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Lanza M, Incagli F, Ceccato C, Reffo ME, Mercuriali E, Parmeggiani F, Pagliano E, Saletti V, Leonardi M, Suppiej A, Dollfus H, LeBreton D, Finger RP, Leroy BP, Zemaitiene R, Nowomiejska K, Guastafierro E. Quality of life, functioning and participation of children and adolescents with visual impairment: A scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 151:104772. [PMID: 38870675 DOI: 10.1016/j.ridd.2024.104772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/24/2024] [Accepted: 06/01/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Vision has a key role in children's neuromotor, cognitive and social development. Children with visual impairment attain developmental milestones at later stages and are at higher risk of developing psychological disorders and social withdrawn. AIMS We performed a scoping review to summarize the mostly used instruments assessing the impact of visual impairment on quality of life, functioning and participation of children and adolescents. In addition, the main findings of the included studies are discussed. METHODS AND PROCEDURES We searched for papers assessing quality of life, functioning and participation of children and adolescents with visual impairment from 0 to 18 years old conducted between 2000 and 2023. OUTCOMES AND RESULTS In total, 69 studies met the inclusion criteria and were included in the review. Child self-report, caregivers-proxy and self-report questionnaires as well as interviews were used. The results showed that quality of life, functioning and participation are significantly reduced in children and adolescents with visual impairment, and that the impact depends on different factors (e.g., severity of the impairment, age). CONCLUSIONS AND IMPLICATIONS Considering the significant impact of visual impairment on quality of life, functioning and participation on this population, it is fundamental to develop integrated and multi-dimensional assessment programs that evaluate the impact of visual impairment on those dimensions considering different contexts of life (e.g., family, school, leisure time). WHAT THIS PAPER ADDS?: The present review aims to give an overview of what is known about the impact of visual impairment on quality of life, functioning and participation of children and adolescents. We assumed a biopsychosocial perspective which, in line with the definition of health by the International Classification of Functioning, Disability and Health (WHO, 2001), considered how body functions and structures, functioning, participation and environmental factors dynamically interact to define the health, or the disease, status of a person at a certain moment of life. We reported the most used instruments for the assessment of quality of life, participation, and functioning, with a specific interest on Patient-Reported Outcome Measures and self-report measures. By reporting the different instruments used, we gave a broad overview about the available tools that can be used in clinical as well as in research field to assess quality of life, functioning and participation in this population. Additionally, the review of the existing literature allowed us to demonstrate that those dimensions are negatively impacted by visual impairment and thus they should be considered in the assessment programs. Specifically, there is the need to provide more integrated assessment programs that investigate the impact of visual impairment on children and adolescents' social and emotional wellbeing, everyday functioning and social relationship, considering their subjective experience together with the one of caregivers, teachers, health care professionals, and other relevant adults involved in their life. Additionally, it is essential to plan and implement multidimensional assessment programs that consider how all areas of life are differently impacted by visual impairment.
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Affiliation(s)
- Martina Lanza
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesca Incagli
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Chiara Ceccato
- Robert Hollman Foundation, Padova, Italy; Pediatric Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | | | - Francesco Parmeggiani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Emanuela Pagliano
- Department of Pediatric Neurosciences Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Veronica Saletti
- Department of Pediatric Neurosciences Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Matilde Leonardi
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Agnese Suppiej
- Robert Hollman Foundation, Padova, Italy; Pediatric Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Hélène Dollfus
- Centre de référence pour les affections rares ophtalmologiques CARGO, FSMR SENSGENE, ERN-EYE, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, Strasbourg, France
| | - David LeBreton
- Institute for Advanced study (USIAS), University of Strasburg, France
| | - Robert P Finger
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bart Peter Leroy
- Department of Ophthalmology and Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium
| | - Reda Zemaitiene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Erika Guastafierro
- SC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Bergamim D, Surgik TCDS, Zinher MT, Nogueira de Lassus TC. Botulinum Toxin A Injection in Horizontal Nystagmus: Effect on the Frequency of the Oscillation on a Pediatric Population. J Pediatr Ophthalmol Strabismus 2024:1-6. [PMID: 38815100 DOI: 10.3928/01913913-20240409-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the effect of botulinum toxin A injection on the frequency of horizontal nystagmus in children. METHODS This was a non-randomized before-and-after clinical trial evaluating a cohort of children with horizontal nystagmus before and after treatment with botulinum toxin A. The toxin was injected under general anesthesia with spontaneous ventilation without intubation using the Mendonça forceps and the effect was evaluated by analyzing the frequency of the oscillation in Hertz (Hz) on video registrations before and after treatment. RESULTS The current study found a statistically significant difference on the frequency of the nystagmus in children before and after the injection of botulinum toxin A, with the mean frequency decreasing from 1.55 ± 0.94 Hz before treatment to 1.04 ± 0.87 Hz at 1 month post-injection (P < .001) and to 1.27 ± 0.87 Hz at 6 months post-injection (P = .002). When comparing the data 1 and 6 months post-injection, this study found a significant increase (P = .001) in the frequency of the nystagmus. CONCLUSIONS The injection of botulinum toxin A is effective in reducing the frequency of oscillations in children with horizontal nystagmus both 1 and 6 months after the procedure, and can be used as a first-line, less invasive treatment aiming to decrease the frequency of oscillation. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].
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Kamath A, Huang WC, Madill SA. How should I approach and manage adult-onset oscillopsia? Eye (Lond) 2024:10.1038/s41433-024-03130-0. [PMID: 38773260 DOI: 10.1038/s41433-024-03130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/23/2024] Open
Abstract
Oscillopsia is the sensation of illusory movement within the visual percept leading to a degradation of visual functioning and quality of life. The constellation of conditions manifesting with oscillopsia marks the overlap between ophthalmology and otorhinolaryngology. The purpose of this article is therefore to review the aetiologies of oscillopsia and provide pathways for investigation and treatment of processes that associate oscillopsia with intrusive ocular movement and for processes manifesting as oscillopsia in the absence of intrusive ocular movement. Points for referral are also included for the diagnoses that are more appropriately investigated and managed by allied medical specialties.
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Affiliation(s)
- Archith Kamath
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Wen Chun Huang
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK
| | - Stephen A Madill
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.
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Fossataro C, Pafundi PC, Mattei R, Cima V, De Rossi F, Savino G. Infantile nystagmus syndrome: An observational, retrospective, multicenter study. Optom Vis Sci 2024; 101:211-223. [PMID: 38684064 DOI: 10.1097/opx.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
SIGNIFICANCE This multicenter study assessed clinical and psychological aspects of infantile nystagmus syndrome (INS) focusing on its management and nonsurgical treatment. PURPOSE This study aimed to assess clinical features, management, relationship life, and psychological impact in a group of patients with nystagmus onset in pediatric age. METHODS This observational study included patients diagnosed with INS referred to two Italian centers from January 1, 2017, to December 31, 2020. Ophthalmologic and orthoptic features and impact of visual function on quality of life, according to nystagmus-specific nystagmus quality of life questionnaire, were analyzed within the overall sample and in any of INS subgroups. RESULTS Forty-three patients were included; 65.1% of them had idiopathic INS (IINS), and 34.9% had INS associated with ocular diseases (INSOD). The median age was 15.4 years (interquartile range [IQR], 10.4 to 17.3 years), significantly different between groups (median, 15.8 years among those with IINS vs. 12.3 years among those with INSOD; p<0.001). In the INSOD subgroup, strabismus was significantly more prevalent (93.3 vs. 57.1%; p=0.017). Binocular distance best-corrected visual acuity in primary position was significantly higher in the IINS subsample (p<0.001). Such behavior was further confirmed at anomalous head position evaluation (p<0.001). At near best-corrected visual acuity assessment, differences between groups were more remarkable in primary position (p<0.001) than in anomalous head position. Contrast sensitivity showed significantly higher values in the IINS subgroup (p<0.001). The nystagmus quality of life questionnaire disclosed a significantly lower score in IINS as compared with INSOD (median total score, 90.5 [IQR, 84 to 97] vs. 94 [IQR, 83.0 to 96.5]; p<0.001). CONCLUSIONS The IINS group showed significantly better ophthalmologic and orthoptic outcomes than the INSOD group. The psychological and quality-of-life impact was instead significantly greater in the IINS group. To the best of our knowledge, this is the first multicenter study investigating the clinical features of IIN and comparing the two main subgroups, IINS and INSOD.
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Affiliation(s)
| | | | - Roberta Mattei
- Ophthalmological Oncology Unit, Department of Neuroscience, Sensory Organs and Chest, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Cima
- Ophthalmological Oncology Unit, Department of Neuroscience, Sensory Organs and Chest, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca De Rossi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients, IAPB Italia Onlus, Rome, Italy
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Dai B, Cham KM, Abel LA. Visual search in infantile nystagmus syndrome. Clin Exp Optom 2023:1-8. [PMID: 37848183 DOI: 10.1080/08164622.2023.2260805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Research on infantile nystagmus syndrome (INS) and visual search is limited. Conducting this research could assist practitioners in understanding how INS affects the real-life visual activities of patients and aid in developing new clinical visual function assessments for INS. BACKGROUND The aim of this work is to investigate how subjects with INS perform visual search tasks, and, particularly, to assess how INS subjects perform when targets are located at their null position or away from it, and when under additional cognitive demands. METHODS INS subjects (N = 15) and controls (N = 20) performed conjunction and feature search tasks, both with and without mental arithmetic. Search performance was assessed using log-transformed total search time, gaze-dependent search time, and accuracy. Cognitive demand was quantified by pupil size and the NASA task-load index score. RESULTS INS subjects showed longer search times compared to controls in conjunction search (P < 0.01), but not in feature search. Within INS and control subjects, the total search times were significantly increased by the addition of mental arithmetic (P < 0.0001). There was no difference in gaze-dependent search times between null target position and 15° away from null target position of subjects in conjunction search (P > 0.05). Accuracies were 100% for both control and INS subjects in both conjunction and feature search. CONCLUSION Conjunction visual search was impaired in adult INS subjects, and further worsened under increased cognitive demand. The null position did not affect the visual search performance in INS.
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Affiliation(s)
- Bing Dai
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Larry Allen Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
- Optometry, School of Medicine, Deakin University, Victoria, Australia
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Wen Z, Kang Y, Zhang Y, Yang H, Xie B. Disrupted voxel-mirrored homotopic connectivity in congenital nystagmus using resting-state fMRI. Neuroreport 2023; 34:315-322. [PMID: 36966812 DOI: 10.1097/wnr.0000000000001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
OBJECTIVES Idiopathic congenital nystagmus (CN) is a rare eye disease that can cause early blindness (EB). CN deficits are observed most frequently with oculomotor dysfunction; however, it is still unclear what neuromechanics underly CN with EB. Based on that visual experience requires the functional integration of both hemispheres, we hypothesized that CN adolescents with EB might exhibit impaired interhemispheric synchrony. Our study aimed to investigate the interhemispheric functional connectivity alterations using voxel-mirrored homotopic connectivity (VMHC) and their relationships with clinical features in CN patients. MATERIALS AND METHODS This study included 21 patients with CN and EB, and 21 sighted controls (SC), who were matched for sex, age and educational level. The 3.0 T MRI scan and ocular examination were performed. The VMHC differences were examined between the two groups, and the relationships between mean VMHC values in altered brain regions and clinical variables in the CN group were evaluated by Pearson correlation analysis. RESULTS Compared with the SC group, the CN had increased VMHC values in the bilateral cerebellum posterior and anterior lobes/cerebellar tonsil/declive/pyramis/culmen/pons, middle frontal gyri (BA 10) and frontal eye field/superior frontal gyri (BA 6 and BA 8). No particular areas of the brain had lower VMHC values. Furthermore, no correlation with the duration of disease or blindness could be demonstrated in CN. CONCLUSION Our results suggest the existence of interhemispheric connectivity changes and provide further evidence for the neurological basis of CN with EB.
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Affiliation(s)
- Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University
| | - Yan Kang
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan
- University of Chinese Academy of Sciences, Beijing, China
| | - Yu Zhang
- Department of Radiology, Renmin Hospital of Wuhan University
| | - Huaguang Yang
- Department of Radiology, Renmin Hospital of Wuhan University
| | - Baojun Xie
- Department of Radiology, Renmin Hospital of Wuhan University
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Rennie K, Alagendran R, Lee H, Griffiths H, Self J. Impact of the COVID-19 pandemic on individuals with nystagmus and an exploration of public assumptions about the condition: an electronic questionnaire study. BMC Ophthalmol 2022; 22:268. [PMID: 35718783 PMCID: PMC9206891 DOI: 10.1186/s12886-022-02484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Nystagmus is a disorder characterized by uncontrolled, rhythmic oscillations of the eyes. It often causes reduced visual function beyond reduced visual acuity alone. There is a paucity of literature regarding the public understanding of nystagmus, and there are no published data on the impact of the COVID-19 pandemic on people living with the condition. This study explores the self-reported impact of the COVID-19 pandemic on those with nystagmus, and examines both public understanding of how nystagmus affects people who have it and the perceptions of public understanding by those with the condition and their carers. Methods A qualitative questionnaire was designed following a stakeholder engagement process. This questionnaire was advertised via social media platforms and charity websites to achieve widespread recruitment. Data were collected between November and December 2020. Participants were divided into two groups based on their response to the question: “Do you, or anyone you know well, have nystagmus?”. Questions were posed to participants in a purpose-built, branching survey. The resulting data were analyzed using descriptive and inferential statistical methods. Results One thousand six hundred forty-five respondents were recruited, of which 849 (51.6%) answered “Yes” to the initial filtering question. Analysis showed that, broadly, public understanding of nystagmus differs from the perception of it by those with nystagmus and their carers, that the COVID-19 pandemic has had a significant impact on those with nystagmus, and that respondents who have met someone with nystagmus, even briefly, tend to have a greater understanding of the impact of the condition. Conclusion This study highlights the lack of public awareness regarding nystagmus and suggests opportunities to increase the awareness of nystagmus without the need for extensive knowledge of the condition. The COVID-19 pandemic has posed additional difficulties for those living with nystagmus, which is likely to be comparable among those with similar ocular disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02484-x.
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Affiliation(s)
- Katherine Rennie
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Rajeeth Alagendran
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | | | | | - James Self
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
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Gu S, Hu Y, Zhao Y, Chen L, Sun W, Chang P, Wang D, Zhao Y. A Retrospective Study on the Eye-Related Quality of Life, Functional Vision, and Their Determinants Among Children Following Congenital and Developmental Cataracts Surgery and Its Impact on Their Families Using the PedEyeQ. Front Public Health 2022; 10:788384. [PMID: 35372237 PMCID: PMC8968105 DOI: 10.3389/fpubh.2022.788384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo evaluate the eye-related quality of life (ER-QOL), functional vision, and their determinants in children following congenital and developmental cataract surgery, as the impact on their families, using the Pediatric Eye Questionnaire (PedEyeQ).Materials and MethodsThis was a retrospective cross-sectional study involving 107 children (aged 0–11 years) with congenital and developmental cataracts who had undergone surgery, as well as 59 visually healthy controls (aged 0–11 years). One parent for each child completed either the Proxy 0–4 PedEyeQ, the Proxy 5–11 PedEyeQ, or the Parent PedEyeQ, depending on their child's age. Mann-Whitney U and Kruskal-Wallis tests were then conducted to compare the differences between groups and to analyze their determinants.ResultsPedEyeQ scores were found to be lower in postoperative children with congenital and developmental cataracts compared with the control group across all study domains. The PedEyeQ Proxy 0 to 4 years' greatest mean difference was 27 points worse in the Functional Vision domain (95% CI −34 to −19; p < 0.001). We also found that the occurrence of nystagmus (p < 0.005) and strabismus (p < 0.005) were the major factors affecting participants' functional vision. The PedEyeQ Proxy 5 to 11 years' greatest mean difference was 23 points worse in this same domain (95% CI −30 to −15; p < 0.001), with nystagmus (p < 0.05) being the main determinant herein. Parent PedEyeQ 0 to 4 years' greatest difference was 46 points worse on the Worry about their Child's Eye Condition domain (95% CI −57 to −36; p < 0.001). Similarly, parents of children with ophthalmologic abnormalities, including nystagmus (p < 0.001) and strabismus (p < 0.05), were significantly more worried about their children's eye condition. Parent PedEyeQ 5 to 11 years' greatest difference was also found to be 30 points worse on the Worry about their Child's Eye Condition domain (95% CI −43 to −17; p < 0.005).ConclusionsChildren who have undergone congenital and developmental cataract surgery experience a lower quality of life and reduced functional vision. Their families are also significantly and adversely affected herein. Thus, more attention is needed on these groups, with more focused measures being administered to both children and their families.
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Affiliation(s)
- Siyi Gu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yiwen Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yinying Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Lulu Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Weijie Sun
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Pingjun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Dandan Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
| | - Yune Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, China
- Eye Hospital of Wenzhou Medical University Hangzhou Branch, Hangzhou, China
- *Correspondence: Yune Zhao
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Dai B, Cham KM, Abel LA. Perception of Coherent Motion in Infantile Nystagmus Syndrome. Invest Ophthalmol Vis Sci 2022; 63:31. [PMID: 35072688 PMCID: PMC8802013 DOI: 10.1167/iovs.63.1.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Research on infantile nystagmus syndrome (INS) and motion perception is limited. We investigated how individuals with INS perform coherent motion tasks. Particularly, we assessed how the null position affects their performance. Methods Subjects with INS and controls identified the direction of coherent motion stimuli (22 subjects with INS and 13 controls) in a two-alternative forced-choice design. For subjects with INS, testing was done at the null position and 15 degrees away from it. If there was no null, testing was done at primary gaze position and 15 degrees away from primary. For controls, testing was done at primary gaze position and 20 degrees away from primary. Horizontal and vertical motion coherence thresholds were determined. Results Subjects with INS showed significantly higher horizontal and vertical motion coherence thresholds compared with controls at both gaze positions (P < 0.001). Within the INS group, for 12 subjects with INS who had an identified null position, no differences in coherence thresholds were found between their null and 15 degrees away from it (P > 0.05). Conclusions Coherent motion perception was impaired in subjects with INS. The null position did not significantly influence motion coherence thresholds for either horizontal or vertical motion.
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Affiliation(s)
- Bing Dai
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Larry Allen Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia.,Optometry, School of Medicine, Deakin University, Waurn Ponds, Australia
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Papageorgiou E, Lazari K, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1970533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, New Jersey, USA
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Syahbana YA, Yasunari Y, Hiroyuki M, Mitsuhiro A, Kanade S, Yoshitaka M. Nystagmus Estimation for Dizziness Diagnosis by Pupil Detection and Tracking Using Mexican-Hat-Type Ellipse Pattern Matching. Healthcare (Basel) 2021; 9:885. [PMID: 34356263 PMCID: PMC8306141 DOI: 10.3390/healthcare9070885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/29/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
The detection of nystagmus using video oculography experiences accuracy problems when patients who complain of dizziness have difficulty in fully opening their eyes. Pupil detection and tracking in this condition affect the accuracy of the nystagmus waveform. In this research, we design a pupil detection method using a pattern matching approach that approximates the pupil using a Mexican hat-type ellipse pattern, in order to deal with the aforementioned problem. We evaluate the performance of the proposed method, in comparison with that of a conventional Hough transform method, for eye movement videos retrieved from Gifu University Hospital. The performance results show that the proposed method can detect and track the pupil position, even when only 20% of the pupil is visible. In comparison, the conventional Hough transform only indicates good performance when 90% of the pupil is visible. We also evaluate the proposed method using the Labelled Pupil in the Wild (LPW) data set. The results show that the proposed method has an accuracy of 1.47, as evaluated using the Mean Square Error (MSE), which is much lower than that of the conventional Hough transform method, with an MSE of 9.53. We conduct expert validation by consulting three medical specialists regarding the nystagmus waveform. The medical specialists agreed that the waveform can be evaluated clinically, without contradicting their diagnoses.
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Affiliation(s)
- Yoanda Alim Syahbana
- Graduate School of Engineering, Gifu University, Yanagido 1-1, Gifu 501-1193, Japan
- Computer Engineering, Information Technology Department, Politeknik Caltex Riau, Umban Sari No. 1, Riau 25265, Indonesia
| | - Yokota Yasunari
- Department of Electrical, Electronics and Computer Engineering, Faculty of Engineering, Gifu University, Yanagido 1-1, Gifu 501-1193, Japan;
| | - Morita Hiroyuki
- Department of General Medicine and General Internal Medicine, Gifu University Hospital, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan;
| | - Aoki Mitsuhiro
- Department of Otolaryngology, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan;
- Center for Healthcare Information Technology, Tokai National Higher Education and Research System, Furo-cho, Chikusa-ku, Nagoya 464-8601, Japan
| | - Suzuki Kanade
- Medical IT Support Department, HRS Co., Ltd., Room B, 10th Floor, Itochu Marunouchi Building, 1-5-28 Marunouchi, Naka-ku, Nagoya 460-0002, Japan; (S.K.); (M.Y.)
| | - Matsubara Yoshitaka
- Medical IT Support Department, HRS Co., Ltd., Room B, 10th Floor, Itochu Marunouchi Building, 1-5-28 Marunouchi, Naka-ku, Nagoya 460-0002, Japan; (S.K.); (M.Y.)
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Gifu University, Yanagido 1-1, Gifu 501-1194, Japan
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12
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Gabapentin and Memantine for Treatment of Acquired Pendular Nystagmus: Effects on Visual Outcomes. J Neuroophthalmol 2021; 40:198-206. [PMID: 31169568 DOI: 10.1097/wno.0000000000000807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most common causes of acquired pendular nystagmus (APN) are multiple sclerosis (MS) and oculopalatal tremor (OPT), both of which result in poor visual quality of life. The objective of our study was to evaluate the effects of memantine and gabapentin treatments on visual function. We also sought to correlate visual outcomes with ocular motor measures and to describe the side effects of our treatments. METHODS This study was single-center cross-over trial. A total of 16 patients with chronic pendular nystagmus, 10 with MS and 6 with OPT were enrolled. Visual acuity (in logarithm of the minimum angle of resolution [LogMAR]), oscillopsia amplitude and direction, eye movement recordings, and visual function questionnaires (25-Item National Eye Institute Visual Functioning Questionnaire [NEI-VFQ-25]) were performed before and during the treatments (gabapentin: 300 mg 4 times a day and memantine: 10 mg 4 times a day). RESULTS A total of 29 eyes with nystagmus were evaluated. Median near monocular visual acuity improved in both treatment arms, by 0.18 LogMAR on memantine and 0.12 LogMAR on gabapentin. Distance oscillopsia improved on memantine and on gabapentin. Median near oscillopsia did not significantly change on memantine or gabapentin. Significant improvement in ocular motor parameters was observed on both treatments. Because of side effects, 18.8% of patients discontinued memantine treatment-one of them for a serious adverse event. Only 6.7% of patients discontinued gabapentin. Baseline near oscillopsia was greater among those with higher nystagmus amplitude and velocity. CONCLUSIONS This study demonstrated that both memantine and gabapentin reduce APN, improving functional visual outcomes. Gabapentin showed a better tolerability, suggesting that this agent should be used as a first-line agent for APN. Data from our investigation emphasize the importance of visual functional outcome evaluations in clinical trials for APN.
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13
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Jin S, Park SE, Won D, Lee ST, Han SH, Han J. TUBB3 M323V Syndrome Presents with Infantile Nystagmus. Genes (Basel) 2021; 12:genes12040575. [PMID: 33921132 PMCID: PMC8071555 DOI: 10.3390/genes12040575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/28/2023] Open
Abstract
Variants in the TUBB3 gene, one of the tubulin-encoding genes, are known to cause congenital fibrosis of the extraocular muscles type 3 and/or malformations of cortical development. Herein, we report a case of a 6-month-old infant with c.967A>G:p.(M323V) variant in the TUBB3 gene, who had only infantile nystagmus without other ophthalmological abnormalities. Subsequent brain magnetic resonance imaging (MRI) revealed cortical dysplasia. Neurological examinations did not reveal gross or fine motor delay, which are inconsistent with the clinical characteristics of patients with the M323V syndrome reported so far. A protein modeling showed that the M323V mutation in the TUBB3 gene interferes with αβ heterodimer formation with the TUBA1A gene. This report emphasizes the importance of considering TUBB3 and TUBA1A tubulinopathy in infantile nystagmus. A brain MRI should also be considered for these patients, although in the absence of other neurologic signs or symptoms.
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Affiliation(s)
- Soohwa Jin
- Department of Opthalmology, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sung-Eun Park
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.-E.P.); (S.-H.H.)
| | - Dongju Won
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.W.); (S.-T.L.)
| | - Seung-Tae Lee
- Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.W.); (S.-T.L.)
| | - Sueng-Han Han
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (S.-E.P.); (S.-H.H.)
| | - Jinu Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
- Correspondence: ; Tel.: +82-2-2019-3445
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14
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Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Cochrane Database Syst Rev 2021; 2:CD013390. [PMID: 33598911 PMCID: PMC8094175 DOI: 10.1002/14651858.cd013390.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infantile nystagmus syndrome (INS) is a type of eye movement disorder that can negatively impact vision. Currently, INS cannot be cured, but its effects can potentially be treated pharmacologically, optically, or surgically. This review focuses on the surgical interventions for INS. Despite the range of surgical interventions available, and currently applied in practice for the management of INS, there is no clear consensus, and no accepted clinical guidelines regarding the relative efficacy and safety of the various treatment options. A better understanding of these surgical options, along with their associated side effects, will assist clinicians in evidence-based decision-making in relation to the management of INS. OBJECTIVES To assess the efficacy and safety of surgical interventions for INS. SEARCH METHODS We searched CENTRAL, MEDLINE Ovid, Embase Ovid, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) to 3 July 2020, with no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) studying the efficacy and safety of surgical options for treating INS. DATA COLLECTION AND ANALYSIS Our prespecified outcome measures were the change from baseline in: binocular best-corrected distance visual acuity; head posture; amplitude, frequency, intensity, and foveation period durations of the nystagmus waveform; visual recognition times; quality of life and self-reported outcome measures; incidence of adverse effects with a probable causal link to treatment; and permanent adverse effects after surgery. Two review authors independently screened titles and abstracts and full-text articles, extracted data from eligible RCTs, and judged the risk of bias using the Cochrane tool. We reached consensus on any disagreements by discussion. We summarised the overall certainty of the evidence using the GRADE approach. MAIN RESULTS We only identified one eligible RCT (N = 10 participants), undertaken in India. This trial randomised participants to receive either a large retro-equatorial recession of the horizontal rectus muscle of 9 mm on the medial rectus and 12 mm on the lateral rectus, or a simple tenotomy and resuturing of the four horizontal rectus muscles. We did not identify any RCTs comparing a surgical intervention for INS relative to no treatment. In the single eligible RCT, both eyes of each participant received the same intervention. The participants' age and gender were not reported, nor was information on whether participants were idiopathic or had sensory disorders. The study only included participants with null in primary position and did not explicitly exclude those with congenital periodic alternating nystagmus. The study did not report funding source(s) or author declaration of interests. The evaluation period was six months. We judged this study at low risk for sequence generation and other sources of bias, but at high risk of bias for performance and detection bias. The risk of bias was unclear for selection bias, attrition bias, and reporting bias. There is very uncertain evidence about the effect of the interventions on visual acuity and change in amplitude, frequency, and intensity of the nystagmus waveform. We were unable to calculate relative effects due to lack of data. None of the participants in either intervention group reported adverse effects at six-month follow-up (very low-certainty evidence). There was no quantitative data reported for quality of life, although the study reported an improvement in quality of life after surgery in both intervention groups (very low-certainty evidence). Change in head posture, foveation period durations of the nystagmus waveform, visual recognition times, and permanent adverse effects after surgery were not reported in the included study. We judged the certainty of the evidence, for both the primary and secondary efficacy outcomes, to be very low. Due to a lack of comprehensive reporting of adverse events, there was also very low-certainty of the safety profile of the evaluated surgical interventions in this population. As such, we are very uncertain about the relative efficacy and safety of these interventions for the surgical management of INS. AUTHORS' CONCLUSIONS This systematic review identified minimal high-quality evidence relating to the efficacy and safety of surgical interventions for INS. The limited availability of evidence must be considered by clinicians when treating INS, particularly given these procedures are irreversible and often performed on children. More high-quality RCTs are needed to better understand the efficacy and safety profile of surgical interventions for INS. This will assist clinicians, people with INS, and their parents or caregivers to make evidence-based treatment decisions.
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Affiliation(s)
- Kwang M Cham
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Larry A Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Ljoudmila Busija
- Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lionel Kowal
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Anat Bachar Zipori
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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15
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Panthagani J, Virdee J, MacDonald T, Bruynseels A, Batra R. Acquired nystagmus. Br J Hosp Med (Lond) 2020; 81:1-8. [PMID: 33263469 DOI: 10.12968/hmed.2020.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nystagmus is the repetitive to and fro movement of the eyes, which may be physiological or pathological. The movements can be horizontal, vertical, torsional or a combination of these movements. It starts by a slow movement of the eye away from the visual target. The second movement brings the eye back to the visual target. If this second movement is quick, the nystagmus is called jerk nystagmus. If the second movement is slow, the nystagmus is said to be pendular. Maintaining steady gaze is dependent upon visual fixation, the vestibulo-ocular reflex and the gaze-holding neural integrator system. Pathological nystagmus typically presents with the symptom of oscillopsia, which is the illusory movement of the surrounding environment. Nystagmus that develops outside of early infancy is termed acquired nystagmus. There may be serious underlying pathology that will require further investigation and management. This article reviews the terminology, pathophysiology, causes and treatment of acquired nystagmus.
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Affiliation(s)
- Jesse Panthagani
- Birmingham and Midland Eye Centre, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jasvir Virdee
- Birmingham and Midland Eye Centre, Birmingham, UK.,Birmingham Neuro-ophthalmology Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | - Ruchika Batra
- Birmingham Neuro-ophthalmology Unit, Queen Elizabeth Hospital, Birmingham, UK
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16
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Salman A, Hutton SB, Newall T, Scott JA, Griffiths HL, Lee H, Gomez-Nicola D, Lotery AJ, Self JE. Characterization of the Frmd7 Knock-Out Mice Generated by the EUCOMM/COMP Repository as a Model for Idiopathic Infantile Nystagmus (IIN). Genes (Basel) 2020; 11:genes11101157. [PMID: 33007925 PMCID: PMC7601595 DOI: 10.3390/genes11101157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/30/2022] Open
Abstract
In this study, we seek to exclude other pathophysiological mechanisms by which Frmd7 knock-down may cause Idiopathic Infantile Nystagmus (IIN) using the Frmd7.tm1a and Frmd7.tm1b murine models. We used a combination of genetic, histological and visual function techniques to characterize the role of Frmd7 gene in IIN using a novel murine model for the disease. We demonstrate that the Frmd7.tm1b allele represents a more robust model of Frmd7 knock-out at the mRNA level. The expression of Frmd7 was investigated using both antibody staining and X-gal staining confirming previous reports that Frmd7 expression in the retina is restricted to starburst amacrine cells and demonstrating that X-gal staining recapitulates the expression pattern in this model. Thus, it offers a useful tool for further expression studies. We also show that gross retinal morphology and electrophysiology are unchanged in these Frmd7 mutant models when compared with wild-type mice. High-speed eye-tracking recordings of Frmd7 mutant mice confirm a specific horizontal optokinetic reflex defect. In summary, our study confirms the likely role for Frmd7 in the optokinetic reflex in mice mediated by starburst amacrine cells. We show that the Frmd7.tm1b model provides a more robust knock-out than the Frmd7.tm1a model at the mRNA level, although the functional consequence is unchanged. Finally, we establish a robust eye-tracking technique in mice that can be used in a variety of future studies using this model and others. Although our data highlight a deficit in the optiokinetic reflex as a result of the starburst amacrine cells in the retina, this does not rule out the involvement of other cells, in the brain or the retina where Frmd7 is expressed, in the pathophysiology of IIN.
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MESH Headings
- Alleles
- Amacrine Cells/metabolism
- Animals
- Cytoskeletal Proteins/genetics
- Cytoskeletal Proteins/metabolism
- Disease Models, Animal
- Electroretinography
- Female
- Gene Expression
- Genetic Diseases, X-Linked/genetics
- Genetic Diseases, X-Linked/pathology
- Genetic Diseases, X-Linked/physiopathology
- Male
- Mice
- Mice, Knockout
- Mutation
- Nystagmus, Congenital/genetics
- Nystagmus, Congenital/pathology
- Nystagmus, Congenital/physiopathology
- Nystagmus, Optokinetic
- Retina/metabolism
- Retina/pathology
- Retina/physiopathology
- Tomography, Optical Coherence
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Affiliation(s)
- Ahmed Salman
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
- Correspondence:
| | - Samuel B. Hutton
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK;
| | - Tutte Newall
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
| | - Jennifer A. Scott
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
| | - Helen L. Griffiths
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
| | - Helena Lee
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
| | - Diego Gomez-Nicola
- School of Biological Sciences, University of Southampton, Southampton SO171BJ, UK;
| | - Andrew J. Lotery
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
| | - Jay E. Self
- Clinical and Experimental Neurosciences, University of Southampton, Southampton SO16 6YD, UK; (T.N.); (J.A.S.); (H.L.G.); (H.L.); (A.J.L.); (J.E.S.)
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17
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The Prevalence of Ptosis and Nystagmus in Rural Population. J Curr Ophthalmol 2020; 32:178-182. [PMID: 32671302 PMCID: PMC7337018 DOI: 10.1016/j.joco.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the prevalence of ptosis and nystagmus in the general rural population in Iran. Methods Two villages were selected from the north and southwest of Iran using a multi-stage cluster sampling approach. After selection of the participants and inviting them to a complete eye exam, they all had vision tests and an ophthalmic examination. Vision tests included measurement of visual acuity, refraction, and the cover test. Then the slit-lamp exam was performed, and the diagnosis of ptosis and nystagmus was determined by an ophthalmologist. Results Of the 3851 invitees, 3314 people participated in the study. The prevalence of ptosis in this study was 2.23% [95% confidence interval (CI): 1.73-2.74], and 45.3% of the cases were bilateral ptosis. The prevalence of ptosis was lowest in the 21-30 year (0.2%) and the under 5 year (0.8%) age groups, and the highest prevalence was observed in people over 70 years of age (6.7%) (P < 0.001). The prevalence of ptosis was higher in illiterate people than those with an academic education level (P = 0.012). The prevalence of astigmatism was 62.8% in those with ptosis and 34.2% in those without ptosis (P < 0.001). The prevalence of nystagmus was 0.39% (13 cases). Conclusions This study found that the prevalence of ptosis is relatively high in the general rural population in Iran, and the prevalence increases with age. Astigmatism is significantly high among cases with ptosis, and its prevalence has an inverse relation with the level of education. Nystagmus also had a high prevalence in this population.
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18
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Abstract
In recent years, we have made enormous strides in elucidating the phenomenology of congenital nystagmus. The purpose of this review is to briefly summarize our current understanding of congenital nystagmus in terms of its clinical symptomatology, pathophysiology, differential diagnosis, and ancillary testing, and clinical management. Finally, this discussion provides the reader with an armamentarium of clinical pearls to facilitate diagnosis of the numerous sensory visual disorders that can underlie congenital nystagmus.
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Affiliation(s)
- Michael C Brodsky
- Departments of Ophthalmology and Neurology, Mayo Clinic , Rochester, Minnesota
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19
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Gummer SL, Evans M, Cygan A, Osborne D, Griffiths HJ, Lee H, Self JE. Evaluating the impact of information and support for people with nystagmus in the digital age: A patient and carer questionnaire study. Curr Eye Res 2019; 45:713-717. [DOI: 10.1080/02713683.2019.1696978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. L. Gummer
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - M. Evans
- Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, University Hospital Southampton, Southampton, UK
| | - A. Cygan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - D. Osborne
- Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, University Hospital Southampton, Southampton, UK
| | - H. J. Griffiths
- Academic Unit of Ophthalmology & Orthoptics, University of Sheffield, Sheffield, UK
| | - H. Lee
- Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, University Hospital Southampton, Southampton, UK
| | - J. E. Self
- Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, University Hospital Southampton, Southampton, UK
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20
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Cham KM, Abel LA, Busija L, Kowal L, Bachar Zipori A, Downie LE. Surgical interventions for infantile nystagmus syndrome. Hippokratia 2019. [DOI: 10.1002/14651858.cd013390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kwang M Cham
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Larry A Abel
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
| | - Ljoudmila Busija
- Monash University; Biostatistics Unit, Department of Epidemiology and Preventive Medicine; Melbourne Victoria Australia 3000
| | - Lionel Kowal
- The University of Melbourne; Department of Surgery (Ophthalmology); Level 4, Alice Hoy Building Melbourne Victoria Australia 3010
| | - Anat Bachar Zipori
- Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University; Department of Ophthalmology; 6 Weizmann Street Tel Aviv Israel 6423906
| | - Laura E Downie
- The University of Melbourne; Department of Optometry and Vision Sciences; Level 4, Alice Hoy Building Monash Road Melbourne Victoria Australia 3010
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21
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Abstract
Pathological nystagmus is a spontaneous oscillation of the eyes. It is a complex problem with many subtypes and causes ranging from the acute neurological emergency to chronic visual disorders. There is considerable variability in clinical management and patient experience across the UK. The Nystagmus Care Pathway (NCP) is a proposal to provide an evidence-based, consistent minimum standard of care across all eye services for patients with nystagmus. The NCP coordinates expertise from the various team members with a staged approach: 1) pathway entry; 2) nystagmus identification; 3) finding underlying causes/associations; 4) managing causes/associations; 5) managing the nystagmus and its effects; 6) support for patients and families; 7) pathway exit. Orthoptists are ideally placed to coordinate the NCP as they are trained in ocular motility and visual assessment. They are accustomed to providing continuity of care, multidisciplinary working and via the British and Irish Orthoptic Society (BIOS), they can provide consistency of care across the UK. Key performance indicators are proposed.
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Affiliation(s)
- Christopher M Harris
- Orthoptic Department, Royal Eye Infirmary, Plymouth, UK.,Nystagmus Network, Kent, UK.,Psychology Department, Plymouth University, Plymouth, UK
| | - Julie Owen
- Orthoptic Department, Royal Eye Infirmary, Plymouth, UK
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22
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Abstract
Nystagmus has a profound impact on patients visual function and social life. Infantile nystagmus (IN) is much more common than neurological nystagmus, and establishing the correct diagnosis is key in guiding the appropriate treatment paradigm. This paper attempts to demonstrate a stepwise approach in investigation and clinical evaluation, that is (often) sufficient in differentiating IN from nystagmus of neurological origin, and to uncover underlying sensory etiologies of IN. Targeted and rational uses of paraclinical exams are emphasized when they deemed necessary to complement the clinical assessment. The author's preferred surgical and non-surgical strategies to optimize vision, and improve the head posture and strabismus that can accompany nystagmus, are discussed (although without the goal of writing a complete revision on the topic).
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Affiliation(s)
- Luis H Ospina
- a Department of Pediatric Ophthalmology and Neuro-Ophthalmology , Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal , Montréal , QC , Canada
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23
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Zahidi AA, Woodhouse JM, Erichsen JT, Dunn MJ. Infantile nystagmus: an optometrist's perspective. CLINICAL OPTOMETRY 2017; 9:123-131. [PMID: 30214368 PMCID: PMC6118861 DOI: 10.2147/opto.s126214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Infantile nystagmus (IN), previously known as congenital nystagmus, is an involuntary to-and-fro movement of the eyes that persists throughout life. IN is one of three types of early-onset nystagmus that begin in infancy, alongside fusion maldevelopment nystagmus syndrome and spasmus nutans syndrome. Optometrists may also encounter patients with acquired nystagmus. The features of IN overlap largely with those of fusion maldevelopment nystagmus syndrome, spasmus nutans syndrome, and acquired nystagmus, yet the management for each subtype is different. Therefore, the optometrist's role is to accurately discern IN from other forms of nystagmus and to manage accordingly. As IN is a lifelong condition, its presence not only affects the visual function of the individual but also their quality of life, both socially and psychologically. In this report, we focus on the approaches that involve optometrists in the investigation and management of patients with IN. Management includes the prescription of optical treatments, low-vision rehabilitation, and other interventions such as encouraging the use of the null zone and referral to support groups. Other treatments available via ophthalmologists are also briefly discussed in the article.
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Affiliation(s)
- Asma Aa Zahidi
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - J Margaret Woodhouse
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - Jonathan T Erichsen
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
| | - Matt J Dunn
- Research Unit for Nystagmus, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK,
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24
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Fabian ID, Naeem Z, Stacey AW, Chowdhury T, Duncan C, Reddy MA, Sagoo MS. Long-term Visual Acuity, Strabismus, and Nystagmus Outcomes Following Multimodality Treatment in Group D Retinoblastoma Eyes. Am J Ophthalmol 2017; 179:137-144. [PMID: 28501391 DOI: 10.1016/j.ajo.2017.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/26/2017] [Accepted: 05/01/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To analyze the long-term visual acuity, strabismus, and nystagmus outcomes in Group D retinoblastoma following multimodality treatments in a national retinoblastoma referral center. DESIGN Retrospective interventional case series. METHODS A 13-year retrospective chart review of Group D eyes treated initially with intravenous chemotherapy (IVC) and followed up for at least 1 year from last treatment. Risk factors for final visual acuity (VA) were analyzed, and rate of strabismus and nystagmus at last follow-up visit were calculated. RESULTS One hundred and four Group D eyes (92 patients) presented to our center during the study period, of which 32 (27 patients) met the inclusion criteria. Following IVC (vincristine, etoposide, and carboplatin), adjuvant treatments included intraophthalmic artery chemotherapy in 5 (16%) eyes, plaque brachytherapy in 5 (16%), transpupillary thermotherapy (TTT) in 18 (56%), and cryotherapy in 24 (75%) eyes. On last examination, 64.41 ± 6.76 months from presentation, mean final VA was 20/283 (logMAR equivalent of 1.15 ± 0.15). On univariate analysis, presentation age, foveal retinoblastoma (at initial examination), use of TTT, and tumor-foveola distance (at last visit) were found to be significant risk factors for worse VA (P < .026). On multivariate analysis, however, only TTT was found to be significant (P = .010). At last visit, 6 of 27 (22%) patients had nystagmus and 12 of 20 (60%) bilaterally salvaged patients had strabismus (n = 10 exotropia and n = 2 esotropia). CONCLUSIONS After multimodality treatments initiated with IVC, 50% of salvaged Group D retinoblastoma eyes had <20/200 vision, with TTT being a risk factor for worse vision; 60% had strabismus; and 22% had nystagmus.
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Affiliation(s)
- Ido D Fabian
- Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Ocular Oncology Service, Goldschleger Eye Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.
| | - Zishan Naeem
- Retinoblastoma Service, Royal London Hospital, London, United Kingdom
| | - Andrew W Stacey
- Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Tanzina Chowdhury
- Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Paediatric Oncology Department, Great Ormond Street Hospital, London, United Kingdom
| | - Catriona Duncan
- Retinoblastoma Service, Royal London Hospital, London, United Kingdom; Paediatric Oncology Department, Great Ormond Street Hospital, London, United Kingdom
| | - M Ashwin Reddy
- Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom
| | - Mandeep S Sagoo
- Moorfields Eye Hospital, London, United Kingdom; Retinoblastoma Service, Royal London Hospital, London, United Kingdom; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
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Nachev P, Rose GE, Verity DH, Manohar SG, MacKenzie K, Adams G, Theodorou M, Pankhurst QA, Kennard C. Magnetic Oculomotor Prosthetics for Acquired Nystagmus. Ophthalmology 2017; 124:1556-1564. [PMID: 28651813 PMCID: PMC5609850 DOI: 10.1016/j.ophtha.2017.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/23/2017] [Accepted: 05/24/2017] [Indexed: 11/20/2022] Open
Abstract
Purpose Acquired nystagmus, a highly symptomatic consequence of damage to the substrates of oculomotor control, often is resistant to pharmacotherapy. Although heterogeneous in its neural cause, its expression is unified at the effector—the eye muscles themselves—where physical damping of the oscillation offers an alternative approach. Because direct surgical fixation would immobilize the globe, action at a distance is required to damp the oscillation at the point of fixation, allowing unhindered gaze shifts at other times. Implementing this idea magnetically, herein we describe the successful implantation of a novel magnetic oculomotor prosthesis in a patient. Design Case report of a pilot, experimental intervention. Participant A 49-year-old man with longstanding, medication-resistant, upbeat nystagmus resulting from a paraneoplastic syndrome caused by stage 2A, grade I, nodular sclerosing Hodgkin's lymphoma. Methods We designed a 2-part, titanium-encased, rare-earth magnet oculomotor prosthesis, powered to damp nystagmus without interfering with the larger forces involved in saccades. Its damping effects were confirmed when applied externally. We proceeded to implant the device in the patient, comparing visual functions and high-resolution oculography before and after implantation and monitoring the patient for more than 4 years after surgery. Main Outcome Measures We recorded Snellen visual acuity before and after intervention, as well as the amplitude, drift velocity, frequency, and intensity of the nystagmus in each eye. Results The patient reported a clinically significant improvement of 1 line of Snellen acuity (from 6/9 bilaterally to 6/6 on the left and 6/5–2 on the right), reflecting an objectively measured reduction in the amplitude, drift velocity, frequency, and intensity of the nystagmus. These improvements were maintained throughout a follow-up of 4 years and enabled him to return to paid employment. Conclusions This work opens a new field of implantable therapeutic devices—oculomotor prosthetics—designed to modify eye movements dynamically by physical means in cases where a purely neural approach is ineffective. Applied to acquired nystagmus refractory to all other interventions, it is shown successfully to damp pathologic eye oscillations while allowing normal saccadic shifts of gaze.
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Affiliation(s)
- Parashkev Nachev
- Institute of Neurology, University College London, London, United Kingdom.
| | - Geoff E Rose
- Orbital Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Institute of Ophthalmology, Bath Street, London, United Kingdom
| | - David H Verity
- Orbital Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Sanjay G Manohar
- Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Kelly MacKenzie
- Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Adams
- Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Theodorou
- Strabismus Clinic, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Quentin A Pankhurst
- Healthcare Biomagnetics Laboratory, University College London, London, United Kingdom
| | - Christopher Kennard
- Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
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Thomas MG, Maconachie GDE, Sheth V, McLean RJ, Gottlob I. Development and clinical utility of a novel diagnostic nystagmus gene panel using targeted next-generation sequencing. Eur J Hum Genet 2017; 25:725-734. [PMID: 28378818 PMCID: PMC5477371 DOI: 10.1038/ejhg.2017.44] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 11/09/2022] Open
Abstract
Infantile nystagmus (IN) is a genetically heterogeneous disorder arising from variants of genes expressed within the developing retina and brain. IN presents a diagnostic challenge and patients often undergo numerous investigations. We aimed to develop and assess the utility of a next-generation sequencing (NGS) panel to enhance the diagnosis of IN. We identified 336 genes associated with IN from the literature and OMIM. NimbleGen Human custom array was used to enrich the target genes and sequencing was performed using HiSeq2000. Using reference genome material (NA12878), we show the sensitivity (98.5%) and specificity (99.9%) of the panel. Fifteen patients with familial IN were sequenced using the panel. Two authors were masked to the clinical diagnosis. We identified variants in 12/15 patients in the following genes: FRMD7 (n=3), CACNA1F (n=2), TYR (n=5), CRYBA1 (n=1) and TYRP1 (n=1). In 9/12 patients, the clinical diagnosis was consistent with the genetic diagnosis. In 3/12 patients, the results from the genetic diagnoses (TYR, CRYBA1 and TYRP1 variants) enabled revision of clinical diagnoses. In 3/15 patients, we were unable to determine a genetic diagnosis. In one patient, copy number variation analysis revealed a FRMD7 deletion. This is the first study establishing the clinical utility of a diagnostic NGS panel for IN. We show that the panel has high sensitivity and specificity. The genetic information from the panel will lead to personalised diagnosis and management of IN and enable accurate genetic counselling. This will allow development of a new clinical care pathway for IN.
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Affiliation(s)
- Mervyn G Thomas
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Gail DE Maconachie
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Viral Sheth
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Rebecca J McLean
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Irene Gottlob
- Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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Tončić Z, Jovović N, Pojužina N, Jakšić V, Šakotić N, Živković M, Janićijević K. VISUAL ABILITY IN AMBLYOPIC CHILDREN COMPARED TO CHILDREN WITH NORMAL VISUAL ACUITY. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Penix K, Swanson MW, DeCarlo DK. Nystagmus in pediatric patients: interventions and patient-focused perspectives. Clin Ophthalmol 2015; 9:1527-36. [PMID: 26345377 PMCID: PMC4551307 DOI: 10.2147/opth.s62786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Nystagmus refers to involuntary, typically conjugate, often rhythmic oscillations of the eyes. The most common cause of nystagmus in children is infantile nystagmus syndrome (INS). INS presents within the first few months of life and is sometimes accompanied by an ocular condition associated with sensory impairment. Because this condition affects a person throughout life, it is important to understand the options available to manage it. This review focuses on the underlying nystagmus etiology, psychosocial and functional effects of nystagmus, as well as current principles of management, including optical, pharmacological, surgical, and rehabilitative options. Currently, the neural mechanisms underlying INS are not fully understood. Treatment options are designed to increase foveation duration or correct anomalous head postures; however, evidence is limited to mainly pre- and post-study designs with few objective comparisons of treatment strategies. Management of INS should be individualized. The decision on which treatment is best suited for a particular patient lies with the patient and his/her physician.
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Affiliation(s)
- Kimberly Penix
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark W Swanson
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dawn K DeCarlo
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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A novel mutation in FRMD7 causes X-linked idiopathic congenital nystagmus in a North Indian family. Neurosci Lett 2015; 597:170-5. [DOI: 10.1016/j.neulet.2015.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/21/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
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Papageorgiou E, McLean RJ, Gottlob I. Nystagmus in childhood. Pediatr Neonatol 2014; 55:341-51. [PMID: 25086850 DOI: 10.1016/j.pedneo.2014.02.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/24/2014] [Indexed: 11/15/2022] Open
Abstract
Nystagmus is an involuntary rhythmic oscillation of the eyes, which leads to reduced visual acuity due to the excessive motion of images on the retina. Nystagmus can be grouped into infantile nystagmus (IN), which usually appears in the first 3-6 months of life, and acquired nystagmus (AN), which appears later. IN can be idiopathic or associated to albinism, retinal disease, low vision, or visual deprivation in early life, for example due to congenital cataracts, optic nerve hypoplasia, and retinal dystrophies, or it can be part of neurological syndromes and neurologic diseases. It is important to differentiate between infantile and acquired nystagmus. This can be achieved by considering not only the time of onset of the nystagmus, but also the waveform characteristics of the nystagmus. Neurological disease should be suspected when the nystagmus is asymmetrical or unilateral. Electrophysiology, laboratory tests, neurological, and imaging work-up may be necessary, in order to exclude any underlying ocular or systemic pathology in a child with nystagmus. Furthermore, the recent introduction of hand-held spectral domain optical coherence tomography (HH SD-OCT) provides detailed assessment of foveal structure in several pediatric eye conditions associated with nystagmus and it can been used to determine the underlying cause of infantile nystagmus. Additionally, the development of novel methods to record eye movements can help to obtain more detailed information and assist the diagnosis. Recent advances in the field of genetics have identified the FRMD7 gene as the major cause of hereditary X-linked nystagmus, which will possibly guide research towards gene therapy in the future. Treatment options for nystagmus involve pharmacological and surgical interventions. Clinically proven pharmacological treatments for nystagmus, such as gabapentin and memantine, are now beginning to emerge. In cases of obvious head posture, eye muscle surgery can be performed to shift the null zone of the nystagmus into the primary position, and also to alleviate neck problems that can arise due to an abnormal head posture.
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Affiliation(s)
- Eleni Papageorgiou
- Ophthalmology Group, University of Leicester, Faculty of Medicine and Biological Sciences, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Rebecca J McLean
- Ophthalmology Group, University of Leicester, Faculty of Medicine and Biological Sciences, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Irene Gottlob
- Ophthalmology Group, University of Leicester, Faculty of Medicine and Biological Sciences, Leicester Royal Infirmary, Leicester, United Kingdom.
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Wilk MA, McAllister JT, Cooper RF, Dubis AM, Patitucci TN, Summerfelt P, Anderson JL, Stepien KE, Costakos DM, Connor TB, Wirostko WJ, Chiang PW, Dubra A, Curcio CA, Brilliant MH, Summers CG, Carroll J. Relationship between foveal cone specialization and pit morphology in albinism. Invest Ophthalmol Vis Sci 2014; 55:4186-98. [PMID: 24845642 DOI: 10.1167/iovs.13-13217] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Albinism is associated with disrupted foveal development, though intersubject variability is becoming appreciated. We sought to quantify this variability, and examine the relationship between foveal cone specialization and pit morphology in patients with a clinical diagnosis of albinism. METHODS We recruited 32 subjects with a clinical diagnosis of albinism. DNA was obtained from 25 subjects, and known albinism genes were analyzed for mutations. Relative inner and outer segment (IS and OS) lengthening (fovea-to-perifovea ratio) was determined from manually segmented spectral domain-optical coherence tomography (SD-OCT) B-scans. Foveal pit morphology was quantified for eight subjects from macular SD-OCT volumes. Ten subjects underwent imaging with adaptive optics scanning light ophthalmoscopy (AOSLO), and cone density was measured. RESULTS We found mutations in 22 of 25 subjects, including five novel mutations. All subjects lacked complete excavation of inner retinal layers at the fovea, though four subjects had foveal pits with normal diameter and/or volume. Peak cone density and OS lengthening were variable and overlapped with that observed in normal controls. A fifth hyper-reflective band was observed in the outer retina on SD-OCT in the majority of the subjects with albinism. CONCLUSIONS Foveal cone specialization and pit morphology vary greatly in albinism. Normal cone packing was observed in the absence of a foveal pit, suggesting a pit is not required for packing to occur. The degree to which retinal anatomy correlates with genotype or visual function remains unclear, and future examination of larger patient groups will provide important insight on this issue.
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Affiliation(s)
- Melissa A Wilk
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - John T McAllister
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Robert F Cooper
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States
| | - Adam M Dubis
- Moorfields Eye Hospital, London, United Kingdom Institute of Ophthalmology, University College London, United Kingdom
| | - Teresa N Patitucci
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Phyllis Summerfelt
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | - Kimberly E Stepien
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Deborah M Costakos
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Thomas B Connor
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - William J Wirostko
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Pei-Wen Chiang
- Casey Eye Institute Molecular Diagnostics Laboratory, Portland, Oregon, United States
| | - Alfredo Dubra
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Christine A Curcio
- Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama, United States
| | - Murray H Brilliant
- Center for Human Genetics, Marshfield Clinic, Marshfield, Wisconsin, United States
| | - C Gail Summers
- Departments of Ophthalmology and Visual Neurosciences and Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin, United States Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Thomas MG, Crosier M, Lindsay S, Kumar A, Araki M, Leroy BP, McLean RJ, Sheth V, Maconachie G, Thomas S, Moore AT, Gottlob I. Abnormal retinal development associated with FRMD7 mutations. Hum Mol Genet 2014; 23:4086-93. [PMID: 24688117 PMCID: PMC4082370 DOI: 10.1093/hmg/ddu122] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Idiopathic infantile nystagmus (IIN) is a genetically heterogeneous disorder, often associated with FRMD7 mutations. As the appearance of the retina is reported to be normal based on conventional fundus photography, IIN is postulated to arise from abnormal cortical development. To determine whether the afferent visual system is involved in FRMD7 mutations, we performed in situ hybridization studies in human embryonic and fetal stages (35 days post-ovulation to 9 weeks post-conception). We show a dynamic retinal expression pattern of FRMD7 during development. We observe expression within the outer neuroblastic layer, then in the inner neuroblastic layer and at 9 weeks post-conception a bilaminar expression pattern. Expression was also noted within the developing optic stalk and optic disk. We identified a large cohort of IIN patients (n = 100), and performed sequence analysis which revealed 45 patients with FRMD7 mutations. Patients with FRMD7 mutations underwent detailed retinal imaging studies using ultrahigh-resolution optical coherence tomography. The tomograms were compared with a control cohort (n = 60). The foveal pit was significantly shallower in FRMD7 patients (P < 0.0001). The optic nerve head morphology was abnormal with significantly decreased optic disk area, retinal nerve fiber layer thickness, cup area and cup depth in FRMD7 patients (P < 0.0001). This study shows for the first time that abnormal afferent system development is associated with FRMD7 mutations and could be an important etiological factor in the development of nystagmus.
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Affiliation(s)
- Mervyn G Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Moira Crosier
- MRC-Wellcome Trust Human Developmental Biology Resource (Newcastle), Institute of Human Genetics, Newcastle University, International Centre for Life, Newcastle upon Tyne NE1 3BZ, UK
| | - Susan Lindsay
- MRC-Wellcome Trust Human Developmental Biology Resource (Newcastle), Institute of Human Genetics, Newcastle University, International Centre for Life, Newcastle upon Tyne NE1 3BZ, UK
| | - Anil Kumar
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Masasuke Araki
- Department of Biological Sciences, Developmental Neurobiology Laboratory, Nara Women's University, Nara 630-8506, Japan
| | - Bart P Leroy
- Department of Ophthalmology and Centre for Medical Genetics, Ghent University and Ghent University Hospital, Ghent 9000, Belgium
| | - Rebecca J McLean
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Viral Sheth
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Gail Maconachie
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
| | - Shery Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK Department of Ophthalmology, Nottingham University Hospital NHS Trust, Nottingham, UK
| | | | - Irene Gottlob
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
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Lundström M, Wendel E. Assessment of vision-related quality of life measures in ophthalmic conditions. Expert Rev Pharmacoecon Outcomes Res 2014; 6:691-724. [DOI: 10.1586/14737167.6.6.691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tadic V, Hogan A, Sobti N, Knowles RL, Rahi JS. Patient-reported outcome measures (PROMs) in paediatric ophthalmology: a systematic review. Br J Ophthalmol 2013; 97:1369-81. [PMID: 23743433 DOI: 10.1136/bjophthalmol-2013-303350] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To identify patient-reported outcome measures (PROMs) specifically developed and used to assess the impact of ophthalmic disorders in children and to systematically assess their quality as a basis for recommendations about their use in clinical and research settings. METHODS A systematic review of the literature was performed in MEDLINE, EMBASE, PsychINFO, CINAHL and AMED, supplemented by a grey literature search. Papers reporting development and validation of questionnaire instruments for assessing patient-reported outcomes of an ophthalmic disorder in patients aged 2-18 years were included. Quality was assessed by examining the purpose and psychometric properties of the instruments. Strengths and limitations were summarised with recommendations regarding use. RESULTS Search identified 17 instruments. Of these, 11 were condition-specific and six were intended for a broader population of children and young people with visual impairment regardless of the ophthalmic condition. Three were developed for use in a specific trial and two are still in development. CONCLUSIONS Paediatric ophthalmology PROM development and application is a developing field and new instruments are needed. There is scope for improvement in this area through (a) clarity of definitions of the underlying constructs intended to be measured at the onset of development of new instruments, (b) application of child-centred approaches and (c) adherence to extant guidance and best practice in questionnaire instrument development.
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Affiliation(s)
- Valerija Tadic
- Medical Research Council (MRC) Centre of Epidemiology for Child Health at the Centre for Paediatric Epidemiology and Biostatistics, University College London (UCL) Institute of Child Health, , London, UK
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Severity of infantile nystagmus syndrome-like ocular motor phenotype is linked to the extent of the underlying optic nerve projection defect in zebrafish belladonna mutant. J Neurosci 2013; 32:18079-86. [PMID: 23238723 DOI: 10.1523/jneurosci.4378-12.2012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infantile nystagmus syndrome (INS), formerly known as congenital nystagmus, is an ocular motor disorder in humans characterized by spontaneous eye oscillations (SOs) and, in several cases, reversed optokinetic response (OKR). Its etiology and pathomechanism is largely unknown, but misrouting of the optic nerve has been observed in some patients. Likewise, optic nerve misrouting, a reversed OKR and SOs with INS-like waveforms are observed in zebrafish belladonna (bel) mutants. We aimed to investigate whether and how misrouting of the optic nerve correlates with the ocular motor behaviors in bel larvae. OKR and SOs were quantified and subsequently the optic nerve fibers were stained with fluorescent lipophilic dyes. Eye velocity during OKR was reduced in larvae with few misprojecting optic nerve fibers and reversed in larvae with a substantial fraction of misprojecting fibers. All larvae with reversed OKR also displayed SOs. A stronger reversed OKR correlated with more frequent SOs. Since we did not find a correlation between additional retinal defects and ocular motor behavior, we suggest that axon misrouting is in fact origin of INS in the zebrafish animal model. Depending on the ratio between misprojecting ipsilateral and correctly projecting contralateral fibers, the negative feedback loop normally regulating OKR can turn into a positive loop, resulting in an increase in retinal slip. Our data not only give new insights into the etiology of INS but may also be of interest for studies on how the brain deals with and adapts to conflicting inputs.
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Theodorou N, Shipman T. An overview of a UK paediatric visual impaired population and low vision aid provision. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2013. [DOI: 10.1177/0264619612469370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of low vision aids issued. The total number of children identified was 204. Of these, 19 percent of the children were registered blind, 45 percent were registered partially sighted, and 36 percent were not registered. The four diagnostic groups were genetic (29%), prenatal (36%), perinatal (23%), and childhood (12%). Describing local characteristics of paediatric visual impairment is a useful measure of current low vision service provision. This information can further inform educational, social, and health needs for the visually impaired children to ensure adequate service provision.
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Huang MYY, Chen CC, Huber-Reggi SP, Neuhauss SCF, Straumann D. Comparison of infantile nystagmus syndrome in achiasmatic zebrafish and humans. Ann N Y Acad Sci 2011; 1233:285-91. [PMID: 21951006 DOI: 10.1111/j.1749-6632.2011.06150.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Infantile nystagmus syndrome (INS; formerly called congenital nystagmus) is an ocular motor disorder characterized by several typical nystagmus waveforms. To date, restrictions inherent to human research and the absence of a handy animal model have impeded efforts to identify the underlying mechanism of INS. Displaying INS-like spontaneous eye oscillations, achiasmatic zebrafish belladonna (bel) mutants may provide new insights into the mystery of INS. In this study, we demonstrate that these spontaneous eye oscillations match the diagnostic waveforms of INS. As a result, zebrafish bel mutants can be used as an animal model for the study of INS. In zebrafish bel mutants, visual pathway abnormalities may contribute to the spontaneous nystagmus via an inverted signal to the pretectal area. We hypothesized that human INS may also be linked to visual pathway abnormalities (possibly underdiagnosed in INS patients) in a similar way.
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The Role of FRMD7 in Idiopathic Infantile Nystagmus. J Ophthalmol 2011; 2012:460956. [PMID: 21904664 PMCID: PMC3163398 DOI: 10.1155/2012/460956] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 06/20/2011] [Indexed: 11/21/2022] Open
Abstract
Idiopathic infantile nystagmus (IIN) is an inherited disorder in which the nystagmus arises independently of any other symptoms, leading to the speculation that the disorder represents a primary defect in the area of the brain responsible for ocular motor control. The inheritance patterns are heterogeneous, however the most common form is X-linked. FRMD7 resides at Xq26-27 and approximately 50% of X-linked IIN families map to this region. Currently 45 mutations within FRMD7 have been associated with IIN, confirming the importance of FRMD7 in the pathogenesis of the disease. Although mutations in FRMD7 are known to cause IIN, very little is known about the function of the protein. FRMD7 contains a conserved N-terminal FERM domain suggesting that it may provide a link between the plasma membrane and actin cytoskeleton. Limited studies together with the knowledge of the function of other FERM domain containing proteins, suggest that FRMD7 may play a role in membrane extension during neuronal development through remodeling of the actin cytoskeleton.
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Maurer CM, Huang YY, Neuhauss SCF. Application of zebrafish oculomotor behavior to model human disorders. Rev Neurosci 2011; 22:5-16. [PMID: 21615257 DOI: 10.1515/rns.2011.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To ensure high acuity vision, eye movements have to be controlled with astonishing precision by the oculomotor system. Many human diseases can lead to abnormal eye movements, typically of the involuntary oscillatory eye movements type called nystagmus. Such nystagmus can be congenital (infantile) or acquired later in life. Although the resulting eye movements are well characterized, there is only little information about the underlying etiology. This is in part owing to the lack of appropriate animal models. In this review article, we describe how the zebrafish with its quick maturing visual system can be used to model oculomotor pathologies. We compare the characteristics and assessment of human and zebrafish eye movements. We describe the oculomotor properties of the zebrafish mutant belladonna, which has non-crossing optical fibers, and is a particularly informative model for human oculomotor deficits. This mutant displays a reverse optokinetic response, spontaneous oscillations that closely mimic human congenital nystagmus and abnormal motor behavior linked to circular vection.
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Affiliation(s)
- Colette M Maurer
- University of Zurich, Institute of Molecular Life Sciences, Neuroscience Center Zurich and Center for Integrative Human Physiology, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
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Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol 2011; 258:1207-22. [PMID: 21461686 PMCID: PMC3132281 DOI: 10.1007/s00415-011-5999-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 01/28/2023]
Abstract
We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the “4 D’s”: correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the “7 A’s”) that can be used: antiemetics; anti-inflammatory, anti-Ménière’s, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière’s disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal “pacemaker” activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière’s disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, University of Munich, Munich, Germany
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Fu VLN, Bilonick RA, Felius J, Hertle RW, Birch EE. Visual acuity development of children with infantile nystagmus syndrome. Invest Ophthalmol Vis Sci 2011; 52:1404-11. [PMID: 21071734 DOI: 10.1167/iovs.09-4686] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Infantile nystagmus syndrome (INS) can be idiopathic or associated with ocular or systemic disease. The ocular oscillation of INS directly contributes to loss of visual acuity. In this study, visual acuity development in patients with INS was examined. METHODS Children with INS were classified as having idiopathic INS (n = 84) or INS with an associated sensory deficit: INS and albinism (n = 71), bilateral optic nerve hypoplasia (ONH; n = 23), or congenital retinal disorder (n = 36). Visual acuity was assessed with Teller cards and/or optotypes, and the data were analyzed for three age groups (<24 months, 24-48 months, and >48 months). RESULTS Patients with idiopathic INS showed mildly reduced visual acuity early in life and gradual maturation with age that paralleled a normative curve. Patients with albinism also showed a mild visual deficit early in life but failed to keep pace with the normative curve, showing a gradual increase in visual acuity deficit. Patients with ONH and congenital retinal disorders exhibited more severe visual acuity deficits during infancy. The ONH group displayed slow improvement of visual acuity with a plateau at 24 months through >48 months, with a small increase in visual acuity deficit. The congenital retinal disorder group had no significant change in visual acuity across age and had a rapid increase in visual acuity deficit. CONCLUSIONS The pattern of visual acuity development differs among children with INS, depending on the presence or absence of associated sensory system deficits. Careful characterization of visual system differences in patients with INS is important if visual acuity is an outcome in clinical trials.
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Thomas MG, Crosier M, Lindsay S, Kumar A, Thomas S, Araki M, Talbot CJ, McLean RJ, Surendran M, Taylor K, Leroy BP, Moore AT, Hunter DG, Hertle RW, Tarpey P, Langmann A, Lindner S, Brandner M, Gottlob I. The clinical and molecular genetic features of idiopathic infantile periodic alternating nystagmus. Brain 2011; 134:892-902. [PMID: 21303855 DOI: 10.1093/brain/awq373] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Periodic alternating nystagmus consists of involuntary oscillations of the eyes with cyclical changes of nystagmus direction. It can occur during infancy (e.g. idiopathic infantile periodic alternating nystagmus) or later in life. Acquired forms are often associated with cerebellar dysfunction arising due to instability of the optokinetic-vestibular systems. Idiopathic infantile periodic alternating nystagmus can be familial or occur in isolation; however, very little is known about the clinical characteristics, genetic aetiology and neural substrates involved. Five loci (NYS1-5) have been identified for idiopathic infantile nystagmus; three are autosomal (NYS2, NYS3 and NYS4) and two are X-chromosomal (NYS1 and NYS5). We previously identified the FRMD7 gene on chromosome Xq26 (NYS1 locus); mutations of FRMD7 are causative of idiopathic infantile nystagmus influencing neuronal outgrowth and development. It is unclear whether the periodic alternating nystagmus phenotype is linked to NYS1, NYS5 (Xp11.4-p11.3) or a separate locus. From a cohort of 31 X-linked families and 14 singletons (70 patients) with idiopathic infantile nystagmus we identified 10 families and one singleton (21 patients) with periodic alternating nystagmus of which we describe clinical phenotype, genetic aetiology and neural substrates involved. Periodic alternating nystagmus was not detected clinically but only on eye movement recordings. The cycle duration varied from 90 to 280 s. Optokinetic reflex was not detectable horizontally. Mutations of the FRMD7 gene were found in all 10 families and the singleton (including three novel mutations). Periodic alternating nystagmus was predominantly associated with missense mutations within the FERM domain. There was significant sibship clustering of the phenotype although in some families not all affected members had periodic alternating nystagmus. In situ hybridization studies during mid-late human embryonic stages in normal tissue showed restricted FRMD7 expression in neuronal tissue with strong hybridization signals within the afferent arms of the vestibulo-ocular reflex consisting of the otic vesicle, cranial nerve VIII and vestibular ganglia. Similarly within the afferent arm of the optokinetic reflex we showed expression in the developing neural retina and ventricular zone of the optic stalk. Strong FRMD7 expression was seen in rhombomeres 1 to 4, which give rise to the cerebellum and the common integrator site for both these reflexes (vestibular nuclei). Based on the expression and phenotypic data, we hypothesize that periodic alternating nystagmus arises from instability of the optokinetic-vestibular systems. This study shows for the first time that mutations in FRMD7 can cause idiopathic infantile periodic alternating nystagmus and may affect neuronal circuits that have been implicated in acquired forms.
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Affiliation(s)
- Mervyn G Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester LE2 7LX, UK
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Abstract
Neuro-ophthalmology covers disorders that fall between the cracks of Neurology and Ophthalmology. Neurologists see patients with neuro-ophthalmic disorders. Recognition of the diagnosis is difficult enough, but treatment can be challenging. This article reviews several common neuro-ophthalmic disorders, outlining their features and treatments, from retinal vascular disorders to eye movements and blepharospasm.
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Affiliation(s)
- Byron Roderick Spencer
- Department of Ophthalmology, Moran Eye Center, University of Utah, 65 Mario Capecchi Drive, Salt Lake City, UT 84132, USA
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McLean RJ, Gottlob I. The pharmacological treatment of nystagmus: a review. Expert Opin Pharmacother 2009; 10:1805-16. [DOI: 10.1517/14656560902978446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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van de Graaf ES, Felius J, van Kempen-du Saar H, Looman CWN, Passchier J, Kelderman H, Simonsz HJ. Construct validation of the Amblyopia and Strabismus Questionnaire (A&SQ) by factor analysis. Graefes Arch Clin Exp Ophthalmol 2009; 247:1263-8. [PMID: 19495785 PMCID: PMC2720588 DOI: 10.1007/s00417-009-1112-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 04/28/2009] [Accepted: 05/11/2009] [Indexed: 11/30/2022] Open
Abstract
Background The Amblyopia and Strabismus Questionnaire (A&SQ) was previously developed to assess quality of life (QoL) in amblyopia and/or strabismus patients. Here, factor analysis with Varimax rotation was employed to confirm that the questions of the A&SQ correlated to dimensions of quality of life (QoL) in such patients. Methods Responses on the A&SQ from three groups were analyzed: healthy adults (controls) (n = 53), amblyopia and/or strabismus patients (n = 72), and a historic cohort of amblyopes born between 1962-1972 and occluded between 1968–1974 (n = 173). The correlations among the responses to the 26 A&SQ items were factor-analysed by Principal Component Analysis (PCA). As the development of the A&SQ was intuitive-deductive, it was expected that the pattern of correlation could be explained by the five a priori hypothesized dimensions: fear of losing the better eye, distance estimation, visual disorientation, diplopia, and social contact and cosmetic problems. Distribution of questions along the factors derived by PCA was examined by orthogonal Varimax rotation. Results Data from 296 respondents were analyzed. PCA provided that six factors (cutoff point eigenvalue >1.0) accumulatively explained 70.5% of the variance. All A&SQ dimensions but one matched with four factors found by Varimax rotation (factor loadings >0.50), while two factors pertained to the fifth dimension. The six factors explained 33.7% (social contact and cosmetic problems); 10.3% (near distance estimation); 8.7% (diplopia); 7.2% (visual disorientation); 6.3% (fear of losing the better eye); and 4.3% (far distance estimation), together 70.48% of the item variance. Conclusion The highly explained variance in the A&SQ scores by the factors found by the PCA confirmed the a priori hypothesized dimensions of this QoL instrument.
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Affiliation(s)
- Elizabeth S van de Graaf
- Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, NL-3000 CA Rotterdam, The Netherlands
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He X, Gu F, Wang Z, Wang C, Tong Y, Wang Y, Yang J, Liu W, Zhang M, Ma X. A novel frameshift mutation in FRMD7 causing X-linked idiopathic congenital nystagmus. ACTA ACUST UNITED AC 2009; 12:607-13. [PMID: 19072571 DOI: 10.1089/gte.2008.0070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Idiopathic congenital nystagmus (ICN) is a common oculomotor disorder characterized by bilateral involuntary, periodic, and predominantly ocular oscillations. X-linked ICN (XLICN) with incomplete penetrance in females is the most common inheritance form, and FERM domain containing (FRMD7) mutation is the major reason for XLICN families. To date, 39 FRMD7 mutations have been identified, and 50% of the XLICN pedigrees have yielded FRMD7 mutations in the Western population. In this study, we identified a novel frameshift mutation (c.1274-1275delTG) in the FRMD7 gene in six XLICN pedigrees. Incorporated with data reported from other two Chinese groups, approximately 47% XLICN pedigrees were caused by the FRMD7 mutation in China. Therefore, this study showed that mutation analysis of the FRMD7 gene had diagnostic value not only in the Western population but also in one of the biggest Eastern populations, Chinese XLICN families. In addition, the results indicated the type of FRMD7 mutation associated with the penetrance of female carriers of XLICN.
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Affiliation(s)
- Xiang He
- Department of Genetics, National Research Institute for Family Planning, Beijing, China
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Zhou P, Wang Z, Zhang J, Hu L, Kong X. Identification of a novel GPR143 deletion in a Chinese family with X-linked congenital nystagmus. Mol Vis 2008; 14:1015-9. [PMID: 18523664 PMCID: PMC2408774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 05/21/2008] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To map and identify the genetic mutation underlying X-linked congenital nystagmus in a Chinese family. METHODS Genomic DNA was prepared from peripheral blood, and linkage analysis was performed using short tandem repeat (STR) polymorphism markers. We used Cyrillic software to manage pedigree and haplotype data and used MLINK to calculate LOD scores. Dye-terminator cycle-sequencing was used to detect the sequence variation of polymerase chain reaction (PCR)-amplified exons. RESULTS Linkage analysis mapped the disease-causing gene to Xp22.3 with a significant two-point LOD score (Z) at marker DXS7103 (Z=3.16, recombination fraction [theta]=0). Haplotype analysis in this region supported the result. In analyzing the candidate gene in the linked region, we found a 37-bp deletion in exon 1 of GPR143 in all male patients. CONCLUSIONS The revealed 37-bp deletion in GPR143 is frameshift and is predicted to result in a truncated protein of 93 residues. These results indicate that this novel GPR143 mutation is associated with the congenital nystagmus observed in this Chinese family.
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48
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Thomas S, Proudlock FA, Sarvananthan N, Roberts EO, Awan M, McLean R, Surendran M, Kumar ASA, Farooq SJ, Degg C, Gale RP, Reinecke RD, Woodruff G, Langmann A, Lindner S, Jain S, Tarpey P, Raymond FL, Gottlob I. Phenotypical characteristics of idiopathic infantile nystagmus with and without mutations in FRMD7. ACTA ACUST UNITED AC 2008; 131:1259-67. [PMID: 18372314 DOI: 10.1093/brain/awn046] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Idiopathic infantile nystagmus (IIN) consists of involuntary oscillations of the eyes. The familial form is most commonly X-linked. We recently found mutations in a novel gene FRMD7 (Xq26.2), which provided an opportunity to investigate a genetically defined and homogeneous group of patients with nystagmus. We compared clinical features and eye movement recordings of 90 subjects with mutation in the gene (FRMD7 group) to 48 subjects without mutations but with clinical IIN (non-FRMD7 group). Fifty-eight female obligate carriers of the mutation were also investigated. The median visual acuity (VA) was 0.2 logMAR (Snellen equivalent 6/9) in both groups and most patients had good stereopsis. The prevalence of strabismus was also similar (FRMD7: 7.8%, non-FRMD7: 10%). The presence of anomalous head posture (AHP) was significantly higher in the non-FRMD7 group (P < 0.0001). The amplitude of nystagmus was more strongly dependent on the direction of gaze in the FRMD7 group being lower at primary position (P < 0.0001), compared to non-FRMD7 group (P = 0.83). Pendular nystagmus waveforms were also more frequent in the FRMD7 group (P = 0.003). Fifty-three percent of the obligate female carriers of an FRMD7 mutation were clinically affected. The VA's in affected females were slightly better compared to affected males (P = 0.014). Subnormal optokinetic responses were found in a subgroup of obligate unaffected carriers, which may be interpreted as a sub-clinical manifestation. FRMD7 is a major cause of X-linked IIN. Most clinical and eye movement characteristics were similar in the FRMD7 group and non-FRMD7 group with most patients having good VA and stereopsis and low incidence of strabismus. Fewer patients in the FRMD7 group had AHPs, their amplitude of nystagmus being lower in primary position. Our findings are helpful in the clinical identification of IIN and genetic counselling of nystagmus patients.
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Affiliation(s)
- Shery Thomas
- Ophthalmology Group, University of Leicester, Leicester, UK
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McLean R, Proudlock F, Thomas S, Degg C, Gottlob I. Congenital nystagmus: Randomized, controlled, double-masked trial of memantine/gabapentin. Ann Neurol 2007; 61:130-8. [PMID: 17279539 DOI: 10.1002/ana.21065] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Nystagmus consists of involuntary to and fro movements of the eyes. Although studies have shown that memantine and gabapentin can reduce acquired nystagmus, no drug treatment has been systematically investigated in congenital nystagmus. METHODS We performed a randomized, double-masked, placebo-controlled study investigating the effects of memantine and gabapentin on congenital nystagmus over a period of 56 days. The primary outcome measure was logarithmic minimum angle of resolution (logMAR) visual acuity; the secondary outcome measures were nystagmus intensity and foveation, subjective questionnaires about visual function (VF-14) and social function. Analyses were by intention to treat. RESULTS Forty-eight patients were included in the study. One patient in the placebo group dropped out. Patients were randomized into either a memantine group (n=16), gabapentin group (n=16), or placebo group (n=15). Mean visual acuity improvements showed a significant effect between treatment groups (F=6.2; p=0.004, analysis of variance) with improvement in both memantine and gabapentin groups. Participants with afferent visual defects showed poorer improvements in visual acuity to medication than those with apparently normal visual systems. However, eye movement recordings showed that both nystagmus forms improved in nystagmus intensity (F=7.7; p=0.001) and foveation (F=8.7; p=0.0007). Participants subjectively reported an improvement in vision after memantine and gabapentin treatment more often than in the placebo group (p=0.03). However, there were no significant differences between the treatment groups with visual function (VF-14) or social function questionnaires because all groups reported improvements. INTERPRETATION Our findings show that pharmacological agents such as memantine and gabapentin can improve visual acuity, reduce nystagmus intensity, and improve foveation in congenital nystagmus.
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Affiliation(s)
- Rebecca McLean
- Ophthalmology Group, University of Leicester, Medical Physics, University Hospitals Leicester, United Kingdom
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50
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Tarpey P, Thomas S, Sarvananthan N, Mallya U, Lisgo S, Talbot CJ, Roberts EO, Awan M, Surendran M, McLean RJ, Reinecke RD, Langmann A, Lindner S, Koch M, Woodruff G, Gale R, Degg C, Droutsas K, Asproudis I, Zubcov AA, Pieh C, Veal CD, Machado RD, Backhouse OC, Baumber L, Jain S, Constantinescu CS, Brodsky MC, Hunter DG, Hertle RW, Read RJ, Edkins S, O’Meara S, Parker A, Stevens C, Teague J, Wooster R, Futreal PA, Trembath RC, Stratton MR, Raymond FL, Gottlob I. Mutations in FRMD7, a newly identified member of the FERM family, cause X-linked idiopathic congenital nystagmus. Nat Genet 2006; 38:1242-4. [PMID: 17013395 PMCID: PMC2592600 DOI: 10.1038/ng1893] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 09/01/2006] [Indexed: 11/09/2022]
Abstract
Idiopathic congenital nystagmus is characterized by involuntary, periodic, predominantly horizontal oscillations of both eyes. We identified 22 mutations in FRMD7 in 26 families with X-linked idiopathic congenital nystagmus. Screening of 42 singleton cases of idiopathic congenital nystagmus (28 male, 14 females) yielded three mutations (7%). We found restricted expression of FRMD7 in human embryonic brain and developing neural retina, suggesting a specific role in the control of eye movement and gaze stability.
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Affiliation(s)
- P Tarpey
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - S Thomas
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - N Sarvananthan
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - U Mallya
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
| | - S Lisgo
- Institute of Human Genetics, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - CJ Talbot
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - EO Roberts
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - M Awan
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - M Surendran
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - RJ McLean
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - RD Reinecke
- Foerderer Eye Movement Centre for Children, Wills Eye Hospital, Philadelphia, Pennsylvania, 19107 USA
| | - A Langmann
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - S Lindner
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - M Koch
- Medical University Graz, Department of Ophthalmology, Auenbruggerplatz 4, 8036, Graz, Austria
| | - G Woodruff
- Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire PR2 9HT
| | - R Gale
- Ophthalmology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - C Degg
- Department of Medical Physics, University Hospitals of Leicester, Leicester, LE1 5WW, UK
| | - K Droutsas
- Department of Ophthalmology, Justus-Liebig-University, 35392 Giessen, Germany
| | - I Asproudis
- Department of Ophthalmology, Medical Faculty, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - AA Zubcov
- University Eye Hospital, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - C Pieh
- University Eye Hospital, Killianstr. 5, 79106 Freiburg, Germany
| | - CD Veal
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
| | - RD Machado
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - OC Backhouse
- Ophthalmology, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - L Baumber
- Department of Genetics, University of Leicester, University Road, Leicester LE1 7RH, UK
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - S Jain
- Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, Lancashire PR2 9HT
| | - CS Constantinescu
- Division of Clinical Neurology, School of Medical and Surgical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - MC Brodsky
- Arkansas Children’s Hospital, 800 Marshall, Little Rock, Arkansas 72202, UK
| | - DG Hunter
- Department of Ophthalmology, Children’s Hospital Boston, Harvard Medical School, Boston, Mass 02115, USA
| | - RW Hertle
- University of Pittsburgh Medical Centre, Division of Paediatric Ophthalmology, Children’s Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - RJ Read
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
| | - S Edkins
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - S O’Meara
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - A Parker
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - C Stevens
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - J Teague
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - R Wooster
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - PA Futreal
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - RC Trembath
- Division of Genetics and Molecular Medicine, King’s College London SE1 9RT, UK
| | - MR Stratton
- Wellcome Trust Sanger Institute, Hinxton Cambridge CB10 1SA UK
| | - FL Raymond
- Cambridge Institute for Medical Research, Addenbrookes Hospital Cambridge CB2 2XY UK
- Joint senior authors and corresponding authors and
| | - I Gottlob
- Ophthalmology Group, School of Medicine, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
- Joint senior authors and corresponding authors and
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