covers some other optic-disc anomalies that have systemic significance.
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Affiliation(s)
- D Taylor
- Institute of Child Health, Visual Sciences Unit, London, UK.
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Abstract
AIM To evaluate the incidence of retinopathy of prematurity (ROP) and other ocular morbidities in extremely premature infants. METHODS A retrospective analysis of the prevalence and nature of ocular abnormalities in a cohort of 22 extremely pre-term infants born <25 + 0 weeks of estimated gestational age (GA) was performed. RESULTS The children were grouped according to the observed disorder: 13 out of 22 (59%) neonates with mild ophthalmologic findings (ROP < or = stage II) [Group 1], 5 out of 22 (23%) infants with ROP stage III or more (Group 2) and 4 out of 22 (18%) neonates with severe ocular morbidity (congenital cataract, microphthalmia, partial optic nerve atrophy and corneal perforation due to an ulcer with lens protrusion), partly combined with ROP > or = stage III (three of four). One child of 22 (5%) needed laser therapy. Out of 22 admitted infants, 20 (91%) were discharged alive. CONCLUSION The high rate of ocular morbidity besides ROP in extremely pre-term infants is noteworthy. Mechanisms influencing the postnatal development of the eye, especially their relation to the grade of prematurity and neonatological therapeutical strategies, require further investigations.
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19
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Garcia ML, Ty EB, Taban M, David Rothner A, Rogers D, Traboulsi EI. Systemic and ocular findings in 100 patients with optic nerve hypoplasia. J Child Neurol 2006; 21:949-56. [PMID: 17092460 DOI: 10.1177/08830738060210111701] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To describe associated ocular, neurologic, and systemic findings in a population of children with optic nerve hypoplasia, a retrospective chart review of 100 patients with optic nerve hypoplasia for the presence of neurologic, radiologic, and endocrine abnormalities was performed. Neuroimaging and endocrine studies were obtained in 65 cases. Visual acuity and associated ocular, neurologic, endocrine, systemic, and structural brain abnormalities were recorded. Seventy-five percent had bilateral optic nerve hypoplasia. Conditions previously associated with optic nerve hypoplasia and present in our patients include premature birth in 21%, fetal alcohol syndrome in 9%, maternal diabetes in 6%, and endocrine abnormalities in 6%. Developmental delay was present in 32%, cerebral palsy in 13%, and seizures in 12%. Of those imaged, 60% had an abnormal study. Neuroimaging showed abnormalities in ventricles or white- or gray-matter development in 29 patients, septo-optic dysplasia in 10, hydrocephalus in 10, and corpus callosum abnormalities in 8. There was an associated clinical neurologic abnormality in 57% of patients with bilateral optic nerve hypoplasia and in 32% of patients with unilateral optic nerve hypoplasia. Patients with unilateral and bilateral optic nerve hypoplasia frequently have a wide range and common occurrence of concomitant neurologic, endocrine, and systemic abnormalities.
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Affiliation(s)
- M Lourdes Garcia
- Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic Foundation, OH 44195, USA
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20
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McLoone E, O'Keefe M, Donoghue V, McLoone S, Horgan N, Lanigan B. RetCam image analysis of optic disc morphology in premature infants and its relation to ischaemic brain injury. Br J Ophthalmol 2006; 90:465-71. [PMID: 16547329 PMCID: PMC1856984 DOI: 10.1136/bjo.2005.078519] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2005] [Indexed: 11/04/2022]
Abstract
AIMS To assess optic disc characteristics in premature infants with and without ischaemic brain injury and to evaluate the role of optic disc morphology in dating the injury. METHODS RetCam fundal images, cranial ultrasounds and magnetic resonance imaging (MRI) of 109 premature infants were analysed. The study cohort was divided into subgroups depending on the presence or absence of periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH). The control group consisted of infants with normal neuroimaging at term and 2 years of age. Using the image analysis software of the RetCam, optic disc diameter (ODD), optic disc area (ODA), and optic cup area (OCA) were measured at 33-34 weeks gestational age. As serial cranial ultrasonography had been performed, it was possible to date the brain injury in those infants with periventricular white matter (PVWM) damage. RESULTS Although there was a trend towards reducing ODD, ODA, and OCA with increasing severity of IVH, only the IVH 4 group differed significantly from the controls for these parameters (p = 0.002, p = 0.02, and p = 0.04, respectively). 44.4% of infants with grade 4 IVH had small discs. Only one patient had a large cup in a normal sized disc; this patient had IVH 4. In patients with PVWM damage, the median time of insult was 27 weeks in those with small discs and 28 weeks in those with normal discs. This difference was not significant (p = 0.23). CONCLUSIONS Premature infants with IVH 4 have an increased incidence of optic nerve hypoplasia. We found no association between disc morphology and timing of brain injury.
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Affiliation(s)
- E McLoone
- The Children's Hospital, Temple Street, Dublin 1, Republic of Ireland
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21
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Abstract
In the 2004 Bowman Lecture, I give a panegyric for Sir William Bowman, an estimate of the importance and the epidemiology of anterior visual pathway developmental disorders, followed by a history of the anterior visual system. I review the normal development of the optic nerve and chiasm and the main developmental disorders: Optic Nerve Aplasia, Optic Nerve Hypoplasia and Achiasmia.
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Affiliation(s)
- D Taylor
- Institute of Child Health, London WC1N IEH, UK.
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22
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Swanson C, Cocker KD, Parker KH, Moseley MJ, Fielder AR. Semiautomated computer analysis of vessel growth in preterm infants without and with ROP. Br J Ophthalmol 2004; 87:1474-7. [PMID: 14660456 PMCID: PMC1920561 DOI: 10.1136/bjo.87.12.1474] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To measure characteristics of the retinal blood vessels close to the optic disc in full term and preterm infants, with and without retinopathy of prematurity (ROP), using digital imaging. To determine whether these measures are indicative of the presence or severity of ROP in the retinal periphery. METHODS 52 digital fundus images from 42 babies were analysed with a semiautomated analysis program developed at Imperial College London. Analysis was limited to the principal temporal vessels close to the optic disc: recording venular diameter and arteriolar diameter and tortuosity. RESULTS Each result was categorised by the gestational age of the infant ("very premature" 24-27 weeks, "moderately premature" 28-31 weeks, and "near term" > or =32 weeks) and by the highest stage of ROP present ("no ROP," "mild ROP" stage 1 or 2, and "severe ROP" stage 3). Arteriolar tortuosity was found to vary significantly (Kruskal-Wallis p=0.002) with ROP severity. Although venular and arteriolar diameters increased monotonically with ROP severity the differences were not significant. Venular diameter, arteriolar diameter, and arterial tortuosity did not vary significantly between gestational age groups. CONCLUSIONS This study confirms it is possible to quantify the size and tortuosity of retinal blood vessels in term and preterm babies using digital image analysis software. This method detected significant increases in arteriolar tortuosity with increasing ROP severity.
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Affiliation(s)
- C Swanson
- Department of Ophthalmology, Imperial College London, 9th Floor Laboratory Block, St Dunstan's Road, London W6 8RP, UK
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23
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Hård AL, Aring E, Hellström A. Subnormal visual perception in school-aged ex-preterm patients in a paediatric eye clinic. Eye (Lond) 2004; 18:628-34. [PMID: 14739924 DOI: 10.1038/sj.eye.6700740] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The aim of this study was to assess visual perception at school age of children born preterm with known lesions to the posterior visual pathways or with ophthalmologic signs that might indicate such lesions. METHODS The study group consisted of 91 patients born before the 37th gestational week. Visual perception was assessed using the TVPS-R (Test of Visual Perceptual Skills - Revised) and a structured interview. In addition, ophthalmologic and orthoptic examinations were performed. RESULTS On the test of visual perception, 67% of the patients had results below the third percentile of the American reference group. This is to be compared with 10% of Swedish full-term controls. Scores below the third percentile were observed in 87% of the patients with known brain lesions, 48% of those with strabismus without known brain lesion, and 86% of those with reduced visual acuity in the absence of strabismus and known brain lesion. CONCLUSIONS Reduced visual perception is common among children born preterm who have strabismus and/or reduced visual acuity, as well as in those with known brain lesions. This study emphasises the need to find tools to identify and assess those patients who have visual perceptual problems that may restrict their ability to meet the demands of daily life.
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Affiliation(s)
- A-L Hård
- Department of Ophthalmology, Institute of Clinical Neuroscience, The Queen Silvia Children's Hospital, The Sahlgrenska Academy of Göteborg University, Gotheburg, Sweden.
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24
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Jacobson L, Hård AL, Svensson E, Flodmark O, Hellström A. Optic disc morphology may reveal timing of insult in children with periventricular leucomalacia and/or periventricular haemorrhage. Br J Ophthalmol 2003; 87:1345-9. [PMID: 14609830 PMCID: PMC1771907 DOI: 10.1136/bjo.87.11.1345] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2003] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the relation between optic disc morphology and timing of periventricular white matter damage, defined as either periventricular leucomalacia (PVL) or periventricular haemorrhage (PVH), as estimated by neuroradiology. METHODS 35 children with periventricular white matter damage who had had neuroradiology performed and ocular fundus photographs taken had their photographs analysed by digital image analysis and compared with a control group of 100 healthy full term children. Timing of brain lesion was estimated by analysis of the brain lesion pattern on neuroradiological examinations (magnetic resonance imaging or computed tomography). RESULTS Four of 35 children had a small optic disc area; these four children had a brain lesion estimated to have occurred before 28 weeks of gestation. Nine of 11 children with a large cup area had a PVL/PVH estimated to have occurred after 28 weeks of gestation. The children with PVL/PVH had a significantly larger cup area (median 0.75 mm(2)) than the control group (median 0.33 mm(2)) (p = 0.001) and a significantly smaller neuroretinal rim area (median 1.58 mm(2)) than the controls (median 2.07 mm(2)) (p = 0.001). CONCLUSION In a child with PVL/PVH and abnormal optic disc morphology, the possibilities of timing of the lesion should be considered.
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Affiliation(s)
- L Jacobson
- Department of Ophthalmology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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25
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Birkebaek NH, Patel L, Wright NB, Grigg JR, Sinha S, Hall CM, Price DA, Lloyd IC, Clayton PE. Endocrine status in patients with optic nerve hypoplasia: relationship to midline central nervous system abnormalities and appearance of the hypothalamic-pituitary axis on magnetic resonance imaging. J Clin Endocrinol Metab 2003; 88:5281-6. [PMID: 14602762 DOI: 10.1210/jc.2003-030527] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
We here: 1) describe the phenotypic spectrum, including magnetic resonance imaging (MRI) appearances of the pituitary stalk and anterior and posterior pituitary [H-P (hypothalamic-pituitary) axis], in children with optic nerve hypoplasia (ONH) with or without an abnormal septum pellucidum (SP); and 2) define endocrine dysfunction according to the MRI findings. Medical records of 55 children with ONH who had been assessed by ophthalmology and endocrine services were reviewed. All had MRI of the brain and H-P axis. Forty-nine percent of the ONH patients had an abnormal SP on MRI, and 64% had a H-P axis abnormality. Twenty-seven patients (49%) had endocrine dysfunction, and 23 of these had H-P axis abnormality. The frequency of endocrinopathy was higher in patients with an abnormal SP (56%) than a normal SP (39%). Patients were divided into four groups based on SP and H-P axis appearance: 1) both normal; 2) abnormal SP and normal H-P axis; 3) normal SP and abnormal H-P axis; and 4) both abnormal. The frequency of multiple pituitary hormone deficiency was highest (56%) in group 4, lower (35%) in group 3, and even lower (22%) in group 2. Precocious puberty was most common in group 2. None of the patients in group 1 had endocrine dysfunction. Thus, SP and H-P axis appearances on MRI can be used to predict the likely spectrum of endocrinopathy.
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Affiliation(s)
- N H Birkebaek
- Department of Paediatrics, Aarhus University Hospital at Skejby, Denmark DK-8200
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26
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Bilotta J, Saszik S, Givin CM, Hardesty HR, Sutherland SE. Effects of embryonic exposure to ethanol on zebrafish visual function. Neurotoxicol Teratol 2002; 24:759-66. [PMID: 12460658 DOI: 10.1016/s0892-0362(02)00319-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Across a variety of species, including humans, it has been shown that embryos exposed to ethanol display eye abnormalities as well as deficiencies in visual physiology and behavior. The purpose of this study was to examine the effects of embryonic exposure to ethanol on visual function in zebrafish. Visual function was assessed physiologically, via electroretinogram (ERG) recordings, and behaviorally, by measuring visual acuity with the optomotor response. Zebrafish larvae were exposed to 1.5% ethanol at various times during development, including the period of maximal eye development. The results show that ethanol effects on visual function were most pronounced when exposure occurred during eye development. ERG recordings from ethanol-exposed larvae differed from normal subjects both in shape of the response waveform and in visual thresholds under both light and dark adaptation; the differences were more pronounced under lower levels of adaptation. Also, ethanol-exposed larvae displayed lower visual acuity as determined from the optomotor response. These results indicate embryonic ethanol exposure affects visual function particularly when exposure occurs during eye development. In addition, these findings illustrate the usefulness of the zebrafish as a viable animal model for studying Fetal Alcohol Syndrome (FAS).
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Affiliation(s)
- Joseph Bilotta
- Department of Psychology and Biotechnology Center, Western Kentucky University, 1 Big Red Way, Bowling Green 42101, USA.
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