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Aboubakar H, Dohvoma VA, Ebana Mvogo SR, Ndongo JA, Epee E, Ebana Mvogo C. [Correlation between refraction and axial length in Albinos]. J Fr Ophtalmol 2024; 47:104189. [PMID: 38663224 DOI: 10.1016/j.jfo.2024.104189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/13/2023] [Accepted: 12/31/2023] [Indexed: 06/12/2024]
Abstract
PURPOSE To investigate the relationship between refraction and ocular axial length in albinos. PATIENTS AND METHODS A cross-sectional, analytical study was carried out from June to November 2021 at the Central Hospital of Yaounde (Cameroon), which included consenting albino subjects aged over 15years. All subjects underwent visual acuity testing, axial length measurements and objective refraction under cycloplegia. RESULTS We included 51 albino subjects. The mean age was 26.06±9.47years, and the sex ratio was 0.5. Type 2 oculocutaneous albinism (OCA2) was predominant, representing 82.4% of cases. The mean uncorrected visual acuity was 0.93±0.25 logMAR, and the most common ametropia was myopic astigmatism (52.9%). The mean axial length was 24.65±2.54mm with extremes of 21.54 and 30.33mm. Eyes with myopia and myopic astigmatism had significantly longer axial lengths than those with hyperopic and mixed astigmatism. A strong, significant negative correlation (r=-0.93; P˂0.001) between the spherical component of the refraction and axial length was found. CONCLUSION The spherical component of the refraction decreases significantly with increasing axial length in albinos.
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Affiliation(s)
- H Aboubakar
- Faculté de médecine et des sciences pharmaceutiques, université de Douala, Douala, Cameroun.
| | - V A Dohvoma
- Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital central de Yaoundé, Yaoundé, Cameroun
| | - S R Ebana Mvogo
- Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - J A Ndongo
- Faculté de médecine et des sciences pharmaceutiques, université de Douala, Douala, Cameroun
| | - E Epee
- Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital central de Yaoundé, Yaoundé, Cameroun
| | - C Ebana Mvogo
- Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Service d'ophtalmologie, hôpital central de Yaoundé, Yaoundé, Cameroun
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Bacci GM, Morales MU, Febbrini Del Magro E, Fortunato P, Marziali E, Virgili G, Amoaku W, Caputo R. Microperimetry assessment in foveal hypoplasia: functional results in a series of pediatric patients. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e61-e66. [PMID: 36423692 DOI: 10.1016/j.jcjo.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 08/17/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study the relationships of functional and morphologic retinal parameters in a series of pediatric patients with varying degrees of foveal hypoplasia (FH). DESIGN Monocentric observational retrospective study. PARTICIPANTS Among 21 pediatric patients, 16 met inclusion criteria, having FH confirmed with spectral-domain optical coherence tomography (SD-OCT) scan METHODS: Data were analyzed retrospectively. Patients able to undergo macular microperimetry (MP) and SD-OCT examinations were included in the analysis. MP and SD-OCT outcomes were compared with FH grading and best-corrected visual acuity (BCVA) using Pearson's correlation. RESULTS Thirty-one eyes from 16 patients (mean age 12.4 years) with different degrees of FH were analyzed. Two patients had grade 1, 7 had grade 2, 5 had grade 3, and 2 had grade 4 FH. Clinical nystagmus was present in 8 patients. The correlation between BCVA and SD-OCT data (-0.31) was lower than that found between BCVA and nystagmus (0.64), that for fixation index P1 (-0.60), as well as that for macular sensitivity (-0.63). CONCLUSIONS Although limited by the small sample, our study confirms the feasibility of automated MP evaluation in pediatric patients with FH. The added value of this work is the provision of data on relationships between anatomic and functional macular measurements acquired with SD-OCT, MP, and BCVA in eyes with various degrees of FH. Larger prospective studies are necessary to confirm these results.
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Affiliation(s)
- Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy.
| | - Marco Ulises Morales
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Elena Febbrini Del Magro
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Pina Fortunato
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Elisa Marziali
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research, and Child Health, Eye Clinic, University of Florence, Florence, Italy
| | - Winfried Amoaku
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
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Malechka VV, Duong D, Bordonada KD, Turriff A, Blain D, Murphy E, Introne WJ, Gochuico BR, Adams DR, Zein WM, Brooks BP, Huryn LA, Solomon BD, Hufnagel RB. Investigating Determinants and Evaluating Deep Learning Training Approaches for Visual Acuity in Foveal Hypoplasia. OPHTHALMOLOGY SCIENCE 2022; 3:100225. [PMID: 36339947 PMCID: PMC9634033 DOI: 10.1016/j.xops.2022.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022]
Abstract
Purpose To describe the relationships between foveal structure and visual function in a cohort of individuals with foveal hypoplasia (FH) and to estimate FH grade and visual acuity using a deep learning classifier. Design Retrospective cohort study and experimental study. Participants A total of 201 patients with FH were evaluated at the National Eye Institute from 2004 to 2018. Methods Structural components of foveal OCT scans and corresponding clinical data were analyzed to assess their contributions to visual acuity. To automate FH scoring and visual acuity correlations, we evaluated the following 3 inputs for training a neural network predictor: (1) OCT scans, (2) OCT scans and metadata, and (3) real OCT scans and fake OCT scans created from a generative adversarial network. Main Outcome Measures The relationships between visual acuity outcomes and determinants, such as foveal morphology, nystagmus, and refractive error. Results The mean subject age was 24.4 years (range, 1–73 years; standard deviation = 18.25 years) at the time of OCT imaging. The mean best-corrected visual acuity (n = 398 eyes) was equivalent to a logarithm of the minimal angle of resolution (LogMAR) value of 0.75 (Snellen 20/115). Spherical equivalent refractive error (SER) ranged from −20.25 diopters (D) to +13.63 D with a median of +0.50 D. The presence of nystagmus and a high-LogMAR value showed a statistically significant relationship (P < 0.0001). The participants whose SER values were farther from plano demonstrated higher LogMAR values (n = 382 eyes). The proportion of patients with nystagmus increased with a higher FH grade. Variability in SER with grade 4 (range, −20.25 D to +13.00 D) compared with grade 1 (range, −8.88 D to +8.50 D) was statistically significant (P < 0.0001). Our neural network predictors reliably estimated the FH grading and visual acuity (correlation to true value > 0.85 and > 0.70, respectively) for a test cohort of 37 individuals (98 OCT scans). Training the predictor on real OCT scans with metadata and fake OCT scans improved the accuracy over the model trained on real OCT scans alone. Conclusions Nystagmus and foveal anatomy impact visual outcomes in patients with FH, and computational algorithms reliably estimate FH grading and visual acuity.
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Casas-Llera P, Ruiz-Casas D, Alió JL. Macular involvement in congenital aniridia. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96 Suppl 1:60-67. [PMID: 34836590 DOI: 10.1016/j.oftale.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/28/2020] [Indexed: 06/13/2023]
Abstract
This review updates the knowledge about the morphological assessment of the foveal hypoplasia in congenital aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7%-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.
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Affiliation(s)
- P Casas-Llera
- Unidad de Glaucoma, Vissum Mirasierra, Madrid, Spain; Unidad de Glaucoma, Fernández Casas Oftalmólogos, Torrelavega, Cantabria, Spain.
| | - D Ruiz-Casas
- Departamento de Oftalmología, Hospital Ramón y Cajal, Madrid, Spain
| | - J L Alió
- Unidad de Córnea, Cataratas y Cirugía Refractiva de Vissum (Grupo Miranza), Alicante, Spain; Departamento de Oftalmología, Patología y Cirugía, Universidad Miguel Hernández, Alicante, Spain
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Casas-Llera P, Ruiz-Casas D, Alió JL. Macular involvement in congenital aniridia. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(21)00007-1. [PMID: 33736873 DOI: 10.1016/j.oftal.2020.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/19/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
This review updates the knowledge about the morphological assessment of the foveal hypoplasia in Congenital Aniridia and resumes the reported genotype-phenotype correlations known to date. Congenital Aniridia is a pan ocular disease. Although iris absence is considered the hallmark of this entity, foveal hypoplasia is present in 94.7-84% of patients. A foveal morphology assessed by optical coherence tomography in which external retina structures can be identified, with presence of the lengthening of photoreceptors outer segment and a greater external retinal thickness, is associated with a better visual outcome, regardless a foveal pit is identified or not. This analysis can be performed once the external retina has completed its differentiation, by 6 years old. PAX6 mutations that introduce premature termination codon, C terminal extension or PAX6 involving deletions have been related to lesser foveal differentiation. Better foveal differentiation has been associated to non-coding PAX6 mutations.
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Affiliation(s)
- P Casas-Llera
- Unidad de Glaucoma, Vissum Mirasierra, Madrid, España; Unidad de Glaucoma, Fernández Casas Oftalmólogos, Torrelavega, Cantabria, España.
| | - D Ruiz-Casas
- Departamento de Oftalmología. Hospital Ramón y Cajal, Madrid, España
| | - J L Alió
- Unidad de Córnea, Cataratas y Cirugía Refractiva de Vissum (Grupo Miranza), Alicante, España; Departamento de Oftalmología, Patología y Cirugía, Universidad Miguel Hernández, Alicante, España
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Landsend ECS, Lagali N, Utheim TP. Congenital aniridia - A comprehensive review of clinical features and therapeutic approaches. Surv Ophthalmol 2021; 66:1031-1050. [PMID: 33675823 DOI: 10.1016/j.survophthal.2021.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Congenital aniridia is a rare genetic eye disorder with total or partial absence of the iris from birth. In most cases the genetic origin of aniridia is a mutation in the PAX6 gene, leading to involvement of most eye structures. Hypoplasia of the fovea is usually present and is associated with reduced visual acuity and nystagmus. Aniridia-associated keratopathy, glaucoma, and cataract are serious and progressive complications that can further reduce visual function. Treatment of the ocular complications of aniridia is challenging and has a high risk of side effects. New approaches such as stem cell therapy may, however, offer better prognoses. We describe the various ocular manifestations of aniridia, with a special focus on conditions that commonly require treatment. We also review the growing literature reporting systemic manifestations of the disease.
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Affiliation(s)
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Tor P Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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Pillay E, Naidoo T, Asmal K, Maliwa L, Mchunua S, van Staden DB, Rampersad N. Characterization of Retinal Thickness in Individuals with Albinism: Baseline Data for a Black South African Population. CLINICAL OPTOMETRY 2021; 13:15-22. [PMID: 33505177 PMCID: PMC7829131 DOI: 10.2147/opto.s273141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The central retina is responsible for several visual functions and continues to develop postnatally. In albinism, which is a genetic disorder characterized by impaired melanin biosynthesis, the development of the central retina is prematurely arrested and results in foveal hypoplasia. Retinal thickness measurements can be determined non-invasively using optical coherence tomography systems. This article reports on the retinal thickness measurements of individuals with albinism in South Africa to aid in the assessment and management of affected individuals. METHODS The study used a comparative research design and included 60 individuals (30 albinism and 30 controls) aged from 10 to 30 years who accessed the eye clinic at a tertiary institution in KwaZulu-Natal, South Africa. The Optovue iVue100 optical coherence tomographer was used to measure retinal thickness in the nine Early Treatment Diabetic Retinopathy Study (ETDRS) sectors including the central foveal, parafoveal and perifoveal regions. Study data were analysed using descriptive and inferential statistics. RESULTS The mean central foveal thickness was significantly higher in individuals with albinism compared with controls (289 µm versus 239 µm, p < 0.001). In contrast, control participants showed thicker retinal thickness measurements in the other ETDRS sectors (p < 0.001). The nasal and temporal quadrants were thickest and thinnest, respectively, in the parafoveal and perifoveal regions for the albinism and control groups. CONCLUSION Individuals with albinism, aged from 10 to 30 years, have higher central foveal thickness but thinner retinal thickness measurements in the parafoveal and perifoveal regions. Optometric personnel should consider these measurements when assessing individuals with albinism with foveal retinal diseases.
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Affiliation(s)
- Ethan Pillay
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Thiroshnee Naidoo
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Khadija Asmal
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Lilitha Maliwa
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Sinenhlanhla Mchunua
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Diane Beverly van Staden
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
| | - Nishanee Rampersad
- Discipline of Optometry, School of Health Sciences, University of KwaZulu-Natal, DurbanX54001, South Africa
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Komoto S, Oie Y, Kawasaki S, Kawasaki R, Nishida N, Soma T, Koh S, Maruyama K, Usui S, Matsushita K, Tsujikawa M, Maeda N, Nishida K. Quantitative Analysis of the Association Between Follow-Up Duration and Severity of Limbal Stem Cell Deficiency or Visual Acuity in Aniridia. Invest Ophthalmol Vis Sci 2021; 61:57. [PMID: 32589199 PMCID: PMC7415892 DOI: 10.1167/iovs.61.6.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose This study aimed to quantitatively analyze the association between follow-up duration and the severity of limbal stem cell deficiency (LSCD) or visual acuity in patients with aniridia. Methods A total of 52 eyes of 27 patients with aniridia were enrolled at Osaka University Hospital. Medical records were retrospectively reviewed to obtain information on the severity of LSCD and corrected distance visual acuity (CDVA). LSCD severity was based on a modified severity grading scale. We used an ordered logistic regression model to examine the association between follow-up duration and LSCD severity, and a linear regression model with a generalized linear mixed model for the association between follow-up duration and visual acuity. Results The mean follow-up duration was 5.2 ± 6.3 years. The mean age at the last follow-up visit was 40.5 ± 18.9 years. The mean CDVA was 1.52 ± 1.09 logMAR. At the last follow-up, 1 examined eye (1.9%) was categorized as stage 0, 7 (13.5%) as Ia, 9 (17.3%) as Ib, 5 (9.6%) as Ic, 2 (3.8%) as IIb, 12 (23.1%) as IIc, and 11 (21.2%) as III. Five eyes (9.6%) were unclassifiable. There was a significant association between follow-up duration and LSCD severity (odds ratio per +1 year, 1.41; P < 0.001). CDVA significantly decreased as follow-up duration increased. Each increase of 1 year in the follow-up duration was associated with a mean difference of +0.021 logMAR (95% confidence interval [CI] 0.01–0.03; P < 0.001). Conclusions We quantitatively demonstrate that LSCD severity and visual impairment significantly progress as follow-up duration increases.
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Chen H, Wu X, Li X, Chen J, Lin Z, Chen W, Lin H. Analysis of Choroidal Thickness in Children with Congenital Aniridia. Curr Eye Res 2020; 45:1292-1297. [PMID: 32141346 DOI: 10.1080/02713683.2020.1736309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To evaluate the choroidal thickness (CT) in children with congenital aniridia in comparison with age-matched controls. Methods: This was a cross-sectional, observational study that included 64 eyes of 32 children with congenital aniridia (aged 5-12 years) and 80 eyes of 40 healthy subjects who were age-matched. In all subjects, subfoveal choroidal thickness (SFCT) was assessed at 750-μm intervals from the fovea to 1.5 mm in the temporal and nasal directions with spectral-domain optical coherence tomography (SD-OCT). Results: The mean SFCT was 207.67 ± 30.99 µm in the aniridic eyes. This SFCT was significantly thinner than that in control eyes (288.55 ± 30.06 µm) (P < .001). The SFCTs at 1.5 mm and 0.75 mm intervals in the temporal and nasal directions from the fovea were also significantly thinner in eyes with aniridia than control eyes (P < .001).There was a significant negative correlation between the SFCT and axial length in eyes with aniridia (B = -10.60, 95%CI = -19.31~-1.89, P = .017). Conclusions: The subfoveal and parafoveal CTs were significantly thinner in eyes with congenital aniridia than in control eyes. These choroidal changes could open up a new way for the research related to the pathophysiology of congenital aniridia.
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Affiliation(s)
- Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University , Guangzhou, China
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Takkar B, Priyanka, Asati DP, Rupla R, Shrivastava V. A Rare Case of Foveal Hypoplasia With Dyschromatosis Universalis. Ophthalmic Surg Lasers Imaging Retina 2019; 50:192-195. [DOI: 10.3928/23258160-20190301-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022]
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Pedersen HR, Hagen LA, Landsend ECS, Gilson SJ, Utheim ØA, Utheim TP, Neitz M, Baraas RC. Color Vision in Aniridia. Invest Ophthalmol Vis Sci 2019; 59:2142-2152. [PMID: 29801149 PMCID: PMC6110168 DOI: 10.1167/iovs.17-23047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose To assess color vision and its association with retinal structure in persons with congenital aniridia. Methods We included 36 persons with congenital aniridia (10–66 years), and 52 healthy, normal trichromatic controls (10–74 years) in the study. Color vision was assessed with Hardy-Rand-Rittler (HRR) pseudo-isochromatic plates (4th ed., 2002); Cambridge Color Test and a low-vision version of the Color Assessment and Diagnosis test (CAD-LV). Cone-opsin genes were analyzed to confirm normal versus congenital color vision deficiencies. Visual acuity and ocular media opacities were assessed. The central 30° of both eyes were imaged with the Heidelberg Spectralis OCT2 to grade the severity of foveal hypoplasia (FH, normal to complete: 0–4). Results Five participants with aniridia had cone opsin genes conferring deutan color vision deficiency and were excluded from further analysis. Of the 31 with aniridia and normal opsin genes, 11 made two or more red-green (RG) errors on HRR, four of whom also made yellow-blue (YB) errors; one made YB errors only. A total of 19 participants had higher CAD-LV RG thresholds, of which eight also had higher CAD-LV YB thresholds, than normal controls. In aniridia, the thresholds were higher along the RG than the YB axis, and those with a complete FH had significantly higher RG thresholds than those with mild FH (P = 0.038). Additional increase in YB threshold was associated with secondary ocular pathology. Conclusions Arrested foveal formation and associated alterations in retinal processing are likely to be the primary reason for impaired red-green color vision in aniridia.
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Affiliation(s)
- Hilde R Pedersen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Lene A Hagen
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway
| | | | - Stuart J Gilson
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Øygunn A Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Tor P Utheim
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Drammen Hospital, Drammen, Norway
| | - Maureen Neitz
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States
| | - Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University College of Southeast Norway, Kongsberg, Norway
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Casas-Llera P, Siverio A, Esquivel G, Bautista C, Alió JL. Spectral-domain optical coherence tomography foveal morphology as a prognostic factor for vision performance in congenital aniridia. Eur J Ophthalmol 2018; 30:58-65. [PMID: 30556423 DOI: 10.1177/1120672118818352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with congenital aniridia usually have some degree of foveal hypoplasia, thus representing a limiting factor in the final visual acuity achieved by these patients. The purpose of this study was to analyze whether the foveal morphology assessed by spectral-domain optical coherence tomography may serve as a prognostic indicator for best-corrected visual acuity in congenital aniridia patients. METHODS Observational two-center study performed between January 2012 and March 2017 in the pediatric ophthalmology department at Vissum Alicante and Vissum Madrid, Spain. A total of 31 eyes from 19 patients with congenital aniridia were included. After a complete ophthalmological examination, a high-resolution spectral-domain optical coherence tomography with a three-dimensional scan program macular protocol was used. A morphological grading system of foveal hypoplasia was used varying from grade 1 in which there is a presence of a shallow foveal pit, extrusion of inner retinal layers, outer nuclear layer widening, and a presence of outer segment lengthening to grade 4 in which none of these processes occur. RESULTS No correlation between central, mid-peripheral, and peripheral macular thickness and logMAR best-corrected visual acuity was found. The presence of outer segment lengthening was associated with better best-corrected visual acuity with a median best-corrected visual acuity, 0.30 logMAR, whereas the absence of this morphologic feature was associated with poorer VA with a median best-corrected visual acuity of 0.61 logMAR (p < 0.001). CONCLUSION Foveal hypoplasia morphology can predict the best-corrected visual acuity. Specifically, the morphologic optical coherence tomography feature that is related to a better best-corrected visual acuity in congenital aniridia patients is the presence of outer segment lengthening.
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Affiliation(s)
| | | | | | | | - Jorge L Alió
- VISSUM Alicante, Alicante, Spain.,Miguel Hernández University, Elche, Spain
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Larsson E, Molnar A, Holmström G. Repeatability, reproducibility and interocular difference in the assessments of optic nerve OCT in children- a Swedish population-based study. BMC Ophthalmol 2018; 18:270. [PMID: 30348126 PMCID: PMC6196413 DOI: 10.1186/s12886-018-0940-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/12/2018] [Indexed: 11/12/2022] Open
Abstract
Background The aim was, first, to collect normative data of the optic nerve head and the peripapillary retinal nerve fibre layer (RNFL) thickness assessed with Cirrus SD-OCT, in healthy children in a population-based study; second, using these data, to examine repeatability, reproducibility and the interocular difference. Methods One-hundred and ten eyes from 57 children aged 6–15 born at term, were examined. Best-corrected visual acuity and refraction were assessed. Both eyes were examined and the interocular difference was calculated. Repeatability was calculated by one examiner performing three assessments. Thereafter, a second examiner repeated the assessments to calculate reproducibility. Results Mean RNFL thickness was 99.2 (SD 8.8) μm, mean disc area 1.89 (SD 0.37) mm2 and mean rim area 1.52 (SD 0.26) mm2. No significant correlations with age, gender or refraction were found. Repeatability and reproducibility were good overall. There was interocular symmetry between the eyes. Conclusions Normal values for optic nerve head and RNFL thickness assessed with Cirrus SD-OCT were gathered to obtain a normal material in children. High repeatability and reproducibility indicated reliability of assessments performed by different examiners on different occasions. Overall, good correlation between right and left eyes was found.
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Affiliation(s)
- Eva Larsson
- Department of Neuroscience/Ophthalmology, Uppsala University, SE-751 85, Uppsala, Sweden.
| | - Anna Molnar
- Department of Neuroscience/Ophthalmology, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, SE-751 85, Uppsala, Sweden
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Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings. Case Rep Ophthalmol Med 2018; 2018:2146826. [PMID: 30147974 PMCID: PMC6083636 DOI: 10.1155/2018/2146826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.
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15
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Iqbal MM, Makar I. Unilateral isolated foveal hypoplasia. Can J Ophthalmol 2018; 53:e107-e109. [PMID: 29784171 DOI: 10.1016/j.jcjo.2017.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Munir M Iqbal
- Department of Ophthalmology, Western University, St. Joseph's Hospital, London, Ont.
| | - Inas Makar
- Department of Ophthalmology, Western University, St. Joseph's Hospital, London, Ont
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16
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Merrill KS, Summers CG. Positive Angle Kappa: A Possible Sign of Aniridia. ACTA ACUST UNITED AC 2017; 62:70-6. [DOI: 10.3368/aoj.62.1.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kimberly S. Merrill
- Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota
| | - C. Gail Summers
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
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17
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Bazvand F, Karkhaneh R, Roohipoor R, Rajabi MB, Ebrahimiadib N, Davoudi S, Modjtahedi BS. Optical Coherence Tomography Angiography in Foveal Hypoplasia. Ophthalmic Surg Lasers Imaging Retina 2017; 47:1127-1131. [PMID: 27977835 DOI: 10.3928/23258160-20161130-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/04/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVE A retrospective case series reporting optical coherence tomography angiography (OCTA) findings in foveal hypoplasia. PATIENTS AND METHODS Patients with foveal hypoplasia who presented to the authors' tertiary eye center. Cases of foveal hypoplasia that underwent OCTA were reviewed, and the clinical histories as well as imaging findings were summarized. RESULTS Three patients presented to the authors' eye center for evaluation of foveal hypoplasia and underwent OCTA: a 5-year-old girl, a 40-year-old woman, and a 22-year-old man. OCTA images were taken for both eyes of all patients. Four of five eyes with foveal hypoplasia had a small but present foveal avascular zone in the deep capillary plexus, whereas all eyes had an absent or severely reduced superficial capillary plexus. CONCLUSION OCTA can be helpful in the diagnosis of foveal hypoplasia and can aid in the anatomical characterization of disease. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1127-1131.].
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18
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Han J, Lee T, Lee JB, Han SH. Retinal microstructures are altered in patients with idiopathic infantile nystagmus. Graefes Arch Clin Exp Ophthalmol 2017; 255:1661-1668. [PMID: 28616716 DOI: 10.1007/s00417-017-3713-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/26/2017] [Accepted: 05/30/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare segmented retinal layer thicknesses between patients with idiopathic infantile nystagmus (IIN) and controls. METHODS This retrospective case-control study included 66 patients with IIN and 66 age-matched controls. The retinal layers were examined using spectral domain optical coherence tomography with autosegmentation. Central foveal thickness (CFT), outer nuclear layer (ONL), and outer segment length (OSL) thickness were measured at the fovea center. Mean values for retinal nerve fiber layer, ganglion cell inner plexiform layer (GCIPL), inner nuclear layer, outer plexiform-outer nuclear layer (OPNL) thicknesses were calculated at two measurement points (nasal and temporal hump points at the macula area). RESULTS There were no significant between-group differences in age, gender, or refraction error. The CFT was thicker in the IIN group compared with the control group (225.0 μm vs. 217.8 μm, P = 0.017) and OSL was shorter in IIN than in controls (40.0 μm vs. 43.7 μm., P < 0.001). The ONL thickness at the central fovea was not statistically different between the two groups. At the nasal and temporal position where the ganglion cell density was thickest, the GCIPL thickness was thinner in the IIN group compared to the controls (99.5 μm vs. 102.8 μm, P = 0.010). The GCIPL thickness was negatively correlated with logMAR visual acuity (Spearman's rho = -0.502, P < 0.001). CONCLUSIONS The foveal pit was shallower, OSL was shorter, and the GCIPL thicknesses at macular humps were decreased in the patients with IIN compared with that of controls. The faulty development of the macula may be related to unknown pathophysiologic mechanism during fovea maturation in IIN or continuous eye movement itself interrupt fovea development.
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Affiliation(s)
- Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, Seodaemun-gu, 03572, Korea
| | - Taekjune Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, Seodaemun-gu, 03572, Korea
| | - Jong Bok Lee
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, Seodaemun-gu, 03572, Korea
- Kong Eye Center, Seoul, Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seoul, Seodaemun-gu, 03572, Korea.
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A SERIES OF FIVE PATIENTS WITH FOVEAL HYPOPLASIA DEMONSTRATING GOOD VISUAL ACUITY. Retin Cases Brief Rep 2017; 13:376-380. [PMID: 28574945 DOI: 10.1097/icb.0000000000000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Foveal hypoplasia is associated with low vision in a variety of conditions. We report and show imaging studies for a series of five patients with foveal hypoplasia who had visual acuity ranging from 20/25 to 20/60. METHODS Observational case series. PATIENTS This series includes five patients aged 5 to 18 years who presented to the Greater Baltimore Medical Center, Hoover Low Vision Clinic. All patients showed a partial or complete absence of the fovea in both eyes on examination. RESULTS Eight eyes exhibited absence of foveal depression on spectral domain optical coherence tomography (Cirrus high-definition OCT; Carl Zeiss Meditec). Four eyes exhibited Grade 3 foveal hypoplasia, two eyes exhibited Grade 4 foveal hypoplasia, and two eyes exhibited Grade 1 foveal hypoplasia. For two eyes (one patient), the optical coherence tomography was no longer available for grading, but was interpreted as foveal hypoplasia in both eyes in the chart. Visual acuities ranged from 20/25 to 20/60. Only two of five patients showed signs of albinism. CONCLUSION Despite the presence of foveal hypoplasia, patients can retain a high level of visual acuity, which suggests that a foveal depression is not essential for the development of good visual acuity.
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CLINICAL SPECTRUM OF MACULAR-FOVEAL CAPILLARIES EVALUATED WITH OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2017; 37:436-443. [DOI: 10.1097/iae.0000000000001199] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Bouraoui R, Bouladi M, Nefaa F, Limaiem R, El Matri L. [Role of SD-OCT in the diagnosis and prognosis of macular hypoplasia in nystagmus patients]. J Fr Ophtalmol 2016; 39:272-6. [PMID: 26995079 DOI: 10.1016/j.jfo.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate whether spectral domain optical coherence tomography (SD-OCT) is helpful for the diagnosis and prognosis of foveal hypoplasia in patients with overt nystagmus. METHODS A retrospective cross-sectional study was conducted in 48 patients with overt nystagmus. All patients underwent a complete ophthalmic examination including best corrected visual acuity, biomicroscopic and fundus examinations. Spectral domain optical coherence tomography was performed using 3D OCT-2000 FA PLUS Topcon, Tokyo, Japan, for the diagnosis and grading of foveal hypoplasia, using the Thomas classification, and its possible correlation with visual acuity. RESULTS Foveal hypoplasia was diagnosed in 6 patients (12.5%). The mean age of the patients was 13.2 years (10-18 years). Mean visual acuity was 1.53/10 (0.87 LogMAR). Foveal hypoplasia was associated with aniridia in 2 patients, albinism in 3 patients and keratoconus in 1 case. On SD-OCT, foveal hypoplasia was grade 4 in 4 patients and grade 3 in 2 patients. Mean visual acuity was 2.55/10 in patients with grade 3 foveal hypoplasia and 1.22/10 in patients with grade 4 foveal hypoplasia, and the difference in visual acuity between the two groups was statistically significant (P<0.001). CONCLUSION SD-OCT plays a double role in the diagnosis and prognosis of foveal hypoplasia in patients with nystagmus.
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Affiliation(s)
- R Bouraoui
- Service B, faculté de médecine de Tunis, institut Hédi Rais d'ophtalmologie de Tunis, université Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisie
| | - M Bouladi
- Service B, faculté de médecine de Tunis, institut Hédi Rais d'ophtalmologie de Tunis, université Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisie.
| | - F Nefaa
- Service B, faculté de médecine de Tunis, institut Hédi Rais d'ophtalmologie de Tunis, université Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisie
| | - R Limaiem
- Service B, faculté de médecine de Tunis, institut Hédi Rais d'ophtalmologie de Tunis, université Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisie
| | - L El Matri
- Service B, faculté de médecine de Tunis, institut Hédi Rais d'ophtalmologie de Tunis, université Tunis El Manar, boulevard du 9-Avril-1938, Tunis, Tunisie
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22
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Samant M, Chauhan BK, Lathrop KL, Nischal KK. Congenital aniridia: etiology, manifestations and management. EXPERT REVIEW OF OPHTHALMOLOGY 2016; 11:135-144. [PMID: 30100922 DOI: 10.1586/17469899.2016.1152182] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Congenital aniridia manifests as total or partial absence of the iris caused most commonly by mutations in PAX6, FOXC1, PITX2, and CYP1B1. Recently two new genes, FOXD3 and TRIM44, have also been implicated in isolated studies. We discuss the genotype-phenotype correlations for the main implicated genes. Classic aniridia is a panocular condition, which includes aniridia, cataract, corneal pannus, foveal, and optic nerve hypoplasia associated with mutations in the PAX6 gene. Classical aniridia is due to PAX6 mutations, while other genes contribute to aniridia-like phenotypes. We review the challenges involved in the management of aniridia, and discuss various surgical interventions. The clinical importance of defining the genotype in cases of congenital aniridia has become acutely apparent with the advent of possible therapies for classical aniridia, which are discussed.
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Affiliation(s)
- Monica Samant
- Children's Eye Center of UPMC, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA
| | - Bharesh K Chauhan
- Children's Eye Center of UPMC, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
| | - Kira L Lathrop
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.,Department of Engineering. University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania 15213, USA
| | - Ken K Nischal
- Children's Eye Center of UPMC, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, 15213, USA.,Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Molnar A, Holmström G, Larsson E. Macular thickness assessed with spectral domain OCT in a population-based study of children: normative data, repeatability and reproducibility and comparison with time domain OCT. Acta Ophthalmol 2015; 93:470-475. [PMID: 25726865 DOI: 10.1111/aos.12695] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/12/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE To collect data on macular thickness assessed with Cirrus OCT in healthy children in a population-based study, to examine the repeatability and reproducibility, and to compare the values with Stratus OCT. METHODS Fifty-eight 6- to 15-year-old children, born at term, were examined. Best-corrected visual acuity and refraction were assessed. One examiner performed three OCT assessments, and the repeatability was calculated. Thereafter, a second examiner repeated the examinations to calculate the reproducibility. One eye was randomized to be included in the normal material. Finally, the second examiner assessed the macular thickness with the Stratus OCT. RESULTS The mean value (±SD) of central macular thickness was 255 ± 17 μm, and the total macular volume was 10.3 ± 0.5 mm(3) . No correlations were found between macular thickness and age, gender or refraction. The coefficients of variance (CoVs) for both repeatability and reproducibility were <1.21%, and the intraclass correlations (ICCs) were over 0.86. The Cirrus OCT showed a 29% thicker central macular thickness than the Stratus OCT. CONCLUSION Normal values for macular thickness assessed with Cirrus OCT in healthy full-term children in a population-based study were reported. The assessments showed high repeatability and reproducibility. The values of Cirrus and Stratus OCT differed and the techniques were not interchangeable.
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Affiliation(s)
- Anna Molnar
- Department of Neuroscience/Ophthalmology; Uppsala University; Uppsala Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology; Uppsala University; Uppsala Sweden
| | - Eva Larsson
- Department of Neuroscience/Ophthalmology; Uppsala University; Uppsala Sweden
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Chang JW, Kim JH, Kim SJ, Yu YS. Congenital aniridia: long-term clinical course, visual outcome, and prognostic factors. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:479-85. [PMID: 25435751 PMCID: PMC4239467 DOI: 10.3341/kjo.2014.28.6.479] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/13/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up. Methods The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. Results Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. Conclusions Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.
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Affiliation(s)
- Ji Woong Chang
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. ; Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. ; Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea. ; Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
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25
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Noval S, Freedman SF, Asrani S, El-Dairi MA. Incidence of fovea plana in normal children. J AAPOS 2014; 18:471-5. [PMID: 25266830 DOI: 10.1016/j.jaapos.2014.07.157] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 06/30/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize the prevalence and features of subclinical foveal hypoplasia detected by optical coherence tomography (OCT) in children. METHODS Fast macular OCT scans were performed on normal children with normal vision for the development of a normative OCT-3 database; from this data, eyes with no discernable foveal depression were identified. When possible, the ocular imaging was repeated 3 years later using both OCT-3 and spectral domain OCT (SD-OCT). SD-OCT results were compared to age-matched controls. RESULTS Of the 286 normal children (mean age, 8.6 ± 3.1 years) scanned, 9 (mean age, 8 ± 2.9 years; 6 males) were found to have bilateral shallow foveal depression on OCT-3 imaging, including 8 of 154 white children (5.4%) and 1 child of mixed ethnicity (white/black). Children with shallow foveas (n = 9) had larger average foveal thickness (FT) compared to the cohort of controls (n = 277) with a defined fovea (FT = 231.4 ± 8.8 vs 188.8 ± 25.0, resp. [P < 0.0001]). Mean macular volume did not differ from that of controls. SD-OCT performed 3 years later on 5 of the 9 children with shallow foveal depression showed persistence of the inner macular layers over the foveal center, corresponding to grades 1 or 2 of foveal hypoplasia. The FT was increased compared to 5 age-matched controls with a defined fovea (FT = 294.5 ± 5.1 vs 219.75 ± 5.68 μm, resp. [P = 0.029]). CONCLUSIONS Up to 3% of children with clinically normal eyes had an anatomically underdeveloped foveal pit bilaterally on OCT.
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MESH Headings
- Black or African American
- Child
- Child, Preschool
- Eye Diseases, Hereditary/diagnosis
- Eye Diseases, Hereditary/epidemiology
- Eye Diseases, Hereditary/ethnology
- Eye Diseases, Hereditary/physiopathology
- Female
- Follow-Up Studies
- Fovea Centralis/abnormalities
- Fovea Centralis/physiopathology
- Humans
- Incidence
- Male
- North Carolina/epidemiology
- Nystagmus, Congenital/diagnosis
- Nystagmus, Congenital/epidemiology
- Nystagmus, Congenital/ethnology
- Nystagmus, Congenital/physiopathology
- Prevalence
- Tomography, Optical Coherence/methods
- Visual Acuity/physiology
- White People
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Affiliation(s)
- Susana Noval
- Duke Eye Center, Durham, North Carolina; Department of Ophthalmology, La Paz University Hospital, IdiPaz, Madrid
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Holmström G, Bondeson ML, Eriksson U, Åkerblom H, Larsson E. 'Congenital' nystagmus may hide various ophthalmic diagnoses. Acta Ophthalmol 2014; 92:412-6. [PMID: 23889849 DOI: 10.1111/aos.12250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 06/29/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate whether patients registered at a low-vision centre with 'nystagmus' had any underlying, but so far unknown, ophthalmic diagnosis. METHODS All patients registered at the low-vision centre of Uppsala county with nystagmus as their major diagnosis were identified. Their medical records were studied to exclude those with other general diagnoses that could explain the nystagmus. The remaining group of patients underwent an ophthalmic examination, refraction and optical coherence tomography (OCT). Electroretinogram and genetic analyses were performed when indicated. RESULTS Sixty-two patients with nystagmus as their main diagnosis were registered at the low-vision centre, Uppsala, and 43 of them had a major diagnosis other than nystagmus. Nystagmus was the major diagnosis in 19 patients, 15 of whom, aged 6-76 years, participated in the study. Two of the patients had foveal hypoplasia and albinism, four a seemingly isolated foveal hypoplasia, three achromatopsia, one rod-cone dystrophy, one degenerative high myopia, and two could not be evaluated. Only two patients appeared to have 'congenital' nystagmus. Eleven of the patients underwent a comprehensive genetic investigation of the PAX 6 gene. In addition, four of the patients were analysed for mutations in FOXC1 and PITX2 and one in FRMD7. No mutations were found in any of the patients analysed. CONCLUSION The study illustrates that many patients in our study group with nystagmus had underlying ophthalmic diagnoses. Early diagnosis is important to facilitate habilitation and to provide genetic counselling and, in the future, possibly also gene therapy.
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Affiliation(s)
- Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
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Lee H, Sheth V, Bibi M, Maconachie G, Patel A, McLean RJ, Michaelides M, Thomas MG, Proudlock FA, Gottlob I. Potential of handheld optical coherence tomography to determine cause of infantile nystagmus in children by using foveal morphology. Ophthalmology 2013; 120:2714-2724. [PMID: 24161406 DOI: 10.1016/j.ophtha.2013.07.018] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 07/15/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To investigate the feasibility of handheld (HH) ultra-high-resolution spectral-domain optical coherence tomography (SD-OCT) in young children with nystagmus, to determine its sensitivity and specificity in classifying foveal abnormalities, and to investigate its potential to determine the cause of infantile nystagmus with the use of foveal morphology. DESIGN Prospective, case-control study. PARTICIPANTS AND CONTROLS A total of 50 patients with nystagmus and 50 healthy control subjects (mean age, 3.2 years; range, 0-8 years). METHODS Each patient was scanned using HH SD-OCT (Bioptigen Inc., Research Triangle Park, NC) without sedation, and foveal morphology was classified into 1 of 4 categories: (1) typical foveal hypoplasia (predicting clinical diagnosis of albinism, PAX6 mutations, or isolated foveal hypoplasia); (2) atypical foveal hypoplasia (predicting achromatopsia); (3) other foveal changes (corresponding to retinal dystrophies); and (4) normal fovea (predicting idiopathic or manifest latent nystagmus). An independent interpretation of the HH SD-OCT scans by masked examiners was performed, and the sensitivity and specificity of the predicted diagnosis were calculated. MAIN OUTCOME MEASURES The success rate of image acquisition and sensitivity and specificity of the HH SD-OCT in classifying foveal abnormalities. RESULTS In 94% of examinations, HH SD-OCT was successful. Twenty-three patients had typical foveal hypoplasia (category 1). Of these patients, 21 were diagnosed with albinism and 2 were diagnosed with PAX6 mutations. Five patients were classified as atypical (category 2) and diagnosed with achromatopsia. Six patients had other abnormal foveal morphology (category 3) and were diagnosed with retinal dystrophy. Sixteen patients had normal foveal morphology (category 4). Of these patients, 12 were diagnosed with idiopathic nystagmus and 4 were diagnosed with manifest latent nystagmus. Sensitivities of HH SD-OCT for classifying typical or atypical foveal hypoplasia, other abnormal foveal morphology, and normal morphology were 92.8%, 86.7%, 41.1%, and 88.4%, respectively, with specificities of 91.4%, 94.8%, 97.7% and 95.1%, respectively. CONCLUSIONS We demonstrate excellent feasibility of HH SD-OCT in the diagnosis of conditions associated with infantile nystagmus. The HH SD-OCT classification of foveal abnormalities was highly sensitive and specific. This classification was used to determine the underlying cause of infantile nystagmus. Handheld SD-OCT in early childhood can facilitate focused investigations and earlier diagnosis. This is important in an era when potentially time-sensitive treatment, such as gene therapy, is imminent.
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Affiliation(s)
- Helena Lee
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Viral Sheth
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Mashal Bibi
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Gail Maconachie
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Aarti Patel
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Rebecca J McLean
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Michel Michaelides
- The UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom
| | - Mervyn G Thomas
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Frank A Proudlock
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Irene Gottlob
- Ophthalmology Group, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom.
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Isolated foveal hypoplasia with secondary nystagmus and low vision is associated with a homozygous SLC38A8 mutation. Eur J Hum Genet 2013; 22:703-6. [PMID: 24045842 DOI: 10.1038/ejhg.2013.212] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/07/2013] [Accepted: 08/16/2013] [Indexed: 11/08/2022] Open
Abstract
Foveal hypoplasia, always accompanied by nystagmus, is found as part of the clinical spectrum of various eye disorders such as aniridia, albinism and achromatopsia. However, the molecular basis of isolated autosomal recessive foveal hypoplasia is yet unknown. Individuals of apparently unrelated non consanguineous Israeli families of Jewish Indian (Mumbai) ancestry presented with isolated foveal hypoplasia associated with congenital nystagmus and reduced visual acuity. Genome-wide homozygosity mapping followed by fine mapping defined a 830 Kb disease-associated locus (LOD score 3.5). Whole-exome sequencing identified a single missense mutation in the homozygosity region: c.95T>G, p.(Ile32Ser), in a conserved amino acid within the first predicted transmembrane domain of SLC38A8. The mutation fully segregated with the disease-associated phenotype, demonstrating an ∼10% carrier rate in Mumbai Jews. SLC38A8 encodes a putative sodium-dependent amino-acid/proton antiporter, which we showed to be expressed solely in the eye. Thus, a homozygous SLC38A8 mutation likely underlies isolated foveal hypoplasia.
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Shen L, Gao F, Xu X, Lin Z, Zhang Z, Zhao B, Zhang X, Li B, Jonas JB. Macular thickness in Chinese. Acta Ophthalmol 2013; 91:e77-9. [PMID: 22520243 DOI: 10.1111/j.1755-3768.2012.02428.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomas MG, Gottlob I. Optical Coherence Tomography Studies Provides New Insights into Diagnosis and Prognosis of Infantile Nystagmus: A Review. Strabismus 2012; 20:175-80. [DOI: 10.3109/09273972.2012.735336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mervyn G. Thomas
- Ophthalmology Group, School of Medicine, University of Leicester,
Leicester, UK
| | - Irene Gottlob
- Ophthalmology Group, School of Medicine, University of Leicester,
Leicester, UK
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Isolated foveal hypoplasia: tomographic, angiographic and autofluorescence patterns. Case Rep Ophthalmol Med 2012; 2012:864958. [PMID: 22900218 PMCID: PMC3415089 DOI: 10.1155/2012/864958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/28/2012] [Indexed: 12/31/2022] Open
Abstract
Purpose. To report clinical aspects, tomographic, angiographic, and autofluorescence patterns of two cases of isolated foveal hypoplasia. Methods. Foveal hypoplasia was found in a 23-year-old male patient and in a 64-year-old woman with impaired visual acuity of unknown etiology that remained unchanged for years. Results. In the first case, spectral-domain optical coherence tomography (SD-OCT) showed reduced foveal pit and continuity of inner retinal layers in the fovea. Photoreceptor layer had a normal thickness centrally. The foveal avascular zone (FAZ) was absent in the flourescein angiogram (FA). Fundus autofluorescence showed reduced foveal attenuation of autofluorescence. In the second patient, there was the same pattern in SD-OCT, with normal aspect in FA and only a slightly reduced foveal attenuation of autofluorescence. Conclusion. OCT, as a noninvasive and quick method, is helpful in the diagnosis of foveal hypoplasia. FA and fundus autofluorescence were less sensitive.
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Non-invasive anterior segment and posterior segment optical coherence tomography and phenotypic characterization of aniridia. Can J Ophthalmol 2011; 46:337-44. [DOI: 10.1016/j.jcjo.2011.06.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/11/2011] [Accepted: 04/11/2011] [Indexed: 11/22/2022]
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Mohammad S, Gottlob I, Kumar A, Thomas M, Degg C, Sheth V, Proudlock FA. The functional significance of foveal abnormalities in albinism measured using spectral-domain optical coherence tomography. Ophthalmology 2011; 118:1645-52. [PMID: 21570122 DOI: 10.1016/j.ophtha.2011.01.037] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The relationship between foveal abnormalities in albinism and best-corrected visual acuity (BCVA) is unclear. High-resolution spectral-domain optical coherence tomography (SD OCT) was used to quantify foveal retinal layer thicknesses and to assess the functional significance of foveal morphologic features in patients with albinism. DESIGN Cross-sectional study. PARTICIPANTS Forty-seven patients with albinism and 20 healthy control volunteers were recruited to the study. METHODS Using high-resolution SD OCT, 7×7×2-mm volumetric scans of the fovea were acquired (3-μm axial resolution). The B scan nearest the center of the fovea was identified using signs of foveal development. The thickness of each retinal layer at the fovea and foveal pit depth were quantified manually using ImageJ software and were compared with BCVA. MAIN OUTCOME MEASURES Total retinal thickness, foveal pit depth, photoreceptor layer thickness, and processing layer thickness in relation to BCVA. RESULTS Total photoreceptor layer thickness at the fovea was correlated highly to BCVA (P = 0.0008; r = -0.501). Of the photoreceptor layers, the outer segment length was correlated most strongly to BCVA (P<0.0001; r = -0.641). In contrast, there was no significant correlation between either total retinal thickness or pit depth and BCVA (P>0.05). This was because of an inverse correlation between total photoreceptor layer thickness and total processing layer thickness (P<0.0001; r = -0.696). CONCLUSIONS Neither the total retinal thickness nor the pit depth are reliable indicators of visual deficit, because patients with similar overall retinal thickness had widely varying foveal morphologic features. In albinism, the size of the photoreceptor outer segment was found to be the strongest predictor of BCVA. These results suggest that detailed SD OCT images of photoreceptor anatomic features provide a useful tool in assessing the visual potential in patients with albinism. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sarim Mohammad
- Ophthalmology Group, University of Leicester, Leicester, UK
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Thomas MG, Kumar A, Mohammad S, Proudlock FA, Engle EC, Andrews C, Chan WM, Thomas S, Gottlob I. Structural grading of foveal hypoplasia using spectral-domain optical coherence tomography a predictor of visual acuity? Ophthalmology 2011; 118:1653-60. [PMID: 21529956 PMCID: PMC5648335 DOI: 10.1016/j.ophtha.2011.01.028] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 01/10/2011] [Accepted: 01/10/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To characterize and grade the spectrum of foveal hypoplasia based on different stages of arrested development of the fovea. Grading was performed using morphologic findings obtained by ultra high-resolution spectral-domain optical coherence tomography. Best-corrected visual acuity (BCVA) was calculated for different grades. DESIGN Observational case series. PARTICIPANTS AND CONTROLS Sixty-nine patients with foveal hypoplasia (albinism, n = 34; PAX6 mutations, n = 10; isolated cases, n = 14; achromatopsia, n = 11) and 65 control subjects were examined. METHODS A 7×7-mm retinal area was sampled using a 3-dimensional scanning protocol (743×75, A scans×B scans) with ultra high-resolution spectral-domain optical coherence tomography (SOCT Copernicus HR; 3-μm axial resolution). Gross morphologic abnormalities were documented. B-scans at the fovea were segmented using a longitudinal reflectivity profile. Logarithm of the minimum angle of resolution BCVA was obtained. MAIN OUTCOME MEASURES Grading was based on presence or absence of foveal pit and widening of the outer nuclear layer (ONL) and outer segment (OS) at the fovea. Quantitative measurements were obtained for comparing atypical foveal hypoplasia in achromatopsia. Best-corrected visual acuity was compared with the grade of foveal hypoplasia. RESULTS Four grades of foveal hypoplasia were distinguished: grade 1, shallow foveal pit, presence of ONL widening, presence of OS lengthening; grade 2, grade 1 but absence of foveal pit; grade 3, grade 2 but absence of OS lengthening; grade 4, grade 3 but absence of ONL widening. There was significant difference in visual acuity (VA) associated with each grade (P<0.0001). Grade 1 was associated with the best VA (median VA, 0.2), whereas grades 2, 3, and 4 were associated with progressively poorer VA with a median VA of 0.44, 0.60, and 0.78, respectively. The atypical features seen with foveal hypoplasia associated with achromatopsia were characterized by decreased retinal and ONL thickness and deeper foveal depth. CONCLUSIONS A structural grading system for foveal hypoplasia was developed based on the stage at which foveal development was arrested, which helps to provide a prognostic indicator for VA and is applicable in a range of disorders associated with foveal hypoplasia. Atypical foveal hypoplasia in achromatopsia shows different characteristics. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Mervyn G Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, Leicester, UK
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Skeens HM, Brooks BP, Holland EJ. Congenital aniridia variant: minimally abnormal irides with severe limbal stem cell deficiency. Ophthalmology 2011; 118:1260-4. [PMID: 21376398 DOI: 10.1016/j.ophtha.2010.11.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 11/12/2010] [Accepted: 11/19/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To clinically and molecularly characterize a group of patients with progressive limbal stem cell deficiency (LSCD) due to aniridic keratopathy (AK), but with minimally affected irides. DESIGN Retrospective case series. PARTICIPANTS A total of 12 eyes of 6 patients who underwent keratolimbal allograft (KLAL) for AK in the absence of the classic stigmata of aniridia at the Cincinnati Eye Institute/University of Cincinnati between 2000 and 2007. METHODS Retrospective chart review. MAIN OUTCOME MEASURES Ocular surface stability after KLAL and change in visual acuity. RESULTS Subjects' mean age was 32.57 years, 66% were female, and mean follow-up was 64.4 months (range, 20-115 months). All patients presented with a decline in their vision secondary to LSCD. Average preoperative best-corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) was 1.4 (range, 0.10-2.8). All patients had minimally affected irides with subtle abnormal findings, including ectropion uveae and stromal atrophy. All patients developed severe LSCD and required KLAL. Average postoperative logMAR BCVA was 0.35 (range, 0.00-1.00). All ocular surfaces remained stable throughout the follow-up period. Family history consistent with autosomal dominant inheritance was positive in 4 of 6 patients. PAX6 genetic testing identified 2 pathologic mutations and 1 possible disease-causing variant. CONCLUSIONS Aniridic keratopathy may present in the absence of other classic stigmata of aniridia and be associated with minimally affected irides. A subset of these patients has definitive mutations in PAX6 and once identified can be counseled appropriately. These patients respond well to KLAL and may therefore benefit from early detection.
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Affiliation(s)
- Heather M Skeens
- Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA.
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Park DY, Kim MM. Clinical Manifestations of Foveal Hypoplasia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dae-young Park
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Myung-Mi Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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