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Rao NT, Sumaroka A, Santos AJ, Parchinski KM, Weber ML, Maguire AM, Cideciyan AV, Aleman TS. Detailed phenotype and long-term follow-up of RAB28-associated cone-rod dystrophy. Ophthalmic Genet 2024:1-10. [PMID: 38956823 DOI: 10.1080/13816810.2024.2362204] [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: 02/14/2024] [Accepted: 05/27/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To gain an insight into the pathophysiology of RAB28-associated inherited retinal degeneration through detailed phenotyping and long-term longitudinal follow-up. METHODS The patient underwent complete ophthalmic examinations. Visual function was assessed with microperimetry, full-field electroretinography (ffERG), imaging with optical coherence tomography (OCT), short-wave (SW), and near-infrared (NIR) fundus autofluorescence (FAF). RESULTS A healthy Haitian woman with homozygous pathogenic variants (c.68C > T; p.Ser23Phe) in RAB28 presented at 16 years of age with a four-year history of blurred vision. Visual acuities were 20/125 in each eye, which remained relatively stable since. At age 27, cone ffERGs were non-detectable and borderline for rod-mediated responses. Kinetic fields were full to a V-4e target, undetectable to a small I-4e stimulus. Microperimetry showed an absolute central scotoma surrounded by a pericentral relative scotoma. SD-OCT showed an undetectable or barely detectable foveal and parafoveal photoreceptor outer nuclear layer (ONL), photoreceptor outer segment (POS), and retinal pigment epithelium (RPE) signals and loss of the SW- and NIR-FAF signals. This atrophic region was separated from a normally laminated retina by a narrow transition zone (TZ) of hyper SW- and NIR-FAF that co-localized with preserved ONL but abnormally thinned POS and RPE. There was minimal centrifugal (<100 μ m) expansion over a six-year period. CONCLUSION The cone-rod dystrophy phenotype documented herein supports a critical role of RAB28 for cone function and POS maintenance. Severe central photoreceptor and RPE loss with a predilection for POS loss in TZs suggests possible disruptions of complex mechanisms that maintain central cone photoreceptor and RPE homeostasis.
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Affiliation(s)
- Nitya T Rao
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander Sumaroka
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arlene J Santos
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelsey M Parchinski
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariejel L Weber
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Albert M Maguire
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Artur V Cideciyan
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tomas S Aleman
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Kunala K, Tang JAH, Parkins K, Hunter JJ. Multispectral label-free in vivo cellular imaging of human retinal pigment epithelium using adaptive optics fluorescence lifetime ophthalmoscopy improves feasibility for low emission analysis and increases sensitivity for detecting changes with age and eccentricity. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:S22707. [PMID: 38962492 PMCID: PMC11221116 DOI: 10.1117/1.jbo.29.s2.s22707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 07/05/2024]
Abstract
Significance Adaptive optics fluorescence lifetime ophthalmoscopy (AOFLIO) provides a label-free approach to observe functional and molecular changes at cellular scale in vivo. Adding multispectral capabilities improves interpretation of lifetime fluctuations due to individual fluorophores in the retinal pigment epithelium (RPE). Aim To quantify the cellular-scale changes in autofluorescence with age and eccentricity due to variations in lipofuscin, melanin, and melanolipofuscin in RPE using multispectral AOFLIO. Approach AOFLIO was performed on six subjects at seven eccentricities. Four imaging channels (λ ex / λ em ) were used: 473/SSC, 473/LSC, 532/LSC, and 765/NIR. Cells were segmented and the timing signals of each pixel in a cell were combined into a single histogram, which were then used to compute the lifetime and phasor parameters. An ANOVA was performed to investigate eccentricity and spectral effects on each parameter. Results A repeatability analysis revealed < 11.8 % change in lifetime parameters in repeat visits for 532/LSC. The 765/NIR and 532/LSC had eccentricity and age effects similar to previous reports. The 473/LSC had a change in eccentricity with mean lifetime and a phasor component. Both the 473/LSC and 473/SSC had changes in eccentricity in the short lifetime component and its relative contribution. The 473/SSC had no trend in eccentricity in phasor. The comparison across the four channels showed differences in lifetime and phasor parameters. Conclusions Multispectral AOFLIO can provide a more comprehensive picture of changes with age and eccentricity. These results indicate that cell segmentation has the potential to allow investigations in low-photon scenarios such as in older or diseased subjects with the co-capture of an NIR channel (such as 765/NIR) with the desired spectral channel. This work represents the first multispectral, cellular-scale fluorescence lifetime comparison in vivo in the human RPE and may be a useful method for tracking diseases.
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Affiliation(s)
- Karteek Kunala
- Stanford University, Byers Eye Institute, Palo Alto, California, United States
| | - Janet A. H. Tang
- University of Rochester, Center for Visual Science, Rochester, New York, United States
- University of Rochester, The Institute of Optics, Rochester, New York, United States
| | - Keith Parkins
- University of Rochester, Center for Visual Science, Rochester, New York, United States
| | - Jennifer J. Hunter
- University of Rochester, Center for Visual Science, Rochester, New York, United States
- University of Rochester, The Institute of Optics, Rochester, New York, United States
- University of Waterloo, School of Optometry and Vision Science, Waterloo, Ontario, Canada
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Bowles Johnson KE, Tang JAH, Kunala K, Huynh KT, Parkins K, Yang Q, Hunter JJ. Fluorescence Lifetime Imaging of Human Retinal Pigment Epithelium in Pentosan Polysulfate Toxicity Using Adaptive Optics Scanning Light Ophthalmoscopy. Invest Ophthalmol Vis Sci 2024; 65:27. [PMID: 38630675 PMCID: PMC11044828 DOI: 10.1167/iovs.65.4.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Fluorescence lifetime ophthalmoscopy (FLIO) is an emerging clinical modality that could provide biomarkers of retinal health beyond fluorescence intensity. Adaptive optics (AO) ophthalmoscopy provides the confocality to measure fluorescence lifetime (FL) primarily from the retinal pigment epithelium (RPE) whereas clinical FLIO has greater influence from fluorophores in the inner retina and lens. Adaptive optics fluorescence lifetime ophthalmoscopy (AOFLIO) measures of FL in vivo could provide insight into RPE health at different stages of disease. In this study, we assess changes in pentosan polysulfate sodium (PPS) toxicity, a recently described toxicity that has clinical findings similar to advanced age-related macular degeneration. Methods AOFLIO was performed on three subjects with PPS toxicity (57-67 years old) and six age-matched controls (50-64 years old). FL was analyzed with a double exponential decay curve fit and with phasor analysis. Regions of interest (ROIs) were subcategorized based on retinal features on optical coherence tomography (OCT) and compared to age-matched controls. Results Twelve ROIs from PPS toxicity subjects met the threshold for analysis by curve fitting and 15 ROIs met the threshold for phasor analysis. Subjects with PPS toxicity had prolonged FL compared to age-matched controls. ROIs of RPE degeneration had the longest FLs, with individual pixels extending longer than 900 ps. Conclusions Our study shows evidence that AOFLIO can provide meaningful information in outer retinal disease beyond what is obtainable from fluorescence intensity alone. More studies are needed to determine the prognostic value of AOFLIO.
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Affiliation(s)
| | - Janet A. H. Tang
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- The Institute of Optics, University of Rochester, Rochester, New York, United States
| | - Karteek Kunala
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Khang T. Huynh
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States
| | - Keith Parkins
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Qiang Yang
- Center for Visual Science, University of Rochester, Rochester, New York, United States
| | - Jennifer J. Hunter
- Flaum Eye Institute, University of Rochester, Rochester, New York, United States
- Center for Visual Science, University of Rochester, Rochester, New York, United States
- The Institute of Optics, University of Rochester, Rochester, New York, United States
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Mizobuchi K, Hayashi T, Tanaka K, Kuniyoshi K, Murakami Y, Nakamura N, Torii K, Mizota A, Sakai D, Maeda A, Kominami T, Ueno S, Kusaka S, Nishiguchi KM, Ikeda Y, Kondo M, Tsunoda K, Hotta Y, Nakano T. Genetic and Clinical Features of ABCA4-Associated Retinopathy in a Japanese Nationwide Cohort. Am J Ophthalmol 2024; 264:36-43. [PMID: 38499139 DOI: 10.1016/j.ajo.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE To clarify the genetic and clinical features of Japanese patients with ABCA4-associated retinopathy. DESIGN Retrospective, multicenter cohort study. METHODS Patients with retinal degeneration and biallelic ABCA4 variants were recruited from 13 different hospitals. Whole exome sequencing analysis was used for genetic testing. Comprehensive ophthalmic examinations were performed on matched patients. The primary outcome measure was identifying multimodal retinal imaging findings associated with disease progression. RESULTS This study included 63 patients: 19 with missense/missense, 23 with missense/truncation, and 21 with truncation/truncation genotypes. In total, 62 variants were identified, including 29 novel variants. Six patients had a mild phenotype characterized by foveal-sparing or preserved foveal structure, including 4 with missense/missense and 2 with missense/truncation genotypes. The p.Arg212His variant was the most frequent in patients with mild phenotypes (4/12 alleles). Clinical findings showed a disease duration-dependent worsening of the phenotypic stage. Patients with the truncation/truncation genotype exhibited rapid retinal degeneration within a few years and definite fundus autofluorescence imaging patterns, including hyper autofluorescence at the macula and few or no flecks. CONCLUSIONS Our results indicate that missense/missense or missense/truncation genotypes, including the p.Arg212His variant, are associated with a relatively mild phenotype. In contrast, the truncation/truncation genotype causes rapid and severe retinal degeneration in Japanese patients with ABCA4-associated retinopathy. These data are vital in predicting patient prognosis, guiding genetic counseling, and stratifying patients for future clinical trials.
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Affiliation(s)
- Kei Mizobuchi
- Department of Ophthalmology (K.M., T.H., T.N.), The Jikei University School of Medicine, Tokyo, Japan
| | - Takaaki Hayashi
- Department of Ophthalmology (K.M., T.H., T.N.), The Jikei University School of Medicine, Tokyo, Japan; Department of Ophthalmology, Katsushika Medical Center (T.H.), The Jikei University School of Medicine, Tokyo, Japan.
| | - Koji Tanaka
- Division of Ophthalmology, Department of Visual Sciences (K.T.), Nihon University School of Medicine, Nihon University Hospital, Tokyo, Japan
| | - Kazuki Kuniyoshi
- Department of Ophthalmology (K.K., S.K.), Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yusuke Murakami
- Department of Ophthalmology (Y.M.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Natsuko Nakamura
- Department of Ophthalmology (N.N.), The University of Tokyo, Tokyo, Japan
| | - Kaoruko Torii
- Department of Ophthalmology (K.T., Y.H.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Atsushi Mizota
- Department of Ophthalmology (A.M.), Teikyo University, Tokyo, Japan
| | - Daiki Sakai
- Department of Ophthalmology (D.S., A.M.), Kobe City Eye Hospital, Kobe, Japan
| | - Akiko Maeda
- Department of Ophthalmology (D.S., A.M.), Kobe City Eye Hospital, Kobe, Japan
| | - Taro Kominami
- Department of Ophthalmology (T.K., S.U., K.M.N.), Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shinji Ueno
- Department of Ophthalmology (T.K., S.U., K.M.N.), Nagoya University Graduate School of Medicine, Aichi, Japan; Department of Ophthalmology (S.U.), Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shunji Kusaka
- Department of Ophthalmology (K.K., S.K.), Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Koji M Nishiguchi
- Department of Ophthalmology (T.K., S.U., K.M.N.), Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuhiro Ikeda
- Department of Ophthalmology (Y.I.), Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Mineo Kondo
- Department of Ophthalmology (M.K.), Mie University Graduate School of Medicine, Mie, Japan
| | - Kazushige Tsunoda
- Division of Vision Research (K.T.), National Institute of Sensory Organs, NHO Tokyo Medical Center, Tokyo, Japan
| | - Yoshihiro Hotta
- Department of Ophthalmology (K.T., Y.H.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tadashi Nakano
- Department of Ophthalmology (K.M., T.H., T.N.), The Jikei University School of Medicine, Tokyo, Japan
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Sabharwal J, Liu TYA, Antonio-Aguirre B, Abousy M, Patel T, Cai CX, Jones CK, Singh MS. Automated identification of fleck lesions in Stargardt disease using deep learning enhances lesion detection sensitivity and enables morphometric analysis of flecks. Br J Ophthalmol 2024:bjo-2023-323592. [PMID: 38408857 DOI: 10.1136/bjo-2023-323592] [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: 03/24/2023] [Accepted: 01/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To classify fleck lesions and assess artificial intelligence (AI) in identifying flecks in Stargardt disease (STGD). METHODS A retrospective study of 170 eyes from 85 consecutive patients with confirmed STGD. Fundus autofluorescence images were extracted, and flecks were manually outlined. A deep learning model was trained, and a hold-out testing subset was used to compare with manually identified flecks and for graders to assess. Flecks were clustered using K-means clustering. RESULTS Of the 85 subjects, 45 were female, and the median age was 37 years (IQR 25-59). A subset of subjects (n=41) had clearly identifiable fleck lesions, and an AI was successfully trained to identify these lesions (average Dice score of 0.53, n=18). The AI segmentation had smaller (0.018 compared with 0.034 mm2, p<0.001) but more numerous flecks (75.5 per retina compared with 40.0, p<0.001), but the total size of flecks was not different. The AI model had higher sensitivity to detect flecks but resulted in more false positives. There were two clusters of flecks based on morphology: broadly, one cluster of small round flecks and another of large amorphous flecks. The per cent frequency of small round flecks negatively correlated with subject age (r=-0.31, p<0.005). CONCLUSIONS AI-based detection of flecks shows greater sensitivity than human graders but with a higher false-positive rate. With further optimisation to address current shortcomings, this approach could be used to prescreen subjects for clinical research. The feasibility and utility of quantifying fleck morphology in conjunction with AI-based segmentation as a biomarker of progression require further study.
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Affiliation(s)
| | | | | | - Mya Abousy
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tapan Patel
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Cindy X Cai
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Craig K Jones
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mandeep S Singh
- Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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6
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Li CHZ, Pas JAAH, Corradi Z, Hitti-Malin RJ, Hoogstede A, Runhart EH, Dhooge PPA, Collin RWJ, Cremers FPM, Hoyng CB. Study of Late-Onset Stargardt Type 1 Disease: Characteristics, Genetics, and Progression. Ophthalmology 2024; 131:87-97. [PMID: 37598860 DOI: 10.1016/j.ophtha.2023.08.011] [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: 04/12/2023] [Revised: 07/07/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
PURPOSE Late-onset Stargardt disease is a subtype of Stargardt disease type 1 (STGD1), defined by an age of onset of 45 years or older. We describe the disease characteristics, underlying genetics, and disease progression of late-onset STGD1 and highlight the differences from geographic atrophy. DESIGN Retrospective cohort study. PARTICIPANTS Seventy-one patients with late-onset STGD1. METHODS Medical files were reviewed for clinical data including age at onset, initial symptoms, and best-corrected visual acuity. A quantitative and qualitative assessment of retinal pigment epithelium (RPE) atrophy was performed on fundus autofluorescence images and OCT scans. MAIN OUTCOME MEASURES Age at onset, genotype, visual acuity, atrophy growth rates, and loss of external limiting membrane, ellipsoid zone, and RPE. RESULTS Median age at onset was 55.0 years (range, 45-82 years). A combination of a mild and severe variant in ATP-binding cassette subfamily A member 4 (ABCA4) was the most common genotype (n = 49 [69.0%]). The most frequent allele, c.5603A→T (p.Asn1868Ile), was present in 43 of 71 patients (60.6%). No combination of 2 severe variants was found. At first presentation, all patients have flecks. Foveal-sparing atrophy was present in 33.3% of eyes, whereas 21.1% had atrophy with foveal involvement. Extrafoveal atrophy was present in 38.9% of eyes, and no atrophy was evident in 6.7% of eyes. Time-to-event curves showed a median duration of 15.4 years (95% confidence interval, 11.1-19.6 years) from onset to foveal involvement. The median visual acuity decline was -0.03 Snellen decimal per year (interquartile range [IQR], -0.07 to 0.00 Snellen decimal; 0.03 logarithm of the minimum angle of resolution). Median atrophy growth was 0.590 mm2/year (IQR, 0.046-1.641 mm2/year) for definitely decreased autofluorescence and 0.650 mm2/year (IQR, 0.299-1.729 mm2/year) for total decreased autofluorescence. CONCLUSIONS Late-onset STGD1 is a subtype of STGD1 with most commonly 1 severe and 1 mild ABCA4 variant. The general patient presents with typical fundus flecks and retinal atrophy in a foveal-sparing pattern with preserved central vision. Misdiagnosis as age-related macular degeneration should be avoided to prevent futile invasive treatments with potential complications. In addition, correct diagnosis lends patients with late-onset STGD1 the opportunity to participate in potentially beneficial therapeutic trials for STGD1. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Catherina H Z Li
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen A A H Pas
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zelia Corradi
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Academic Alliance Genetics, Radboud University Medical Center, Nijmegen, and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rebekkah J Hitti-Malin
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Academic Alliance Genetics, Radboud University Medical Center, Nijmegen, and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Anne Hoogstede
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmee H Runhart
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patty P A Dhooge
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rob W J Collin
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Academic Alliance Genetics, Radboud University Medical Center, Nijmegen, and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Frans P M Cremers
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Human Genetics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Academic Alliance Genetics, Radboud University Medical Center, Nijmegen, and Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
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Cohen SY, Chowers I, Nghiem-Buffet S, Mrejen S, Souied E, Gaudric A. Subretinal autofluorescent deposits: A review and proposal for clinical classification. Surv Ophthalmol 2023; 68:1050-1070. [PMID: 37392968 DOI: 10.1016/j.survophthal.2023.06.009] [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: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
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Affiliation(s)
- Salomon Yves Cohen
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France.
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Hospital, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sarah Mrejen
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Eric Souied
- Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France
| | - Alain Gaudric
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, AP-HP, Hôpital Lariboisière, Université Paris Cité, Paris, France
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Das AV, Venugopal R, Takkar B, Sharma S, Balakrishnan N, Narayanan R, Parameswarappa D, Padhy SK. Clinical profile and demographic distribution of Stargardt disease phenotypes: An Electronic medical record-driven big data analytics from a multitier eye care network. Indian J Ophthalmol 2023; 71:3407-3411. [PMID: 37787244 PMCID: PMC10683681 DOI: 10.4103/ijo.ijo_3290_22] [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: 12/18/2022] [Revised: 04/19/2023] [Accepted: 06/06/2023] [Indexed: 10/04/2023] Open
Abstract
Purpose To describe the demographics and clinical profile of Stargardt disease in patients presenting a multitier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study was performed among 2,834,616 new patients presenting between August 2010 and June 2021 in our network. Patients with a clinical diagnosis of Stargardt disease in at least one eye were included as cases. The data were collected using an electronic medical record system. Results Overall, 1,934 (0.069%) patients were diagnosed with Stargardt disease. Most of the patients were male (63.14%). The most common age group at presentation was during the second decade of life, with 626 (31.87%) patients. The overall prevalence was higher in patients from a higher socioeconomic status (0.077%), in those presenting from the urban geography (0.079%), and in students (0.197%). Systemic history of hypertension was seen in 56 (2.85%) patients, while diabetes mellitus was seen in (2.49%) patients. Of the 3,917 eyes, 1,910 (48.76%) eyes had moderate visual impairment (>20/70-20/200) followed by severe visual impairment (>20/200 to 20/400) in 646 (16.49%) eyes. The most commonly associated retinal signs were retinal flecks in 1,260 (32.17%) eyes, followed by RPE changes in 945 (24.13%) eyes. The most documented investigations were autofluorescence (39.85%), followed by optical coherence tomography (23.90). Cataract surgery was the commonest performed surgical intervention in (0.66%) eyes, followed by intravitreal injection in 4 (0.10%) eyes. The family history of parent consanguinity marriage was reported by 212 (10.79%) patients. Conclusion Stargardt disease was seen more commonly in males presenting during the second decade of life. It is predominantly a bilateral disease, with the majority of the eyes having moderate visual impairment.
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Affiliation(s)
- Anthony Vipin Das
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ragukumar Venugopal
- Department of EyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Brijesh Takkar
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sumant Sharma
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Neelima Balakrishnan
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Department of Ophthalmology, Indian Health Outcomes, Public Health, and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Deepika Parameswarappa
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Srikanta Kumar Padhy
- Department of Ophthalmology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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9
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Sajovic J, Meglič A, Corradi Z, Khan M, Maver A, Vidmar MJ, Hawlina M, Cremers FPM, Fakin A. ABCA4 Variant c.5714+5G>A in Trans With Null Alleles Results in Primary RPE Damage. Invest Ophthalmol Vis Sci 2023; 64:33. [PMID: 37728905 PMCID: PMC10516765 DOI: 10.1167/iovs.64.12.33] [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: 02/28/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
Purpose To determine the disease pathogenesis associated with the frequent ABCA4 variant c.5714+5G>A (p.[=,Glu1863Leufs*33]). Methods Patient-derived photoreceptor precursor cells were generated to analyze the effect of c.5714+5G>A on splicing and perform a quantitative analysis of c.5714+5G>A products. Patients with c.5714+5G>A in trans with a null allele (i.e., c.5714+5G>A patients; n = 7) were compared with patients with two null alleles (i.e., double null patients; n = 11); with a special attention to the degree of RPE atrophy (area of definitely decreased autofluorescence and the degree of photoreceptor impairment (outer nuclear layer thickness and pattern electroretinography amplitude). Results RT-PCR of mRNA from patient-derived photoreceptor precursor cells showed exon 40 and exon 39/40 deletion products, as well as the normal transcript. Quantification of products showed 52.4% normal and 47.6% mutant ABCA4 mRNA. Clinically, c.5714+5G>A patients displayed significantly better structural and functional preservation of photoreceptors (thicker outer nuclear layer, presence of tubulations, higher pattern electroretinography amplitude) than double null patients with similar degrees of RPE loss, whereas double null patients exhibited signs of extensive photoreceptor ,damage even in the areas with preserved RPE. Conclusions The prototypical STGD1 sequence of events of primary RPE and secondary photoreceptor damage is congruous with c.5714+5G>A, but not the double null genotype, which implies different and genotype-dependent disease mechanisms. We hypothesize that the relative photoreceptor sparing in c.5714+5G>A patients results from the remaining function of the ABCA4 transporter originating from the normally spliced product, possibly by decreasing the direct bisretinoid toxicity on photoreceptor membranes.
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Affiliation(s)
- Jana Sajovic
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Meglič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zelia Corradi
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Mubeen Khan
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | - Aleš Maver
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Martina Jarc Vidmar
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Frans P. M. Cremers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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10
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Parmann R, Tsang SH, Sparrow JR. Primary versus Secondary Elevations in Fundus Autofluorescence. Int J Mol Sci 2023; 24:12327. [PMID: 37569703 PMCID: PMC10419315 DOI: 10.3390/ijms241512327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
The method of quantitative fundus autofluorescence (qAF) can be used to assess the levels of bisretinoids in retinal pigment epithelium (RPE) cells so as to aid the interpretation and management of a variety of retinal conditions. In this review, we focused on seven retinal diseases to highlight the possible pathways to increased fundus autofluorescence. ABCA4- and RDH12-associated diseases benefit from known mechanisms whereby gene malfunctioning leads to elevated bisretinoid levels in RPE cells. On the other hand, peripherin2/RDS-associated disease (PRPH2/RDS), retinitis pigmentosa (RP), central serous chorioretinopathy (CSC), acute zonal occult outer retinopathy (AZOOR), and ceramide kinase like (CERKL)-associated retinal degeneration all express abnormally high fundus autofluorescence levels without a demonstrated pathophysiological pathway for bisretinoid elevation. We suggest that, while a known link from gene mutation to increased production of bisretinoids (as in ABCA4- and RDH12-associated diseases) causes primary elevation in fundus autofluorescence, a secondary autofluorescence elevation also exists, where an impairment and degeneration of photoreceptor cells by various causes leads to an increase in bisretinoid levels in RPE cells.
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Affiliation(s)
- Rait Parmann
- Departments of Ophthalmology, Columbia University, 635 W. 165th Street, New York, NY 10032, USA
| | - Stephen H. Tsang
- Departments of Ophthalmology, Columbia University, 635 W. 165th Street, New York, NY 10032, USA
- Departments of Pathology and Cell Biology, Columbia University, 635 W. 165th Street, New York, NY 10032, USA
| | - Janet R. Sparrow
- Departments of Ophthalmology, Columbia University, 635 W. 165th Street, New York, NY 10032, USA
- Departments of Pathology and Cell Biology, Columbia University, 635 W. 165th Street, New York, NY 10032, USA
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11
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Birtel J, Bauer T, Pauleikhoff L, Rüber T, Gliem M, Charbel Issa P. Fundus autofluorescence imaging using red excitation light. Sci Rep 2023; 13:9916. [PMID: 37336979 DOI: 10.1038/s41598-023-36217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 05/31/2023] [Indexed: 06/21/2023] Open
Abstract
Retinal disease accounts significantly for visual impairment and blindness. An important role in the pathophysiology of retinal disease and aging is attributed to lipofuscin, a complex of fluorescent metabolites. Fundus autofluorescence (AF) imaging allows non-invasive mapping of lipofuscin and is a key technology to diagnose and monitor retinal disease. However, currently used short-wavelength (SW) excitation light has several limitations, including glare and discomfort during image acquisition, reduced image quality in case of lens opacities, limited visualization of the central retina, and potential retinal light toxicity. Here, we establish a novel imaging modality which uses red excitation light (R-AF) and overcomes these drawbacks. R-AF images are high-quality, high-contrast fundus images and image interpretation may build on clinical experience due to similar appearance of pathology as on SW-AF images. Additionally, R-AF images may uncover disease features that previously remained undetected. The R-AF signal increases with higher abundance of lipofuscin and does not depend on photopigment bleaching or on the amount of macular pigment. Improved patient comfort, limited effect of cataract on image quality, and lack of safety concerns qualify R-AF for routine clinical monitoring, e.g. for patients with age-related macular degeneration, Stargardt disease, or for quantitative analysis of AF signal intensity.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Laurenz Pauleikhoff
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Martin Gliem
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Charbel Issa
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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12
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Greenstein VC, Castillejos DS, Tsang SH, Lee W, Sparrow JR, Allikmets R, Birch DG, Hood DC. Monitoring Lesion Area Progression in Stargardt Disease: A Comparison of En Face Optical Coherence Tomography and Fundus Autofluorescence. Transl Vis Sci Technol 2023; 12:2. [PMID: 37126335 PMCID: PMC10153573 DOI: 10.1167/tvst.12.5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose To compare longitudinal changes in en face spectral domain-optical coherence tomography (SD-OCT) measurements of ellipsoid zone (EZ) and retinal pigment epithelium (RPE) loss to changes in the hypoautofluorescent and hyperautofluorescent (AF) areas detected with short-wavelength (SW)-AF in ABCA4-associated retinopathy. Methods SD-OCT volume scans were obtained from 20 patients (20 eyes) over 2.6 ± 1.2 years (range 1-5 years). The EZ, and RPE/Bruch's membrane boundaries were segmented, and en face slab images generated. SubRPE and EZ slab images were used to measure areas of atrophic RPE and EZ loss. These were compared to longitudinal measurements of the hypo- and abnormal AF (hypoAF and surrounding hyperAF) areas. Results At baseline, the en face area of EZ loss was significantly larger than the subRPE atrophic area, and the abnormal AF area was significantly larger than the hypoAF area. The median rate of EZ loss was significantly greater than the rate of increase in the subRPE atrophic area (1.2 mm2/yr compared to 0.5 mm2/yr). The median rate of increase in the abnormal AF area was significantly greater than the increase in the hypoAF area (1.6 mm2/yr compared to 0.6 mm2/yr). Conclusions En face SD-OCT can be used to quantify changes in RPE atrophy and photoreceptor integrity. It can be a complementary or alternative technique to SW-AF with the advantage of monitoring EZ loss. The SW-AF results emphasize the importance of measuring changes in the hypo- and abnormal AF areas. Translational Relevance The findings are relevant to the selection of outcome measures for monitoring ABCA4-associated retinopathy.
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Affiliation(s)
- Vivienne C. Greenstein
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
| | - David S. Castillejos
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Stephen H. Tsang
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Winston Lee
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
- Department of Genetics and Development, Columbia University Medical Center, New York, NY, USA
| | - Janet R. Sparrow
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | | | - Donald C. Hood
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
- Department of Psychology, Columbia University, New York, NY, USA
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13
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Wang CT, Chang YH, Tan GSW, Lee SY, Chan RVP, Wu WC, Tsai ASH. Optical Coherence Tomography and Optical Coherence Tomography Angiography in Pediatric Retinal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13081461. [PMID: 37189561 DOI: 10.3390/diagnostics13081461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023] Open
Abstract
Indirect ophthalmoscopy and handheld retinal imaging are the most common and traditional modalities for the evaluation and documentation of the pediatric fundus, especially for pre-verbal children. Optical coherence tomography (OCT) allows for in vivo visualization that resembles histology, and optical coherence tomography angiography (OCTA) allows for non-invasive depth-resolved imaging of the retinal vasculature. Both OCT and OCTA were extensively used and studied in adults, but not in children. The advent of prototype handheld OCT and OCTA have allowed for detailed imaging in younger infants and even neonates in the neonatal care intensive unit with retinopathy of prematurity (ROP). In this review, we discuss the use of OCTA and OCTA in various pediatric retinal diseases, including ROP, familial exudative vitreoretinopathy (FEVR), Coats disease and other less common diseases. For example, handheld portable OCT was shown to detect subclinical macular edema and incomplete foveal development in ROP, as well as subretinal exudation and fibrosis in Coats disease. Some challenges in the pediatric age group include the lack of a normative database and the difficulty in image registration for longitudinal comparison. We believe that technological improvements in the use of OCT and OCTA will improve our understanding and care of pediatric retina patients in the future.
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Affiliation(s)
- Chung-Ting Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Yin-Hsi Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore 168751, Singapore
- DUKE NUS Medical School, Singapore 169857, Singapore
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14
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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15
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Zhao PY, Branham K, Schlegel D, Fahim AT, Jayasundera KT. Automated Segmentation of Autofluorescence Lesions in Stargardt Disease. Ophthalmol Retina 2022; 6:1098-1104. [PMID: 35644472 PMCID: PMC10370158 DOI: 10.1016/j.oret.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To train a deep learning (DL) algorithm to perform fully automated semantic segmentation of multiple autofluorescence lesion types in Stargardt disease. DESIGN Cross-sectional study with retrospective imaging data. SUBJECTS The study included 193 images from 193 eyes of 97 patients with Stargardt disease. METHODS Fundus autofluorescence images obtained from patient visits between 2013 and 2020 were annotated with ground-truth labels. Model training and evaluation were performed using fivefold cross-validation. MAIN OUTCOMES MEASURES Dice similarity coefficients, intraclass correlation coefficients, and Bland-Altman analyses comparing algorithm-predicted and grader-labeled segmentations. RESULTS The overall Dice similarity coefficient across all lesion classes was 0.78 (95% confidence interval [CI], 0.69-0.86). Dice coefficients were 0.90 (95% CI, 0.85-0.94) for areas of definitely decreased autofluorescence (DDAF), 0.55 (95% CI, 0.35-0.76) for areas of questionably decreased autofluorescence (QDAF), and 0.88 (95% CI, 0.73-1.00) for areas of abnormal background autofluorescence (ABAF). Intraclass correlation coefficients comparing the ground-truth and automated methods were 0.997 (95% CI, 0.996-0.998) for DDAF, 0.863 (95% CI, 0.823-0.895) for QDAF, and 0.974 (95% CI, 0.966-0.980) for ABAF. CONCLUSIONS A DL algorithm performed accurate segmentation of autofluorescence lesions in Stargardt disease, demonstrating the feasibility of fully automated segmentation as an alternative to manual or semiautomated labeling methods.
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Affiliation(s)
- Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Kari Branham
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Dana Schlegel
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Abigail T Fahim
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - K Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
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16
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Lee W, Su PY, Zernant J, Nagasaki T, Tsang SH, Allikmets R. Longitudinal Analysis of a Resolving Foveomacular Vitelliform Lesion in ABCA4 Disease. Ophthalmol Retina 2022; 6:847-860. [PMID: 35413457 PMCID: PMC9464664 DOI: 10.1016/j.oret.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the longitudinal progression and phenotypic association of bilateral foveomacular vitelliform lesions in the setting of ABCA4 disease. DESIGN Case report and cross-sectional cohort study. PARTICIPANTS Nineteen patients with confirmed ABCA4 disease exhibiting an optical gap phenotype. METHODS Multimodal retinal imaging across multiple visits included autofluorescence imaging, spectral-domain OCT (SD-OCT), and OCT angiography. Electro-oculogram (EOG) and full-field electroretinogram testing results were analyzed. Exome sequencing was performed for diagnostic confirmation and the verification of other variations. MAIN OUTCOME MEASURES Light-peak-to-dark-trough ratio (Arden ratio) on EOG; thickness and en face maps of various retinal layers on SD-OCT; area measurements on 488- and 787-nm autofluorescence images; and the presence of variation in vitelliform-associated genes identified using exome sequencing. RESULTS A 25-year-old White man presented with bilateral central vision loss due to foveal lesions consisting of vitelliform fluid. The result of EOG testing was inconsistent with bestrophinopathy (Arden ratio = 1.62), and no generalized rod or cone dysfunction was detected on full-field electroretinogram. Exome sequencing identified the pathogenic variants c.5882G>A (p.(Gly1961Glu)) and c.4139C>T (p.(Pro1380Leu)) in ABCA4 and no other vitelliform-associated genes. Significant thinning and abnormal reflectivity of photoreceptor-attributable layers as well as near-infrared autofluorescence abnormalities were found in lesion-adjacent areas. Complete resorption of the vitelliform fluid occurred after 30 months, after which the optical gap lesions exhibited an enlarged and "cavitated" appearance. Phenotypic screening for additional cases from a large ABCA4 disease database (n = 602) identified 18 additional patients at various stages of optical gap lesion formation, most of whom harbored the c.5882G>A (p.(Gly1961Glu)) variant (P < 0.001), although none had apparent vitelliform fluid. At least 5 of the 18 (31.6%) patients exhibited optical gap lesions with the distinct "cavitated" appearance, whereas the lesions remained unperturbed in the other patients over the course of examination. CONCLUSIONS Foveomacular vitelliform deposition is a mechanistically congruent but rare manifestation of ABCA4 disease. Specifically, this disease phenotype may be clinically associated with the c.5882G>A (p.(Gly1961Glu)) allele and optical gap lesions.
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Affiliation(s)
- Winston Lee
- Department of Genetics & Development, Columbia University, New York, New York; Department of Ophthalmology, Columbia University, New York, New York
| | - Pei-Yin Su
- Department of Ophthalmology, Columbia University, New York, New York
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, New York
| | - Takayuki Nagasaki
- Department of Ophthalmology, Columbia University, New York, New York
| | - Stephen H Tsang
- Department of Genetics & Development, Columbia University, New York, New York; Department of Pathology & Cell Biology, Columbia University, New York, New York
| | - Rando Allikmets
- Department of Genetics & Development, Columbia University, New York, New York; Department of Pathology & Cell Biology, Columbia University, New York, New York.
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17
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Verra DM, Spinnhirny P, Sandu C, Grégoire S, Acar N, Berdeaux O, Brétillon L, Sparrow JR, Hicks D. Intrinsic differences in rod and cone membrane composition: implications for cone degeneration. Graefes Arch Clin Exp Ophthalmol 2022; 260:3131-3148. [PMID: 35524799 DOI: 10.1007/s00417-022-05684-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE In many retinal pathological conditions, rod and cone degeneration differs. For example, the early-onset maculopathy Stargardts disease type 1 (STGD1) is typified by loss of cones while rods are often less affected. We wanted to examine whether there exist intrinsic membrane differences between rods and cones that might explain such features. METHODS Abca4 mRNA and protein levels were quantified in rod- and cone-enriched samples from wild-type and Nrl-/- mice retinas; rod- and cone-enriched outer segments (ROS and COS respectively) were prepared from pig retinas, and total lipids were analyzed by flame ionization, chromatography, and tandem mass spectrometry. Immunohistochemical staining of cone-rich rodent Arvicanthis ansorgei retinas was conducted, and ultra-high performance liquid chromatography of lipid species in porcine ROS and COS was performed. RESULTS Abca4 mRNA and Abca4 protein content was significantly higher (50-300%) in cone compared to rod-enriched samples. ROS and COS displayed dramatic differences in several lipids, including very long chain poly-unsaturated fatty acids (VLC-PUFAs), especially docosahexaenoic acid (DHA, 22:6n-3): ROS 20.6% DHA, COS 3.3% (p < 0.001). VLC-PUFAs (> 50 total carbons) were virtually absent from COS. COS were impoverished (> 6× less) in phosphatidylethanolamine compared to ROS. ELOVL4 ("ELOngation of Very Long chain fatty acids 4") antibody labelled Arvicanthis cones only very weakly compared to rods. Finally, there were large amounts (905 a.u.) of the bisretinoid A2PE in ROS, whereas it was much lower (121 a.u., ~ 7.5-fold less) in COS fractions. In contrast, COS contained fivefold higher amounts of all-trans-retinal dimer (115 a.u. compared to 22 a.u. in rods). CONCLUSIONS Compared to rods, cones expressed higher levels of Abca4 mRNA and Abca4 protein, were highly impoverished in PUFA (especially DHA) and phosphatidylethanolamine, and contained significant amounts of all-trans-retinal dimer. Based on these and other data, we propose that in contrast to rods, cones are preferentially vulnerable to stress and may die through direct cellular toxicity in pathologies such as STGD1.
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Affiliation(s)
- Daniela M Verra
- Département de Neurobiologie des Rythmes, Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 8 Allée Général Rouvillois, 67000, Strasbourg Cedex, France
| | - Perrine Spinnhirny
- Département de Neurobiologie des Rythmes, Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 8 Allée Général Rouvillois, 67000, Strasbourg Cedex, France
| | - Cristina Sandu
- Département de Neurobiologie des Rythmes, Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 8 Allée Général Rouvillois, 67000, Strasbourg Cedex, France
| | - Stéphane Grégoire
- UMR 1324 Centre des Sciences du Goût et de l'Alimentation, Eye and Nutrition Research Group, INRA, Dijon, France.,UMR 6265 Centre des Sciences du Goût et de l'Alimentation, CNRS, Dijon, France.,Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, Dijon, France
| | - Niyazi Acar
- UMR 1324 Centre des Sciences du Goût et de l'Alimentation, Eye and Nutrition Research Group, INRA, Dijon, France.,UMR 6265 Centre des Sciences du Goût et de l'Alimentation, CNRS, Dijon, France.,Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, Dijon, France
| | - Olivier Berdeaux
- UMR 1324 Centre des Sciences du Goût et de l'Alimentation, Eye and Nutrition Research Group, INRA, Dijon, France.,UMR 6265 Centre des Sciences du Goût et de l'Alimentation, CNRS, Dijon, France.,Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, Dijon, France
| | - Lionel Brétillon
- UMR 1324 Centre des Sciences du Goût et de l'Alimentation, Eye and Nutrition Research Group, INRA, Dijon, France.,UMR 6265 Centre des Sciences du Goût et de l'Alimentation, CNRS, Dijon, France.,Centre des Sciences du Goût et de l'Alimentation, Université de Bourgogne, Dijon, France
| | - Janet R Sparrow
- Departments of Ophthalmology, and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - David Hicks
- Département de Neurobiologie des Rythmes, Institut des Neurosciences Cellulaires et Intégratives, CNRS UPR 3212, 8 Allée Général Rouvillois, 67000, Strasbourg Cedex, France.
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18
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Rodríguez-Bocanegra E, Biarnés M, Garcia M, Ferraro LL, Fischer MD, Monés J. Kinetics of Heterogeneous Background in Stargardt’s Disease over Time. Life (Basel) 2022; 12:life12030381. [PMID: 35330133 PMCID: PMC8953836 DOI: 10.3390/life12030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Stargardt’s disease (STGD1) is caused by mutations in the ABCA4 gene. Different lesions characterised by decreased autofluorescence levels are found in fundus autofluorescence (FAF) from STGD1 patients and could be used as outcome indicators for disease progression. We investigated the fate of foci with reduced autofluorescence (FRA) within the heterogeneous background of STGD1 patients using FAF imaging. Genetically confirmed STGD1 patients presenting heterogeneous background autofluorescence on high-quality FAF images at a minimum of two visits at least 12 months apart were chosen. A grid centred on the fovea was used to define five different zones. Within each zone, five FRA were randomly selected for each eye. The eccentricity of foci was determined at different time points for each patient. Analysis of 175 randomly chosen FRA showed consistent centrifugal displacement over time, most notably in eyes showing areas with definitely decreased autofluorescence. Interestingly, FRA did not leave an area of hypo-autofluorescence on FAF in locations where they were previously located. These findings may help to better understand STGD1 progression, improve FAF interpretation, and shed light on the nature of heterogeneous background.
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Affiliation(s)
- Eduardo Rodríguez-Bocanegra
- Barcelona Macula Foundation: Research for Vision, 08022 Barcelona, Spain; (M.B.); (M.G.); (L.L.F.); (J.M.)
- Centre for Ophthalmology, University Hospital Tübingen, University Eye Hospital, 72076 Tübingen, Germany;
- Centre for Ophthalmology, Institute for Ophthalmic Research, University Hospital Tübingen, 72076 Tübingen, Germany
- Correspondence:
| | - Marc Biarnés
- Barcelona Macula Foundation: Research for Vision, 08022 Barcelona, Spain; (M.B.); (M.G.); (L.L.F.); (J.M.)
- Institut de la Màcula, Hospital Quirón Teknon, 08022 Barcelona, Spain
| | - Míriam Garcia
- Barcelona Macula Foundation: Research for Vision, 08022 Barcelona, Spain; (M.B.); (M.G.); (L.L.F.); (J.M.)
- Institut de la Màcula, Hospital Quirón Teknon, 08022 Barcelona, Spain
| | - Lucía Lee Ferraro
- Barcelona Macula Foundation: Research for Vision, 08022 Barcelona, Spain; (M.B.); (M.G.); (L.L.F.); (J.M.)
- Institut de la Màcula, Hospital Quirón Teknon, 08022 Barcelona, Spain
| | - Manuel Dominik Fischer
- Centre for Ophthalmology, University Hospital Tübingen, University Eye Hospital, 72076 Tübingen, Germany;
- Centre for Ophthalmology, Institute for Ophthalmic Research, University Hospital Tübingen, 72076 Tübingen, Germany
- Oxford Eye Hospital, Oxford University NHS Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jordi Monés
- Barcelona Macula Foundation: Research for Vision, 08022 Barcelona, Spain; (M.B.); (M.G.); (L.L.F.); (J.M.)
- Institut de la Màcula, Hospital Quirón Teknon, 08022 Barcelona, Spain
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19
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Tang JAH, Granger CE, Kunala K, Parkins K, Huynh KT, Bowles-Johnson K, Yang Q, Hunter JJ. Adaptive optics fluorescence lifetime imaging ophthalmoscopy of in vivo human retinal pigment epithelium. BIOMEDICAL OPTICS EXPRESS 2022; 13:1737-1754. [PMID: 35414970 PMCID: PMC8973160 DOI: 10.1364/boe.451628] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 05/18/2023]
Abstract
The intrinsic fluorescence properties of lipofuscin - naturally occurring granules that accumulate in the retinal pigment epithelium - are a potential biomarker for the health of the eye. A new modality is described here which combines adaptive optics technology with fluorescence lifetime detection, allowing for the investigation of functional and compositional differences within the eye and between subjects. This new adaptive optics fluorescence lifetime imaging ophthalmoscope was demonstrated in 6 subjects. Repeated measurements between visits had a minimum intraclass correlation coefficient of 0.59 Although the light levels were well below maximum permissible exposures, the safety of the imaging paradigm was tested using clinical measures; no concerns were raised. This new technology allows for in vivo adaptive optics fluorescence lifetime imaging of the human RPE mosaic.
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Affiliation(s)
- Janet A. H. Tang
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Contributed equally
| | - Charles E. Granger
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Contributed equally
| | - Karteek Kunala
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Keith Parkins
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Khang T. Huynh
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
| | - Kristen Bowles-Johnson
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY 14627, USA
| | - Qiang Yang
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
| | - Jennifer J. Hunter
- The Institute of Optics, University of Rochester, Rochester, NY 14627, USA
- Center for Visual Science, University of Rochester, Rochester, NY 14627, USA
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14627, USA
- Flaum Eye Institute, University of Rochester, Rochester, NY 14627, USA
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20
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Parmann R, Tsang SH, Zernant J, Allikmets R, Greenstein VC, Sparrow JR. Comparisons Among Optical Coherence Tomography and Fundus Autofluorescence Modalities as Measurements of Atrophy in ABCA4-Associated Disease. Transl Vis Sci Technol 2022; 11:36. [PMID: 35089312 PMCID: PMC8802021 DOI: 10.1167/tvst.11.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose In ABCA4-associated retinopathy, central atrophy was assessed by spectral domain optical coherence tomography (SD-OCT) and by short-wavelength (SW-AF) and near-infrared (NIR-AF) autofluorescence. Methods Patients exhibited a central atrophic lesion characterized by hypoautofluorescence (hypoAF) surrounded either by hyperautofluorescent (hyperAF) rings in both AF images (group 1, 4 patients); or a hyperAF ring in SW-AF but not in NIR-AF images (group 2, 11 patients); or hyperAF rings in neither AF images (group 3, 11 patients). Choroidal hypertransmission and widths of ellipsoid zone (EZ) loss were measured in foveal SD-OCT scans, and in AF images hypoAF and total hypo+hyperAF widths were measured along the same axis. Bland-Altman and repeated measures analysis of variance with Tukey post hoc were applied. Results For all groups, hypertransmission widths were significantly smaller than EZ loss widths. In Groups 1 and 2, hypertransmission width was not significantly different than SW-hypoAF width, but hypertransmission was narrower than the width of SW-hypo+hyperAF (groups 1, 2) and NIR-hypo+hyperAF (group 1). In group 3, the hypertransmission width was also significantly less than the width of SW-hypoAF and NIR-hypoAF. The EZ loss widths were not significantly different than measurements of total lesion size, the latter being the widths of SW-hypo+hyperAF and NIR-hypo+hyperAF (group 1); widths of NIR-hypoAF and SW-hypo+hyperAF (group 2); and widths of NIR-hypoAF and SW-hypoAF (group 3). Conclusions Hypertransmission and SW-hypoAF (except when reflecting total lesion width) underestimate lesion size detected by EZ loss, SW-hypoAF+hyperAF, and NIR-hypo+hyperAF. Translational Relevance The findings are significant to the selection of outcome measures in clinical studies.
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Affiliation(s)
- Rait Parmann
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Jana Zernant
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Vivienne C Greenstein
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA
| | - Janet R Sparrow
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, NY, USA.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
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21
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Abstract
The beginning of the twenty-first century was marked by the innovative use of pharmacochemical interventions, which have since expanded to include gene-based molecular therapies. For years, treatment has focused on tackling the pathophysiology of monogenic orphan diseases, and one of the first applications of these novel genome editing technologies was the treatment of rare inherited retinal dystrophies. In this review, we present recent, ongoing, and future gene therapy-based treatment trials for choroideremia, X-linked retinitis pigmentosa, Stargardt disease, and age-related macular degeneration. As these trials pave the way toward halting the progression of such devastating diseases, we will begin to see the exciting development of newer, cutting-edge strategies including base editing and prime editing, ushering in a new era of precision medicine.
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Affiliation(s)
- Sarah R Levi
- Jonas Children's Vision Care, Department of Ophthalmology, New York-Presbyterian Hospital, New York, New York 10032, USA; , , ,
| | - Joseph Ryu
- Jonas Children's Vision Care, Department of Ophthalmology, New York-Presbyterian Hospital, New York, New York 10032, USA; , , ,
| | - Pei-Kang Liu
- Jonas Children's Vision Care, Department of Ophthalmology, New York-Presbyterian Hospital, New York, New York 10032, USA; , , , .,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Stephen H Tsang
- Jonas Children's Vision Care, Department of Ophthalmology, New York-Presbyterian Hospital, New York, New York 10032, USA; , , , .,Department of Pathology & Cell Biology, Columbia Stem Cell Initiative, New York, New York 10032, USA
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22
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Huang D, Heath Jeffery RC, Aung-Htut MT, McLenachan S, Fletcher S, Wilton SD, Chen FK. Stargardt disease and progress in therapeutic strategies. Ophthalmic Genet 2021; 43:1-26. [PMID: 34455905 DOI: 10.1080/13816810.2021.1966053] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Stargardt disease (STGD1) is an autosomal recessive retinal dystrophy due to mutations in ABCA4, characterized by subretinal deposition of lipofuscin-like substances and bilateral centrifugal vision loss. Despite the tremendous progress made in the understanding of STGD1, there are no approved treatments to date. This review examines the challenges in the development of an effective STGD1 therapy.Materials and Methods: A literature review was performed through to June 2021 summarizing the spectrum of retinal phenotypes in STGD1, the molecular biology of ABCA4 protein, the in vivo and in vitro models used to investigate the mechanisms of ABCA4 mutations and current clinical trials.Results: STGD1 phenotypic variability remains an challenge for clinical trial design and patient selection. Pre-clinical development of therapeutic options has been limited by the lack of animal models reflecting the diverse phenotypic spectrum of STDG1. Patient-derived cell lines have facilitated the characterization of splice mutations but the clinical presentation is not always predicted by the effect of specific mutations on retinoid metabolism in cellular models. Current therapies primarily aim to delay vision loss whilst strategies to restore vision are less well developed.Conclusions: STGD1 therapy development can be accelerated by a deeper understanding of genotype-phenotype correlations.
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Affiliation(s)
- Di Huang
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.,Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), the University of Western Australia, Nedlands, Western Australia, Australia.,Perron Institute for Neurological and Translational Science & the University of Western Australia, Nedlands, Western Australia, Australia
| | - Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), the University of Western Australia, Nedlands, Western Australia, Australia
| | - May Thandar Aung-Htut
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.,Perron Institute for Neurological and Translational Science & the University of Western Australia, Nedlands, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), the University of Western Australia, Nedlands, Western Australia, Australia
| | - Sue Fletcher
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.,Perron Institute for Neurological and Translational Science & the University of Western Australia, Nedlands, Western Australia, Australia
| | - Steve D Wilton
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Western Australia, Australia.,Perron Institute for Neurological and Translational Science & the University of Western Australia, Nedlands, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), the University of Western Australia, Nedlands, Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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23
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Kim HJ, Montenegro D, Zhao J, Sparrow JR. Bisretinoids of the Retina: Photo-Oxidation, Iron-Catalyzed Oxidation, and Disease Consequences. Antioxidants (Basel) 2021; 10:antiox10091382. [PMID: 34573014 PMCID: PMC8467448 DOI: 10.3390/antiox10091382] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/06/2023] Open
Abstract
The retina and, in particular, retinal pigment epithelial cells are unusual for being encumbered by exposure to visible light, while being oxygen-rich, and also amassing photoreactive molecules. These fluorophores (bisretinoids) are generated as a byproduct of the activity of vitamin A aldehyde-the chromophore necessary for vision. Bisretinoids form in photoreceptor cells due to random reactions of two molecules of vitamin A aldehyde with phosphatidylethanolamine; bisretinoids are subsequently transferred to retinal pigment epithelial (RPE) cells, where they accumulate in the lysosomal compartment with age. Bisretinoids can generate reactive oxygen species by both energy and electron transfer, and they become photo-oxidized and photolyzed in the process. While these fluorescent molecules are accrued by RPE cells of all healthy eyes, they are also implicated in retinal disease.
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Affiliation(s)
- Hye Jin Kim
- Department of Ophthalmology, Columbia University Medical Center, 635 W., 165th Str., New York, NY 10032, USA; (H.J.K.); (D.M.); (J.Z.)
| | - Diego Montenegro
- Department of Ophthalmology, Columbia University Medical Center, 635 W., 165th Str., New York, NY 10032, USA; (H.J.K.); (D.M.); (J.Z.)
| | - Jin Zhao
- Department of Ophthalmology, Columbia University Medical Center, 635 W., 165th Str., New York, NY 10032, USA; (H.J.K.); (D.M.); (J.Z.)
| | - Janet R. Sparrow
- Department of Ophthalmology, Columbia University Medical Center, 635 W., 165th Str., New York, NY 10032, USA; (H.J.K.); (D.M.); (J.Z.)
- Department of Pathology and Cell Biology, Columbia University Medical Center, 635 W., 165th Str., New York, NY 10032, USA
- Correspondence: ; Tel.: +1-212-305-9944
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24
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Cao D, Leong B, Messinger JD, Kar D, Ach T, Yannuzzi LA, Freund KB, Curcio CA. Hyperreflective Foci, Optical Coherence Tomography Progression Indicators in Age-Related Macular Degeneration, Include Transdifferentiated Retinal Pigment Epithelium. Invest Ophthalmol Vis Sci 2021; 62:34. [PMID: 34448806 PMCID: PMC8399556 DOI: 10.1167/iovs.62.10.34] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose By optical coherence tomography (OCT) imaging, hyperreflective foci (HRF) indicate progression risk for advanced age-related macular degeneration (AMD) and are in part attributable to ectopic retinal pigment epithelium (RPE). We hypothesized that ectopic RPE are molecularly distinct from in-layer cells and that their cross-retinal course follows Müller glia. Methods In clinical OCT (61 eyes, 44 patients with AMD, 79.4 ± 7.7 years; 29 female; follow-up = 4.7 ± 0.9 years), one HRF type, RPE plume (n = 129 in 4 morphologies), was reviewed. Twenty eyes of 20 donors characterized by ex vivo OCT were analyzed by histology (normal, 4; early/intermediate AMD, 7; geographic atrophy, 6; neovascular AMD, 3). Cryosections were stained with antibodies to retinoid (RPE65, CRALPB) and immune (CD68, CD163) markers. In published RPE cellular phenotypes, red immunoreactivity was assessed semiquantitatively by one observer (none, some cells, all cells). Results Plume morphology evolved over time and many resolved (40%). Trajectories of RPE plume and cellular debris paralleled Müller glia, including near atrophy borders. RPE corresponding to HRF lost immunoreactivity for retinoid markers and gained immunoreactivity for immune markers. Aberrant immunoreactivity appeared in individual in-layer RPE cells and extended to all abnormal phenotypes. Müller glia remained CRALBP positive. Plume cells approached and contacted retinal capillaries. Conclusions HRF are indicators not predictors of overall disease activity. Gain and loss of function starts with individual in-layer RPE cells and extends to all abnormal phenotypes. Evidence for RPE transdifferentiation, possibly due to ischemia, supports a proposed process of epithelial–mesenchyme transition. Data can propel new biomarkers and therapeutic strategies for AMD.
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Affiliation(s)
- Dongfeng Cao
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Belinda Leong
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Retina Associates, Sydney, New South Wales, Australia
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, United States.,Department of Ophthalmology, New York University, Grossman School of Medicine, New York, New York, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
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25
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Arunkumar R, Gorusupudi A, Li B, Blount JD, Nwagbo U, Kim HJ, Sparrow JR, Bernstein PS. Lutein and zeaxanthin reduce A2E and iso-A2E levels and improve visual performance in Abca4 -/-/Bco2 -/- double knockout mice. Exp Eye Res 2021; 209:108680. [PMID: 34161819 PMCID: PMC8595537 DOI: 10.1016/j.exer.2021.108680] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
Accumulation of bisretinoids such as A2E and its isomer iso-A2E is thought to mediate blue light-induced oxidative damage associated with age-related macular degeneration (AMD) and autosomal recessive Stargardt disease (STGD1). We hypothesize that increasing dietary intake of the macular carotenoids lutein and zeaxanthin in individuals at risk of AMD and STGD1 can inhibit the formation of bisretinoids A2E and iso-A2E, which can potentially ameliorate macular degenerative diseases. To study the beneficial effect of macular carotenoids in a retinal degenerative diseases model, we used ATP-binding cassette, sub-family A member 4 (Abca4-/-)/β,β-carotene-9',10'-oxygenase 2 (Bco2-/-) double knockout (KO) mice that accumulate elevated levels of A2E and iso-A2E in the retinal pigment epithelium (RPE) and macular carotenoids in the retina. Abca4-/-/Bco2-/- and Abca4-/- mice were fed a lutein-supplemented chow, zeaxanthin-supplemented chow or placebo chow (~2.6 mg of carotenoid/mouse/day) for three months. Visual function and electroretinography (ERG) were measured after one month and three months of carotenoid supplementation. The lutein and zeaxanthin supplemented Abca4-/-/Bco2-/- mice had significantly lower levels of RPE/choroid A2E and iso-A2E compared to control mice fed with placebo chow and improved visual performance. Carotenoid supplementation in Abca4-/- mice minimally raised retinal carotenoid levels and did not show much difference in bisretinoid levels or visual function compared to the control diet group. There was a statistically significant inverse correlation between carotenoid levels in the retina and A2E and iso-A2E levels in the RPE/choroid. Supplementation with retinal carotenoids, especially zeaxanthin, effectively inhibits bisretinoid formation in a mouse model of STGD1 genetically enhanced to accumulate carotenoids in the retina. These results provide further impetus to pursue oral carotenoids as therapeutic interventions for STGD1 and AMD.
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Affiliation(s)
- Ranganathan Arunkumar
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Aruna Gorusupudi
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Binxing Li
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - J David Blount
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Uzoamaka Nwagbo
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Hye Jin Kim
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Paul S Bernstein
- Department of Ophthalmology and Visual Science, John A. Moran Eye Center, University of Utah, School of Medicine, Salt Lake City, UT, USA.
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26
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Heath Jeffery RC, Chen FK. Stargardt disease: Multimodal imaging: A review. Clin Exp Ophthalmol 2021; 49:498-515. [PMID: 34013643 PMCID: PMC8366508 DOI: 10.1111/ceo.13947] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/20/2022]
Abstract
Stargardt disease (STGD1) is an autosomal recessive retinal dystrophy, characterised by bilateral progressive central vision loss and subretinal deposition of lipofuscin-like substances. Recent advances in molecular diagnosis and therapeutic options are complemented by the increasing recognition of new multimodal imaging biomarkers that may predict genotype and disease progression. Unique non-invasive imaging features of STDG1 are useful for gene variant interpretation and may even provide insight into the underlying molecular pathophysiology. In addition, pathognomonic imaging features of STGD1 have been used to train neural networks to improve time efficiency in lesion segmentation and disease progression measurements. This review will discuss the role of key imaging modalities, correlate imaging signs across varied STGD1 presentations and illustrate the use of multimodal imaging as an outcome measure in determining the efficacy of emerging STGD1 specific therapies.
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Affiliation(s)
- Rachael C. Heath Jeffery
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute)The University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of OphthalmologyRoyal Perth HospitalPerthWestern AustraliaAustralia
| | - Fred K. Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute)The University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of OphthalmologyRoyal Perth HospitalPerthWestern AustraliaAustralia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and PhysicsSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
- Department of OphthalmologyPerth Children's HospitalNedlandsWestern AustraliaAustralia
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27
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Dhooge PPA, Runhart EH, Lambertus S, Bax NM, Groenewoud JMM, Klevering BJ, Hoyng CB. Correlation of Morphology and Function of Flecks Using Short-Wave Fundus Autofluorescence and Microperimetry in Patients With Stargardt Disease. Transl Vis Sci Technol 2021; 10:18. [PMID: 34003952 PMCID: PMC7991959 DOI: 10.1167/tvst.10.3.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the functional relevance of longitudinal changes in hyperautofluorescent areas and flecks in Stargardt disease (STGD1) using short-wavelength autofluorescence (SW-AF) imaging. Methods In this prospective, longitudinal study, 31 patients with STGD1 (56 eyes) underwent microperimetry (MP) and SW-AF imaging twice in 3 to 5 years. A total of 760 MP test points were included in the statistical analysis based on stable fixation and accurate alignment of SW-AF and MP. Autofluorescence intensity was qualitatively assessed in all MP test points. Small circumscriptive hyperautofluorescent lesions were defined as flecks. Longitudinal imaging characteristics observed on SW-AF were classified into the following categories: appearing, disappearing, and stable flecks, stable hyperautofluorescent, and stable background autofluorescence. The relationship between SW-AF intensity changes and MP changes was analyzed using a linear mixed model corrected for baseline sensitivity. Results Retinal sensitivity declined most in locations without change in SW-AF intensity. Functional decline per year was significantly larger in flecks that disappeared (−0.72 ± 1.30 dB) compared to flecks that appeared (−0.34 ± 0.65 dB), if baseline sensitivity was high (≥10 dB; P < 0.01). The correlation between the change observed on SW-AF and the sensitivity change significantly depended on the sensitivity at baseline (P = 0.000). Conclusions Qualitative longitudinal assessment of SW-AF poorly reflected the retinal sensitivity loss observed over the course of 3 to 5 years. Translational Relevance When aiming to assess treatment effect on lesion level, a multimodal end point including MP focused on hyperautofluorescent lesions appears essential but needs further studies on optimizing MP grids, eye-tracking systems, and alignment software.
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Affiliation(s)
- Patty P A Dhooge
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmee H Runhart
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stanley Lambertus
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nathalie M Bax
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes M M Groenewoud
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Jeroen Klevering
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sparrow JR, Parmann R, Tsang SH, Allikmets R, Chang S, Jauregui R. Shared Features in Retinal Disorders With Involvement of Retinal Pigment Epithelium. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 34115091 PMCID: PMC8196415 DOI: 10.1167/iovs.62.7.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
When using spectral domain optical coherence tomography (SD-OCT) to inform the status of outer retina, we have noted discrete hyperreflective lesions extending through photoreceptor-attributable bands that have a similar presentation in multiple retinal diseases. These lesions present as either corrugated thickenings of interdigitation zone and ellipsoid zone bands or in later stages as rectangular or pyramidal shaped foci that extend radially through photoreceptor cell-attributable bands. In ABCA4-related and peripherin-2/RDS-disease (PRPH2/RDS), monogenic forms of retinopathy caused by mutations in proteins expressed in photoreceptor cells, these punctate lesions colocalize with fundus flecks in en face images. In fundus albipunctatus and retinitis punctata albescens, diseases caused by mutations in genes (retinol dehydrogenase 5, RDH5; and retinaldehyde-binding protein 1, RLBP1) encoding proteins of the visual cycle, these lesions manifest as white dot-like puncta. Similar aberrations in photoreceptor cell-attributable SD-OCT reflectivity layers manifest as reticular pseudodrusen (RPD) in short-wavelength fundus autofluorescence and near-infrared fundus autofluorescence fundus images and are linked to age-related macular degeneration a complex disease. Despite differences in the etiologies of retinal diseases presenting as fundus flecks, dots and RPD, underlying degenerative processes in photoreceptor cells are signified in SD-OCT scans by the loss of structural features that would otherwise define healthy photoreceptor cells at these foci.
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Affiliation(s)
- Janet R Sparrow
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Rait Parmann
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States
| | - Stephen H Tsang
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Rando Allikmets
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Stanley Chang
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States
| | - Ruben Jauregui
- Department of Ophthalmology, Harkness Eye Institute, Columbia University, New York, New York, United States
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Lee W, Zernant J, Nagasaki T, Molday LL, Su PY, Fishman GA, Tsang SH, Molday RS, Allikmets R. Cis-acting modifiers in the ABCA4 locus contribute to the penetrance of the major disease-causing variant in Stargardt disease. Hum Mol Genet 2021; 30:1293-1304. [PMID: 33909047 DOI: 10.1093/hmg/ddab122] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Abstract
Over 1200 variants in the ABCA4 gene cause a wide variety of retinal disease phenotypes, the best known of which is autosomal recessive Stargardt disease (STGD1). Disease-causing variation encompasses all mutation categories, from large copy number variants to very mild, hypomorphic missense variants. The most prevalent disease-causing ABCA4 variant, present in ~ 20% of cases of European descent, c.5882G > A p.(Gly1961Glu), has been a subject of controversy since its minor allele frequency (MAF) is as high as ~ 0.1 in certain populations, questioning its pathogenicity, especially in homozygous individuals. We sequenced the entire ~140Kb ABCA4 genomic locus in an extensive cohort of 644 bi-allelic, i.e. genetically confirmed, patients with ABCA4 disease and analyzed all variants in 140 compound heterozygous and 10 homozygous cases for the p.(Gly1961Glu) variant. A total of 23 patients in this cohort additionally harbored the deep intronic c.769-784C > T variant on the p.(Gly1961Glu) allele, which appears on a specific haplotype in ~ 15% of p.(Gly1961Glu) alleles. This haplotype was present in 5/7 of homozygous cases, where the p.(Gly1961Glu) was the only known pathogenic variant. Three cases had an exonic variant on the same allele with the p.(Gly1961Glu). Patients with the c.[769-784C > T;5882G > A] complex allele exhibit a more severe clinical phenotype, as seen in compound heterozygotes with some more frequent ABCA4 mutations, e.g. p.(Pro1380Leu). Our findings indicate that the c.769-784C > T variant is major cis-acting modifier of the p.(Gly1961Glu) allele. The absence of such additional allelic variation on most p.(Gly1961Glu) alleles largely explains the observed paucity of affected homozygotes in the population.
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Affiliation(s)
- Winston Lee
- Department of Genetics & Development, Columbia University, New York, NY 10032, USA
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
| | - Jana Zernant
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
| | - Takayuki Nagasaki
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
| | - Laurie L Molday
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Pei-Yin Su
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
| | - Gerald A Fishman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL 60608, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
- Department of Pathology & Cell Biology, Columbia University, New York, NY 10032, USA
| | - Robert S Molday
- Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY 10032, USA
- Department of Pathology & Cell Biology, Columbia University, New York, NY 10032, USA
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Chen L, Messinger JD, Ferrara D, Freund KB, Curcio CA. Fundus Autofluorescence in Neovascular Age-Related Macular Degeneration: A Clinicopathologic Correlation Relevant to Macular Atrophy. Ophthalmol Retina 2021; 5:1085-1096. [PMID: 33540168 DOI: 10.1016/j.oret.2021.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Macular atrophy (MA) of retinal pigment epithelium (RPE) and photoreceptors leads to vision loss in neovascular age-related macular degeneration (nAMD) despite successful treatment with antiangiogenic agents. To enhance understanding of MA, fortify the cellular basis of fundus autofluorescence (FAF) imaging, and inform management of nAMD, we performed histologic analysis of an eye with multimodal clinical imaging and apparent prior exudation due to nAMD. DESIGN Case study and clinicopathologic correlation. PARTICIPANT A White woman in whom age-related macular degeneration (AMD) findings of inactive subretinal fibrosis (right eye) were followed for 9 years using FAF and OCT, with no detectable subretinal fluid or other recurrent exudation and no intravitreal injections before her death at age 90 years. METHODS The right eye was preserved 6.25 hours after death, postfixed in osmium tannic acid paraphenylenediamine, and prepared for submicrometer epoxy resin sections (n = 115), with 19 matched to clinical OCT B-scans. MAIN OUTCOME MEASURES Light microscopic morphology of a hyperautofluorescent (hyperFAF) area due to prior exudation ("floodplain" hyperFAF), hypoautofluorescent (hypoFAF) spots of MA, and areas of unremarkable FAF. RESULTS Floodplain hyperFAF was visible throughout the 9 years of follow-up, with several hypoFAF atrophic spots expanding within it over time. The hyperFAF pattern corresponded to outer retinal atrophy (ORA) on OCT and photoreceptor loss over dysmorphic yet continuous RPE in histology. The hypoFAF spots inside the floodplain corresponded to complete RPE and outer retinal atrophy (cRORA) on OCT and loss of both photoreceptors and RPE in histology. In contrast, areas of unremarkable FAF showed continuous RPE accompanied by full-length photoreceptors and a thick outer nuclear layer. CONCLUSIONS This direct clinicopathologic correlation for FAF imaging is the first for nAMD. Fundus autofluorescence is a projection image that involves optical signal modulation by photoreceptors as well as emission signal sources in RPE. Hyperautofluorescence due to an exudative floodplain signifies loss of photoreceptors over continuous RPE. Hypoautofluorescence in MA signifies loss of both cell layers. For maximal value, fundus autofluorescence imaging should be interpreted with the multilayer perspective provided by OCT. Prevention of exudation in nAMD may preserve photoreceptors.
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Affiliation(s)
- Ling Chen
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China; Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Columbia University College of Physicians and Surgeons, Harkness Eye Institute, New York, New York
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
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Inferred retinal sensitivity in recessive Stargardt disease using machine learning. Sci Rep 2021; 11:1466. [PMID: 33446864 PMCID: PMC7809282 DOI: 10.1038/s41598-020-80766-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/21/2020] [Indexed: 01/29/2023] Open
Abstract
Spatially-resolved retinal function can be measured by psychophysical testing like fundus-controlled perimetry (FCP or 'microperimetry'). It may serve as a performance outcome measure in emerging interventional clinical trials for macular diseases as requested by regulatory agencies. As FCP constitute laborious examinations, we have evaluated a machine-learning-based approach to predict spatially-resolved retinal function ('inferred sensitivity') based on microstructural imaging (obtained by spectral domain optical coherence tomography) and patient data in recessive Stargardt disease. Using nested cross-validation, prediction accuracies of (mean absolute error, MAE [95% CI]) 4.74 dB [4.48-4.99] were achieved. After additional inclusion of limited FCP data, the latter reached 3.89 dB [3.67-4.10] comparable to the test-retest MAE estimate of 3.51 dB [3.11-3.91]. Analysis of the permutation importance revealed, that the IS&OS and RPE thickness were the most important features for the prediction of retinal sensitivity. 'Inferred sensitivity', herein, enables to accurately estimate differential effects of retinal microstructure on spatially-resolved function in Stargardt disease, and might be used as quasi-functional surrogate marker for a refined and time-efficient investigation of possible functionally relevant treatment effects or disease progression.
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Jauregui R, Nuzbrokh Y, Su PY, Zernant J, Allikmets R, Tsang SH, Sparrow JR. Retinal Pigment Epithelium Atrophy in Recessive Stargardt Disease as Measured by Short-Wavelength and Near-Infrared Autofluorescence. Transl Vis Sci Technol 2021; 10:3. [PMID: 33505770 PMCID: PMC7794276 DOI: 10.1167/tvst.10.1.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/10/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To compare the detection of retinal pigment epithelium (RPE) atrophy in short-wavelength (SW-AF) and near-infrared autofluorescence (NIR-AF) images in Stargardt disease (STGD1) patients. Methods SW-AF and NIR-AF images (115 eyes from 115 patients) were analyzed by two independent graders. Hypoautofluorescent (hypoAF) areas, indicative of RPE atrophy, were measured, and the two modalities were compared. Results Patients were segregated into four groups: nascent (6 [5%]), widespread (21 [18%]), discrete (55 [48%]), and chorioretinal atrophy (33 [29%]). The areas of hypoAF were larger in NIR-AF compared to SW-AF images in discrete (3.9 vs. 2.2 mm2, P < 0.001) and chorioretinal atrophy (12.7 vs. 11.4 mm2, P = 0.015). Similar findings were observed qualitatively in nascent and widespread atrophy patients. Using the area linear model (ALM), lesion area increased at similar rates in SW-AF and NIR-AF images of discrete atrophy (0.20 vs. 0.32 mm2/y, P = 0.275) and chorioretinal atrophy (1.30 vs. 1.74 mm2/y, P = 0.671). Using the radius linear model (RLM), the lesion effective radius also increased similarly in SW-AF and NIR-AF images in discrete (0.03 vs. 0.05 mm2/y, P = 0.221) and chorioretinal atrophy (0.08 vs. 0.10 mm2/y, P = 0.754) patients. Conclusions NIR-AF reveals a larger area of RPE atrophy in STGD1 patients compared to SW-AF images, but rates of lesion enlargement in the two modalities are similar. Translational Relevance Measurements of RPE atrophy by AF imaging are crucial for monitoring STGD1 disease progression and given our findings we advocate greater use of NIR-AF for patients.
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Affiliation(s)
- Ruben Jauregui
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.,Jonas Children's Vision Care, New York, NY, USA
| | - Yan Nuzbrokh
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.,Jonas Children's Vision Care, New York, NY, USA
| | - Pei-Yin Su
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Jana Zernant
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA.,Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Janet R Sparrow
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
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Al-Khuzaei S, Shah M, Foster CR, Yu J, Broadgate S, Halford S, Downes SM. The role of multimodal imaging and vision function testing in ABCA4-related retinopathies and their relevance to future therapeutic interventions. Ther Adv Ophthalmol 2021; 13:25158414211056384. [PMID: 34988368 PMCID: PMC8721514 DOI: 10.1177/25158414211056384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this review article is to describe the specific features of Stargardt disease and ABCA4 retinopathies (ABCA4R) using multimodal imaging and functional testing and to highlight their relevance to potential therapeutic interventions. Standardised measures of tissue loss, tissue function and rate of change over time using formal structured deep phenotyping in Stargardt disease and ABCA4R are key in diagnosis, and prognosis as well as when selecting cohorts for therapeutic intervention. In addition, a meticulous documentation of natural history will be invaluable in the future to compare treated with untreated retinas. Despite the familiarity with the term Stargardt disease, this eponymous classification alone is unhelpful when evaluating ABCA4R, as the ABCA4 gene is associated with a number of phenotypes, and a range of severity. Multimodal imaging, psychophysical and electrophysiologic measurements are necessary in diagnosing and characterising these differing retinopathies. A wide range of retinal dystrophy phenotypes are seen in association with ABCA4 mutations. In this article, these will be referred to as ABCA4R. These different phenotypes and the existence of phenocopies present a significant challenge to the clinician. Careful phenotypic characterisation coupled with the genotype enables the clinician to provide an accurate diagnosis, associated inheritance pattern and information regarding prognosis and management. This is particularly relevant now for recruiting to therapeutic trials, and in the future when therapies become available. The importance of accurate genotype-phenotype correlation studies cannot be overemphasised. This approach together with segregation studies can be vital in the identification of causal mutations when variants in more than one gene are being considered as possible. In this article, we give an overview of the current imaging, psychophysical and electrophysiological investigations, as well as current therapeutic research trials for retinopathies associated with the ABCA4 gene.
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Affiliation(s)
- Saoud Al-Khuzaei
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mital Shah
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Stephanie Halford
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Susan M. Downes
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 6 John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Sung YC, Yang CH, Yang CM, Lin CW, Huang DS, Huang YS, Hu FR, Chen PL, Chen TC. Genotypes Predispose Phenotypes-Clinical Features and Genetic Spectrum of ABCA4-Associated Retinal Dystrophies. Genes (Basel) 2020; 11:genes11121421. [PMID: 33261146 PMCID: PMC7759801 DOI: 10.3390/genes11121421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
The ABCA4 gene is one of the most common disease-causing genes of inherited retinal degeneration. In this study, we report different phenotypes of ABCA4-associated retinal dystrophies in the Taiwanese population, its clinical progression, and its relationship with genetic characteristics. Thirty-seven subjects were recruited and all patients underwent serial ophthalmic examinations at a single medical center. Fundus autofluorescence (FAF) images were quantified for clinical evaluation, and panel-based next-generation sequencing testing was performed for genetic diagnosis. Visual preservation, disease progression, and genotype–phenotype correlation were analyzed. In this cohort, ABCA4-associated retinal degeneration presented as Stargardt disease 1 (STGD1, 62.16%), retinitis pigmentosa (32.43%), and cone-rod dystrophy (5.41%). STGD1 could be further divided into central and dispersed types. In each phenotype, the lesion areas quantified by FAF increased with age (p < 0.01) and correlated with poorer visual acuity. However, three patients had the foveal sparing phenotype and had relatively preserved visual acuity. Forty-two ABCA4 variants were identified as disease-causing, with c.1804C>T (p.Arg602Trp) the most frequent (37.84%). Patients with a combination of severe/null variants could have more extensive phenotypes, such as arRP and dispersed STGD1. This is the first cohort study of ABCA4-associated retinal degeneration in Taiwan with wide spectrums of both genotypic and phenotypic characteristics. An extremely high prevalence of c.1804C>T, which has not been reported in East Asia before, was noted. The extensiveness of retinal involvement might be regarded as a spectrum of ABCA4-associated retinal dystrophies. Different types of genetic variations could lead to distinctive phenotypes, according to the coding impact of variants.
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Affiliation(s)
- Yu-Chi Sung
- Department of Medical Education, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Ding-Siang Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Yu-Shu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Pei-Lung Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: (P.-L.C.); (T.-C.C.); Tel.: +886-2-23123456 (ext. 71942) (P.-L.C.); +886-2-23123456 (ext. 63783) (T.-C.C.); Fax: +886-2-23934420 (T.-C.C.)
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Correspondence: (P.-L.C.); (T.-C.C.); Tel.: +886-2-23123456 (ext. 71942) (P.-L.C.); +886-2-23123456 (ext. 63783) (T.-C.C.); Fax: +886-2-23934420 (T.-C.C.)
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Evidence of complement dysregulation in outer retina of Stargardt disease donor eyes. Redox Biol 2020; 37:101787. [PMID: 33214125 PMCID: PMC7767765 DOI: 10.1016/j.redox.2020.101787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 01/24/2023] Open
Abstract
Stargardt macular degeneration (STGD) is a central blinding disease caused by loss of or dysfunctional ABCA4 transporter in both photoreceptors and retinal pigment epithelial (RPE) cells. Toxic bisretinoid-lipofuscin buildup in the RPE cells is a pathological hallmark of STGD patients and its mouse model, the Abca4-/-. These vitamin A-derived fluorophores have been shown to induce oxidative stress, stimulate complement activity, and cause chronic inflammation of the RPE. In vivo modulation of complement regulatory pathway in the STGD mouse model has partially rescued the STGD phenotype suggesting that complement attack on the RPE is an important etiologic factor in disease pathogenesis. While bisretinoid-dependent complement activation was further evidenced in cultured RPE cells, this pathway has never been investigated directly in the context of RPE from STGD donor eyes. In the current study, we evaluate the complement reactivity in postmortem donor eyes of clinically diagnosed STGD patients. All three STGD donor eyes RPE displayed strong immunoreactivity for an antibody specific to 4-Hydroxynonenal, a lipid peroxidation byproduct. Also, unlike the control eyes, all three STGD donor eyes showed significantly increased membrane attack complex deposition on the RPE cells. In STGD eyes, increased MAC accumulation was mirrored by elevated C3 fragments internalized by the RPE and inversely correlated with the levels of complement factor H, a major complement regulatory protein. Here, we report the first direct evidence of RPE complement dysregulation as a causative factor in developing Stargardt phenotype.
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36
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Charng J, Xiao D, Mehdizadeh M, Attia MS, Arunachalam S, Lamey TM, Thompson JA, McLaren TL, De Roach JN, Mackey DA, Frost S, Chen FK. Deep learning segmentation of hyperautofluorescent fleck lesions in Stargardt disease. Sci Rep 2020; 10:16491. [PMID: 33020556 PMCID: PMC7536408 DOI: 10.1038/s41598-020-73339-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Stargardt disease is one of the most common forms of inherited retinal disease and leads to permanent vision loss. A diagnostic feature of the disease is retinal flecks, which appear hyperautofluorescent in fundus autofluorescence (FAF) imaging. The size and number of these flecks increase with disease progression. Manual segmentation of flecks allows monitoring of disease, but is time-consuming. Herein, we have developed and validated a deep learning approach for segmenting these Stargardt flecks (1750 training and 100 validation FAF patches from 37 eyes with Stargardt disease). Testing was done in 10 separate Stargardt FAF images and we observed a good overall agreement between manual and deep learning in both fleck count and fleck area. Longitudinal data were available in both eyes from 6 patients (average total follow-up time 4.2 years), with both manual and deep learning segmentation performed on all (n = 82) images. Both methods detected a similar upward trend in fleck number and area over time. In conclusion, we demonstrated the feasibility of utilizing deep learning to segment and quantify FAF lesions, laying the foundation for future studies using fleck parameters as a trial endpoint.
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Affiliation(s)
- Jason Charng
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia
| | - Di Xiao
- The Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Maryam Mehdizadeh
- The Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Mary S Attia
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia
| | - Sukanya Arunachalam
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Ophthalmology, Perth Children's Hospital, Perth, WA, Australia
| | - Shaun Frost
- The Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating Lions Eye Institute), The University of Western Australia, 2 Verdun Street, Nedlands, WA, Australia. .,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. .,Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia. .,Department of Ophthalmology, Perth Children's Hospital, Perth, WA, Australia.
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Greenstein VC, Lima de Carvalho JR, Parmann R, Amaro-Quireza L, Lee W, Hood DC, Tsang SH, Sparrow JR. Quantitative Fundus Autofluorescence in HCQ Retinopathy. Invest Ophthalmol Vis Sci 2020; 61:41. [PMID: 32976563 PMCID: PMC7521180 DOI: 10.1167/iovs.61.11.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/31/2020] [Indexed: 01/23/2023] Open
Abstract
Purpose To increase our understanding of the mechanisms underlying hydroxychloroquine (HCQ) retinopathy, analyses by quantitative fundus autofluorescence (qAF) and near-infrared fundus autofluorescence (NIR-AF) were compared to results obtained by recommended screening tests. Methods Thirty-one patients (28 females, 3 males) were evaluated with standard automated perimetry and spectral domain optical coherence tomography (SD-OCT); 28 also had multifocal electroretinography (mfERG). Measurement of short-wavelength fundus autofluorescence (SW-AF) by qAF involved the use of an internal fluorescent reference and intensity measurements in eight concentric segments at 7° to 9° eccentricity. For semiquantitative analysis of NIR-AF, intensities were acquired along a vertical axis through the fovea. Results Four of 15 high-dose (total dose >1000 g, daily dose >5.0 mg/kg) patients and one of 16 low-dose (total dose <1000 g, daily dose 4.4 mg/kg) patients were diagnosed with HCQ-associated retinopathy based on abnormal 10-2 visual fields, SD-OCT, and SW-AF imaging. Three of the high-dose patients also had abnormal mfERG results. Of the five patients exhibiting retinopathy, two had qAF color-coded images revealing higher intensities inferior, nasal, and lateral to the fovea. The abnormal visual fields also exhibited superior-inferior differences. Mean NIR-AF gray-level intensities were increased in four high-dose patients with no evidence of retinopathy. In two patients with retinopathy, NIR-AF intensity within the parafovea was below the normal range. One high-dose patient (6.25 mg/kg) had only abnormal mfERG results. Conclusions These findings indicate that screening for HCQ retinopathy should take into consideration superior-inferior differences in susceptibility to HCQ retinopathy.
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Affiliation(s)
- Vivienne C. Greenstein
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
- Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | | | - Rait Parmann
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Luz Amaro-Quireza
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Winston Lee
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
| | - Donald C. Hood
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
- Deparment of Psychology, Columbia University, New York, New York, United States
| | - Stephen H. Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Janet R. Sparrow
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, New York, United States
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ASSOCIATION BETWEEN GENOTYPE AND DISEASE PROGRESSION IN ITALIAN STARGARDT PATIENTS: A Retrospective Natural History Study. Retina 2020; 39:1399-1409. [PMID: 29642238 DOI: 10.1097/iae.0000000000002151] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the natural history of Stargardt disease over a multiyear follow-up. METHODS We reviewed medical records of Stargardt disease patients, with clinical diagnosis of Stargardt disease at a single institution, which was also supported by molecular diagnosis. All patients underwent best-corrected visual acuity, fundus photography, optical coherence tomography, and full-field electroretinography. RESULTS The study cohort consisted of 157 Stargardt disease patients aged 30.4 ± 1.1 years. Longitudinal analysis (mean follow-up: 3 years) showed a significant worsening of best-corrected visual acuity at an average rate of 1.5 Early Treatment Diabetic Retinopathy Study letters/year (P < 0.001), an enlargement of retinal pigment epithelium lesion area by optical coherence tomography at an average linear rate of 0.10 mm/year (P < 0.001), and a thinning of central macular thickness at a mean rate of -1.42 μm/year (P < 0.001). Survival analysis showed that patients with 2 alleles harboring likely-null variants, on average, reached most severe disease stage, i.e., legal blindness, alteration in both dark-adapted and light-adapted electroretinographic responses, and retinal pigment epithelium lesion area larger than 2.5 mm significantly earlier than patients with at least one allele harboring a missense variant. CONCLUSION The current longitudinal study showed a significant genotype-phenotype correlation characterization, because patients harboring 2 likely-null alleles reach a severe disease stage about 10 years earlier than patients with at least one missense allele.
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Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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40
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Abstract
In Stargardt disease, retinal fluorescence lifetimes can be used to analyze hyperfluorescent flecks and hypofluorescent atrophic lesions. This study establishes that autofluorescence lifetime demonstrates explicit, reproducible patterns and confirms the diagnostic value of fluorescence lifetime imaging ophthalmoscopy as a noninvasive imaging modality. Supplemental Digital Content is Available in the Text. Purpose: Stargardt disease is the most common inherited juvenile macular dystrophy and is characterized by yellowish flecks across the posterior pole. The purpose of this study was to investigate fluorescence lifetime changes of retinal flecks over time using fluorescence lifetime imaging ophthalmoscopy. Methods: Longitudinal fluorescence lifetime data of 12 patients with Stargardt disease (mean age ± SEM, 42.25 ± 2.1 years; range, 28–58 years) were acquired using a fluorescence lifetime imaging ophthalmoscope based on a Heidelberg Engineering Spectralis system. Retinal autofluorescence was excited with a 470-nm laser. The emitted fluorescence was detected in two wavelength channels: a short spectral channel (498–560 nm) and a long spectral channel (560–720 nm). The mean retinal autofluorescence lifetimes were calculated and further analyzed with corresponding color fundus images, autofluorescence intensity images, and spectral domain optical coherence tomography. Patients were classified into three subtypes. Results: All patients with Stargardt disease displayed characteristic autofluorescence lifetime patterns. Mean fluorescence lifetime values within areas of yellow flecks were significantly prolonged (long spectral channel 484 ps) compared with the surrounding tissue (long spectral channel 297 ps). In 91.6% of the eyes, flecks with short fluorescence lifetimes (long spectral channel 255 ps) were identified. Short lifetime flecks progressed to flecks with characteristic long lifetimes in 75.1% of eyes within a mean interval of 29.2 months (range 3–45 months). Between baseline and follow-up, the rate of newly developed short lifetime flecks (number/per year) based on subtypes was 2.62 in Group 1, 1.43 in Group 2, and 0.81 in Group 3. Conclusion: Recent onset flecks in Stargardt disease display short fluorescence lifetimes and convert into longer fluorescence lifetime flecks over time. This transition may represent a change in the composition of retinal deposits with accumulation of lipofuscin and retinoid by-products from the visual cycle. With emerging treatment options, these findings may prove useful to monitor disease progression and therapeutic effects.
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Cicinelli MV, Rabiolo A, Brambati M, Viganò C, Bandello F, Battaglia Parodi M. Factors Influencing Retinal Pigment Epithelium-Atrophy Progression Rate in Stargardt Disease. Transl Vis Sci Technol 2020; 9:33. [PMID: 32832238 PMCID: PMC7414677 DOI: 10.1167/tvst.9.7.33] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/08/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate demographic, clinical, imaging, and genetic factors associated with retinal pigment epithelium enlargement in Stargardt disease (STGD1) and to measure the agreement between short-wavelength fundus autofluorescence (SW-FAF) and near-infrared fundus autofluorescence (NIR-FAF). Methods Retrospective cohort study of patients with STGD1 with ≥2 gradable SW-FAF images. RPE-atrophy areas were measured on SW-FAF and NIR-FAF at each visit and regressed against time to obtain the rate of RPE-atrophy enlargement. Agreement between SW-FAF and NIR-FAF with regards to baseline atrophic areas and rates of enlargement was evaluated. Baseline factors predictive of faster SW-FAF RPE-atrophy enlargement were investigated with linear mixed models. Results Fifty-four eyes of 28 patients (median age: 45 years; 13 males) were included. SW-FAF and NIR-FAF agreed well for slow rates of RPE-atrophy progression, but agreement decreased as the rate increased. Median (interquartile range [IQR]) rate of RPE-atrophy expansion was 0.18 (0.10–0.85) mm2/year on SW-FAF and 0.24 (0.08–0.33) mm2/year on NIR-FAF. Larger baseline RPE-atrophy area (estimate: 0.057 mm2/year, P < 0.001), worse visual acuity (0.305 mm2/year, P = 0.005), multifocal disease (0.401 mm2/year, P = 0.02), and SW-FAF pattern (0.534 mm2/year, P =0 .03) were associated with a faster rate of progression (predictive R2: 0.65). Conclusions SW-FAF and NIR-FAF are not interchangeable in the evaluation of RPE-atrophy enlargement, and both imaging modalities may be required for optimal detection of disease progression. A multivariable model based on baseline clinical and imaging information may identify patients at higher risk of fast disease progression. Translational Relevance The knowledge of the agreement of different FAF modalities, the estimated rates of RPE-atrophy enlargement, and factors predictive of faster anatomic decay in STGD1 may allow tailored clinical management and better clinical trials design.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Rabiolo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, Gloucestershire Hospitals NHS, Cheltenham, UK
| | - Maria Brambati
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Viganò
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maurizio Battaglia Parodi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Short-Wavelength and Near-Infrared Autofluorescence in Patients with Deficiencies of the Visual Cycle and Phototransduction. Sci Rep 2020; 10:8998. [PMID: 32488013 PMCID: PMC7265524 DOI: 10.1038/s41598-020-65763-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/05/2020] [Indexed: 11/08/2022] Open
Abstract
Fundus autofluorescence is a valuable imaging tool in the diagnosis of inherited retinal dystrophies. With the advent of gene therapy and the numerous ongoing clinical trials for inherited retinal degenerations, quantifiable and reliable outcome measurements continually need to be identified. In this retrospective analysis, normalized and non-normalized short-wavelength (SW-AF) and near-infrared (NIR-AF) autofluorescence images of ten patients with mutations in visual cycle (VC) genes and nineteen patients with mutations in phototransduction (PT) genes were analyzed. Normalized SW-AF and NIR-AF images appeared darker in all patients with mutations in the VC as compared to patients with mutations in PT despite the use of significantly higher detector settings for image acquisition in the former group. These findings were corroborated by quantitative analysis of non-normalized SW-AF and NIR-AF images; signal intensities were significantly lower in all patients with mutations in VC genes as compared to those with mutations in PT genes. We conclude that qualitative and quantitative SW-AF and NIR-AF images can serve as biomarkers of deficiencies specific to the VC. Additionally, quantitative autofluorescence may have potential for use as an outcome measurement to detect VC activity in conjunction with future therapies for patients with mutations in the VC.
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Cremers FPM, Lee W, Collin RWJ, Allikmets R. Clinical spectrum, genetic complexity and therapeutic approaches for retinal disease caused by ABCA4 mutations. Prog Retin Eye Res 2020; 79:100861. [PMID: 32278709 PMCID: PMC7544654 DOI: 10.1016/j.preteyeres.2020.100861] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022]
Abstract
The ABCA4 protein (then called a “rim protein”) was first
identified in 1978 in the rims and incisures of rod photoreceptors. The
corresponding gene, ABCA4, was cloned in 1997, and variants
were identified as the cause of autosomal recessive Stargardt disease (STGD1).
Over the next two decades, variation in ABCA4 has been
attributed to phenotypes other than the classically defined STGD1 or fundus
flavimaculatus, ranging from early onset and fast progressing cone-rod dystrophy
and retinitis pigmentosa-like phenotypes to very late onset cases of mostly mild
disease sometimes resembling, and confused with, age-related macular
degeneration. Similarly, analysis of the ABCA4 locus uncovered
a trove of genetic information, including >1200 disease-causing mutations
of varying severity, and of all types – missense, nonsense, small
deletions/insertions, and splicing affecting variants, of which many are located
deep-intronic. Altogether, this has greatly expanded our understanding of
complexity not only of the diseases caused by ABCA4 mutations,
but of all Mendelian diseases in general. This review provides an in depth
assessment of the cumulative knowledge of ABCA4-associated retinopathy –
clinical manifestations, genetic complexity, pathophysiology as well as current
and proposed therapeutic approaches.
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Affiliation(s)
- Frans P M Cremers
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9104, 6500 HE, Nijmegen, the Netherlands.
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, 10032, USA; Department of Genetics & Development, Columbia University, New York, NY, 10032, USA
| | - Rob W J Collin
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9104, 6500 HE, Nijmegen, the Netherlands
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, 10032, USA; Department of Pathology & Cell Biology, Columbia University, New York, NY, 10032, USA.
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Prospective Cohort Study of Childhood-Onset Stargardt Disease: Fundus Autofluorescence Imaging, Progression, Comparison with Adult-Onset Disease, and Disease Symmetry. Am J Ophthalmol 2020; 211:159-175. [PMID: 31812472 PMCID: PMC7082771 DOI: 10.1016/j.ajo.2019.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the reliability and repeatability of quantitative evaluation of areas of decreased autofluorescence (DAF) from fundus autofluorescence (FAF) images and track disease progression in children with Stargardt disease (STGD1), and to investigate clinical and genotype correlations, disease symmetry, and intrafamilial variability. DESIGN Prospective cohort study. METHODS Children and adults with molecularly confirmed STGD1 (n = 90) underwent longitudinal FAF imaging with subsequent semiautomated measurement of the area of DAF and calculation of the annual rate of progression. The age of disease onset was recorded for all subjects, as well as the electroretinography (ERG) group at baseline (n = 86). Patients were grouped for analysis based on the age at baseline and age of onset, into children (n = 56), adults with childhood-onset STGD1 (n = 15), and adults with adult-onset (n = 19). Fifty FAF images were selected randomly and analyzed by 2 observers to evaluate repeatability and reproducibility. Differences between groups, interocular symmetry, genotype-phenotype correlations, and intrafamilial variability were also investigated both for baseline measurements as well as progression rates. We measured visual acuity, molecular genetics, ERG group, FAF metrics, and their correlations. RESULTS The mean age of onset ± SD was 9.6 ± 3.4 years for childhood-onset (n = 71) and 28.3 ± 7.8 years for adult-onset STGD1 (n = 19). The intra- and interobserver reliability of DAF quantification was excellent (intraclass correlation coefficients 0.995 and 0.987, respectively). DAF area was symmetric between eyes and the mean rate of progression (SD) was 0.69 (0.72), 0.78 (0.48), and 0.40 (0.36) mm2/year for children, adults with childhood-onset, and adults with adult-onset disease, respectively. Patients belonging to a group 3 ERG phenotype (generalized cone and rod dysfunction) had a significantly greater progression rate. Limited intrafamilial variability was observed. CONCLUSIONS This is the first large prospective study of FAF in a cohort of molecularly confirmed children with STGD1. DAF area quantification was highly reliable and may thereby serve as a robust structural endpoint. A high rate of progression was observed in childhood-onset disease, making this subtype of STGD1 ideally suited to be considered for prioritization in clinical trials.
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Nassisi M, Mohand-Saïd S, Andrieu C, Antonio A, Condroyer C, Méjécase C, Dhaenens CM, Sahel JA, Zeitz C, Audo I. Peripapillary Sparing With Near Infrared Autofluorescence Correlates With Electroretinographic Findings in Patients With Stargardt Disease. Invest Ophthalmol Vis Sci 2020; 60:4951-4957. [PMID: 31790517 DOI: 10.1167/iovs.19-27100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the correlation between the quantification of peripapillary sparing and electroretinogram (ERG) outcomes in autosomal recessive Stargardt disease (STGD1). Methods Near infrared fundus autofluorescence (NIR-FAF) images of 101 eyes of 101 patients were retrospectively reviewed. Peripapillary sparing was assessed both qualitatively and quantitatively. The area of spared tissue (AST) was calculated in a 1-mm-wide ring around the optic disc after binarization of the 55° NIR-FAF. These measurements were correlated with the presence of normal ERG (group I), abnormal photopic responses (group II), or abnormal photopic and scotopic responses (group III). Results AST showed significant correlations with ERG groups (R = -0.802, P < 0.001). While qualitative assessment of peripapillary sparing (i.e., present or not) also showed a significant correlation with ERG groups (R = -0.435, P < 0.001), it was weaker than by AST quantification. The ordinal regression analysis showed that the increase in AST was associated with a decrease in the odds of belonging to ERG groups II and III, with an odds ratio of 0.82 (95% confidence interval [CI] 0.78-0.87), P < 0.001. Conclusions The AST around the optic disc in eyes with STGD1 correlates with the impairment of photoreceptors as shown in the ERG. If replicated in future longitudinal studies, the quantification of peripapillary sparing may prove to be a useful parameter for evaluating the visual prognosis of these eyes.
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Affiliation(s)
- Marco Nassisi
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France
| | - Saddek Mohand-Saïd
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC 1423, Paris, France
| | - Camille Andrieu
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC 1423, Paris, France
| | - Aline Antonio
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France
| | - Christel Condroyer
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France
| | - Cécile Méjécase
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France
| | - Claire-Marie Dhaenens
- University of Lille, Institut National de la Santé et de la Recherche Médicale UMR-S 1172, CHU Lille, Biochemistry and Molecular Biology Department-UF Génopathies, Lille, France
| | - José-Alain Sahel
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC 1423, Paris, France.,Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,Académie des Sciences-Institut de France, Paris, France.,Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburg, Pennsylvania, United States
| | - Christina Zeitz
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France
| | - Isabelle Audo
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientfique, Institut de la Vision, Paris, France.,Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC 1423, Paris, France.,Institute of Ophthalmology, University College of London, London, United Kingdom
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Runhart EH, Valkenburg D, Cornelis SS, Khan M, Sangermano R, Albert S, Bax NM, Astuti GDN, Gilissen C, Pott JWR, Verheij JBGM, Blokland EAW, Cremers FPM, van den Born LI, Hoyng CB. Late-Onset Stargardt Disease Due to Mild, Deep-Intronic ABCA4 Alleles. Invest Ophthalmol Vis Sci 2020; 60:4249-4256. [PMID: 31618761 DOI: 10.1167/iovs.19-27524] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the role of two deep-intronic ABCA4 variants, that showed a mild splice defect in vitro and can occur on the same allele as the low penetrant c.5603A>T, in Stargardt disease (STGD1). Methods Ophthalmic data were assessed of 18 STGD1 patients who harbored c.769-784C>T or c.4253+43G>A in combination with a severe ABCA4 variant. Subjects carrying c.[769-784C>T; 5603A>T] were clinically compared with a STGD1 cohort previously published carrying c.5603A>T noncomplex. We calculated the penetrances of the intronic variants using ABCA4 allele frequency data of the general population and investigated the effect of c.769-784C>T on splicing in photoreceptor progenitor cells (PPCs). Results Mostly, late-onset, foveal-sparing STGD1 was observed among subjects harboring c.769-784C>T or c.4253+43G>A (median age of onset, 54.5 and 52.0 years, respectively). However, ages of onset, phenotypes in fundo, and visual acuity courses varied widely. No significant clinical differences were observed between the c.[769-784C>T; 5603A>T] cohort and the c.4253+43G>A or the c.5603A>T cohort. The penetrances of c.769-784C>T (20.5%-39.6%) and c.4253+43G>A (35.8%-43.1%) were reduced, when not considering the effect of yet unidentified or known factors in cis, such as c.5603A>T (identified in 7/7 probands with c.769-784C>T; 1/8 probands with c.4253+43G>A). Variant c.769-784C>T resulted in a pseudo-exon insertion in 15% of the total mRNA (i.e., ∼30% of the c.769-784C>T allele alone). Conclusions Two mild intronic ABCA4 variants could further explain missing heritability in late-onset STGD1, distinguishing it from AMD. The observed clinical variability and calculated reduced penetrance urge research into modifiers within and outside of the ABCA4 gene.
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Affiliation(s)
- Esmee H Runhart
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dyon Valkenburg
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stéphanie S Cornelis
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mubeen Khan
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Riccardo Sangermano
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Silvia Albert
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nathalie M Bax
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Galuh D N Astuti
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Human Genetics, Center for Biomedical Research, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Christian Gilissen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan-Willem R Pott
- Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joke B G M Verheij
- Department of Medical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen A W Blokland
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frans P M Cremers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Carel B Hoyng
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Paavo M, Carvalho JRL, Lee W, Sengillo JD, Tsang SH, Sparrow JR. Patterns and Intensities of Near-Infrared and Short-Wavelength Fundus Autofluorescence in Choroideremia Probands and Carriers. Invest Ophthalmol Vis Sci 2020; 60:3752-3761. [PMID: 31499530 PMCID: PMC6735265 DOI: 10.1167/iovs.19-27366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose To ascertain cellular constituents within islands of preserved retina in choroideremia (CHM) by multimodal imaging. Methods CHM probands (16) and female carriers (9) of CHM were studied. Near-infrared autofluorescence (NIR-AF; 787-nm excitation; emission, >830 nm), short-wavelength autofluorescence (SW-AF; 488-nm excitation, 500- to 680-nm emission), and spectral-domain optical coherence tomography (SD-OCT) images were acquired with a confocal scanning laser ophthalmoscope. SW-AF intensities were measured by quantitative fundus autofluorescence (qAF), and NIR-AF intensity profiles were analyzed. Retinal thicknesses and visual acuity were measured. Results In 19 of 31 eyes of affected males, islands of preserved NIR-AF signal were also visible as fluorescence signal in SW-AF images. Notable in 12 eyes were areas of speckled SW-AF that was hypoautofluorescent in the NIR-AF image. Islands of preserved NIR-AF and SW-AF signal were often associated with the presence of visible but thinned outer nuclear layer and discontinuous interdigitation zone, ellipsoid zone, and external limiting membrane. NIR-AF profiles revealed that even in areas of preserved retina, the NIR-AF signal from retinal pigment epithelium (RPE) melanin is greatly reduced. qAF was reduced overall. The fundus of carriers was characterized by a mosaicism in which patches of reduced NIR-AF colocalized with reduced SW-AF. Conclusions In CHM-affected males, the presence of RPE was indicated by an NIR-AF signal and the absence of hypertransmission of OCT signal into the choroid. RPE preservation was associated with better visual acuity. In carriers, patches of reduced SW-AF colocalized with decreased NIR-AF and qAF was severely reduced.
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Affiliation(s)
- Maarjaliis Paavo
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Jose R L Carvalho
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States.,Department of Ophthalmology, Empresa Brasileira de Servicos Hospitalares, Hospital das Clinicas de Pernambuco, Federal University of Pernambuco, Recife, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Winston Lee
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States
| | - Jesse D Sengillo
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States.,Department of Internal Medicine, Reading Hospital of Tower Health, West Reading, Pennsylvania, United States
| | - Stephen H Tsang
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
| | - Janet R Sparrow
- Department of Ophthalmology Columbia University Medical Center, New York, New York, United States.,Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, United States
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Müller PL, Birtel J, Herrmann P, Holz FG, Charbel Issa P, Gliem M. Functional Relevance and Structural Correlates of Near Infrared and Short Wavelength Fundus Autofluorescence Imaging in ABCA4-Related Retinopathy. Transl Vis Sci Technol 2019; 8:46. [PMID: 31879568 PMCID: PMC6927733 DOI: 10.1167/tvst.8.6.46] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the functional relevance and structural correlates of autofluorescence (AF) alterations under short-wavelength (SW) and near-infrared (NIR) excitation light in ABCA4-related retinopathy. Methods In this prospective, cross-sectional case series, 88 eyes of 44 patients with ABCA4-related retinopathy (mean age, 37.6 years; range, 9-77 years) underwent SW-AF and NIR-AF imaging. The AF images were graded for disease characteristic patterns by two independent readers and correlated with alterations in optical coherence tomography (OCT) and impairment of retinal sensitivity along a foveo-papillary line assessed by fundus-controlled microperimetry. Results A centrifugal sequence of AF patterns from atrophic lesions to homogeneous background was found for both AF modalities. The eccentricity of each AF pattern in NIR-AF was larger compared to those in SW-AF (P < 0.001). Increasing eccentricity of each pattern correlated with increasing retinal sensitivity. The distant border of the zone of hyperfluorescent flecks in SW-AF and hypoautofluorescent flecks in NIR-AF correlated with the margins of the ellipsoid zone loss in OCT (r = 0.979 and r = 0.971, P < 0.001). The expansion of hypofluorescent flecks in SW-AF was associated with the boundaries of external limiting membrane loss (r = 0.933, P < 0.001). Conclusions SW-AF and NIR-AF revealed a characteristic sequence of AF patterns that correlated with functional and structural alterations, suggesting different stages in disease progression. Translational Relevance Alterations in NIR-AF exceeded those in SW-AF images, substantiating the hypothesis of different AF origins and suggesting NIR-AF as surrogate marker for early disease-related changes.
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Affiliation(s)
- Philipp L Müller
- University of Bonn, Department of Ophthalmology, Bonn, Germany.,University of Bonn, Center for Rare Diseases Bonn (ZSEB), Bonn, Germany.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Johannes Birtel
- University of Bonn, Department of Ophthalmology, Bonn, Germany.,University of Bonn, Center for Rare Diseases Bonn (ZSEB), Bonn, Germany
| | - Philipp Herrmann
- University of Bonn, Department of Ophthalmology, Bonn, Germany.,University of Bonn, Center for Rare Diseases Bonn (ZSEB), Bonn, Germany
| | - Frank G Holz
- University of Bonn, Department of Ophthalmology, Bonn, Germany.,University of Bonn, Center for Rare Diseases Bonn (ZSEB), Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, Oxford, UK
| | - Martin Gliem
- University of Bonn, Department of Ophthalmology, Bonn, Germany.,University of Bonn, Center for Rare Diseases Bonn (ZSEB), Bonn, Germany.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, Oxford, UK
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Xiao M, Dai C, Li L, Zhou C, Wang F. Evaluation of Retinal Pigment Epithelium and Choroidal Neovascularization in Rats Using Laser-Scanning Optical-Resolution Photoacoustic Microscopy. Ophthalmic Res 2019; 63:271-283. [PMID: 31665740 DOI: 10.1159/000502800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To demonstrate the value of the laser-scanning optical-resolution (LSOR)-photoacoustic (PA) microscopy (PAM) system and the conventional multimodal imaging techniques in the evaluation of laser-induced retinal injury and choroidal neovascularization (CNV) in rats. METHODS Different degrees of retinal injury were induced using laser photocoagulation. We compared the LSOR-PAM system with conventional imaging techniques in evaluating retinal injury with or without CNV. Six additional rats, treated with an anti-VEGF antibody or immunoglobulin G immediately after photocoagulation, were imaged 7 and 14 days after injection, and CNV lesion areas were compared. RESULTS In the retinal injury model, fundus autofluorescence showed well-defined hyperreflection, while the lesion displayed abundant PA signals demonstrating nonuniform melanin distribution in retinal pigment epithelium (RPE). RPE was detected with higher contrast in the PAM B-scan image than optical coherence tomography (OCT). Additionally, the CNV lesion was present with multiple PA signal intensities which distinctly characterized the location and area of CNV as found in fundus fluorescein angiography. Furthermore, the decreased PA signals extending from the CNV lesion were similar to those of the vascular bud in ex vivo imaging, which was invisible in other in vivo images. When treated with anti-VEGF agents, statistically significant differences can be demonstrated by PAM similar to other modalities. CONCLUSIONS LSOR-PAM can detect the melanin distribution of RPE in laser-induced retinal injury and CNV in rats. PAM imaging provides a potential new tool to evaluate the vitality and functionality of RPE in vivo as well as to monitor the development and treatment of CNV.
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Affiliation(s)
- Meichun Xiao
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuixia Dai
- College of Science, Shanghai Institute of Technology, Shanghai, China
| | - Lin Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chuanqing Zhou
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China, .,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China,
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