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Longitudinal Evaluation of Visual Function Impairments in Early and Intermediate Age-Related Macular Degeneration Patients. OPHTHALMOLOGY SCIENCE 2022; 2:100173. [PMID: 36245764 PMCID: PMC9559970 DOI: 10.1016/j.xops.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate visual function (VF) changes in early and intermediate age-related macular degeneration (eAMD and iAMD) over 24 months. Design Prospective, observational natural history study. Participants Participants were enrolled at the Duke Eye Center. Methods A total of 101 subjects (33 with eAMD, 47 with iAMD, and 21 normal controls) were recruited. Visual function (VF) tests included best-corrected visual acuity (BCVA), low- luminance visual acuity (LLVA), microperimetry (MP), cone contrast tests (CCTs), and dark adaptation (DA). Mixed-effect model repeated measures based on absolute values and change from baseline identified VF tests differentiating AMD from controls and revealing longitudinal VF decline when controlling for covariates (baseline value, age, coronary artery disease, dry eye, and phakic status). Nine AMD genetic risk variants, combinations of these (genetic burden score), reticular pseudodrusen (RPD), and hyperreflective foci (HRF) were tested as predictors of diagnosis and VF performance. Main Outcome Measures Longitudinal changes in VF metrics over 24 months. Results A total of 70 subjects completed the 2-year visit (22 with eAMD, 31 with iAMD, and 17 controls). Percent reduced threshold (PRT) on MP and CCT red significantly distinguished iAMD versus controls after 12 and 24 months, respectively. Cone contrast test red, PRT, and absolute threshold (AT) on MP showed significant longitudinal deterioration of VF in iAMD versus baseline at 12 months and onward, however, with a reduced rate of worsening. The DA data confirmed a preexisting functional deficit in iAMD at baseline and revealed an increasing proportion of poorly performing iAMD subjects in DA over the study period. None of the other VF measures showed consistent significant changes among the normal, early, and intermediate groups or over time. The genetic burden score was significantly associated with AMD diagnosis (relative risk for iAMD = 1.64, P < 0.01) and DA (r = 0.42, P = 0.00005). Reticular pseudodrusen and HRF showed moderate associations with DA and weak to moderate associations with MP variables. Conclusions In iAMD, MP variables, CCT red, and DA revealed slow and nonlinear functional decline over 24 months. A structure-function relationship in eAMD and iAMD stages was demonstrated among HRF, RPD, and DA, possibly modified by genetic risk factors. These structural and functional features represent potential end points for clinical trials in iAMD.
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Key Words
- AMD, age-related macular degeneration
- AREDS, Age-Related Eye Disease Study
- AT, absolute threshold
- BCVA, best-corrected visual acuity
- CCT, cone contrast test
- CFP, color fundus photography
- DA, dark adaptation
- Early AMD
- HRF, hyperreflective foci
- Intermediate AMD
- LLD, low-luminance deficit
- LLVA
- LLVA, low-luminance visual acuity
- MMRM, mixed-effect repeated measure
- MP, microperimetry
- Microperimetry
- PRT, percent reduced threshold
- RIT, rod intercept time
- RPD, reticular pseudodrusen
- RPE, retinal pigment epithelium
- SD, standard deviation
- SD-OCT, spectral domain OCT
- SNP, single nucleotide polymorphism
- VF, visual function
- Visual function
- dB, decibels
- eAMD, early AMD
- iAMD, intermediate AMD
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Ahmadieh H, Behbahani S, Safi S. Continuous wavelet transform analysis of ERG in patients with diabetic retinopathy. Doc Ophthalmol 2020; 142:305-314. [PMID: 33226538 DOI: 10.1007/s10633-020-09805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/10/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide. Non-proliferative diabetic retinopathy (NPDR) is a stage of the disease that contains morphological and functional disruption of the retinal vasculature and dysfunction of retinal neurons. This study aimed to compare time and time-frequency-domain analysis in the evaluation of electroretinograms (ERGs) in subjects with NPDR. METHOD The ERG responses were recorded in 16 eyes from 12 patients with NPDR and 24 eyes from 12 healthy subjects as the control group. The implicit time, amplitude, and time-frequency-domain parameters of photopic and scotopic ERGs were analyzed. RESULTS The implicit times of b-waves in the dark-adapted 10.0 (P = 0.0513) and light-adapted 3.0 (P = 0.0414) were significantly increased in the NPDR group. The amplitudes of a- and b-wave showed a significantly decreased dark-adapted 10.0 (P = 0.0212; P = 0.0133) and light-adapted 3.0 (P = 0.0517; P = 0.0021) ERG of the NPDR group. The Cohen's d effect size had higher values in the amplitude of dark-adapted 10.0 b-wave (|d|= 1.8058) and amplitude of light-adapted 3.0 b-wave (|d|= 1.9662). The CWT results showed that the frequency ranges of the dominant components in dark-adapted 10.0 and light-adapted 3.0 ERG were decreased in the NPDR group compared to the healthy group (P < 0.05). The times associated with the NDPR group's dominant components were increased compared to normal eyes in both dark-adapted 10.0 and light-adapted 3.0 ERG (P < 0.05). All Cohen's d effect sizes of the implicit times and dominant frequency components were on a large scale (|d|> 1). CONCLUSION These findings suggest that the time and time-frequency parameters of both photopic and scotopic ERGs can be good indicators for DR. However, time-frequency-domain analysis could present more information might be helpful in the assessment of the DR severity.
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Affiliation(s)
- Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soroor Behbahani
- Department of Biomedical Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran.
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies-epidemiology, pathogenesis, clinical signs, imaging and available treatment options. Doc Ophthalmol 2020; 142:133-152. [PMID: 32949328 PMCID: PMC7943509 DOI: 10.1007/s10633-020-09792-x] [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: 05/07/2020] [Accepted: 09/02/2020] [Indexed: 01/06/2023]
Abstract
Purpose The purpose of this paper is to provide a meaningful literature review about the epidemiology, pathogenesis, clinical signs, imaging and treatment of ocular siderosis (OS). Methods A computerized search from inception up to March 2020 of the online electronic database PubMed was performed using the following search strings: “ocular siderosis” and “siderosis bulbi”. The reference list in each article was analysed for additional relevant publications. Results OS is an uncommon cause of visual loss due to a retained ferrous intraocular foreign body (IOFB). It may develop from 18 days to years after a penetrating trauma that usually occurs during hammering. On average, patients are 22–25 years old, and the vast majority are male. The most common cause of OS development is delayed presentation by the patient or missed diagnosis of IOFB after trauma. The pathophysiology is not fully understood; nevertheless, iron deposition causes hydroxyl radical formation, which damages photoreceptors and retinal pigment epithelium. Moreover, iron damages retinal vessels with consequent inner retinal layers degeneration. The most frequent signs are iris heterochromia, pupillary mydriasis, cataract development and retinal arteriolar narrowing with pigmentary retinal degeneration. Electroretinogram signs, in particular, b-wave amplitude reduction, arise earlier than clinical signs. Orbital CT scans and ultrasonography play an essential role in detecting IOFBs. Treatment depends on the IOFB location and OS development. However, it is crucial to remove the IOFB after OS development because visual acuity and clinical signs may improve. Anterior segment IOFBs can be dislodged using an intraocular magnet (IOM) or forceps through limbal paracentesis. In contrast, posterior segment IOFBs require a pars plana vitrectomy and IOM or forceps to be removed through an enlarged sclerotomy or the limbus. Conclusion Recommending the usage of protective glasses and spreading knowledge about OS may further benefit patient care.
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Perez-Ortiz AC, Peralta-Ildefonso MJ, Lira-Romero E, Moya-Albor E, Brieva J, Ramirez-Sanchez I, Clapp C, Luna-Angulo A, Rendon A, Adan-Castro E, Ramírez-Hernández G, Díaz-Lezama N, Coral-Vázquez RM, Estrada-Mena FJ. Lack of Delta-Sarcoglycan ( Sgcd) Results in Retinal Degeneration. Int J Mol Sci 2019; 20:ijms20215480. [PMID: 31689918 PMCID: PMC6862322 DOI: 10.3390/ijms20215480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Age-related macular degeneration (AMD) is the leading cause of central vision loss and severe blindness among the elderly population. Recently, we reported on the association of the SGCD gene (encoding for δ-sarcoglycan) polymorphisms with AMD. However, the functional consequence of Sgcd alterations in retinal degeneration is not known. Herein, we characterized changes in the retina of the Sgcd knocked-out mouse (KO, Sgcd-/-). At baseline, we analyzed the retina structure of three-month-old wild-type (WT, Sgcd+/+) and Sgcd-/- mice by hematoxylin and eosin (H&E) staining, assessed the Sgcd-protein complex (α-, β-, γ-, and ε-sarcoglycan, and sarcospan) by immunofluorescence (IF) and Western blot (WB), and performed electroretinography. Compared to the WT, Sgcd-/- mice are five times more likely to have retinal ruptures. Additionally, all the retinal layers are significantly thinner, more so in the inner plexiform layer (IPL). In addition, the number of nuclei in the KO versus the WT is ever so slightly increased. WT mice express Sgcd-protein partners in specific retinal layers, and as expected, KO mice have decreased or no protein expression, with a significant increase in the α subunit. At three months of age, there were no significant differences in the scotopic electroretinographic responses, regarding both a- and b-waves. According to our data, Sgcd-/- has a phenotype that is compatible with retinal degeneration.
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Affiliation(s)
- Andric C Perez-Ortiz
- Massachusetts General Hospital, Division of Surgery, 55 Fruit St, Boston, MA 02214, USA.
- Laboratory of Epidemiology and Public Health, Yale University School of Public Health, 60 College St, New Haven, CT 06510, USA.
| | - Martha J Peralta-Ildefonso
- Facultad de Química, Universidad Nacional Autónoma de México, 04510 Ciudad de México, Mexico.
- Laboratorio de Biología Molecular, Universidad Panamericana, Escuela de Medicina, Donatello 59 Insurgentes Mixcoac Benito Juárez, 03920 Ciudad de México, Mexico.
| | - Esmeralda Lira-Romero
- Laboratorio de Biología Molecular, Universidad Panamericana, Escuela de Medicina, Donatello 59 Insurgentes Mixcoac Benito Juárez, 03920 Ciudad de México, Mexico.
| | - Ernesto Moya-Albor
- Facultad de Ingeniería, Universidad Panamericana, Augusto Rodin 498, 03920 Ciudad de México, Mexico.
| | - Jorge Brieva
- Facultad de Ingeniería, Universidad Panamericana, Augusto Rodin 498, 03920 Ciudad de México, Mexico.
| | - Israel Ramirez-Sanchez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico.
| | - Carmen Clapp
- Instituto de Neurobiología, Campus UNAM-Juriquilla, Universidad Nacional Autónoma de México (UNAM), 76230 Querétaro, Mexico.
| | - Alexandra Luna-Angulo
- Departamento de Neurociencias, Instituto Nacional de rehabilitación, México-Xochimilco, No.289. Arenal de Guadalupe, 14389 Ciudad de México, Mexico.
| | - Alvaro Rendon
- Institut De La Vision, Sorbonne Universites, F-75012 Paris, France.
| | - Elva Adan-Castro
- Instituto de Neurobiología, Campus UNAM-Juriquilla, Universidad Nacional Autónoma de México (UNAM), 76230 Querétaro, Mexico.
| | - Gabriela Ramírez-Hernández
- Instituto de Neurobiología, Campus UNAM-Juriquilla, Universidad Nacional Autónoma de México (UNAM), 76230 Querétaro, Mexico.
| | - Nundehui Díaz-Lezama
- Department of Physiological Genomics, Ludwig-Maximilians-Universität München, Großhaderner Str. 9, 82152 Planegg-Martinsried, Germany.
| | - Ramón M Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, 11340 Ciudad de México, Mexico.
- Subdirección de Enseñanza e Investigación, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 03100 Ciudad de México, Mexico.
| | - Francisco J Estrada-Mena
- Laboratorio de Biología Molecular, Universidad Panamericana, Escuela de Medicina, Donatello 59 Insurgentes Mixcoac Benito Juárez, 03920 Ciudad de México, Mexico.
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Rodriguez JD, Lane K, Hollander DA, Shapiro A, Saigal S, Hertsenberg AJ, Wallstrom G, Narayanan D, Angjeli E, Abelson MB. Cone photoreceptor macular function and recovery after photostress in early non-exudative age-related macular degeneration. Clin Ophthalmol 2018; 12:1325-1335. [PMID: 30100705 PMCID: PMC6067527 DOI: 10.2147/opth.s165658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Purpose To identify parameters from cone function and recovery after photostress that detect functional deficits in early non-exudative age-related macular degeneration (AMD) and to determine the repeatability of these parameters. Methods Cone-mediated visual function recovery after photostress was examined in three groups of subjects: young normal subjects (ages 20–29; N=8), older normal subjects (ages 50–90; N=9), and early non-exudative AMD subjects (ages 50–90; N=12). Eight AMD and four normal subjects were retested 1 year after the initial evaluation. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) and parameters of cone function (baseline cone sensitivity and cone recovery half-life following photobleach) were measured and compared between AMD and normal subjects. Short-term repeatability was assessed for each subject’s initial evaluation. Long-term repeatability was assessed by comparing outcomes from the initial evaluation and 1-year follow-up. Results The mean baseline cone threshold was significantly worse in subjects with early AMD compared to older normal subjects (−1.80±0.04 vs −1.57±0.06 log cd/m2p=0.0027). Moreover, the baseline cone threshold parameter exhibited good short-term (intraclass correlation coefficient [ICC]=0.88) and long-term (ICC=0.85) repeatability in all subjects. The cone intercept parameter and ETDRS VA were not significantly different between AMD and older normal subject groups. Cone recovery half-life was significantly different between older normal and AMD subject groups (p=0.041). Neither ETDRS VA nor cone function parameters were significantly different for any group at the 1-year follow-up. Conclusion The baseline cone threshold shows potential as a novel parameter to assess visual dysfunction in early AMD. This outcome consistently detected deficits in AMD subjects, and differentiated them from age-matched controls with high test–retest repeatability.
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Affiliation(s)
| | | | - David A Hollander
- Ora, Inc., Andover, MA, USA, .,Jules Stein Eye Institute, University of California, Los Angeles, CA, USA
| | | | | | | | | | | | | | - Mark B Abelson
- Ora, Inc., Andover, MA, USA, .,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Moschos MM, Nitoda E. The Role of mf-ERG in the Diagnosis and Treatment of Age-Related Macular Degeneration: Electrophysiological Features of AMD. Semin Ophthalmol 2017; 33:461-469. [PMID: 28328288 DOI: 10.1080/08820538.2017.1301496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Age-related macular cegeneration (AMD) is the leading cause of visual dysfunction worldwide, affecting 9-25% of individuals between 65 and 75 years old. METHODS We have reviewed the published articles investigating the role of multifocal electroretinogram (mf-ERG) in the diagnosis and treatment of AMD. RESULTS Visual evoked potentials have revealed decreased amplitudes and higher latencies in patients with AMD, while the degeneration of photoreceptors and abnormalities of retinal pigment epithelium can be identified by electro-oculogram recordings. Moreover, ERG can detect the functional abnormalities observed in AMD and evaluate each therapeutic approach. The record of local electrophysiological responses coming from different retinal areas can be accurately performed by mfERG. CONCLUSION The accuracy of mfERG in detecting the degeneration of photoreceptors, as well the disturbances of macular function, could be useful both in the early diagnosis of AMD and the assessment of treatment efficacy.
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Affiliation(s)
- Marilita M Moschos
- a First Department of Ophthalmology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Eirini Nitoda
- a First Department of Ophthalmology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Ambrosio L, Ambrosio G, Nicoletti G, de Crecchio G, Falsini B. The value of multifocal electroretinography to predict progressive visual acuity loss in early AMD. Doc Ophthalmol 2015; 131:125-35. [PMID: 26135127 DOI: 10.1007/s10633-015-9507-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 06/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate, in a prospective study, the role of multifocal electroretinography (mfERG) for predicting visual acuity decline in early age-related macular degeneration (AMD) with time. METHODS Twenty-six early AMD patients (12 males and 14 females, mean age 66.9 ± 9.8; range 46-82 years) were included in the study. A complete ophthalmic examination and mfERG (Retiscan, Roland Germany, ISCEV standard protocol) were performed at the study entry (baseline), after 20 and 24 months. The first-order kernel mfERG responses were analyzed by ring analysis. The amplitude density (AD) of the first positive peak (P1, nV/deg(2)), the P1 amplitude (µV) and P1 implicit time (ms) for Rings 1 (central) to 6 (most peripheral) were evaluated. Data were statistically analyzed by analysis of variance and receiver operating characteristic (ROC) curves. RESULTS The loss in the mfERG Ring 1 AD from normal control values, recorded at baseline, was correlated with the decrease in ETDRS visual acuity with time (P = 0.004). ROC analysis showed that, after 24 months, the average decline in visual acuity was greater (3 letters vs 0.4 letters, P = 0.0021) in patients whose Ring 1 P1 AD at baseline was equal to or less than 65.9 nV/deg(2), compared to those with higher AD values. Both P1 amplitude and AD of Ring 1 had an area under the curve of 0.702 (95% confidence interval 0.50-0.92) with a sensitivity of 64.3% (35.14-87.24%) and a specificity of 91.7% (61.52-99.79%). CONCLUSIONS The present results indicate that mfERG P1 amplitude and AD of Ring 1 may be highly specific to predict visual acuity decline in early AMD.
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Affiliation(s)
- L Ambrosio
- Department of Neuroscience, University of Naples Federico II, Via Pansini, Naples, Italy.
| | - G Ambrosio
- Department of Neuroscience, University of Naples Federico II, Via Pansini, Naples, Italy
| | - G Nicoletti
- Department of Neuroscience, University of Naples Federico II, Via Pansini, Naples, Italy
| | - G de Crecchio
- Department of Neuroscience, University of Naples Federico II, Via Pansini, Naples, Italy
| | - B Falsini
- Department of Ophthalmology, Catholic University, Rome, Italy
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