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Woon PY, Chien JY, Wang JH, Chou YY, Lin MC, Huang SP. Prevalence and associated relating factors in patients with hereditary retinal dystrophy: a nationwide population-based study in Taiwan. BMJ Open 2022; 12:e054111. [PMID: 35396285 PMCID: PMC8995947 DOI: 10.1136/bmjopen-2021-054111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate the prevalence, incidence and relating factors that are associated with hereditary retinal dystrophy (HRD) in Taiwan from 2000 to 2013. DESIGN, SETTING AND PARTICIPANTS This is a nationwide, population-based, retrospective case-control study using National Health Insurance Database. Study groups are patients with HRD as case group; age-matched patients without any diagnosis of HRD as control group. We enrolled 2418 study subjects, of which 403 were HRD patients. Important relating factors such as hypertension, diabetes, coronary artery disease, autoimmune disease, cancer, liver cirrhosis, chronic kidney disease, stroke, hyperlipidaemia, asthma, depression and dementia are also included. EXPOSURE Patients diagnosed with HRD were retrieved from National Health Insurance Database. MAIN OUTCOMES AND MEASURES OR calculated between the relating factors and HRD for objects and stratified by age and sex group between 2000 and 2013. RESULTS Four hundred and three patients were included in the study group and 2015 in the control group. The incidence of HRD was 3.29/100 000, and the prevalence of HRD was 40.5/100 000 persons. The tendency of study group to have more cataract, cystoid macula oedema (CME) as compared with the control group. Among the subgroup with comorbidities, the relating factors such as hypertension, diabetes and chronic kidney disease was significantly higher among HRD patients with age 55 and above. CONCLUSIONS 74% of the diagnosed HRD are retinitis pigmentosa. Population-based data suggested an increased incidence of cataract in younger patients, whereas older HRD patients are more susceptible to develop CME. Further work is needed to elucidate the mechanism between these ophthalmological disorders and HRD.
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Affiliation(s)
- Peng Yeong Woon
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Jia-Ying Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Medical Center, Hualien, Taiwan
| | - Yu-Yau Chou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Lin
- College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shun-Ping Huang
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung, Taiwan
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2
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Mateos-Olivares M, Sobas E, Puertas-Neyra K, Peralta-Ramírez M, Gonzalez-Pérez R, Martín-Vallejo J, García-Vazquez C, Coco R, Pastor J, Pastor-Idoate S, Usategui-Martín R. Hair cortisol level as a molecular biomarker in retinitis pigmentosa patients. Exp Eye Res 2022; 219:109019. [DOI: 10.1016/j.exer.2022.109019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Abstract
A 45-year-old man presented with longstanding poor vision in both eyes. His medical history was significant for a remote overdose of quinine. After the ingestion, he fell into a coma and on awakening was not able to see light out of both eyes. Several days later, his central vision began to gradually recover and continued to improve over the span of several months. Presently, he had 20/20 visual acuity in both eyes with severely constricted peripheral visual fields. There were bilateral iris transillumination defects, and both optic nerves were diffusely pale with attenuated vasculature and inner retinal thinning on ocular coherence tomography. We present a patient with the stereotypical findings and natural history of quinine toxicity, a rare and not widely known cause of toxic optic neuropathy and retinopathy.
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4
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Lacy GD, Abalem MF, Andrews CA, Abuzaitoun R, Popova LT, Santos EP, Yu G, Rakine HY, Baig N, Ehrlich JR, Fahim AT, Branham KH, Swenor BK, Lichter PR, Dagnelie G, Stelmack JA, Musch DC, Jayasundera KT. The Michigan Vision-Related Anxiety Questionnaire: A Psychosocial Outcomes Measure for Inherited Retinal Degenerations. Am J Ophthalmol 2021; 225:137-146. [PMID: 33309692 DOI: 10.1016/j.ajo.2020.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We sought to construct and validate a patient-reported outcome measure for screening and monitoring vision-related anxiety in patients with inherited retinal degenerations. DESIGN Item-response theory and graded response modeling to quantitatively validate questionnaire items generated from qualitative interviews and patient feedback. METHODS Patients at the Kellogg Eye Center (University of Michigan, Ann Arbor, Michigan, USA) with a clinical diagnosis of an inherited retinal degeneration (n = 128) participated in an interviewer-administered questionnaire. The questionnaire consisted of 166 items, 26 of which pertained to concepts of "worry" and "anxiety." The subset of vision-related anxiety questions was analyzed by a graded response model using the Cai Metropolis-Hastings Robbins-Monro algorithm in the R software mirt package. Item reduction was performed based on item fit, item information, and item discriminability. To assess test-retest variability, 25 participants completed the questionnaire a second time 4 to 16 days later. RESULTS The final questionnaire consisted of 14 items divided into 2 unidimensional domains: rod function anxiety and cone function anxiety. The questionnaire exhibited convergent validity with the Patient Health Questionnaire for symptoms of depression and anxiety. This vision-related anxiety questionnaire has high marginal reliability (0.81 for rod-function anxiety, 0.83 for cone-function anxiety) and exhibits minimal test-retest variability (ρ = 0.81 [0.64-0.91] for rod-function anxiety and ρ = 0.83 [0.68-0.92] for cone-function anxiety). CONCLUSIONS The Michigan Vision-Related Anxiety Questionnaire is a psychometrically validated 14-item patient-reported outcome measure to be used as a psychosocial screening and monitoring tool for patients with inherited retinal degenerations. It can be used in therapeutic clinical trials for measuring the benefit of an investigational therapy on a patient's vision-related anxiety.
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5
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O'Hare F, Edwards TL, Hu ML, Hickey DG, Zhang AC, Wang JH, Liu Z, Ayton LN. An optometrist's guide to the top candidate inherited retinal diseases for gene therapy. Clin Exp Optom 2021; 104:431-443. [PMID: 33689629 DOI: 10.1080/08164622.2021.1878851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This review presents the phenotypic and genotypic profiles of a select group of inherited retinal diseases (IRDs) that are currently the focus of retinal gene therapy trials globally. Research progress in IRD treatment trials may soon lead to their availability in Australia and New Zealand, as either approved treatment or a clinical trial. The salient clinical characteristics of retinitis pigmentosa-the largest IRD category-are highlighted, with specific reference to RPE65-associated Leber congenital amaurosis, followed by other specific IRDs, namely choroideremia and ABCA4-associated Stargardt disease. These IRDs are selected based on their candidacy for gene therapy. Guidance on the clinical diagnostic tests that support each of these diagnoses will be presented. More broadly, the most useful structure and function measures to monitor IRD progression is discussed, along with the key assessments that offer differential diagnostic insight. This review is intended to be a clinical guide for optometrists, to assist in assessment and management of individuals who may be eligible for current and future gene therapies. A companion article in this issue will provide an overview of the basic principles of gene therapy and its development as a new treatment for inherited retinal diseases.
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Affiliation(s)
- Fleur O'Hare
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Thomas L Edwards
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Monica L Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Doron G Hickey
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Alexis C Zhang
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Jiang-Hui Wang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Zhengyang Liu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren N Ayton
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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6
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Sher I, Tucker Y, Gurevich M, Hamburg A, Bubis E, Kfir J, Zorani S, Derazne E, Skaat A, Rotenstreich Y. Chromatic Pupilloperimetry Measures Correlate With Visual Acuity and Visual Field Defects in Retinitis Pigmentosa Patients. Transl Vis Sci Technol 2020; 9:10. [PMID: 32855857 PMCID: PMC7422758 DOI: 10.1167/tvst.9.8.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the ability of chromatic pupilloperimetry to identify visual field (VF) defects in patients with retinitis pigmentosa (RP) and to test the correlation between pupilloperimetry impairment and retinal structural and functional measures. Methods The pupil responses of 10 patients with RP (mean age, 41.3 ± 16.2 years) and 32 healthy age-similar controls (mean age, 50.7 ± 15.5 years) for 54 focal blue and red stimuli presented in a 24-2 VF were recorded. The pupilloperimetry measures were correlated with Humphrey VF mean deviation, best-corrected visual acuity, and ellipsoid zone area. Results Substantially lower percentage of pupil contraction and maximal pupil contraction velocity (MCV) were recorded in patients with RP throughout the VF in response to blue and red stimuli. The mean absolute deviation (MADEV) in the latency of MCV (LMCV) was significantly larger in patients compared with controls for blue and red stimuli (P = 1.0 × 10−7 and P = 1.0 × 10−6, respectively). The LMCV MADEV differentiated between patients and controls with high specificity and sensitivity (area under the receiver operating characteristic curve, 0.987 and 0.973 for blue and red, respectively). The MADEV of LMCV for blue stimuli correlated with best-corrected visual acuity (ρ = 0.938, P = 5.9 × 10−5) and ellipsoid zone area (ρ = −0.857; P = 0.002). The MADEV of LMCV for red stimuli correlated with Humphrey VF mean deviation (ρ = −0.709; P = 0.022). Minimizing the test to 15 targets maintained a diagnosis of retinal damage in patients with RP with high sensitivity and specificity (area under the receiver operating characteristic curve, 0.927). Conclusions The chromatic pupilloperimetry measures significantly correlated with retinal function and structure in patients with RP at various disease stages. Translational Relevance Chromatic pupilloperimetry may enable objective assessment of visual field defects and visual acuity in RP.
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Affiliation(s)
- Ifat Sher
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yisroel Tucker
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maya Gurevich
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Hamburg
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ettel Bubis
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Kfir
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Zorani
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ygal Rotenstreich
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Ayton LN, Rizzo JF, Bailey IL, Colenbrander A, Dagnelie G, Geruschat DR, Hessburg PC, McCarthy CD, Petoe MA, Rubin GS, Troyk PR. Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce. Transl Vis Sci Technol 2020; 9:25. [PMID: 32864194 PMCID: PMC7426586 DOI: 10.1167/tvst.9.8.25] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/08/2019] [Indexed: 01/05/2023] Open
Abstract
Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International “Eye and the Chip” meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.
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Affiliation(s)
- Lauren N Ayton
- Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Joseph F Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ian L Bailey
- School of Optometry, University of California-Berkeley, Berkeley, CA, USA
| | - August Colenbrander
- Smith-Kettlewell Eye Research Institute and California Pacific Medical Center, San Francisco, CA, USA
| | - Gislin Dagnelie
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Duane R Geruschat
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Philip C Hessburg
- Detroit Institute of Ophthalmology, Henry Ford Health System, Grosse Pointe Park, MI, USA
| | - Chris D McCarthy
- Department of Computer Science & Software Engineering, Swinburne University of Technology, Melbourne, Australia
| | | | - Gary S Rubin
- University College London Institute of Ophthalmology, London, UK
| | - Philip R Troyk
- Armour College of Engineering, Illinois Institute of Technology, Chicago, IL, USA
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8
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Lacy GD, Abalem MF, Popova LT, Santos EP, Yu G, Rakine HY, Rosenthal JM, Ehrlich JR, Musch DC, Jayasundera KT. Content generation for patient-reported outcome measures for retinal degeneration therapeutic trials. Ophthalmic Genet 2020; 41:315-324. [PMID: 32571121 DOI: 10.1080/13816810.2020.1776337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Generate content for a patient-reported outcome (PRO) measure for use in future clinical trials for inherited retinal degenerations. METHODS Patients at the University of Michigan Kellogg Eye Center with a clinical diagnosis of inherited retinal degeneration with varying phenotypes were recruited for interviews. First, in-depth interviews were performed to solicit a wide range of patient experiences pertaining to visual function. Coders qualitatively analyzed the transcripts from these interviews using Atlas.ti software (Version 8.1.3 (522)) to draft questionnaire items. Next, the questionnaire was tested and refined based on participant feedback in cognitive interviews and administrator feedback in the pilot survey administration (pilot interviews). RESULTS A total of 55 participants with a clinical diagnosis of inherited retinal degeneration were interviewed throughout the three study phases: in-depth interviews (n = 26), cognitive interviews (n = 16), and pilot interviews (n = 13). Coded items were analyzed for frequency of occurrence and related themes, then organized into common domains. Within each domain, PRO items were drafted to address the functional limitations or adaptations experienced by patients. CONCLUSIONS Items for a PRO measure have been drafted and evaluated for interpretability in the target inherited retinal degeneration patient population. Content validity for the items was established through a process of in-depth interviews, cognitive interviews, and pilot interviews.
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Affiliation(s)
- Gabrielle D Lacy
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA.,Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Lilia T Popova
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Erin P Santos
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Gina Yu
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Hanan Y Rakine
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Julie M Rosenthal
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan, USA
| | - K Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
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Menghini M, Cehajic-Kapetanovic J, MacLaren RE. Monitoring progression of retinitis pigmentosa: current recommendations and recent advances. Expert Opin Orphan Drugs 2020; 8:67-78. [PMID: 32231889 PMCID: PMC7104334 DOI: 10.1080/21678707.2020.1735352] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Retinitis pigmentosa (RP) is the most common form of inherited retinal degenerations with an estimated prevalence of 1 in 4,000 and more than 1 million individuals affected worldwide. With the introduction of the first retinal gene therapy in 2017 the importance of understanding the mechanisms of retinal degeneration and its natural progression has shifted from being of academic interest to being of pivotal for the development of new therapies. AREAS COVERED This review covers standard and innovative diagnostic techniques and complementary examinations needed for the evaluation and treatment of RP. It includes chapters on the assessment of visual function, retinal morphology, and genotyping. EXPERT OPINION Monitoring the progression of RP can best be achieved by combining assessments of both visual function and morphology. Visual acuity testing using ETDRS charts should be complemented by low-luminance visual acuity and colour vision tests. Assessment of the visual field can also be useful in less advanced cases. In those with central RP involvement measuring retinal sensitivity using microperimetry is recommended. Retinal morphology is best assessed by OCT and autofluorescence. Genetic testing is pivotal as it contributes to the pathophysiological understanding and can guide clinical management as well as identify individuals that could benefit from retinal gene therapy.
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Affiliation(s)
- Moreno Menghini
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +41 79 704 52 58
| | - Jasmina Cehajic-Kapetanovic
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +44 7725 197054
| | - Robert E MacLaren
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +44 1865 228974
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10
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Lacy GD, Abalem MF, Musch DC, Jayasundera KT. Patient-reported outcome measures in inherited retinal degeneration gene therapy trials. Ophthalmic Genet 2020; 41:1-6. [PMID: 32100594 DOI: 10.1080/13816810.2020.1731836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient-reported outcome (PRO) measures have the potential to uniquely capture patient experience and serve as an outcome measure in inherited retinal degeneration (IRD) gene therapy trials. An IRD-specific patient-reported outcome measure may yield valuable information that has not been obtained from inherited retinal dystrophy gene therapy trials published to-date. Existing PRO measures have inherent limitations for use in IRD gene therapy trials. Developing an applicable patient-reported outcome measure for such trials needs to incorporate patient input from the target population, demonstrate sound psychometric properties, and be made in accordance with U.S. Food and Drug Administration (FDA) guidelines. This review will discuss the currently available PRO instruments, their limitations for IRD therapeutic trials, and suggestions for future PRO development in IRD populations. The PRO instruments highlighted were identified in PubMed search of English-language journals and previously published review articles.
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Affiliation(s)
- Gabrielle D Lacy
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kanishka T Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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11
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MacDonald IM, Moen C, Duncan JL, Tsang SH, Cehajic-Kapetanovic J, Aleman TS. Perspectives on Gene Therapy: Choroideremia Represents a Challenging Model for the Treatment of Other Inherited Retinal Degenerations. Transl Vis Sci Technol 2020; 9:17. [PMID: 32714643 PMCID: PMC7351877 DOI: 10.1167/tvst.9.3.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose To report combined viewpoints on ocular gene therapy from a select group of clinician scientists and a patient advocacy group. Methods With the support of Randy Wheelock and Dr. Chris Moen from the Choroideremia Research Foundation (CRF), a special interest group at the 2019 Annual meeting of the Association for Research in Vision and Ophthalmology in Vancouver, Canada, shared their knowledge, experience, concepts, and ideas and provided a forum to discuss therapeutic strategies for the treatment of inherited retinal disorders, using experience in choroideremia (CHM) as a model. Results A member of the CRF presented the patient perspective and role in clinical trials. Five clinician scientists presented reasons for limited long-term visual improvement in many gene therapy trials, including challenges with dose, incomplete understanding of photoreceptor metabolism, vector delivery, inflammation, and identification of patients likely to benefit from treatment. Conclusions The shared experience of the five clinician scientists indicates that the results of ocular gene therapy for choroideremia have been less successful than for RPE65-related Leber congenital amaurosis. Improvement in vector delivery and developing a better understanding of gene expression in target tissues, treatment dose and side effects, and inflammation, as well as identifying patients who are most likely to benefit without suffering excessive risk, are necessary to advance the development of effective therapies for inherited retinal degenerations. Translational Relevance Additional long-term data are required to determine if ocular gene therapy will be sufficient to alter natural progression in choroideremia. Combination therapies may have to be considered, as well as alternative vectors that minimize risk.
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Affiliation(s)
- Ian M. MacDonald
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | | | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen H. Tsang
- Jonas Children's Vision Care, Columbia Stem Cell Initiative, Departments of Ophthalmology, Pathology, and Cell Biology, Institute of Human Nutrition, Vagelos College of Physicians and Surgeons, Columbia University,New York, NY, USA
- Edward S. Harkness Eye Institute, New York–Presbyterian Hospital, New York, NY, USA
| | | | - Tomas S. Aleman
- Center for Advanced Research and Ocular Therapeutics, Scheie Eye Institute at the Perelman Center for Advanced Medicine, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
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12
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Jolly JK, Juenemann K, Boagey H, Nadsady M, Bridge H, Maclaren RE. Validation of electronic visual acuity (EVA) measurement against standardised ETDRS charts in patients with visual field loss from inherited retinal degenerations. Br J Ophthalmol 2019; 104:924-931. [PMID: 31585961 DOI: 10.1136/bjophthalmol-2019-315124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND With the increase in clinical trials testing therapy for retinal disease, there is a need to ensure that outcome measures are both accurate and standardised. The US Food and Drug Administration favours the use of visual acuity measured using ETDRS logMAR charts. The loss of visual field can interfere with visual tracking across the charts, leading to increased variability of measurements. Electronic visual acuity (EVA) presents the optotype on the centre of a screen, thereby removing the tracking element of the task, and may provide a more precise measurement. METHODS Visual acuity was measured twice using ETDRS charts, EVA automated single letter (E-ETDRS) and EVA single line (EVA-SL) presentation (EMMES). Patients underwent microperimetry (MAIA; Centervue) to determine visual field. We tested 65 patients with rod-cone dystrophies and 41 healthy volunteers. RESULTS Both participant groups read 2-3 letters more on average on the electronic charts compared with ETDRS. Limits of agreement using a modified Bland-Altman analysis account for replicates were wider in eyes with foveal defects (-9 to 18) compared with eyes without foveal defects (-11 to 15). Electronic charts in the presence of foveal defects reduced the range (-11 to 13). CONCLUSION EVA may provide more accurate measures of visual acuity than traditional ETDRS charts in patients when the visual field loss encroached on the central vision. Electronic presentation with a single line of letters was the favoured style reported by patients and should be considered in future interventional clinical trials.
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Affiliation(s)
- Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK .,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Kristin Juenemann
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Heather Boagey
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marie Nadsady
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Holly Bridge
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Robert E Maclaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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13
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Bensinger E, Rinella N, Saud A, Loumou P, Ratnam K, Griffin S, Qin J, Porco TC, Roorda A, Duncan JL. Loss of Foveal Cone Structure Precedes Loss of Visual Acuity in Patients With Rod-Cone Degeneration. Invest Ophthalmol Vis Sci 2019; 60:3187-3196. [PMID: 31335944 PMCID: PMC6657704 DOI: 10.1167/iovs.18-26245] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/13/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the relationship between cone spacing and visual acuity in eyes with rod-cone degeneration (RCD) followed longitudinally. Methods High-resolution images of the retina were obtained using adaptive optics scanning laser ophthalmoscopy from 13 eyes of nine RCD patients and 13 eyes of eight healthy subjects at two sessions separated by 10 or more months (mean 765 days, range 311-1935 days). Cone spacing Z-score measured as close as possible (average <0.25°) to the preferred retinal locus was compared with visual acuity (letters read on the Early Treatment of Diabetic Retinopathy Study [ETDRS] chart and logMAR) and foveal sensitivity. Results Cone spacing was significantly correlated with ETDRS letters read (ρ = -0.47, 95%CI -0.67 to -0.24), logMAR (ρ = 0.46, 95%CI 0.24 to 0.66), and foveal sensitivity (ρ = -0.30, 95%CI -0.52 to -0.018). There was a small but significant increase in mean cone spacing Z-score during follow-up of +0.97 (95%CI 0.57 to 1.4) in RCD patients, but not in healthy eyes, and there was no significant change in any measure of visual acuity. Conclusions Cone spacing was correlated with visual acuity and foveal sensitivity. In RCD patients, cone spacing increased during follow-up, while visual acuity did not change significantly. Cone spacing Z-score may be a more sensitive measure of cone loss at the fovea than visual acuity in patients with RCD.
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Affiliation(s)
- Ethan Bensinger
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, California, United States
| | - Nicholas Rinella
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Asma Saud
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Panagiota Loumou
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Kavitha Ratnam
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, California, United States
| | - Shane Griffin
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Jia Qin
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Travis C. Porco
- Department of Ophthalmology, University of California, San Francisco, California, United States
- Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Austin Roorda
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, California, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, California, United States
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14
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Abnormal intrinsic brain activity in individuals with peripheral vision loss because of retinitis pigmentosa using amplitude of low-frequency fluctuations. Neuroreport 2019; 29:1323-1332. [PMID: 30113921 DOI: 10.1097/wnr.0000000000001116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The study aimed to determine alterations in intrinsic brain activity in retinitis pigmentosa (RP) individuals using the amplitude of low-frequency fluctuation (ALFF)/fractional amplitude of low-frequency fluctuation (fALFF) method. Sixteen RP individuals (10 men and six women) and 14 healthy controls (HCs) (six men and eight women) closely matched in age, sex, and education were enrolled in the study. The ALFF/fALFF method was applied to compare different intrinsic brain activities between the RP group and the HC group. The relationship between the mean ALFF/fALFF signal values of different brain regions and the visual measurements in RP group was analyzed by Pearson correlation. Compared with HCs, RP individuals had significantly lower ALFF values in the bilateral lingual gyrus (LIGG)/cerebellum posterior lobe [Brodmann area (BA) 17,18], but lower fALFF values in the bilateral LIGG/cerebellum anterior lobe (BA 17,18). Meanwhile, RP individuals had significantly higher ALFF in the bilateral precuneus cortex/middle cingulate cortex (BA 7,31), as well as higher fALFF values in the left superior/middle frontal gyrus (BA 9,10) and bilateral supplementary motor area (BA 6,8) (voxel-level P<0.01, cluster-level P<0.05). Moreover, the fALFF values of the bilateral LIGG/cerebellum anterior lobe showed positive relationships with the best-corrected visual acuity (BCVA)-oculus dexter (r=0.574, P=0.020) and BCVA-oculus sinister (r=0.570, P=0.021) in RP individuals; our results provide evidence that RP individuals may have impaired intrinsic brain activity in the primary visual area and the visuomotor coordination area that correlates with BCVA. Moreover, our findings indicate that reorganization of the dorsal visual stream and the parietoprefrontal pathway occurs in RP individuals.
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15
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Iftikhar M, Lemus M, Usmani B, Campochiaro PA, Sahel JA, Scholl HPN, Shah SMA. Classification of disease severity in retinitis pigmentosa. Br J Ophthalmol 2019; 103:1595-1599. [PMID: 30705041 DOI: 10.1136/bjophthalmol-2018-313669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 11/03/2022]
Abstract
AIM To develop a simple and easily applicable classification of disease severity in retinitis pigmentosa (RP). METHODS This is a retrospective cross-sectional study. Visual acuity (VA), visual field width (VF) and ellipsoid zone width (EZ) were obtained from medical records of patients with RP. A scoring criterion was developed wherein each variable was assigned a score from 0 to 5 depending on its distribution. The cumulative score (from 0 to 15) was used to classify disease severity from grade 0 to 5. The scores were correlated with each other and the final grade. The grades were then correlated with age and disease duration. RESULTS The median age (range) of patients (n=93) was 55 (12-87) years, 51% were female, 70% had been diagnosed within 10 years, and 50% had autosomal recessive disease. Most eyes (n=181) at least had a VA of 20/40 (67%), a VF of 20° (75%) and an EZ of 5° (76%). All scores were correlated with each other (r=0.509-0.613; p<0.001 for all) and with the final grade (r=0.790-0.869; p<0.001 for all). Except for grade 0 (5%), all grades were evenly distributed: 21% for grade 1, 23% for grade 2, 22% for grade 3, 17% for grade 4 and 12% for grade 5. Grades were correlated with both age (r=0.252; p<0.001) and disease duration (r=0.383; p<0.001). CONCLUSIONS We present a simple, objective and easy to use disease severity classification for RP which can be used to categorise and compare patients.
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Affiliation(s)
- Mustafa Iftikhar
- The Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Marili Lemus
- The Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bushra Usmani
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter A Campochiaro
- The Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - José Alain Sahel
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Hendrik P N Scholl
- The Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Syed Mahmood Ali Shah
- The Wilmer Eye Institute, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA .,Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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16
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Takahashi VKL, Takiuti JT, Jauregui R, Lima LH, Tsang SH. Structural disease progression in PDE6-associated autosomal recessive retinitis pigmentosa. Ophthalmic Genet 2018; 39:610-614. [PMID: 30153077 DOI: 10.1080/13816810.2018.1509354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the progression of retinitis pigmentosa (RP) caused by mutations in either PDE6A or PDE6B by measuring the progressive constriction of the hyperautofluorescent ring and shortening of the ellipsoid zone (EZ)-line width. PATIENTS AND METHODS Fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) images were obtained from seven patients with autosomal recessive RP caused by mutations in either PDE6A or PDE6B. Measurements of the EZ line width on SD-OCT images and horizontal, vertical diameter, and ring area on FAF images were performed by two independent graders. The measurements of these four parameters were correlated with one another. RESULTS We observed that the EZ line width decreased by an average of 91 ± 64 µm per year, while the horizontal and vertical diameters decreased by 103 ± 53 µm and 92 ± 49 µm per year, respectively. The ring area decreased by a rate of 0.3 ± 0.18 mm2 per year. Progression rates were similar for the left eye. CONCLUSIONS We observed a progressive loss of EZ line width and Short-wavelength fundus autofluorescence (SW-AF) ring constriction over time. These results may serve as reference for better prognostic prediction and patients selection for clinical trials promoting cone rescue.
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Affiliation(s)
- Vitor K L Takahashi
- a Department of Ophthalmology , Columbia University , New York , New York , USA.,b Jonas Children's Vision Care and the Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Columbia Stem Cell Initiative, Institute of Human Nutrition, Columbia University , New York , NY , USA.,c Department of Ophthalmology , Federal University of São Paulo , São Paulo , Brazil
| | - Júlia T Takiuti
- a Department of Ophthalmology , Columbia University , New York , New York , USA.,b Jonas Children's Vision Care and the Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Columbia Stem Cell Initiative, Institute of Human Nutrition, Columbia University , New York , NY , USA.,d Division of Ophthalmology , University of São Paulo Medical School , São Paulo , Brazil
| | - Ruben Jauregui
- a Department of Ophthalmology , Columbia University , New York , New York , USA.,b Jonas Children's Vision Care and the Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Columbia Stem Cell Initiative, Institute of Human Nutrition, Columbia University , New York , NY , USA.,e Weill Cornell Medical College , New York , NY , USA
| | - Luiz H Lima
- c Department of Ophthalmology , Federal University of São Paulo , São Paulo , Brazil
| | - Stephen H Tsang
- a Department of Ophthalmology , Columbia University , New York , New York , USA.,b Jonas Children's Vision Care and the Bernard & Shirlee Brown Glaucoma Laboratory, Departments of Ophthalmology, Pathology & Cell Biology, Columbia Stem Cell Initiative, Institute of Human Nutrition, Columbia University , New York , NY , USA.,f Department of Pathology & Cell Biology , Stem Cell Initiative (CSCI), Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University , New York , New York , USA
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17
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Sabel BA, Wang J, Cárdenas-Morales L, Faiq M, Heim C. Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine. EPMA J 2018; 9:133-160. [PMID: 29896314 PMCID: PMC5972137 DOI: 10.1007/s13167-018-0136-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
The loss of vision after damage to the retina, optic nerve, or brain has often grave consequences in everyday life such as problems with recognizing faces, reading, or mobility. Because vision loss is considered to be irreversible and often progressive, patients experience continuous mental stress due to worries, anxiety, or fear with secondary consequences such as depression and social isolation. While prolonged mental stress is clearly a consequence of vision loss, it may also aggravate the situation. In fact, continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomous nervous system (sympathetic) imbalance and vascular dysregulation; hence stress may also be one of the major causes of visual system diseases such as glaucoma and optic neuropathy. Although stress is a known risk factor, its causal role in the development or progression of certain visual system disorders is not widely appreciated. This review of the literature discusses the relationship of stress and ophthalmological diseases. We conclude that stress is both consequence and cause of vision loss. This creates a vicious cycle of a downward spiral, in which initial vision loss creates stress which further accelerates vision loss, creating even more stress and so forth. This new psychosomatic perspective has several implications for clinical practice. Firstly, stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended not only as complementary to traditional treatments of vision loss but possibly as preventive means to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism in their patients while giving them the information the patients are entitled to, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. More clinical studies are now needed to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision recovery and restoration in randomized trials as a foundation of psychosomatic ophthalmology.
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Affiliation(s)
- Bernhard A. Sabel
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Jiaqi Wang
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Lizbeth Cárdenas-Morales
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Muneeb Faiq
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029 India
- Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, New York, NY USA
| | - Christine Heim
- Berlin Institute of Health (BIH), Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA USA
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18
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Retrospective Analysis of Structural Disease Progression in Retinitis Pigmentosa Utilizing Multimodal Imaging. Sci Rep 2017; 7:10347. [PMID: 28871101 PMCID: PMC5583352 DOI: 10.1038/s41598-017-10473-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/10/2017] [Indexed: 12/02/2022] Open
Abstract
In this report, we assess the natural progression rate of retinitis pigmentosa (RP) over an average of three years using spectral-domain optical coherence tomography (SD-OCT) and short wavelength fundus autofluorescence (SW-AF). Measurement of the ellipsoid zone (EZ) line width and hyperautofluorescent ring diameters was performed in 81 patients with RP in a retrospective, longitudinal fashion. Rate of structural disease progression, symmetry between eyes, and test-retest variability were quantified. We observed on average, EZ-line widths decreased by 140 µm (5.2%, p < 0.001) per year, and average horizontal and vertical hyperautofluorescent ring diameters decreased by 149 µm (3.6%, p < 0.001) and 120 µm (3.9%, p < 0.001) per year, respectively. The 95th percentile of this cohort had differences in progression slopes between eyes that were less than 154 µm, 118 µm, and 132 µm for EZ-line width and horizontal and vertical ring diameters, respectively. For all measures except horizontal ring diameter, progression rates were significantly slower at end-stage disease. From our data, we observed a statistically significant progression rate in EZ line width and SW-AF ring diameters over time, verifying the utility of these measurements for disease monitoring purposes. Additionally, calculated differences in progression slopes between eyes may prove useful for investigators evaluating the efficacy of unilateral treatments for RP in clinical trials.
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19
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Prem Senthil M, Khadka J, Pesudovs K. Assessment of patient-reported outcomes in retinal diseases: a systematic review. Surv Ophthalmol 2017; 62:546-582. [DOI: 10.1016/j.survophthal.2016.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023]
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20
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Physical Activity and Quality of Life in Retinitis Pigmentosa. J Ophthalmol 2017; 2017:6950642. [PMID: 28596918 PMCID: PMC5449727 DOI: 10.1155/2017/6950642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/12/2017] [Accepted: 03/28/2017] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Aerobic exercise has been found to be neuroprotective in animal models of retinal degeneration. This study aims to report physical activity levels in patients with RP and investigate the relationship between physical activity and vision-related quality-of-life (QOL). MATERIALS AND METHODS A retrospective study of adult patients with RP examined in 2005-2014. Physical activity levels were assessed using the Godin Exercise Questionnaire. The NEI-Visual Function Questionaire-25 (VFQ-25), SF-36 General Health survey, and Pepper Assessment Tool for Disability (PAT-D) were administered. RESULTS 143 patients participated. 81 (56.6%) patients were classified as "active" and 62 (43.4%) as "insufficiently active" by Godin score. VFQ-25 revealed statistically significant differences between the active and insufficiently active patients, including overall visual function (53.3 versus 45.1, p = 0.010), color vision (73.8 versus 52.9, p < 0.001), and peripheral vision (34.3 versus 23.8, p = 0.021). The physical component of the SF-36 and the PAT-D survey also demonstrated statistically significant differences (47.2 versus 52.9, p = 0.002; 24.3 versus 30.0, p = 0.010). Active patients had a higher initial Goldmann visual field (GVF) score (74.8 versus 60.1 degrees, p = 0.255) and final GVF score (78.7 versus 47.1 degrees, p = 0.069) but did not reach statistical significance. CONCLUSIONS In RP, increased physical activity is associated with greater self-reported visual function and QOL.
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21
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Dorr M, Lesmes LA, Elze T, Wang H, Lu ZL, Bex PJ. Evaluation of the precision of contrast sensitivity function assessment on a tablet device. Sci Rep 2017; 7:46706. [PMID: 28429773 PMCID: PMC5399462 DOI: 10.1038/srep46706] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/28/2017] [Indexed: 11/26/2022] Open
Abstract
The contrast sensitivity function (CSF) relates the visibility of a spatial pattern to both its size and contrast, and is therefore a more comprehensive assessment of visual function than acuity, which only determines the smallest resolvable pattern size. Because of the additional dimension of contrast, estimating the CSF can be more time-consuming. Here, we compare two methods for rapid assessment of the CSF that were implemented on a tablet device. For a single-trial assessment, we asked 63 myopes and 38 emmetropes to tap the peak of a “sweep grating” on the tablet’s touch screen. For a more precise assessment, subjects performed 50 trials of the quick CSF method in a 10-AFC letter recognition task. Tests were performed with and without optical correction, and in monocular and binocular conditions; one condition was measured twice to assess repeatability. Results show that both methods are highly correlated; using both common and novel measures for test-retest repeatability, however, the quick CSF delivers more precision with testing times of under three minutes. Further analyses show how a population prior can improve convergence rate of the quick CSF, and how the multi-dimensional output of the quick CSF can provide greater precision than scalar outcome measures.
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Affiliation(s)
- Michael Dorr
- Technical University Munich, Department of Electrical and Computer Engineering, Munich, 80333, Germany
| | - Luis A Lesmes
- Adaptive Sensory Technology, Inc., San Diego, CA 92121, USA
| | - Tobias Elze
- Harvard Medical School, Schepens Eye Research Institute, Boston, MA 02114, USA
| | - Hui Wang
- Harvard Medical School, Schepens Eye Research Institute, Boston, MA 02114, USA.,Jilin University of Finance and Economics, Changchun, China
| | - Zhong-Lin Lu
- The Ohio State University, Department of Psychology, Columbus, OH 43210, USA
| | - Peter J Bex
- Northeastern University, Department of Psychology, Boston, MA 02115, USA
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22
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Ferreira S, Pereira AC, Quendera B, Reis A, Silva ED, Castelo-Branco M. Primary visual cortical remapping in patients with inherited peripheral retinal degeneration. NEUROIMAGE-CLINICAL 2016; 13:428-438. [PMID: 28116235 PMCID: PMC5233796 DOI: 10.1016/j.nicl.2016.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/10/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022]
Abstract
Human studies addressing the long-term effects of peripheral retinal degeneration on visual cortical function and structure are scarce. Here we investigated this question in patients with Retinitis Pigmentosa (RP), a genetic condition leading to peripheral visual degeneration. We acquired functional and anatomical magnetic resonance data from thirteen patients with different levels of visual loss and twenty-two healthy participants to study primary (V1) visual cortical retinotopic remapping and cortical thickness. We identified systematic visual field remapping in the absence of structural changes in the primary visual cortex of RP patients. Remapping consisted in a retinotopic eccentricity shift of central retinal inputs to more peripheral locations in V1. Importantly, this was associated with changes in visual experience, as assessed by the extent of the visual loss, with more constricted visual fields resulting in larger remapping. This pattern of remapping is consistent with expansion or shifting of neuronal receptive fields into the cortical regions with reduced retinal input. These data provide evidence for functional changes in V1 that are dependent on the magnitude of peripheral visual loss in RP, which may be explained by rapid cortical adaptation mechanisms or long-term cortical reorganization. This study highlights the importance of analyzing the retinal determinants of brain functional and structural alterations for future visual restoration approaches.
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Key Words
- FPZ, Function Projection Zone
- Functional magnetic resonance imaging (fMRI)
- Human
- LE, Left Eye
- LH, Left Hemisphere
- LPZ, Lesion Projection Zone
- MRI, Magnetic Resonance Imaging
- Plasticity
- Primary visual cortex
- RE, Right Eye
- RH, Right Hemisphere
- RNFL, Retinal Nerve Fiber Layer
- RP, Retinitis Pigmentosa
- Reorganization
- Retinitis pigmentosa
- Retinotopy
- fMRI, functional Magnetic Resonance Imaging
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Affiliation(s)
- Sónia Ferreira
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Andreia Carvalho Pereira
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Bruno Quendera
- Institute of Nuclear Sciences Applied to Health (ICNAS), Brain Imaging Network of Portugal, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Aldina Reis
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; Ophthalmology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), 3000-075 Coimbra, Portugal
| | - Eduardo Duarte Silva
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Miguel Castelo-Branco
- Visual Neuroscience Laboratory, Institute for Biomedical Imaging and Life Sciences (CNC.IBILI), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; Institute of Nuclear Sciences Applied to Health (ICNAS), Brain Imaging Network of Portugal, University of Coimbra, 3000-548 Coimbra, Portugal
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23
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Comparison of nonparametric methods for static visual field interpolation. Med Biol Eng Comput 2016; 55:117-126. [PMID: 27106755 PMCID: PMC5222903 DOI: 10.1007/s11517-016-1485-x] [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: 09/21/2015] [Accepted: 03/04/2016] [Indexed: 11/01/2022]
Abstract
Visual field testing with standard automated perimetry produces a sparse representation of a sensitivity map, sometimes called the hill of vision (HOV), for the retina. Interpolation or resampling of these data is important for visual display, clinical interpretation, and quantitative analysis. Our objective was to compare several popular interpolation methods in terms of their utility to visual field testing. We evaluated nine nonparametric scattered data interpolation algorithms and compared their performances in normal subjects and patients with retinal degeneration. Interpolator performance was assessed by leave-one-out cross-validation accuracy and high-density interpolated HOV surface smoothness. Radial basis function (RBF) interpolation with a linear kernel yielded the best accuracy, with an overall mean absolute error (MAE) of 2.01 dB and root-mean-square error (RMSE) of 3.20 dB that were significantly better than all other methods (p ≤ 0.003). Thin-plate spline RBF interpolation yielded the best smoothness results (p < 0.001) and scored well for accuracy with overall MAE and RMSE values of 2.08 and 3.28 dB, respectively. Natural neighbor interpolation, which may be a more readily accessible method to some practitioners, also performed well. While no interpolator will be universally optimal, these interpolators are good choices among nonparametric methods.
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24
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Ayton LN, Blamey PJ, Guymer RH, Luu CD, Nayagam DAX, Sinclair NC, Shivdasani MN, Yeoh J, McCombe MF, Briggs RJ, Opie NL, Villalobos J, Dimitrov PN, Varsamidis M, Petoe MA, McCarthy CD, Walker JG, Barnes N, Burkitt AN, Williams CE, Shepherd RK, Allen PJ. First-in-human trial of a novel suprachoroidal retinal prosthesis. PLoS One 2014; 9:e115239. [PMID: 25521292 PMCID: PMC4270734 DOI: 10.1371/journal.pone.0115239] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/18/2014] [Indexed: 11/19/2022] Open
Abstract
Retinal visual prostheses (“bionic eyes”) have the potential to restore vision to blind or profoundly vision-impaired patients. The medical bionic technology used to design, manufacture and implant such prostheses is still in its relative infancy, with various technologies and surgical approaches being evaluated. We hypothesised that a suprachoroidal implant location (between the sclera and choroid of the eye) would provide significant surgical and safety benefits for patients, allowing them to maintain preoperative residual vision as well as gaining prosthetic vision input from the device. This report details the first-in-human Phase 1 trial to investigate the use of retinal implants in the suprachoroidal space in three human subjects with end-stage retinitis pigmentosa. The success of the suprachoroidal surgical approach and its associated safety benefits, coupled with twelve-month post-operative efficacy data, holds promise for the field of vision restoration. Trial Registration Clinicaltrials.gov NCT01603576
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Affiliation(s)
- Lauren N. Ayton
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- * E-mail:
| | - Peter J. Blamey
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Chi D. Luu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - David A. X. Nayagam
- Bionics Institute, East Melbourne, Australia
- Department of Pathology, University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | | | - Mohit N. Shivdasani
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Jonathan Yeoh
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mark F. McCombe
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Robert J. Briggs
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Nicholas L. Opie
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | - Peter N. Dimitrov
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mary Varsamidis
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | - Chris D. McCarthy
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Janine G. Walker
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Nick Barnes
- NICTA, Computer Vision Research Group, Canberra, Australia
- National Institute for Mental Health Research, Australian National University, Canberra, Australia
| | - Anthony N. Burkitt
- Bionics Institute, East Melbourne, Australia
- Centre for Neural Engineering, University of Melbourne, National Information and Communications Technology Australia (NICTA), Ltd., Melbourne, Australia
| | | | - Robert K. Shepherd
- Bionics Institute, East Melbourne, Australia
- Department of Medical Bionics, University of Melbourne, East Melbourne, Australia
| | - Penelope J. Allen
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Rizzo S, Belting C, Cinelli L, Allegrini L, Genovesi-Ebert F, Barca F, di Bartolo E. The Argus II Retinal Prosthesis: 12-month outcomes from a single-study center. Am J Ophthalmol 2014; 157:1282-90. [PMID: 24560994 DOI: 10.1016/j.ajo.2014.02.039] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/14/2014] [Accepted: 02/15/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To study the anatomic and functional outcomes of Argus II Retinal Prosthesis System implantation in patients with retinitis pigmentosa. DESIGN Interventional case series. METHODS The study population included 6 patients with visual acuity no better than light perception. After the Argus II Retinal Prosthesis System was implanted, complications and anatomic and functional results were studied. The main outcome measures were mobility, square localization, direction of motion, grating visual acuity, and Goldmann visual field, all of which were assessed. Optical coherence tomography was performed. RESULTS Implantation of the Argus II Retinal Prosthesis System was safely performed in all patients. One patient experienced postoperative elevation in intraocular pressure, which was controlled medically. In 1 patient, moderate detachment of the choroid occurred postoperatively, and it resolved spontaneously. One patient withdrew from the study. Wound dehiscence, endophthalmitis or retinal detachment was not observed. All patients were able to locate a bright light on the ceiling and a dark line on the floor after the surgery. Performance in square localization tests improved in 4 patients, and direction of motion improved in 3 patients. One patient achieved grating visual acuity. Goldmann visual field test results improved in all patients. CONCLUSIONS The patients showed improvement in visual tasks after the surgery, and the device was well tolerated and functional over a 1-year follow-up period. A rigorous patient-selection process is necessary to maximize patient compliance with the rigorous follow-up testing schedule. Both patients and medical staff should be prepared for a lengthy, arduous rehabilitation process.
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Affiliation(s)
- Stanislao Rizzo
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy.
| | - Claudia Belting
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
| | - Laura Cinelli
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
| | - Luca Allegrini
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
| | - Federica Genovesi-Ebert
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
| | - Francesco Barca
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
| | - Emanuele di Bartolo
- Azienda Ospedaliero-Universitaria Pisana, Unità Operativa Chirurgia Oftalmica, Via Paradisa 2, 56124 Pisa, Italy
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26
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Rozanski C, Haythornthwaite JA, Dagnelie G, Bittner AK. Applying theories and interventions from behavioral medicine to understand and reduce visual field variability in patients with vision loss. Med Hypotheses 2014; 83:190-5. [PMID: 24854574 DOI: 10.1016/j.mehy.2014.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/21/2014] [Accepted: 04/06/2014] [Indexed: 11/18/2022]
Abstract
Visual field (VF) test results are often unreliable in visually impaired patients, but continue to be a cornerstone of clinical trials and play a vital role in clinical decision making since they are the primary method to determine patients' functional vision loss or progression. Currently, patients are typically asked to perform VF tasks with minimal instruction or consideration of their psychological experience during the test. The gradual loss of vision due to retinal diseases, such as retinitis pigmentosa (RP), age-related macular degeneration (AMD), or glaucoma can contribute to the experience of negative psychosocial states, such as anxiety, stress, and depression, as well as diminished quality of life. We hypothesize that VF testing elicits test performance anxiety and perception of functional losses of vision, which induces distracting negative thoughts that result in increased VF test variability. Resources for processing and responding to vision-related information may be diverted from task-relevant VF stimuli to task-irrelevant ones, such as internal worry and test anxiety, thereby resulting in VF test performance decrements. We present a theoretical model to support the hypothesis that VF variability is linked to patients' negative thoughts during VF testing. This conceptual framework provides a basis for the development of coping strategies and mindfulness-based interventions to be evaluated in future research aimed at improving psychosocial states and VF reliability in visually-impaired patients. It would be highly significant to intervene by modifying negative thoughts during VF testing to reduce test variability in glaucoma patients who are progressively losing vision to a blinding eye disease, but whose vision loss has not been accurately identified and treated early enough due to variable VF results. In clinical trials of potential interventions for RP and non-neovascular AMD, reducing VF variability would effectively increase the precision for detecting treatment effects and allow a reduction in the number of VF tests needed to estimate the treatment responses, thus reducing burden on investigators and patients, as well as saving time and money.
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Affiliation(s)
- Collin Rozanski
- Johns Hopkins University, 3400 N. Charles Street Baltimore, MD 21218, United States
| | | | - Gislin Dagnelie
- Johns Hopkins University, Dept. of Ophthalmology, Wilmer Eye Institute, United States
| | - Ava K Bittner
- Nova Southeastern University, College of Optometry, United States.
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Abstract
PURPOSE The purpose of this study was to evaluate and compare the mental health of patients with retinitis pigmentosa (RP) with that of the general population of Korea. METHODS Online surveys were completed by patients registered with the KRPS (Korean Retinitis Pigmentosa Society), an online organization that promotes research on RP and provides advocacy and online and offline support and information for patients with RP. Control population was selected from the fourth round of the KNHANES (Korean National Health and Nutrition Examination Survey). One hundred eighty-seven patients with RP were matched with the control population using the propensity-score method to optimize comparative analysis. RESULTS Stress was reported in 51.9% of RP patients and 29.4% of controls (p < 0.001). Depressive mood of at least 2 weeks' duration in the previous year was reported by 34.8 and 17.1% of patients and controls, respectively (p < 0.001). Suicidal thoughts were reported by 38.5 and 12.9% of patients and controls, respectively (p < 0.001), although there was no significant difference in the number of suicide attempts between the groups (2.1 vs. 1.6%, p = 0.703). In multivariate analysis, disability rating was significantly associated with stress (adjusted odds ratio, 0.46; 95% confidence interval, 0.24 to 0.88). CONCLUSIONS People with RP had poorer mental health than the general population. Further investigations are warranted on the mental health of RP patients, and appropriate welfare services are needed to decrease the impact of mental illness in this population.
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Ratnam K, Carroll J, Porco TC, Duncan JL, Roorda A. Relationship between foveal cone structure and clinical measures of visual function in patients with inherited retinal degenerations. Invest Ophthalmol Vis Sci 2013; 54:5836-47. [PMID: 23908179 DOI: 10.1167/iovs.13-12557] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To study the relationship between cone spacing and density and clinical measures of visual function near the fovea. METHODS High-resolution images of the photoreceptor mosaic were obtained with adaptive optics scanning laser ophthalmoscopy from 26 patients with inherited retinal degenerations. Cone spacing measures were made close to or at the foveal center (mean [SD] eccentricity, 0.02 [0.03] degree; maximum eccentricity, 0.13 degree) and were converted to Z-scores, fraction of cones, and percentage-of-cones-below-average compared with normal values for each location (based on 37 age-similar visually normal eyes). Z-scores and percentage of cones below average were compared with best-corrected visual acuity (VA) and foveal sensitivity. RESULTS Visual acuity was significantly correlated with cone spacing (Spearman rank correlation ρ = -0.60, P = 0.003) and was preserved (≥ 80 letters), despite cone density measures that were 52% below normal. Foveal sensitivity showed significant correlation with cone spacing (ρ = -0.47, P = 0.017) and remained normal (≥ 35 decibels), despite density measures that were approximately 52% to 62% below normal. CONCLUSIONS Cone density was reduced by up to 62% below normal at or near the fovea in eyes with VA and sensitivity that remained within normal limits. Despite a significant correlation with foveal cone spacing, VA and sensitivity are insensitive indicators of the integrity of the foveal cone mosaic. Direct, objective measures of cone structure may be more sensitive indicators of disease severity than VA or foveal sensitivity in eyes with inherited retinal degenerations.
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Affiliation(s)
- Kavitha Ratnam
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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29
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Wang YZ, He YG, Mitzel G, Zhang S, Bartlett M. Handheld shape discrimination hyperacuity test on a mobile device for remote monitoring of visual function in maculopathy. Invest Ophthalmol Vis Sci 2013; 54:5497-505. [PMID: 23860761 DOI: 10.1167/iovs.13-12037] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Frequency monitoring of age-related macular degeneration (AMD) and diabetic retinopathy (DR) is crucial for timely intervention. This study evaluated a handheld shape discrimination hyperacuity (hSDH) test iPhone app designed for visual function self-monitoring in patients with AMD and DR. METHODS One hundred subjects (27 visually normal, 37 with AMD, and 36 with DR) were included based on clinical documentation and visual acuity of 20/100 or better. The hSDH test was implemented on the iOS platform. A cross-sectional study was conducted to compare the hSDH test with a previously established desktop SDH (dSDH) test and to assess the effect of disease severity on the hSDH test. A user survey was also conducted to assess the usability of the hSDH test on the mobile device. RESULTS The hSDH test and dSDH test were highly correlated (r = 0.88, P < 0.0001). Bland-Altman analysis indicated no significant difference in hSDH and dSDH measurements. One-way ANOVA indicated that the mean hSDH measurement of the eyes with advanced AMD (n = 16) or with severe to very severe nonproliferative DR (NPDR) (n = 12) was significantly worse than that of the eyes with intermediate AMD (n = 11) or with mild to moderate NPDR (n = 11) (P < 0.0001). Ninety-eight percent of 46 patients (10 with AMD and 36 with DR) who completed the usability survey reported that the hSDH test was easy to use. CONCLUSIONS This study demonstrated that the hSDH test on a mobile device is comparable to PC-based testing methods. As a mobile app, it is intuitive to use, readily accessible, and sensitive to the severity of maculopathy. It has the potential to provide patients having maculopathy with a new tool to monitor their vision at home.
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Affiliation(s)
- Yi-Zhong Wang
- Retina Foundation of the Southwest, 9600 North Central Expressway, Suite 200, Dallas, TX 75231, USA.
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Lesmes LA, Jackson ML, Bex P. Visual Function Endpoints to Enable Dry AMD Clinical Trials. ACTA ACUST UNITED AC 2013; 10:e43-e50. [PMID: 32863843 DOI: 10.1016/j.ddstr.2012.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The slow progression of non-exudative age-related macular degeneration (dry AMD) presents challenges for drug discovery. The standard endpoint used for ophthalmic clinical trials, best-corrected visual acuity, is insensitive to the early stages and slow progression of dry AMD. Effective drug discovery for dry AMD treatments will therefore require novel applications of more effective visual function endpoints. This review will present candidates for visual function endpoints for dry AMD clinical trials. The promising visual assessments include contrast sensitivity, reading speed, microperimetry, and dark adaptation. Their adoption as exploratory endpoints in future trials will be critical for determining their accuracy, precision, and applicability, and ultimately determine their value for drug discovery.
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Affiliation(s)
- Luis Andres Lesmes
- Schepens Eye Research Institute, 20 Staniford St, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, United States
| | - Mary Lou Jackson
- Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, United States
| | - Peter Bex
- Schepens Eye Research Institute, 20 Staniford St, Boston, MA, United States
- Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, United States
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Roman AJ, Cideciyan AV, Schwartz SB, Olivares MB, Heon E, Jacobson SG. Intervisit variability of visual parameters in Leber congenital amaurosis caused by RPE65 mutations. Invest Ophthalmol Vis Sci 2013; 54:1378-83. [PMID: 23341016 DOI: 10.1167/iovs.12-11341] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the intervisit variability of kinetic visual fields and visual acuity in patients with Leber congenital amaurosis (LCA) caused by mutations in the RPE65 (Retinal Pigment Epithelium-specific protein 65kDa) gene. METHODS RPE65-LCA patients (n = 20; ages 11-40 years) were studied on at least two visits separated by fewer than 120 days using Goldmann visual field (GVF) and ETDRS visual acuity (VA) in a retrospective review. GVFs were quantified by computing the spherical coordinates of their vertices and calculating the solid angle subtended, and reported in normalized solid-angle units (nsu) as a percentage of average normal field extent. Repeatability coefficients were calculated using 95% confidence intervals on log(10)-converted variables. RESULTS Visual field extents in RPE65-LCA spanned a wide range from 4 to 95 nsu. The repeatability coefficient was 0.248 (log(10)nsu), suggesting cutoffs for significant change (in nsu) of +77% for improvement and -44% for worsening. VA in RPE65-LCA ranged from logMAR = 0.14 to 1.96 (20/40 to 20/1250). The repeatability coefficient was 0.170 (logMAR) (±8.5 ETDRS letters). Comparisons with published studies of ungenotyped retinitis pigmentosa showed that the RPE65-LCA patients had higher variability in kinetic field extent. VA variability in RPE65-LCA fell within reported results for retinitis pigmentosa. CONCLUSIONS Variability data for GVF and VA are provided to permit interpretation of the significance of increases and decreases of these functional outcomes in ongoing and planned clinical trials of therapy for LCA caused by RPE65 mutations.
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Affiliation(s)
- Alejandro J Roman
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bittner AK, Haythornthwaite JA, Diener-West M, Dagnelie G. Worse-than-usual visual fields measured in retinitis pigmentosa related to episodically decreased general health. Br J Ophthalmol 2012; 97:145-8. [PMID: 23212205 DOI: 10.1136/bjophthalmol-2012-302116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS We examined whether retinitis pigmentosa (RP) subjects' worse-than-usual vision measures were related to episodic changes in psychosocial factors and/or general health. METHODS In a prospective, cohort study, 37 RP subjects self-administered personal computer (PC)-based visual acuity (VA), contrast sensitivity (CS) and visual field (VF) tests at home twice a week, for 16 sessions in 2-3 months. Subjects rated their general health prior to each vision test session, and completed the Perceived Stress Scale, Positive and Negative Affect Schedules, and Epworth and Stanford Sleepiness Scales immediately after each session. RESULTS Nine subjects with reduced mean VA >0.5 log minimal angle of resolution (logMAR) on average had statistically significant 26% more sessions with measured deviations ≥0.1 logMAR from their mean (95% CI 20% to 32%; p<0.001), which were not significantly related to changes in psychosocial factors or general health. Measured deviations ≥0.1 logCS from mean CS were not statistically significantly related to any measured factors. We found a statistically significant increased frequency of sessions with ≥20% VF reduction from the mean (p<0.001) as mean log VF area was reduced. Subjects reporting reduced general health during a session had a statistically significant over twofold greater odds of having a VF reduction from the mean beyond 1 SD (95% CI 1.26 to 5.00; p=0.009). CONCLUSIONS Measured episodic VF reductions were more common in advanced RP and related to decreased general health at a session, which should be considered during clinical examinations and trials when determining true changes in vision. We did not find evidence that fluctuations in psychosocial factors were significantly correlated with vision reductions across subjects.
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Affiliation(s)
- Ava Katherine Bittner
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N. Wolfe St., Woods 465, Baltimore, MD 21287, USA.
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Barone I, Novelli E, Piano I, Gargini C, Strettoi E. Environmental enrichment extends photoreceptor survival and visual function in a mouse model of retinitis pigmentosa. PLoS One 2012; 7:e50726. [PMID: 23209820 PMCID: PMC3508993 DOI: 10.1371/journal.pone.0050726] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 10/24/2012] [Indexed: 01/03/2023] Open
Abstract
Slow, progressive rod degeneration followed by cone death leading to blindness is the pathological signature of all forms of human retinitis pigmentosa (RP). Therapeutic schemes based on intraocular delivery of neuroprotective agents prolong the lifetime of photoreceptors and have reached the stage of clinical trial. The success of these approaches depends upon optimization of chronic supply and appropriate combination of factors. Environmental enrichment (EE), a novel neuroprotective strategy based on enhanced motor, sensory and social stimulation, has already been shown to exert beneficial effects in animal models of various disorders of the CNS, including Alzheimer and Huntington disease. Here we report the results of prolonged exposure of rd10 mice, a mutant strain undergoing progressive photoreceptor degeneration mimicking human RP, to such an enriched environment from birth. By means of microscopy of retinal tissue, electrophysiological recordings, visual behaviour assessment and molecular analysis, we show that EE considerably preserves retinal morphology and physiology as well as visual perception over time in rd10 mutant mice. We find that protective effects of EE are accompanied by increased expression of retinal mRNAs for CNTF and mTOR, both factors known as instrumental to photoreceptor survival. Compared to other rescue approaches used in similar animal models, EE is highly effective, minimally invasive and results into a long-lasting retinal protection. These results open novel perspectives of research pointing to environmental strategies as useful tools to extend photoreceptor survival.
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Affiliation(s)
- Ilaria Barone
- Neuroscience Institute, Italian National Research Council (CNR), Pisa, Italy
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