Molecular biology of myopia

Applications of Genomics and Transcriptomics in Precision Medicine for Myopia Control or Prevention

Myopia is a globally emerging concern accompanied by multiple medical and socio-economic burdens with no well-established causal treatment to control thus far. The study of the genomics and transcriptomics of myopia treatment is crucial to delineate disease pathways and provide valuable insights for the design of precise and effective therapeutics. A strong understanding of altered biochemical pathways and underlying pathogenesis leading to myopia may facilitate early diagnosis and treatment of myopia, ultimately leading to the development of more effective preventive and therapeutic measures. In this review, we summarize current data about the genomics and transcriptomics of myopia in human and animal models. We also discuss the potential applicability of these findings to precision medicine for myopia treatment.

Whole-exome sequencing identifies LRIT3 mutations as a cause of autosomal-recessive complete congenital stationary night blindness

Congenital stationary night blindness (CSNB) is a clinically and genetically heterogeneous retinal disorder. Two forms can be distinguished clinically: complete CSNB (cCSNB) and incomplete CSNB. Individuals with cCSNB have visual impairment under low-light conditions and show a characteristic electroretinogram (ERG). The b-wave amplitude is severely reduced in the dark-adapted state of the ERG, representing abnormal function of ON bipolar cells. Furthermore, individuals with cCSNB can show other ocular features such as nystagmus, myopia, and strabismus and can have reduced visual acuity and abnormalities of the cone ERG waveform. The mode of inheritance of this form can be X-linked or autosomal recessive, and the dysfunction of four genes (NYX, GRM6, TRPM1, and GPR179) has been described so far. Whole-exome sequencing in one simplex cCSNB case lacking mutations in the known genes led to the identification of a missense mutation (c.983G>A [p.Cys328Tyr]) and a nonsense mutation (c.1318C>T [p.Arg440(∗)]) in LRIT3, encoding leucine-rich-repeat (LRR), immunoglobulin-like, and transmembrane-domain 3 (LRIT3). Subsequent Sanger sequencing of 89 individuals with CSNB identified another cCSNB case harboring a nonsense mutation (c.1151C>G [p.Ser384(∗)]) and a deletion predicted to lead to a premature stop codon (c.1538_1539del [p.Ser513Cysfs(∗)59]) in the same gene. Human LRIT3 antibody staining revealed in the outer plexiform layer of the human retina a punctate-labeling pattern resembling the dendritic tips of bipolar cells; similar patterns have been observed for other proteins implicated in cCSNB. The exact role of this LRR protein in cCSNB remains to be elucidated.

The GEnes in Myopia (GEM) study in understanding the aetiology of refractive errors

Refractive errors represent the leading cause of correctable vision impairment and blindness in the world with an estimated 2 billion people affected. Refractive error refers to a group of refractive conditions including hypermetropia, myopia, astigmatism and presbyopia but relatively little is known about their aetiology. In order to explore the potential role of genetic determinants in refractive error the "GEnes in Myopia (GEM) study" was established in 2004. The findings that have resulted from this study have not only provided greater insight into the role of genes and other factors involved in myopia but have also gone some way to uncovering the aetiology of other refractive errors. This review will describe some of the major findings of the GEM study and their relative contribution to the literature, illuminate where the deficiencies are in our understanding of the development of refractive errors and how we will advance this field in the future.

Biometric measurement of the mouse eye using optical coherence tomography with focal plane advancement

PURPOSE

To demonstrate that high-resolution biometry is possible in mouse eyes in vivo, using real-time OCT with focal plane advancement by a stepper motor.

METHODS

OCT images of eyes were taken from nine 29-day-old C57BL/6 mice(18 eyes) on two consecutive days. A custom-built real-time OCT instrument with a stepper motor was used to advance the focal plane from the corneal apex to the retina along the ocular axis. The ocular dimensions were determined by advancement of the stepper motor as it displayed on the OCT scan images.

RESULTS

OCT images of the entire eye, including the cornea, anterior chamber, lens, vitreous chamber, and retina, were successfully obtained from both eyes of all mice. The measured average corneal thickness from 18 eyes at the age of 29 days was 90.8+/-4.6microm, anterior chamber depth 707.4+/-21.4microm, lens thickness 1558.7+/-18.0microm, vitreous chamber depth 707.4+/-21.4microm and retinal thickness was 186.9+/-15.1microm. Total axial length (from the corneal apex to the nerve fiber layer of the retina) was 3003.3+/-44.1microm. None of them were significantly different if measured on two consecutive days, and no significant differences were found between measurements in the left and right eyes.

CONCLUSION

By focal plane advancement of a real-time OCT instrument through the mouse eye, highly repeatable measurements of the ocular dimensions were obtained. This novel method may be used to study small animal models of normal and abnormal eye development.

The role of the retinal pigment epithelium in eye growth regulation and myopia: a review

Myopia is increasing in prevalence world-wide, nearing epidemic proportions in some populations. This has led to expanded research efforts to understand how ocular growth and refractive errors are regulated. Eye growth is sensitive to visual experience, and is altered by both form deprivation and optical defocus. In these cases, the primary targets of growth regulation are the choroidal and scleral layers of the eye that demarcate the boundary of the posterior vitreous chamber. Of significance to this review are observations of local growth modulation that imply that the neural retina itself must be the source of growth-regulating signals. Thus the retinal pigment epithelium (RPE), interposed between the retina and the choroid, is likely to play a critical role in relaying retinal growth signals to the choroid and sclera. This review describes the ion transporters and signal receptors found in the chick RPE and their possible roles in visually driven changes in eye growth. We focus on the effects of four signaling molecules, otherwise implicated in eye growth changes (dopamine, acetylcholine, vasoactive intestinal peptide (VIP), and glucagon), on RPE physiology, including fluid transport. A model for RPE-mediated growth regulation is proposed.

How genetic is school myopia?

Myopia is of diverse aetiology. A small proportion of myopia is clearly familial, generally early in onset and of high level, with defined chromosomal localisations and in some cases, causal genetic mutations. However, in economically developed societies, most myopia appears during childhood, particularly during the school years. The chromosomal localisations characterised so far for high familial myopia do not seem to be relevant to school myopia. Family correlations in refractive error and axial length are consistent with a genetic contribution to variations in school myopia, but potentially confound shared genes and shared environments. High heritability values are obtained from twin studies, but rest on contestable assumptions, and require further critical analysis, particularly in view of the low heritability values obtained from parent-offspring correlations where there has been rapid environmental change between generations. Since heritability is a population-specific parameter, the values obtained on twins cannot be extrapolated to define the genetic contribution to variation in the general population. In addition, high heritability sets no limit to the potential for environmentally induced change. There is in fact strong evidence for rapid, environmentally induced change in the prevalence of myopia, associated with increased education and urbanisation. These environmental impacts have been found in all major branches of the human family, defined in modern molecular terms, with the exception of the Pacific Islanders, where the evidence is too limited to draw conclusions. The idea that populations of East Asian origin have an intrinsically higher prevalence of myopia is not supported by the very low prevalence reported for them in rural areas, and by the high prevalence of myopia reported for Indians in Singapore. A propensity to develop myopia in "myopigenic" environments thus appears to be a common human characteristic. Overall, while there may be a small genetic contribution to school myopia, detectable under conditions of low environmental variation, environmental change appears to be the major factor increasing the prevalence of myopia around the world. There is, moreover, little evidence to support the idea that individuals or populations differ in their susceptibility to environmental risk factors.

In vivo biometry in the mouse eye with low coherence interferometry

PURPOSE

A major drawback of the mouse model of myopia is that the ocular dimensions cannot be measured in vivo, and that histological techniques post-mortem suffer from limited resolution. We have tested the potential of a newly developed technique, optical low coherence interferometry (OLCI), adapted for short measurement distances by Meditec, Carl Zeiss, Jena, Germany (the "ACMaster"). Using this technique, ocular biometry was performed in mice with normal vision and after deprivation of form vision.

METHODS

Axial eye length, corneal thickness and anterior chamber depth were measured in 23 mice, aged 25-53 days, and standard deviations from repeated measurements in the same eyes, as well as intra-individual and inter-individual variability were determined in different age groups. The data were compared to those from a preceding study in which biometrical data were obtained from frozen sections [Vision Res. 44 (2004) 1857]. Refractions were measured by automated infrared photorefraction. Mice had either normal visual exposure or were monocularly deprived of form vision for 14 days.

RESULTS

Using OLCI, axial length could be determined with an average standard deviation of 8.0 +/- 2.9 microm, corneal thickness with 3.5 +/- 2.1 microm, and anterior chamber depth with 10.6 +/- 12.3 microm. Neither axial length, nor corneal thickness, nor anterior chamber depth were significantly different in left and right eyes of individual mice that had normal visual experience (mean absolute difference between axial lengths: 17 +/- 18 microm, between corneal thickness 5.1 +/- 4.8 microm, and between anterior chamber depths 16.7 +/- 14.8 microm). Compared to the variability that was previously found in frozen sections, the variability of axial length measurements with OLCI was 2.7 times less. After two weeks of form deprivation, OLCI revealed a significant axial elongation in the occluded eyes, compared to the contralateral fellow eyes (+38 +/- 36 microm or 1.16%, p = 0.045, n = 7, paired t-test). In this sample, no accompanying myopic shift was observed in the occluded eyes but this observation is not unexpected given the inherently variable responses of mouse eye growth to visual deprivation.

CONCLUSION

OLCI had sufficient resolution in living mice to detect axial length changes in vivo that were equivalent to a dioptric change of 2 D. Using this technique, it was confirmed that mouse eyes respond to form deprivation by axial elongation, similar to the eyes of other animal models. The lack of a myopic shift in this sample, despite the axial elongation, demonstrates that biometric data are particularly important when the mouse eye is used as a model to study myopia.

A paraxial schematic eye model for the growing C57BL/6 mouse

PURPOSE

The mouse eye has potential to become an important model for studies on the genetic control of eye growth and myopia. However, no data are published on the development of its optical properties. We developed a paraxial schematic model of the growing eye for the most common laboratory mouse strain, the C57BL/6 mouse, for the age range between 22 and 100 days.

METHODS

Refractive development was followed with eccentric infrared photorefraction and corneal curvature with infrared photokeratometry. To measure ocular dimensions, freshly excised eyes were immediately frozen after enucleation to minimize distortions. Eyes were cut with a cryostat down to the bisecting horizontal plane, until the optic nerve head became visible. The standard deviations were +/-10 microm for repeated measurements in highly magnified videographs, taken in several section planes close to the equator in the same eyes. To evaluate inter-eye and inter-individual variability, a total of 20 mice (34 eyes) were studied, with 3-4 eyes for each of the 9 sampling ages. Schematic eye models were developed using paraxial ray tracing software (OSLO, LT Lambda Research Corporation, and a self-written program).

RESULTS

The measured refractive errors were initially +4.0+/-0.6 D at approximately 30 days, and levelled off with +7.0+/-2.5 D at about 70 days. Corneal radius of curvature did not change with age (1.414+/-0.019 mm). Both axial lens diameter and axial eye length grew linearly (regression equations: lens, 1619 microm +5.5 microm/day, R=0.916; axial length, 2899 microm +4.4 microm/day, R=0.936). The lens grew so fast that vitreous chamber depth declined with age (regression equation: 896 microm -3.2 microm/day, R=0.685). The radii of curvature of the anterior lens surface increased during development (from 0.982 mm at day 22 to 1.208 mm at day 100), whereas the radii of the posterior lens surface remained constant (-1.081+/-0.054 mm). The calculated homogeneous lens index increased linearly with age (from 1.568 to 1.605). The small eye artifact, calculated from the dioptric difference of the positions of the vitreo-retinal interface and the photoreceptor plane, increased from +35.2 to +39.1 D, which was much higher than the hyperopia measured with photorefraction. Retinal image magnification increased from 31 to 34 microm/deg, and the f/number remained < or =1 at all ages, suggesting a bright retinal image. A calculated axial eye elongation of 5.4-6.5 microm was sufficient to make the schematic eye 1 D more myopic.

CONCLUSIONS

The most striking features of the mouse eye were that linear growth was slow but extended far beyond sexual maturity, that the corneal curvature did not increase, and that the prominent lens growth caused a developmental decline of the vitreous chamber depth.

Myopia: precedents for research in the twenty-first century

The myopic eye is generally considered to be a vulnerable eye and, at levels greater than 6 D, one that is especially susceptible to a range of ocular pathologies. There is concern therefore that the prevalence of myopia in young adolescent eyes has increased substantially over recent decades and is now approaching 10-25% and 60-80%, respectively, in industrialized societies of the West and East. Whereas it is clear that the major structural correlate of myopia is longitudinal elongation of the posterior vitreous chamber, other potential correlates include profiles of lenticular and corneal power, the relationship between longitudinal and transverse vitreous chamber dimensions and ocular volume. The most potent predictors for juvenile-onset myopia continue to be a refractive error </=+0.50 D at 5 years of age and family history. Significant and continuing progress is being made on the genetic characteristics of high myopia with at least four chromosomes currently identified. Twin studies and genetic modelling have computed a heritability index of at least 80% across the whole ametropic continuum. The high index does not, however, preclude an environmental precursor, sustained near work with high cognitive demand being the most likely. The significance of associations between accommodation, oculomotor dysfunction and human myopia is equivocal despite animal models that have demonstrated that sustained hyperopic defocus can induce vitreous chamber growth. Recent optical and pharmaceutical approaches to the reduction of myopia progression in children are likely precedents for future research, for example progressive addition spectacle lens trials and the use of the topical M1 muscarinic antagonist pirenzepine.