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Chen AH, Rafiuddin MSM, Ahmad A, Rosli SA. A simplification of intricate multifocal electroretinogram understanding: A mini-review. Oman J Ophthalmol 2024; 17:11-18. [PMID: 38524335 PMCID: PMC10957048 DOI: 10.4103/ojo.ojo_48_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/07/2023] [Accepted: 11/26/2023] [Indexed: 03/26/2024] Open
Abstract
Variation of multifocal electroretinogram (mfERG) data presentation in existing scientific publications is a challenge for eye care practitioners to apply the scientific information for evidence-based practice in patient management. This review offers an overview of the mfERG data presentation types. Eight types of data presentation in the form of a table, scatter plot, line graph, bar graph/box plot, single waveform/a group of waveforms, trace array topography, three-dimensional topography, and two-dimensional topography are identified. The table format is used to provide the exact values. Line graphs, scatter, and box plots offer information about the relationship of mfERG values. Waveforms are helpful for comparison between groups or conditions. Topographies outline the retinal, especially the specific localized retinal abnormalities. An infographic of fundamental mfERG electrical response with definitions and clinical indications is provided to bridge the gap between researchers and clinicians to facilitate efficient clinical application.
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Affiliation(s)
- Ai-Hong Chen
- Optometry, iROViS, Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | | | - Azmir Ahmad
- Optometry, iROViS, Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
| | - Saiful Azlan Rosli
- Optometry, iROViS, Faculty of Health Sciences, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Bandar Puncak Alam, Selangor Darul Ehsan, Malaysia
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Elgaly MA, Hosny H, El Habashy HR, Hussein M, Magdy R, Elanwar R. Neurophysiological visual assessment in patients with idiopathic intracranial hypertension: visual evoked potential and multifocal field electroretinography. BMC Neurol 2023; 23:188. [PMID: 37165341 PMCID: PMC10170672 DOI: 10.1186/s12883-023-03220-8] [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: 12/18/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Determining the cause of visual deterioration in idiopathic intracranial hypertension (IIH) patients is of clinical necessity. This study aimed to study the effect of chronic increased ICP on the retina and optic nerve through objective electrophysiological measures in chronic IIH patients. METHODS Thirty patients with chronic IIH and thirty age and sex-matched healthy controls were included in this study. Papilledema grade and CSF pressure were evaluated in the patients' group. Both groups were submitted to visual evoked potentials (VEP) and multifocal electroretinogram (mfERG). RESULT The mean value of P100 latencies of the right and left on two check sizes, 1 deg and 15ṁ in chronic IIH patients, was significantly delayed than controls (P-value < 0.001 for each). Chronic IIH patients showed a significantly lower amplitude of the right and left R1, R2, R3, R4 & R5 compared to controls (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, < 0.001) (P-value < 0.001, = 0.001) (P-value = 0.002, < 0.001), respectively. Also, patients showed a significantly delayed peak time of the right and left R1 and R2 compared to controls (P-value < 0.001, < 0.001) (P-value = 0.001, = 0.009), respectively. There was a significant positive correlation between each of CSF pressure and papilledema grade with right and left PVEP latencies. In contrast, there was no statistically significant correlation between either CSF pressure or papilledema grade and PVEP amplitudes in both eyes. CONCLUSION In chronic IIH patients, both optic nerve dysfunction and central retinal changes were identified, supported by VEP and the mfERG findings.
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Affiliation(s)
- Marwa A Elgaly
- Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Beni-Suef, Egypt
| | - Hanan Hosny
- Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Cairo, Egypt
| | - Hala R El Habashy
- Department of Clinical Neurophysiology, Cairo University, Cairo, Egypt
| | - Mona Hussein
- Department of Neurology, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab Magdy
- Department of Neurology, Cairo University, Cairo, Egypt
| | - Rehab Elanwar
- Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Beni-Suef, Egypt.
- Neuro Diagnostic Research Center (NDRC), Beni-Suef University, Salah Salem Street, Beni-Suef, 62511, Egypt.
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Alieldin RA, Boonarpha N, Saedon H. Outcomes of screening for hydroxychloroquine retinopathy at the Manchester Royal Eye Hospital: 2 years' audit. Eye (Lond) 2023; 37:1410-1415. [PMID: 35764873 PMCID: PMC10170114 DOI: 10.1038/s41433-022-02159-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Royal College of Ophthalmologists has produced guidelines for screening for hydroxychloroquine retinopathy. New imaging modalities had suggested an increased prevalence of retinopathy compared with previous reports. The aim of this study is to identify the real-life prevalence of hydroxychloroquine retinopathy in patients attending Manchester Royal Eye Hospital screening service over a 2-year period using The RCOphth diagnostic criteria. METHODS Data were collected prospectively from all patients attending Manchester Royal Eye Hospital hydroxychloroquine screening service over the audit period. Results of Humphrey visual field tests, spectral-domain optical coherence tomography and fundus autofluorescence were collected as well as data on dose, indication, duration of treatment, and additional risk factors. Cases were identified as having definite, possible, or no retinopathy based on the 2018 RCOphth criteria. The data are not publicly available due to information that could compromise research participant privacy and confidentiality but are available upon request from the corresponding author. RESULTS 910 patients attended for screening. 566 were identified as being at risk of retinopathy (543 had been on treatment >5 years, 10 had renal impairment, 12 were on doses of >5 mg/kg/day, and one was concurrently on tamoxifen). The prevalence of HCQ retinopathy was 10/910 (1.09%) of all those screened, and 1.76% of those at risk (10/566). Six patients of those deemed at risk were identified as having definite hydroxychloroquine retinopathy, while four had possible retinopathy. CONCLUSIONS Our results show a prevalence of retinopathy largely consistent with reports from regional audits yet reveal a far lower estimate compared to previously reported figures.
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Affiliation(s)
- Rowayda Amin Alieldin
- Manchester Royal Eye Hospital, Manchester, UK.
- Ophthalmology Department, Alexandria University, Alexandria, Egypt.
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4
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Ebeid WM, El-Shazly AAEF, Kamal NM, Fakhary EE, Mansour A, Ashour DM. New insights into amiodarone induced retinal and optic nerve toxicity: functional and structural changes. Ther Adv Ophthalmol 2023; 15:25158414231194159. [PMID: 37701727 PMCID: PMC10493063 DOI: 10.1177/25158414231194159] [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: 03/18/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
Background Amiodarone is widely used for heart arrhytmia. Previous studies have suggested the possibility of optic neuropathy with the chronic use of this drug. Objectives To identify structural or functional changes in the retina and optic nerve in patients on chronic amiodarone therapy without visual complaints. Methods This observational study included 15 eyes of 15 patients with cardiac arrythmia on chronic amiodarone treatment and 15 healthy matched subjects as a control group. All subjects underwent electrophysiological tests [pattern visual evoked potential (PVEP), pattern electroretinogram (PERG), multifocal electroretinogram (mfERG), and optical coherence tomography (OCT) and angiography (OCTA)]. Results There were no statistically significant differences between the two groups regarding the PVEP, PERG, and the mfERG parameters. Macular and optic nerve head OCT and OCTA have not shown statistically significant differences except for the morphological parameters of the optic disc (p = 0.008 for the horizontal and p = 0.013 for vertical cup/disc ratio and p = 0.045 for rim area). Conclusion Patients on chronic amiodarone therapy have not shown evident structural or functional changes in the retinal or optic nerve as demonstrated by electrophysiological tests, OCT, and OCTA results compared to controls.
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Affiliation(s)
- Weam Mohamed Ebeid
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Armed Forces College of Medicine, Cairo, Egypt
| | | | - Norhan Mohamed Kamal
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Emad Effat Fakhary
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amr Mansour
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Doaa Maamoun Ashour
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University Hospitals, Ramsis Street, Abbasiya, Cairo 11591, Egypt
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Song MY, Kim US. Current usage of electrophysiological tests in a secondary referral hospital in Korea. Doc Ophthalmol 2022; 145:127-131. [PMID: 36006567 DOI: 10.1007/s10633-022-09894-8] [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: 01/18/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the current status of electrophysiological test use in ophthalmology. METHODS We analyzed 1057 electrophysiological tests conducted at Kim's Eye Hospital from January 1 to December 31, 2018. The included tests were electroretinogram (full-field, multifocal, and pattern ERG), electrooculogram (EOG), and visual evoked potential (pattern and flash VEP). To investigate the distribution of use of subspecialties, it was divided by subspecialties (retina, glaucoma, oculoplastic surgery, pediatric ophthalmology, neuro-ophthalmology, cornea, and external diseases). RESULTS The patients were aged 50.6 years on average and included 624 men and 433 women. Among the electrophysiological tests, VEP was the most common, with 567 cases (53.6%), followed by ERG with 311 cases (29.4%) and EOG with 98 cases (9.3%). Regarding the purpose of use, the objective of visual function evaluation was the highest at 56.3%, followed by the differential diagnosis of unknown causes (33.0%) and the confirmation of diagnoses (10.7%). Both VEP and ERG were used the most for visual function evaluation, and mfERG was most used for differential diagnosis of unknown etiology. Electrophysiological tests were most often used in the retina department, but VEPs were used in various fields such as neuro-ophthalmology, glaucoma, and oculoplastics. CONCLUSION Electrophysiological tests are used to objectively evaluate visual function or discriminate diseases of unknown causes and are used in various departments. Electrophysiology testing is expected to be an additional test to assess visual function.
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Affiliation(s)
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Chung-Ang University, Gwangmyeong Hospital, Deokan-ro 110, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea.
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Dettoraki M, Droutsas K, Lazaridis A, Moschos MM. Evaluation of macular function and morphology following accelerated collagen cross-linking in progressive keratoconus. Eur J Ophthalmol 2022; 32:2547-2553. [PMID: 35450449 DOI: 10.1177/11206721221094880] [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: 11/17/2022]
Abstract
PURPOSE To assess any changes in macular function and morphology in patients with progressive keratoconus undergoing accelerated corneal cross-linking (CXL). METHODS This prospective case series included 9 eyes of 8 patients with progressive keratoconus undergoing CXL using a high intensity accelerated protocol (9 mW/cm2 for 14 min) with a total surface dose of 7.5 J/cm2. Visual acuity assessment, slit lamp biomicroscopy, dilated fundoscopy, corneal tomography, multifocal electroretinography (mfERG) and spectral domain optical coherence tomography scan were performed at baseline, 2 weeks and 6 weeks postoperatively. RESULTS Uncorrected and corrected distance visual acuity did not change significantly at 2 weeks and 6 weeks following accelerated CXL compared to baseline. Retinal response density (RRD) of mfERG significantly decreased at 2 weeks postoperatively compared to baseline (p = 0.008) but did not differ from the baseline value at 6 weeks postoperatively in the fovea (ring 1) (p = 0.95). Similarly, P1 latency significantly decreased at 2 weeks (p = 0.04) but did not change at 6 weeks (p = 1.00) postoperatively compared to baseline in the fovea. No changes in RRD or P1 latency were observed in the retinal rings surrounding the fovea (rings 2 to 5). Central foveal thickness did not change at 2 weeks and 6 weeks postoperatively compared to baseline (p = 0.53 and p = 0.93, respectively). CONCLUSIONS A short-term reversible decrease in macular electrical activity without any structural changes seems to occur after accelerated CXL in patients with progressive keratoconus. The return of macular response to the preoperative values shows the safety of the CXL protocol.
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Affiliation(s)
- M Dettoraki
- First Department of Ophthalmology, Medical School, 393206National and Kapodistrian University of Athens, Athens, Greece
| | - K Droutsas
- First Department of Ophthalmology, Medical School, 393206National and Kapodistrian University of Athens, Athens, Greece.,Department of Ophthalmology, 98594Philipps University of Marburg, Marburg, Germany
| | - A Lazaridis
- Department of Ophthalmology, 98594Philipps University of Marburg, Marburg, Germany
| | - M M Moschos
- First Department of Ophthalmology, Medical School, 393206National and Kapodistrian University of Athens, Athens, Greece
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Orsini A, Ferrari D, Riva A, Santangelo A, Macrì A, Freri E, Canafoglia L, D'Aniello A, Di Gennaro G, Massimetti G, Minetti C, Zara F, Michelucci R, Tumber A, Vincent A, Minassian BA, Striano P. Ocular phenotype and electroretinogram abnormalities in Lafora disease and correlation with disease stage. J Neurol 2022; 269:3597-3604. [PMID: 35184210 PMCID: PMC9217906 DOI: 10.1007/s00415-022-10974-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/01/2022]
Abstract
Abstract
Background
Lafora disease (LD) is a neurodegenerative disorder featuring action and stimulus-sensitive myoclonus, epilepsy, and cognitive deterioration. Mutations in the EPM2A/EPM2B genes classically prove causative for the disease in most cases. Since full-field electroretinogram (ffERG) may reveal early-stage changes in a wide spectrum of diseases, we aimed to evaluate retinal cones and rods dysfunction in a cohort of Italian LD patients.
Methods
Patients with genetically confirmed LD were recruited and subjected to ffERG analysis following the International Society for Clinical Electrophysiology of Vision (ISCEV) protocol.
Results
Six patients aged between 13 and 26 years (mean 19.5 years) were included. The mean age at disease onset was 12.5 years with a mean disease duration of 7 years. The ffERG analysis revealed a global mild to severe generalized cones dysfunction in all patients. Linear correlation was identified between disease stage and the degree of cones and rods dysfunction, as well as between the type of mutation and the cones and rods dysfunction.
Conclusions
This study brings further evidence of early retinal alterations in LD patients. The cones and rods dysfunction grade is related to disease duration. The ffERG is an important tool to determine the disease stage, allowing to evaluate either natural or treatment-related disease progression in a minimally invasive way.
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Affiliation(s)
- Alessandro Orsini
- Paediatric Neurology, Paediatric Department, Santa Chiara's University Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Daniele Ferrari
- Ophthalmology Unit, Department of Head/Neck Pathologies, Policlinico San Martino Hospital, IRCCS Hospital-University San Martino, Viale Benedetto XV, 16132, Genoa, Italy
| | - Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, IRCCS Istituto "G. Gaslini", Via Gaslini 5, 16148, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Andrea Santangelo
- Paediatric Neurology, Paediatric Department, Santa Chiara's University Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Angelo Macrì
- Ophthalmology Unit, Department of Head/Neck Pathologies, Policlinico San Martino Hospital, IRCCS Hospital-University San Martino, Viale Benedetto XV, 16132, Genoa, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Laura Canafoglia
- Department of Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Gabriele Massimetti
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Minetti
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, IRCCS Istituto "G. Gaslini", Via Gaslini 5, 16148, Genoa, Italy
| | - Federico Zara
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, IRCCS Istituto "G. Gaslini", Via Gaslini 5, 16148, Genoa, Italy
| | - Roberto Michelucci
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Anupreet Tumber
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
| | - Berge Arakel Minassian
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, IRCCS Istituto "G. Gaslini", Via Gaslini 5, 16148, Genoa, Italy.
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
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Onyango O, Sitati S. Retinal Toxicity from Chronic Hydroxychloroquine use in Kenya. Ann Afr Med 2022; 21:301-304. [PMID: 36204922 PMCID: PMC9671192 DOI: 10.4103/aam.aam_118_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Irreversible visual loss due to retinal toxicity is one of the side effects of hydroxychloroquine (HCQ) therapy. The recent outbreak of the novel coronavirus-19 (COVID 19) has seen HCQ proposed as a possible treatment and prophylactic drug, leading to its increased use. Many are unaware of its ocular side effects. We describe a case of HCQ-induced retinopathy in a 46-year-old female who was referred by a rheumatologist for routine eye review.
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O'Neill EK, Smith R. Visual electrophysiology in the assessment of toxicity and deficiency states affecting the visual system. Eye (Lond) 2021; 35:2344-2353. [PMID: 34290445 PMCID: PMC8377028 DOI: 10.1038/s41433-021-01663-2] [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: 03/07/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
Visual disturbance or visual failure due to toxicity of an ingested substance or a severe nutritional deficiency can present significant challenges for diagnosis and management, for instance, where an adverse reaction to a prescribed medicine is suspected. Objective assessment of visual function is important, particularly where structural changes in the retina or optic nerve have not yet occurred, as there may be a window of opportunity to mitigate or reverse visual loss. This paper reviews a number of clinical presentations where visual electrophysiological assessment has an important role in early diagnosis or management alongside clinical assessment and ocular imaging modalities. We highlight the importance of vitamin A deficiency as an easily detected marker for severe combined micronutrient deficiency.
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Affiliation(s)
- Emily K O'Neill
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK. Emily.O'
| | - Richard Smith
- Eye Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK.
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Lee EJ, Chan P, Chea L, Kim K, Kaufman RJ, Lin JH. ATF6 is required for efficient rhodopsin clearance and retinal homeostasis in the P23H rho retinitis pigmentosa mouse model. Sci Rep 2021; 11:16356. [PMID: 34381136 PMCID: PMC8357971 DOI: 10.1038/s41598-021-95895-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Retinitis Pigmentosa (RP) is a blinding disease that arises from loss of rods and subsequently cones. The P23H rhodopsin knock-in (P23H-KI) mouse develops retinal degeneration that mirrors RP phenotype in patients carrying the orthologous variant. Previously, we found that the P23H rhodopsin protein was degraded in P23H-KI retinas, and the Unfolded Protein Response (UPR) promoted P23H rhodopsin degradation in heterologous cells in vitro. Here, we investigated the role of a UPR regulator gene, activating transcription factor 6 (Atf6), in rhodopsin protein homeostasis in heterozygous P23H rhodopsin (Rho+/P23H) mice. Significantly increased rhodopsin protein levels were found in Atf6-/-Rho+/P23H retinas compared to Atf6+/-Rho+/P23H retinas at early ages (~ P12), while rhodopsin mRNA levels were not different. The IRE1 pathway of the UPR was hyper-activated in young Atf6-/-Rho+/P23H retinas, and photoreceptor layer thickness was unchanged at this early age in Rho+/P23H mice lacking Atf6. By contrast, older Atf6-/-Rho+/P23H mice developed significantly increased retinal degeneration in comparison to Atf6+/-Rho+/P23H mice in all retinal layers, accompanied by reduced rhodopsin protein levels. Our findings demonstrate that Atf6 is required for efficient clearance of rhodopsin protein in rod photoreceptors expressing P23H rhodopsin, and that loss of Atf6 ultimately accelerates retinal degeneration in P23H-KI mice.
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Affiliation(s)
- Eun-Jin Lee
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA.,Department of Pathology, Stanford University, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA.,USC ROSKI Eye Institute and Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Priscilla Chan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Leon Chea
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA.,Department of Pathology, Stanford University, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Kyle Kim
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA.,Department of Pathology, Stanford University, Palo Alto, CA, USA.,VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Randal J Kaufman
- Degenerative Diseases Program, Sanford-Burnham-Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Jonathan H Lin
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA. .,Department of Pathology, Stanford University, Palo Alto, CA, USA. .,VA Palo Alto Healthcare System, Palo Alto, CA, USA. .,School of Medicine, Stanford University, 300 Pasteur Dr. L235, Palo Alto, CA, 94305, USA.
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11
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Barbano L, Ziccardi L, Landi D, Nicoletti CG, Mataluni G, Falsini B, Centonze D, Marfia GA, Quaranta L, Parisi V. Assessment of Macular Function by Multifocal Electroretinogram in Patients with Multiple Sclerosis Treated with Fingolimod. Adv Ther 2021; 38:3986-3996. [PMID: 34109558 PMCID: PMC8280030 DOI: 10.1007/s12325-021-01728-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction This study aimed to evaluate whether treatment with fingolimod (FTY) may induce functional changes on the macular pre-ganglionic retinal elements in patients affected by relapsing–remitting multiple sclerosis (RR-MS) without optic neuritis (ON). Methods This case–control observational and retrospective study assessed multifocal electroretinogram (mfERG) responses from 35 healthy controls (mean age 43.58 ± 5.76 years), 41 patients with RR-MS without ON (mean age 40.64 ± 4.83 years, MS-noFTY group), and from 21 patients with RR-MS without ON (mean age 42.38 ± 12.34 years) and treated with fingolimod (Gilenya®, Novartis Europharm, 0.5 mg/day) (MS-FTY group). MfERG N1 and P1 implicit times (ITs), and N1–P1 response amplitude densities (RADs) were measured from concentric rings (R) with increasing foveal eccentricity: 0–5° (R1), 5–10° (R2), 10–15° (R3), 15–20° (R4), 20–25° (R5). We considered R1 and R2 as “central macular areas” and R3, R4 and R5 as “more eccentric retinal areas”. In the MS-FTY group, mfERG recordings were performed between 6 and 12 months (mean 7.2 ± 1.5 months) from the start of FTY. Results In the MS-FTY group, the mean values of mfERG N1 and P1 ITs and RADs detected in both central macular areas (R1 and R2) and in more eccentric retinal areas (R3, R4 and R5) were not significantly different (p > 0.01) with respect to those of control and MS-noFTY groups. Conclusions Our mfERG results suggest that the chronic use of FTY does not induce a dysfunction of pre-ganglionic retinal elements located in the 0–25° of central retina. Since FTY does not cause any retinal functional abnormality, we suggest that FTY treatment could not produce any toxic effect on pre-ganglionic retinal elements even in the absence of macular oedema.
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Affiliation(s)
| | | | - Doriana Landi
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Carolina Gabri Nicoletti
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Giorgia Mataluni
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
| | - Benedetto Falsini
- Ophthalmology Department, IRCCS Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | - Diego Centonze
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Via Montpellier 1, 00133, Rome, Italy
- Unit of Neurology, IRCCS Neuromed, Via Atinense 18, 86077, Pozzilli, IS, Italy
| | - Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
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Kim MS, Lee SG, Kim JY, Kang MY. Maculopathy from an accidental exposure to welding arc. BMJ Case Rep 2019; 12:12/2/bcr-2018-227677. [PMID: 30718265 DOI: 10.1136/bcr-2018-227677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10-15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.
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Affiliation(s)
- Min-Seok Kim
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sang-Gil Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, South Korea
| | - Jae Yun Kim
- Myungdong St. Mary's Eye Center, Seoul, South Korea
| | - Mo-Yeol Kang
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, South Korea.,Department of Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Abstract
Psoralen compounds such as methoxsalen are photosensitizer agents used in conjunction with ultraviolet A (UVA) radiation exposure as photochemotherapy (Psoralens and ultraviolet-A therapy [PUVA therapy]) for certain epidermal skin disorders such as psoriasis and vitiligo. Methoxsalen has been shown to be associated with premature cataract formation by forming adducts with lens proteins following oral administration and subsequent UVA exposure. Hence, the use of UV-filtering glasses is recommended during PUVA therapy sessions. Ocular tissues can be exposed to its photosensitizing effect with subsequent UV radiation exposure through sunlight if the patient was to be without protective eye glasses, potentially causing macular toxicity. Till date, there have been no reports in the literature of any posterior segment ocular toxicity arising from methoxsalen use. Here, we describe a case of a bilateral macular toxicity in a middle-aged male treated with methoxsalen for vitiligo.
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Affiliation(s)
- Aditya Maitray
- Shri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Pukhraj Rishi
- Shri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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15
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Moschos MM, Dettoraki M, Tsatsos M, Kitsos G, Kalogeropoulos C. Effect of carotenoids dietary supplementation on macular function in diabetic patients. EYE AND VISION 2017; 4:23. [PMID: 29046877 PMCID: PMC5641400 DOI: 10.1186/s40662-017-0088-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/29/2017] [Indexed: 01/25/2023]
Abstract
Background Diabetic retinopathy is a major cause of visual impairment and blindness among working-age people worldwide. The aim of our study was to investigate the effects of a carotenoid supplementation on retinal thickness and macular function of patients with diabetes using optical coherence tomography (OCT) and multifocal electroretinography (mfERG). Methods A retrospective study of one hundred and twenty eyes of sixty patients age between 40 and 60 years with non-insulin dependent type 2 diabetes mellitus without diabetic retinopathy who underwent OCT and mfERG and took vitamin supplements for a period of two years. Patients received a carotenoid supplement containing lutein (10 mg), zeaxanthin (2 mg) and meso-zeaxanthin (10 mg) once a day for two years. The thickness of the fovea was evaluated using OCT and the macular function was tested by mfERG. Results OCT showed an increase in the central foveal thickness and mfERG revealed increased retinal response density within the central 13° surrounding the fovea (rings 1 to 3) at two years after the onset of carotenoids supplement intake. Conclusion The use of carotenoid supplements may be of benefit for improving visual function of type 2 diabetes patients. However, further study is needed to assess the treatment’s long-term efficacy.
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Affiliation(s)
- Marilita M Moschos
- First Department of Ophthalmology, Medical School, National and Kapodistrian University of Athens, 6 Ikarias street, Ekali, 14578 Athens, Greece
| | - Maria Dettoraki
- First Department of Ophthalmology, Medical School, National and Kapodistrian University of Athens, 6 Ikarias street, Ekali, 14578 Athens, Greece
| | - Michael Tsatsos
- Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Kitsos
- Department of Ophthalmology, Medical School, University of Ioannina, Ioannina, Greece
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Dettoraki M, Kattamis A, Ladas I, Maragkos K, Koutsandrea C, Chatzistefanou K, Laios K, Brouzas D, Moschos MM. Electrophysiological assessment for early detection of retinal dysfunction in β-thalassemia major patients. Graefes Arch Clin Exp Ophthalmol 2017; 255:1349-1358. [PMID: 28361176 DOI: 10.1007/s00417-017-3650-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/12/2017] [Accepted: 03/20/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the role of various diagnostic tests in early detection of retinal changes in β-thalassemia major patients. METHODS Thirty-eight visually asymptomatic β-thalassemia major patients receiving regular blood transfusions and iron-chelation therapy with deferoxamine (group A, n = 13), deferasirox (group B, n = 11) or deferoxamine with deferiprone (group C, n = 14) and fourteen age- and sex- matched healthy individuals were included in the study. All participants underwent ophthalmoscopy, full-field electroretinography (ERG), visual evoked potentials (VEP), multifocal electroretinography (mfERG), fundus autofluorescence (FAF) imaging and optical coherence tomography (OCT) scans. RESULTS Retinal pigment epithelium changes were present in two cases. Scotopic ERG demonstrated decreased a-wave amplitude in groups A, B and C (p = 0.03, p = 0.002 and p = 0.002, respectively) and decreased b-wave amplitude in groups B and C (p = 0.002 and p = 0.01, respectively) compared to controls. Photopic ERG showed delayed b-wave latency in groups A and C (p = 0.03 and p = 0.03, respectively) ERG maximal combined response and VEP response did not differ between groups. MfERG showed reduced retinal response density in ring 1 in groups A, B, C (p < 0.001, p < 0.001, p = 0.001, respectively) and ring 2 in group B (p = 0.02) and delayed latency in ring 5 in groups A and B (p = 0.04 and p = 0.04, respectively). Abnormal FAF images appeared in three cases and OCT abnormalities in one case, whereas no changes were observed in controls (p = 0.55 and p = 1.00, respectively). CONCLUSIONS Full-field ERG and mfERG are more sensitive tools for detecting early retinal changes in β-thalassemia patients compared with ophthalmoscopy, VEP, FAF imaging and OCT scans.
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Affiliation(s)
- Maria Dettoraki
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece
| | - Antonis Kattamis
- Thalassemia Unit, First Department of Pediatrics, Aghia Sofia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ladas
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece
| | | | - Chryssanthi Koutsandrea
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece
| | - Klio Chatzistefanou
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece
| | - Konstantinos Laios
- Department of History of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Brouzas
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece
| | - Marilita M Moschos
- First Department of Ophthalmology, "G. Gennimatas" General Hospital, Medical School, National and Kapodistrian University of Athens, 154 Mesogion Avenue, Athens, 11527, Greece.
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