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Fang D, Liang J, Diao Y, Cui D, Hou F, Zheng B, Zheng H, Pan C, Feng L, Li W, Xie T, Li P, Zhang J, Zhang G, Chen L, Zhang S. Morphologic and Functional Assessment of Photoreceptors in Laser-Induced Retinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy and Microperimetry. Am J Ophthalmol 2024; 265:61-72. [PMID: 38555010 DOI: 10.1016/j.ajo.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To assess the cone photoreceptors' morphology and associated retinal sensitivity in laser-induced retinopathy (LIR) using adaptive optics scanning laser ophthalmoscopy (AO-SLO) and microperimetry (MP). DESIGN Cohort study. METHODS This study included 13 patients (15 eyes) with LIR and 38 age-matched healthy volunteers (38 eyes). Participants underwent comprehensive evaluations including AO-SLO, MP, and spectral-domain OCT. Lesion morphology, cone density, dispersion, and regularity in AO-SLO were assessed and correlated with visual function. RESULTS In AO-SLO images, LIR lesions were predominantly characterized by hyporeflective regions, suggesting potential cone loss at the fovea, accompanied by the presence of sizable clumps of hyperreflective material within these lesions. The average size of lesions in affected eyes was 97,128±107,478 µm², ranging from 6705 to 673,348 µm². Compared with the healthy contralateral eye and control group, LIR demonstrated significantly reduced cone density, increased cone dispersion, and notably decreased cone regularity in all 4 quadrants at 3° eccentricity (all P values < .05). Lesion morphology in AO-SLO correlated with ellipsoid zone defects observed in OCT, showing a positive correlation in size (r = 0.84, P < .001) but not with retinal sensitivities (P = .09). Similarly, cone density at 3° eccentricity did not correlate with retinal sensitivities (P = .13). CONCLUSIONS AND RELEVANCE The study provides crucial insights into the morphologic and functional impacts of LIR on cone photoreceptors, revealing significant morphologic changes in cones that do not consistently align with functional outcomes. This research highlights the need for continued exploration into the relationship between retinal structure and function in LIR, and the importance of heightened public awareness and preventive strategies to mitigate the risk of LIR.
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Affiliation(s)
- Dong Fang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Jia Liang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Yingying Diao
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Dongmei Cui
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Fei Hou
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Bingru Zheng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Huiyan Zheng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Changfeng Pan
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Lujia Feng
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Wangting Li
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Ting Xie
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Pengfeng Li
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Jie Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong; Advanced Ophthalmology Laboratory, Robotrak Technologies (J.Z.), Nanjing, China
| | - Guoming Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong
| | - Lu Chen
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong.
| | - Shaochong Zhang
- From the Shenzhen Eye Hospital, Jinan University, Shenzhen Key Laboratory of Ophthalmology (D.F., J.L., Y.D., D.C., F.H., B.Z., H.Z., C.P., L.F., W.L., T.X., P.L., G.Z., L.C., S.Z.), Shenzhen, Guangdong.
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Britten-Jones AC, Thai L, Flanagan JPM, Bedggood PA, Edwards TL, Metha AB, Ayton LN. Adaptive optics imaging in inherited retinal diseases: A scoping review of the clinical literature. Surv Ophthalmol 2024; 69:51-66. [PMID: 37778667 DOI: 10.1016/j.survophthal.2023.09.006] [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: 03/09/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Adaptive optics (AO) imaging enables direct, objective assessments of retinal cells. Applications of AO show great promise in advancing our understanding of the etiology of inherited retinal disease (IRDs) and discovering new imaging biomarkers. This scoping review systematically identifies and summarizes clinical studies evaluating AO imaging in IRDs. Ovid MEDLINE and EMBASE were searched on February 6, 2023. Studies describing AO imaging in monogenic IRDs were included. Study screening and data extraction were performed by 2 reviewers independently. This review presents (1) a broad overview of the dominant areas of research; (2) a summary of IRD characteristics revealed by AO imaging; and (3) a discussion of methodological considerations relating to AO imaging in IRDs. From 140 studies with AO outcomes, including 2 following subretinal gene therapy treatments, 75% included fewer than 10 participants with AO imaging data. Of 100 studies that included participants' genetic diagnoses, the most common IRD genes with AO outcomes are CNGA3, CNGB3, CHM, USH2A, and ABCA4. Confocal reflectance AO scanning laser ophthalmoscopy was the most reported imaging modality, followed by flood-illuminated AO and split-detector AO. The most common outcome was cone density, reported quantitatively in 56% of studies. Future research areas include guidelines to reduce variability in the reporting of AO methodology and a focus on functional AO techniques to guide the development of therapeutic interventions.
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Affiliation(s)
- Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
| | - Lawrence Thai
- Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Jeremy P M Flanagan
- Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Phillip A Bedggood
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Thomas L Edwards
- Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Andrew B Metha
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Department of Surgery (Ophthalmology), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
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Daich Varela M, Wong SW, Kiray G, Schlottmann PG, Arno G, Shams ANA, Mahroo OA, Webster AR, AlTalbishi A, Michaelides M. Detailed Clinical, Ophthalmic, and Genetic Characterization of ADGRV1-Associated Usher Syndrome. Am J Ophthalmol 2023; 256:186-195. [PMID: 37422204 PMCID: PMC11139646 DOI: 10.1016/j.ajo.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To present the clinical characteristics, retinal features, natural history, and genetics of ADGRV1-Usher syndrome (USH). DESIGN Multicenter international retrospective cohort study. METHODS Clinical notes, hearing loss history, multimodal retinal imaging, and molecular diagnosis were reviewed. Thirty patients (28 families) with USH type 2 and disease-causing variants in ADGRV1 were identified. Visual function, retinal imaging, and genetics were evaluated and correlated, with retinal features also compared with those of the commonest cause of USH type 2, USH2A-USH. RESULTS The mean age at the first visit was 38.6 ± 12.0 years (range: 19-74 years), and the mean follow-up time was 9.0 ± 7.7 years. Hearing loss was reported in the first decade of life by all patients, 3 (10%) described progressive loss, and 93% had moderate-severe impairment. Visual symptom onset was at 17.0 ± 7.7 years of age (range: 6-32 years), with 13 patients noticing problems before the age of 16. At baseline, 90% of patients had no or mild visual impairment. The most frequent retinal features were a hyperautofluorescent ring at the posterior pole (70%), perimacular patches of decreased autofluorescence (59%), and mild-moderate peripheral bone-spicule-like deposits (63%). Twenty-six (53%) variants were previously unreported, 19 families (68%) had double-null genotypes, and 9 were not-double-null. Longitudinal analysis showed significant differences between baseline and follow-up central macular thickness (-1.25 µm/y), outer nuclear layer thickness (-1.19 µm/y), and ellipsoid zone width (-40.9 µm/y). The rate of visual acuity decline was 0.02 LogMAR (1 letter)/y, and the rate of constriction of the hyperautofluorescent ring was 0.23 mm2/y. CONCLUSIONS ADGRV1-USH is characterized by early-onset, usually non-progressive, mild-to-severe hearing loss and generally good central vision until late adulthood. Perimacular atrophic patches and relatively retained ellipsoid zone and central macular thickness in later adulthood are more often seen in ADGRV1-USH than in USH2A-USH.
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Affiliation(s)
- Malena Daich Varela
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK; UCL Institute of Ophthalmology, University College London (M.D.V., G.A., O.A.M., A.R.W., M.M.), London, UK
| | - Shiao Wei Wong
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK
| | - Gulunay Kiray
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK
| | | | - Gavin Arno
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK; UCL Institute of Ophthalmology, University College London (M.D.V., G.A., O.A.M., A.R.W., M.M.), London, UK
| | - Amjaad N Abu Shams
- St John of Jerusalem Eye Hospital Group, Jerusalem, Palestine (A.N.A.S., A.A.T.)
| | - Omar A Mahroo
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK; UCL Institute of Ophthalmology, University College London (M.D.V., G.A., O.A.M., A.R.W., M.M.), London, UK
| | - Andrew R Webster
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK; UCL Institute of Ophthalmology, University College London (M.D.V., G.A., O.A.M., A.R.W., M.M.), London, UK
| | - Alaa AlTalbishi
- St John of Jerusalem Eye Hospital Group, Jerusalem, Palestine (A.N.A.S., A.A.T.)
| | - Michel Michaelides
- From the Moorfields Eye Hospital (M.D.V., S.W.W., G.K., G.A., O.A.M., A.R.W., M.M.), London, UK; UCL Institute of Ophthalmology, University College London (M.D.V., G.A., O.A.M., A.R.W., M.M.), London, UK.
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Duncan JL, Liang W, Maguire MG, Porco TC, Wong J, Audo I, Cava JA, Grieve K, Kalitzeos A, Kreis J, Michaelides M, Norberg N, Paques M, Carroll J. Change in Cone Structure Over 24 Months in USH2A-Related Retinal Degeneration. Am J Ophthalmol 2023; 252:77-93. [PMID: 36948373 PMCID: PMC11087021 DOI: 10.1016/j.ajo.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To describe cone structure changes using adaptive optics scanning laser ophthalmoscopy (AOSLO) in the Rate of Progression of USH2A-related Retinal Degeneration (RUSH2A) study. DESIGN Multicenter, longitudinal natural history study. METHODS AOSLO images were acquired at 4 centers, twice at baseline and annually for 24 months in this natural history study. For each eye, at least 10 regions of interest (ROIs) with ≥50 contiguous cones were analyzed by masked, independent graders. Cone spacing Z-scores, standard deviations from the normal mean at the measured location, were compared between graders and tests at baseline. The association of cone spacing with clinical characteristics was assessed using linear mixed effects regression models weighted by image quality score. Annual rates of change were calculated based on differences between visits. RESULTS Fourteen eyes of 14 participants were imaged, with 192 ROIs selected at baseline. There was variability among graders, which was greater in images with lower image quality score (P < .001). Cone spacing was significantly correlated with eccentricity, quality score, and disease duration (P < .02). On average, the cone spacing Z-score increased 0.14 annually (about 9%, P < .001). We observed no significant differences in rate of change between disease type (Usher syndrome or retinitis pigmentosa), imaging site, or grader. CONCLUSIONS Using current methods, the analysis of quantitative measures of cone structure showed some challenges, yet showed promise that AOSLO images can be used to characterize progressive change over 24 months. Additional multicenter studies using AOSLO are needed to advance cone mosaic metrics as sensitive outcome measures for clinical trials. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
| | - Wendi Liang
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | | | - Jessica Wong
- University of California, San Francisco, CA, USA
| | - Isabelle Audo
- Quinze Vingts National Ophthalmology Hospital, Paris, France
| | - Jenna A Cava
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate Grieve
- Quinze Vingts National Ophthalmology Hospital, Paris, France
| | | | - Joseph Kreis
- Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Michel Paques
- Quinze Vingts National Ophthalmology Hospital, Paris, France
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