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Harris JM, Saricay LY, Gregg AT, Fulton AB, Armstrong-Javors A, Gaier ED. Vision Loss and Difficulty Walking in a Pediatric Sexual Assault Victim. J Neuroophthalmol 2024:00041327-990000000-00653. [PMID: 38755743 DOI: 10.1097/wno.0000000000002182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Affiliation(s)
- James M Harris
- Department of Ophthalmology (JMH, LYS, EDG), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Harvard Medical School (JMH, LYS, ATG, ABF, AA-J, EDG), Boston, Massachusetts; Department of Ophthalmology (ABF), Boston Children's Hospital, Boston, Massachusetts; Department of Neurology (AA-J), Massachusetts General Hospital, Boston, Massachusetts; and Picower Institute for Learning and Memory (EDG), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Abstract
PURPOSE Kearns-Sayre syndrome (KSS) is a mitochondrial DNA deletion syndrome that is characterized by the triad of onset commonly before age 20, pigmentary retinopathy, and chronic progressive external ophthalmoplegia. Here, we present a case of KSS masquerading as myasthenia gravis. METHODS Case report. RESULTS A 15-year-old boy with a presumed diagnosis of myasthenia gravis presented with blurry vision, ophthalmoplegia, and ptosis. He was found to have a mitochondrial pigmentary retinopathy and was eventually diagnosed with KSS after mitochondrial DNA sequencing revealed a novel large-scale deletion of 7.9 kb of mitochondrial DNA from nucleotides 6,578 to 14,460. CONCLUSION We report a case of KSS found to have a novel large-scale mitochondrial DNA deletion. The presence of a mitochondrial pigmentary retinopathy found on dilated examination led to reconsideration of the previous diagnosis of myasthenia gravis and ultimately led to the correct diagnosis of KSS.
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Affiliation(s)
- Jared T Sokol
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Dodd DO, Mechaussier S, Yeyati PL, McPhie F, Anderson JR, Khoo CJ, Shoemark A, Gupta DK, Attard T, Zariwala MA, Legendre M, Bracht D, Wallmeier J, Gui M, Fassad MR, Parry DA, Tennant PA, Meynert A, Wheway G, Fares-Taie L, Black HA, Mitri-Frangieh R, Faucon C, Kaplan J, Patel M, McKie L, Megaw R, Gatsogiannis C, Mohamed MA, Aitken S, Gautier P, Reinholt FR, Hirst RA, O'Callaghan C, Heimdal K, Bottier M, Escudier E, Crowley S, Descartes M, Jabs EW, Kenia P, Amiel J, Bacci GM, Calogero C, Palazzo V, Tiberi L, Blümlein U, Rogers A, Wambach JA, Wegner DJ, Fulton AB, Kenna M, Rosenfeld M, Holm IA, Quigley A, Hall EA, Murphy LC, Cassidy DM, von Kriegsheim A, Papon JF, Pasquier L, Murris MS, Chalmers JD, Hogg C, Macleod KA, Urquhart DS, Unger S, Aitman TJ, Amselem S, Leigh MW, Knowles MR, Omran H, Mitchison HM, Brown A, Marsh JA, Welburn JPI, Ti SC, Horani A, Rozet JM, Perrault I, Mill P. Ciliopathy patient variants reveal organelle-specific functions for TUBB4B in axonemal microtubules. Science 2024; 384:eadf5489. [PMID: 38662826 DOI: 10.1126/science.adf5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
Tubulin, one of the most abundant cytoskeletal building blocks, has numerous isotypes in metazoans encoded by different conserved genes. Whether these distinct isotypes form cell type- and context-specific microtubule structures is poorly understood. Based on a cohort of 12 patients with primary ciliary dyskinesia as well as mouse mutants, we identified and characterized variants in the TUBB4B isotype that specifically perturbed centriole and cilium biogenesis. Distinct TUBB4B variants differentially affected microtubule dynamics and cilia formation in a dominant-negative manner. Structure-function studies revealed that different TUBB4B variants disrupted distinct tubulin interfaces, thereby enabling stratification of patients into three classes of ciliopathic diseases. These findings show that specific tubulin isotypes have distinct and nonredundant subcellular functions and establish a link between tubulinopathies and ciliopathies.
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Affiliation(s)
- Daniel O Dodd
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Sabrina Mechaussier
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Patricia L Yeyati
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Fraser McPhie
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Jacob R Anderson
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Chen Jing Khoo
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Amelia Shoemark
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Deepesh K Gupta
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Thomas Attard
- Wellcome Trust Centre for Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - Maimoona A Zariwala
- Department of Pathology and Laboratory Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Marie Legendre
- Molecular Genetics Laboratory, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Paris 75012, France
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
| | - Diana Bracht
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Julia Wallmeier
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Miao Gui
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Mahmoud R Fassad
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria 21561, Egypt
| | - David A Parry
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Peter A Tennant
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Alison Meynert
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Gabrielle Wheway
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Lucas Fares-Taie
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Holly A Black
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- South East of Scotland Genetics Service, Western General Hospital, Edinburgh EH4 2XU, UK
| | - Rana Mitri-Frangieh
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
- Biomechanics and Respiratory Apparatus, IMRB, U955 INSERM - Université Paris Est Créteil, CNRS ERL 7000, Créteil 94000, France
| | - Catherine Faucon
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
| | - Josseline Kaplan
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Mitali Patel
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- MRC Prion Unit, Institute of Prion Diseases, University College London, London W1W 7FF, UK
| | - Lisa McKie
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Roly Megaw
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
- Princess Alexandra Eye Pavilion, Edinburgh EH3 9HA, UK
| | - Christos Gatsogiannis
- Center for Soft Nanoscience and Institute of Medical Physics and Biophysics, Münster 48149, Germany
| | - Mai A Mohamed
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
- Biochemistry Division, Chemistry Department, Faculty of Science, Zagazig University, Ash Sharqiyah 44519, Egypt
| | - Stuart Aitken
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Philippe Gautier
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Finn R Reinholt
- Core Facility for Electron Microscopy, Department of Pathology, Oslo University Hospital-Rikshospitalet, Oslo 0372, Norway
| | - Robert A Hirst
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Chris O'Callaghan
- Centre for PCD Diagnosis and Research, Department of Respiratory Sciences, University of Leicester, Leicester LE1 9HN, UK
| | - Ketil Heimdal
- Department of Medical Genetics, Oslo University Hospital, Oslo 0407, Norway
| | - Mathieu Bottier
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Estelle Escudier
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
- Department of Anatomy, Cytology and Pathology, Hôpital Intercommuncal de Créteil, Créteil 94000, France
| | - Suzanne Crowley
- Paediatric Department of Allergy and Lung Diseases, Oslo University Hospital, Oslo 0407, Norway
| | - Maria Descartes
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35294-0024, USA
| | - Ethylin W Jabs
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York 10029-6504, New York, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, NY 55905, USA
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris 75015, France
- Laboratory of Embryology and Genetics of Human Malformations, INSERM UMR 1163, Institut Imagine, Université de Paris, Paris 75015, France
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Claudia Calogero
- Pediatric Pulmonary Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Viviana Palazzo
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | - Lucia Tiberi
- Medical Genetics Unit, Meyer Children's Hospital IRCCS, Florence 50139, Italy
| | | | - Andrew Rogers
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Jennifer A Wambach
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Daniel J Wegner
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Margaret Kenna
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Research Institute, Seattle, WA 98015, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Alan Quigley
- Department of Paediatric Radiology, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Emma A Hall
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Laura C Murphy
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Diane M Cassidy
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Alex von Kriegsheim
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Jean-François Papon
- ENT Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Saclay University, Le Kremlin-Bicêtre 94270, France
| | - Laurent Pasquier
- Medical Genetics Department, CHU Pontchaillou, Rennes 35033, France
| | - Marlène S Murris
- Department of Pulmonology, Transplantation, and Cystic Fibrosis Centre, Larrey Hospital, Toulouse 31400, France
| | - James D Chalmers
- Respiratory Research Group, Molecular and Cellular Medicine, University of Dundee, Dundee DD1 9SY, UK
| | - Claire Hogg
- Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK
| | - Kenneth A Macleod
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Don S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Stefan Unger
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
- Department of Child Life and Health, University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Timothy J Aitman
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Serge Amselem
- Molecular Genetics Laboratory, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Paris 75012, France
- Sorbonne Université, INSERM, Childhood Genetic Disorders, Paris 75012, France
| | - Margaret W Leigh
- Department of Pediatrics, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Michael R Knowles
- Department of Medicine, Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7248, USA
| | - Heymut Omran
- Department of General Pediatrics, University Children's Hospital Münster, Münster 48149, Germany
| | - Hannah M Mitchison
- Genetics and Genomic Medicine Department, UCL Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Alan Brown
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph A Marsh
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Julie P I Welburn
- Wellcome Trust Centre for Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh EH9 3BF, UK
| | - Shih-Chieh Ti
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Amjad Horani
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63130, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jean-Michel Rozet
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Isabelle Perrault
- Laboratory of Genetics in Ophthalmology, INSERM UMR_1163, Institute of Genetic Diseases, Institut Imagine, Université de Paris, Paris 75015, France
| | - Pleasantine Mill
- MRC Human Genetics Unit, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
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Ayash J, Woods RL, Akula JD, Rajabi F, Alwattar BK, Altschwager P, Fulton AB. Characteristics of Eyes With CRB1-Associated EOSRD/LCA: Age-Related Changes. Am J Ophthalmol 2024; 263:168-178. [PMID: 38461945 DOI: 10.1016/j.ajo.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To evaluate ocular and retinal features of CRB1-associated early onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA) for age-related changes. DESIGN Retrospective cohort study. METHODS Sixteen pediatric patients with biallelic CRB1 EOSRD/LCA who had been followed for up to 18 years were reviewed. Results of comprehensive ophthalmic examinations-including visual acuity, refractive error, dark-adapted visual threshold, Goldmann perimetry, and macular optical coherence tomography (OCT)-were analyzed for significant age-related changes using mixed-effects models. RESULTS Visual acuity dark-adapted visual sensitivity, and area of seeing visual field (all subnormal from the earliest ages recorded) declined with increasing age. Hyperopia was stable through childhood and adolescence. In CRB1 EOSRD/LCA, OCT extrafoveal inner and outer laminar thicknesses exceeded those in controls but varied little with age, and foveal metrics (depth, breadth, thickness at rim) differed significantly from those in controls, but variations in foveal metrics were not associated with declines in acuity. CONCLUSIONS From the youngest ages, retinal and visual function is significantly subnormal and becomes progressively compromized. A goal of future therapies should be intervention at young ages, when there is more function to be rescued.
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Affiliation(s)
- Jad Ayash
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell L Woods
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - James D Akula
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Farrah Rajabi
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Bilal K Alwattar
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Pablo Altschwager
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Anne B Fulton
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA.
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Chiou C, Rajabi F, Fulton AB, Acsadi G, Waitzman D, Gaier ED. Membrane Frizzled-Related Protein-Related Disease Mimicking Idiopathic Intracranial Hypertension. J Neuroophthalmol 2024; 44:e26-e28. [PMID: 36255095 PMCID: PMC10110761 DOI: 10.1097/wno.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carolina Chiou
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
- Harvard Medical School, Boston, MA
| | - Farrah Rajabi
- Harvard Medical School, Boston, MA
- Department of Genetics, Boston Children’s Hospital, Boston, MA
| | - Anne B. Fulton
- Harvard Medical School, Boston, MA
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
| | - Gyula Acsadi
- Department of Neurology, Connecticut Children’s Medical Center, Hartford, CT
| | - David Waitzman
- Departments of Neurology and Ophthalmology, University of Connecticut Health Center, Farmington, CT
| | - Eric D. Gaier
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
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Akula JD, Lancos AM, AlWattar BK, De Bruyn H, Hansen RM, Fulton AB. A Simplified Model of Activation and Deactivation of Human Rod Phototransduction-An Electroretinographic Study. Invest Ophthalmol Vis Sci 2023; 64:36. [PMID: 37738060 PMCID: PMC10528468 DOI: 10.1167/iovs.64.12.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Purpose To test the hypothesis that a simple model having properties consistent with activation and deactivation in the rod approximates the whole time course of the photoresponse. Methods Routinely, an exponential of the form f = α·(1 - exp(-(τ·(t - teff)s-1))), with amplitude α, rate constant τ (often scaled by intensity), irreducible delay teff, and time exponent s-1, is fit to the early period of the flash electroretinogram. Notably, s (an integer) represents the three integrating stages in the rod amplification cascade (rhodopsin isomerization, transducin activation, and cGMP hydrolysis). The time course of the photoresponse to a 0.17 cd·s·m-2 conditioning flash (CF) was determined in 21 healthy eyes by presenting the CF plus a bright probe flash (PF) in tandem, separated by interstimulus intervals (ISIs) of 0.01 to 1.4 seconds, and calculating the proportion of the PF a-wave suppressed by the CF at each ISI. To test if similar kinetics describe deactivation, difference of exponential (DoE) functions with common α and teff parameters, respective rate constants for the initiation (I) and quenching (Q) phases of the response, and specified values of s (sI, sQ), were compared to the photoresponse time course. Results As hypothesized, the optimal values of sI and sQ were 3 and 2, respectively. Mean ± SD α was 0.80 ± 0.066, I was 7700 ± 2400 m2·cd-1·s-3, and Q was 1.4 ± 0.47 s-1. Overall, r2 was 0.93. Conclusions A method, including a DoE model with just three free parameters (α, I, Q), that robustly captures the magnitude and time-constants of the complete rod response, was produced. Only two steps integrate to quench the rod photoresponse.
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Affiliation(s)
- James D. Akula
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Annie M. Lancos
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Bilal K. AlWattar
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Hanna De Bruyn
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Ronald M. Hansen
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B. Fulton
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Ambrosio L, Akula JD, Harman JC, Arellano IA, Fulton AB. Do the retinal abnormalities in X-linked juvenile retinoschisis include impaired phototransduction? Exp Eye Res 2023; 234:109591. [PMID: 37481224 DOI: 10.1016/j.exer.2023.109591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
X-linked juvenile retinoschisis (XLRS), a hereditary retinal disorder primarily affecting males, is characterized by the formation of cystic spaces between the outer plexiform layer and outer nuclear layer of the retina. Mutations in the RS1 gene, which encodes the extracellular binding protein retinoschisin, are responsible for XLRS pathogenesis. While the role of retinoschisin in maintaining retinal integrity is well established, there is growing evidence suggesting compromised photoreceptor function in XLRS. To investigate the molecular pathways affected by RS1 deficiency, particularly in phototransduction, we performed electroretinographic (ERG) and proteomic analyses on retinae from Rs1 knockout mice, a model of human XLRS. The Rs1 knockout mice had reduced ERG a-wave amplitudes. Correspondingly, differential expression analysis revealed downregulation of proteins crucial for phototransduction, with Ingenuity Pathway Analysis (IPA) highlighting "phototransduction" as the most significantly downregulated biological theme. Compensatory mechanisms were also observed in the IPA, including upregulation of synaptic remodeling, inflammation, cell adhesion, and G-protein signaling. These findings strongly implicate an underrecognized role of photoreceptor dysfunction in XLRS pathology. We speculate that entrapment of mutant retinoschisin protein within photoreceptor inner segments as well as disrupted reciprocal regulation between L-type voltage-gated calcium channels and retinoschisin contribute to the dysfunction in photoreceptors.
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Affiliation(s)
- Lucia Ambrosio
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy; Department of Public Health, University of Naples Federico II, Naples, Italy; Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - James D Akula
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Jarrod C Harman
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Pharmacology and Bioanalytics, EyeCRO LLC, Ann Arbor, MI, USA
| | - Ivana A Arellano
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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8
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Curran ALK, Stukin J, Ambrosio L, Mantagos IS, Wu C, Vanderveen DK, Hansen RM, Akula JD, Fulton AB. Electroretinographic Responses in Retinopathy of Prematurity Treated Using Intravitreal Bevacizumab or Laser. Am J Ophthalmol 2023; 252:275-285. [PMID: 37146743 PMCID: PMC10524994 DOI: 10.1016/j.ajo.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Intravitreal injection of bevacizumab (IVB) offers advantages over laser photoablation for treatment of type 1 retinopathy of prematurity (ROP). However, retinal function has not, to date, been quantitatively compared following these interventions. Therefore, electroretinography (ERG) was used compare retinal function among eyes treated using IVB or laser, and control eyes. In addition, among the IVB-treated eyes, ERG was used to compare function in individuals in whom subsequent laser was and was not required. DESIGN Prospective clinical cohort study. METHODS ERG was used to record dark- and light-adapted stimulus/response functions in 21 children treated using IVB (12 of whom required subsequent laser in at least 1 eye for persistent avascular retina [PAR]). Sensitivity and amplitude parameters were derived from the a-wave, b-wave, and oscillatory potentials (OPs), representing activity in photoreceptor, postreceptor, and inner retinal cells, respectively. These parameters were then referenced to those of 76 healthy, term-born controls and compared to those of 10 children treated using laser only. RESULTS In children with treated ROP, every ERG parameter was significantly below the mean in controls. However, these significant ERG deficits did not differ between IVB- and laser-treated eyes. Among children treated using IVB, no ERG parameter was significantly associated with dose or need for subsequent laser. CONCLUSION Retinal function was significantly impaired in treated ROP eyes. Function in IVB-treated eyes did not differ from that in laser-treated eyes. Functional differences also did not distinguish those IVB-treated eyes that would subsequently need laser for PAR.
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Affiliation(s)
| | - Justyna Stukin
- Boston Children’s Hospital, Ophthalmology
- Northeastern University, Behavioral Neuroscience
| | - Lucia Ambrosio
- University of Naples Federico II, Department of Neuroscience, Reproductive and Odontostomatological Sciences
- University of Naples Federico II, Department of Public Health
| | - Iason S. Mantagos
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - Carolyn Wu
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | | | - Ronald M. Hansen
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - James D. Akula
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
| | - Anne B. Fulton
- Boston Children’s Hospital, Ophthalmology
- Harvard Medical School, Ophthalmology
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9
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De Bruyn H, Hansen RM, Akula JD, Fulton AB. The Development of Retinal Function and Refractive Error in Children With Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2023; 64:35. [PMID: 37651111 PMCID: PMC10476440 DOI: 10.1167/iovs.64.11.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 07/29/2023] [Indexed: 09/01/2023] Open
Abstract
Purpose The purpose of this study was to test the hypothesis that retinopathy of prematurity (ROP) prolongs development of rod-mediated thresholds for detection of stimuli at 10 degrees but not 30 degrees eccentricity. In addition, to evaluate the thresholds at each site for an association with visual acuity (VA) and spherical equivalent (SE). Methods We estimated rod-mediated dark-adapted thresholds (DATs) for the detection of 2 degree diameter, 50 ms, blue (λ < 510 nm) flashes at 10 degrees and 30 degrees eccentric in former preterm subjects (n = 111), stratified by ROP severity: None (n = 32), Mild (n = 66), and Severe (n = 13). We also tested Term-born (n = 28) controls. To determine the age at half-maximal sensitivity (Agehalf) for each group and eccentricity, we fit DATs to logistic growth curves. We obtained VA and SE for Preterm subjects and evaluated the course of threshold development at 10 degrees and 30 degrees for significant association with VA and SE predicted at age 10 years. Results DAT development at 10 degrees was significantly delayed in ROP (Mild and Severe); ROP did not significantly alter DAT development at 30 degrees. At age 10 years, among Preterm subjects, both VA and SE were significantly associated with group (None,Mild, and Severe). SE was predicted by the course of DAT development at 30 degrees. VA was not associated with the course of DAT development at 10 degrees. Conclusions At 10 degrees, ROP-whether mild or severe-is associated with significant delays in DAT development, evidence that the late-maturing central retina is vulnerable to ROP. The association of 30 degree threshold and myopia are evidence that more peripheral retina is important to refractive development.
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Affiliation(s)
- Hanna De Bruyn
- Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Ronald M. Hansen
- Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology Department, Harvard Medical School, Boston, Massachusetts, United States
| | - James D. Akula
- Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology Department, Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B. Fulton
- Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts, United States
- Ophthalmology Department, Harvard Medical School, Boston, Massachusetts, United States
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10
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Mujat M, Akula JD, Fulton AB, Ferguson RD, Iftimia N. Non-Rigid Registration for High-Resolution Retinal Imaging. Diagnostics (Basel) 2023; 13:2285. [PMID: 37443679 PMCID: PMC10341150 DOI: 10.3390/diagnostics13132285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Adaptive optics provides improved resolution in ophthalmic imaging when retinal microstructures need to be identified, counted, and mapped. In general, multiple images are averaged to improve the signal-to-noise ratio or analyzed for temporal dynamics. Image registration by cross-correlation is straightforward for small patches; however, larger images require more sophisticated registration techniques. Strip-based registration has been used successfully for photoreceptor mosaic alignment in small patches; however, if the deformations along strips are not simple displacements, averaging can degrade the final image. We have applied a non-rigid registration technique that improves the quality of processed images for mapping cones over large image patches. In this approach, correction of local deformations compensates for local image stretching, compressing, bending, and twisting due to a number of causes. The main result of this procedure is improved definition of retinal microstructures that can be better identified and segmented. Derived metrics such as cone density, wall-to-lumen ratio, and quantification of structural modification of blood vessel walls have diagnostic value in many retinal diseases, including diabetic retinopathy and age-related macular degeneration, and their improved evaluations may facilitate early diagnostics of retinal diseases.
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Affiliation(s)
- Mircea Mujat
- Physical Sciences, Inc., 20 New England Business Center, Andover, MA 01810, USA; (R.D.F.); (N.I.)
| | - James D. Akula
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA 02115, USA; (J.D.A.); (A.B.F.)
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
| | - Anne B. Fulton
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA 02115, USA; (J.D.A.); (A.B.F.)
- Department of Ophthalmology, Harvard Medical School, Boston, MA 02115, USA
| | - R. Daniel Ferguson
- Physical Sciences, Inc., 20 New England Business Center, Andover, MA 01810, USA; (R.D.F.); (N.I.)
| | - Nicusor Iftimia
- Physical Sciences, Inc., 20 New England Business Center, Andover, MA 01810, USA; (R.D.F.); (N.I.)
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11
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Ramamirtham R, Akula JD, Curran ALK, Szczygiel J, Lancos AM, Grytz R, Ferguson RD, Fulton AB. Modelling eye lengths and refractions in the periphery. Ophthalmic Physiol Opt 2023. [PMID: 36999932 DOI: 10.1111/opo.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE To create a simplified model of the eye by which we can specify a key optical characteristic of the crystalline lens, namely its power. METHODS Cycloplegic refraction and axial length were obtained in 60 eyes of 30 healthy subjects at eccentricities spanning 40° nasal to 40° temporal and were fitted with a three-dimensional parabolic model. Keratometric values and geometric distances to the cornea, lens and retina from 45 eyes supplied a numerical ray tracing model. Posterior lens curvature (PLC) was found by optimising the refractive data using a fixed lens equivalent refractive index ( n eq $$ {n}_{eq} $$ ). Then, n eq $$ {n}_{eq} $$ was found using a fixed PLC. RESULTS Eccentric refractive errors were relatively hyperopic in eyes with central refractions ≤-1.44 D but relatively myopic in emmetropes and hyperopes. Posterior lens power, which cannot be measured directly, was derived from the optimised model lens. There was a weak, negative association between derived PLC and central spherical equivalent refraction. Regardless of refractive error, the posterior retinal curvature remained fixed. CONCLUSIONS By combining both on- and off-axis refractions and eye length measurements, this simplified model enabled the specification of posterior lens power and captured off-axis lenticular characteristics. The broad distribution in off-axis lens power represents a notable contrast to the relative stability of retinal curvature.
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Affiliation(s)
| | - James D Akula
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Justyna Szczygiel
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Annie M Lancos
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rafael Grytz
- Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Anne B Fulton
- Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
- Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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12
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Abstract
A critical review of mechanisms of action and pharmacokinetics of nerve growth factor (NGF), including topical administration, and the studies showing the NGF treatment for anterior and posterior segment diseases in adult and pediatric population are summarized in our paper. Nerve growth factor is commonly used for many different ocular conditions in the adult population to promote nerve regeneration or cellular rescue. Clinical trials for recombinant human NGF have also treated several challenging ocular conditions, such as neurotrophic keratopathy, glaucoma, and retinitis pigmentosa with cystoid macular edema. The safety and efficacy of NGF have been demonstrated in pediatric patients as well. This leads us to consider new applications of NGF for the treatment of pediatric eye diseases.
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Affiliation(s)
- Leyla Yavuz Saricay
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jose Efren Gonzalez Monroy
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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13
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Wiecek E, Akula JD, Vanderveen DK, Mantagos IS, Wu C, Curran AL, De Bruyn H, Peterson B, Fulton AB. Longitudinal Change of Refractive Error in Retinopathy of Prematurity Treated With Intravitreal Bevacizumab or Laser Photocoagulation. Am J Ophthalmol 2022; 240:252-259. [PMID: 35367438 PMCID: PMC9308642 DOI: 10.1016/j.ajo.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare progression of myopia and refractive error in former premature infants with retinopathy of prematurity (ROP) treated using intravitreal bevacizumab (IVB) or laser. DESIGN Retrospective clinical cohort study. METHODS We identified premature infants with ROP treated using IVB from 2011 to 2020 and compared their longitudinal cycloplegic refraction data to that of infants with ROP treated using laser during the same timeframe. A subset of infants treated using IVB also underwent additional treatment using laser. We included cycloplegic refractions from 789 cumulative visits over a median 3.2 years. We used a linear mixed-effects model with a log decay function to evaluate how refraction changed with age after treatment. RESULTS In aggregate, the model estimated a significant (P < .001) trend in refraction-from slight hyperopia to relatively more myopic states. However, progression in laser-treated eyes was significantly (P < .001) more rapid, regardless of treatment with IVB. The number of laser spots resulted in increased myopic progression by approximately 0.16 diopters per 100 laser spots. Both ROP stage and zone had a significant effect on myopic progression, with more severe disease resulting in faster myopic progression. Random effects, including individual subject variation with nested variance for left and right eye, accounted for 86.4% of the remaining variance not explained by age and treatment. CONCLUSIONS Laser treatment for severe ROP increases the trend to severe myopia. In our sample, IVB did not affect myopic progression but did substantially reduce the amount of consequent laser required to treat ROP. The effect of laser persists after accounting for differences in ROP stage and zone.
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Affiliation(s)
- Emily Wiecek
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA.
| | - James D Akula
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Deborah K Vanderveen
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Iason S Mantagos
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Carolyn Wu
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
| | - Amber-Lee Curran
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Hanna De Bruyn
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Bridget Peterson
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA
| | - Anne B Fulton
- From Boston Children's Hospital (E.W., J.A., D.V., I.M., C.W., A-L.C., H.D., B.P., A.F.), Boston, Massachusetts, USA; Harvard Medical School (E.W., J.A., D.V., I.M., C.W., A.F.), Boston, Massachusetts, USA
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14
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Fonseca MI, Nouck-A-Nwal A, Ambrosio L, Altschwager P, Hansen RM, Fulton AB, Akula JD. The relation of the multifocal electroretinographic response to macular layer volume. Doc Ophthalmol 2022; 145:1-10. [PMID: 35536490 DOI: 10.1007/s10633-022-09873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the association of the multifocal electroretinographic (mfERG) response amplitude with the volumes of the inner, postreceptor, and photoreceptor retinal layers in the region stimulated by each mfERG element. METHODS Sixteen healthy, young adult control subjects were studied. Each of the 103 hexagonal elements of the standard, scaled mfERG were aligned, where possible, with patches of retina imaged using optical coherence tomography. Stimuli falling on the fovea and on the optic nerve head were excluded. Linear mixed-effects modeling was then used to derive estimated coefficients (voltage/volume) for the mfERG response throughout the full 80 ms standard epoch. The resulting predicted response amplitudes originating in each layer were then compared to pharmacologically "dissected" mfERGs obtained from other studies in monkey eyes. RESULTS Across the duration of the response, the amplitude of the modeled contribution from (1) the inner retina was small-to-modest, (2) the postreceptor retina was larger and contained two prominent peaks, and (3) the photoreceptor response was the largest and most closely paralleled the overall (i.e., intact) response, including late-appearing oscillations. The significance of each layer's contribution was greatest when the absolute amplitude of that layer's response was largest. The contribution of the inner retina was maximally significant in the interval between the prominent troughs and peaks of the intact response. The contributions of the postreceptor and photoreceptor responses were maximally significant at the prominent troughs and peaks of the intact response. CONCLUSIONS The results of the model were in good overall agreement with previous interpretations of the cellular contributions to the mfERG. There was also fair agreement with pharmacologically dissected monkey mfERG responses. Thus, the estimations of the contributions of the retinal layers to the mfERG so produced appeared plausible.
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Affiliation(s)
- Mariana I Fonseca
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA.,Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - Alexandra Nouck-A-Nwal
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA.,Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - Lucia Ambrosio
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy.,Department of Public Health, University of Naples Federico II, Napels, Italy
| | - Pablo Altschwager
- Department of Ophthalmology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - James D Akula
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Ave, Fegan 4, Boston, MA, 02115, USA. .,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. .,Department of Psychology, Northeastern University, Boston, MA, USA.
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15
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Kruijt CC, Gradstein L, Bergen AA, Florijn RJ, Arveiler B, Lasseaux E, Zanlonghi X, Bagdonaite-Bejarano L, Fulton AB, Yahalom C, Blumenfeld A, Perez Y, Birk OS, de Wit GC, Schalij-Delfos NE, van Genderen MM. The Phenotypic and Mutational Spectrum of the FHONDA Syndrome and Oculocutaneous Albinism: Similarities and Differences. Invest Ophthalmol Vis Sci 2022; 63:19. [PMID: 35029636 PMCID: PMC8762694 DOI: 10.1167/iovs.63.1.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study was to further expand the mutational spectrum of the Foveal Hypoplasia, Optic Nerve Decussation defect, and Anterior segment abnormalities (FHONDA syndrome), to describe the phenotypic spectrum, and to compare it to albinism. Subjects and Methods We retrospectively collected molecular, ophthalmic, and electrophysiological data of 28 patients molecularly confirmed with FHONDA from the Netherlands (9), Israel (13), France (2), and the United States of America (4). We compared the data to that of 133 Dutch patients with the 3 most common types of albinism in the Netherlands: oculocutaneous albinism type 1 (49), type 2 (41), and ocular albinism (43). Results Patients with FHONDA had a total of 15 different mutations in SLC38A8, of which 6 were novel. Excluding missing data, all patients had moderate to severe visual impairment (median visual acuity [VA] = 0.7 logMAR, interquartile range [IQR] = 0.6-0.8), nystagmus (28/28), and grade 4 foveal hypoplasia (17/17). Misrouting was present in all nine tested patients. None of the patients had any signs of hypopigmentation of skin and hair. VA in albinism was better (median = 0.5 logMAR, IQR = 0.3-0.7, P 0.006) and the phenotypes were more variable: 14 of 132 without nystagmus, foveal hypoplasia grades 1 to 4, and misrouting absent in 16 of 74. Conclusions Compared to albinism, the FHONDA syndrome appears to have a more narrow phenotypic spectrum, consisting of nonprogressive moderately to severely reduced VA, nystagmus, severe foveal hypoplasia, and misrouting. The co-occurrence of nystagmus, foveal hypoplasia, and misrouting in the absence of hypopigmentation implies that these abnormalities are not caused by lack of melanin, which has important implications for understanding the pathogenesis of these features.
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Affiliation(s)
- Charlotte C Kruijt
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Libe Gradstein
- Department of Ophthalmology, Soroka Medical Center and Clalit Health Services, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Arthur A Bergen
- Department of Human Genetics, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands.,The Netherlands Institute for Neurosciences (NIN-KNAW), Amsterdam, The Netherlands.,Department of Ophthalmology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ralph J Florijn
- Department of Human Genetics, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Benoit Arveiler
- Maladies Rares: Génétique et Métabolisme (MRGM), Inserm U1211, University of Bordeaux, Bordeaux, France.,Department of Medical Genetics, CHU Bordeaux, Bordeaux, France
| | | | - Xavier Zanlonghi
- Centre de Compétence Maladie Rares, Clinique Pluridisciplinaire Jules Verne, Nantes, France
| | | | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Claudia Yahalom
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Anat Blumenfeld
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Yonatan Perez
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Ohad S Birk
- The Morris Kahn Laboratory of Human Genetics, National Institute for Biotechnology in the Negev and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.,Genetics Institute, Soroka Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Gerard C de Wit
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands
| | | | - Maria M van Genderen
- Bartiméus Diagnostic Center for Complex Visual Disorders, Zeist, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Raja S, Emadi BS, Gaier ED, Gise RA, Fulton AB, Heidary G. Evaluation of the Relationship Between Preferential Looking Testing and Visual Evoked Potentials as a Biomarker of Cerebral Visual Impairment. Front Hum Neurosci 2021; 15:769259. [PMID: 34776912 PMCID: PMC8578861 DOI: 10.3389/fnhum.2021.769259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022] Open
Abstract
Cerebral visual impairment (CVI) is a leading cause of visual impairment in children in developed countries, but diagnostic tools to detect CVI are limited. We sought to analyze the visual acuity of children with CVI as assessed by visual evoked potentials (VEPs) and preferential looking test (PLT) to determine whether the relationship between the visual outcomes on these two testing methods may serve as a biomarker of CVI. We performed a retrospective chart review of patients with a confirmed diagnosis of CVI and at least one ophthalmological assessment with visual acuity measured by VEP and PLT. Of the 218 patients included in the study, the most common condition associated with CVI was an underlying genetic disorder (36%, 79/218). Treatment for seizures occurred in the majority of the entire cohort of patients (80%, 175/218). Ophthalmic comorbidities included retinal disease in 23 patients, optic nerve disease in 68 patients, nystagmus in 78 patients, and strabismus in 176 patients. When assessed by either VEP or PLT, visual acuity in children with CVI fell below expected norms. At initial and final presentations, VEP acuity exceeded PLT acuity by one or more octaves, and this difference was greater than expected compared with normal visual development. We propose utilizing this quantifiable disparity between VEP and PLT as a biomarker of CVI.
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Affiliation(s)
- Sruti Raja
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, FL, United States.,Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States
| | - Batool Sahar Emadi
- Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States
| | - Eric D Gaier
- Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States.,Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ryan A Gise
- Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States
| | - Anne B Fulton
- Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States
| | - Gena Heidary
- Department of Ophthalmology, Harvard Medical School and Boston Children's Hospital, Boston, MA, United States
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17
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Olson HE, Costantini JA, Swanson LC, Kaufmann WE, Benke TA, Fulton AB, Hansen R, Poduri A, Heidary G. Cerebral visual impairment in CDKL5 deficiency disorder: vision as an outcome measure. Dev Med Child Neurol 2021; 63:1308-1315. [PMID: 34028805 PMCID: PMC8782241 DOI: 10.1111/dmcn.14908] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
AIM To characterize the neuro-ophthalmological phenotype of cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) and assess visual acuity as a reproducible, quantitative outcome measure. METHOD We retrospectively analyzed clinical data from patients with CDD. Complete neuro-ophthalmological assessments, including visual acuity, were evaluated. RESULTS Of 26 patients (22 females, four males; median age 4y, interquartile range 2y 1mo-7y 10mo), cerebral visual impairment (CVI), defined as visual dysfunction in the absence of ocular or anterior visual pathway abnormalities, was diagnosed in all those over 2 years of age. Ophthalmological examinations revealed nystagmus in 10 patients and strabismus in 24 patients. Visual acuity was measured in 24 patients, by preferential looking in all and by sweep visual evoked potential in 13. Visual acuities were lower than age expectations and demonstrated improvement in the first 3 years. Adjusting for age and sex, average preferential looking visual acuity after 2 years of age was higher in patients with intact mobility than in those who were non-mobile. INTERPRETATION CVI was observed in patients with CDD. Visual acuity improved over time and correlated with mobility. Visual acuity, as a quantifiable measure of visual function, should be considered as an outcome measure in pre-clinical and clinical studies for CDD. What this paper adds Cerebral visual impairment is highly prevalent in cyclin-dependent kinase-like 5 deficiency disorder (CDD). Visual acuity is a measurable quantitative outcome measure in CDD. Visual acuity in CDD correlates with gross motor ability.
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Affiliation(s)
- Heather E. Olson
- Division of Epilepsy and Clinical Neurophysiology and
Epilepsy Genetics Program, Department of Neurology, Boston Children’s
Hospital and Harvard Medical School, Boston, MA, USA,CDKL5 Center of Excellence, Department of Neurology, Boston
Children’s Hospital, Boston, MA, USA
| | - Julia A. Costantini
- CDKL5 Center of Excellence, Department of Neurology, Boston
Children’s Hospital, Boston, MA, USA
| | - Lindsay C. Swanson
- CDKL5 Center of Excellence, Department of Neurology, Boston
Children’s Hospital, Boston, MA, USA
| | - Walter E. Kaufmann
- Department of Human Genetics, Emory University School of
Medicine, Atlanta, GA, USA
| | - Timothy A. Benke
- Children’s Hospital Colorado, University of Colorado
School of Medicine Departments of Pediatrics, Neurology, Pharmacology and
Otolaryngology, Aurora, Colorado, USA
| | - Anne B. Fulton
- Department of Ophthalmology, Boston Children’s
Hospital and Harvard Medical School, Boston, MA, USA
| | - Ronald Hansen
- Department of Ophthalmology, Boston Children’s
Hospital and Harvard Medical School, Boston, MA, USA
| | - Annapurna Poduri
- Division of Epilepsy and Clinical Neurophysiology and
Epilepsy Genetics Program, Department of Neurology, Boston Children’s
Hospital and Harvard Medical School, Boston, MA, USA
| | - Gena Heidary
- CDKL5 Center of Excellence, Department of Neurology, Boston
Children’s Hospital, Boston, MA, USA,Department of Ophthalmology, Boston Children’s
Hospital and Harvard Medical School, Boston, MA, USA
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18
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Akula JD, Arellano IA, Swanson EA, Favazza TL, Bowe TS, Munro RJ, Ferguson RD, Hansen RM, Moskowitz A, Fulton AB. The Fovea in Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2021; 61:28. [PMID: 32936301 PMCID: PMC7500148 DOI: 10.1167/iovs.61.11.28] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose Because preterm birth and retinopathy of prematurity (ROP) are associated with poor visual acuity (VA) and altered foveal development, we evaluated relationships among the central retinal photoreceptors, postreceptor retinal neurons, overlying fovea, and VA in ROP. Methods We obtained optical coherence tomograms (OCTs) in preterm born subjects with no history of ROP (none; n = 61), ROP that resolved spontaneously without treatment (mild; n = 51), and ROP that required treatment by laser ablation of the avascular peripheral retina (severe; n = 22), as well as in term born control subjects (term; n = 111). We obtained foveal shape descriptors, measured central retinal layer thicknesses, and demarcated the anatomic parafovea using automated routines. In subsets of these subjects, we obtained OCTs eccentrically through the pupil (n = 46) to reveal the fiber layer of Henle (FLH) and obtained adaptive optics scanning light ophthalmograms (AO-SLOs) of the parafoveal cones (n = 34) and measured their spacing and distribution. Results Both VA and foveal depth decreased with increasing ROP severity (term, none, mild, severe). In severe subjects, foveae were broader than normal and the parafovea was significantly enlarged compared to every other group. The FLH was thinner than normal in mild (but not severe) subjects. VA was associated with foveal depth more than group. Density of parafoveal cones did not differ significantly among groups. Conclusions Foveal structure is associated with loss of VA in ROP. The preserved FLH in severe (relative to mild) eyes suggests treatment may help cone axon development. The significantly larger parafovea and increased outer nuclear layer (ONL) thickness in ROP hint that some developmental process affecting the photoreceptors is not arrested in ROP but rather is supranormal.
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Affiliation(s)
- James D Akula
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ivana A Arellano
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Emily A Swanson
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Tara L Favazza
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Theodore S Bowe
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Robert J Munro
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - R Daniel Ferguson
- Department of Biomedical Optics, Physical Sciences, Inc., Andover, Massachusetts, United States
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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19
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Abstract
Artificial intelligence (AI), with its subdivisions (machine and deep learning), is a new branch of computer science that has shown impressive results across a variety of domains. The applications of AI to medicine and biology are being widely investigated. Medical specialties that rely heavily on images, including radiology, dermatology, oncology and ophthalmology, were the first to explore AI approaches in analysis and diagnosis. Applications of AI in ophthalmology have concentrated on diseases with high prevalence, such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration (AMD), and glaucoma. Here we provide an overview of AI applications for diagnosis, classification, and clinical management of AMD and other macular dystrophies.
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Affiliation(s)
- Tatiana Perepelkina
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, United States
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20
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Jabroun MN, AlWattar BK, Fulton AB. Optical Coherence Tomography Angiography in Prematurity. Semin Ophthalmol 2021; 36:264-269. [PMID: 33689582 DOI: 10.1080/08820538.2021.1893760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: During normal foveal development there is a close interaction between the neurosensory and vascular elements of the fovea making it vulnerable to prematurity and retinopathy of prematurity (ROP). We aim to assess this potential effect on foveal development in preterms evaluated simultaneously with both optical coherence tomography (OCT) and OCT angiography (OCTA).Method: Unrestricted literature search in the PubMed and Cochrane library databases yielded 20 distinct citations. Fifteen were relevant and reviewed.Results: In preterms, OCTA demonstrated a significant decrease in the foveal avascular zone area and an increase in foveal vessel density. OCT showed a decrease in foveal pit depth and an increase in the thickness of the subfoveal retinal layers. Some studies correlated these changes with reduced vision.Conclusion: Changes in the vascular and neurosensory retina were found in premature children. It remains unclear whether this is related to prematurity alone or ROP and its treatment.
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Affiliation(s)
- Mireille N Jabroun
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Bilal K AlWattar
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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21
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Ehrenberg M, Bagdonite-Bejarano L, Fulton AB, Orenstein N, Yahalom C. Genetic causes of nystagmus, foveal hypoplasia and subnormal visual acuity- other than albinism. Ophthalmic Genet 2021; 42:243-251. [PMID: 33594928 DOI: 10.1080/13816810.2021.1888128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: To describe genetic molecular findings in individuals with congenital nystagmus, foveal hypoplasia, and subnormal vision, with normal ocular pigmentation (absence of diffuse transillumination or transparent retinal pigment typical for albinism).Methods: This is a retrospective, multicenter study of ophthalmic, systemic, and genetic features, as collected from medical records of patients diagnosed with infantile nystagmus and foveal hypoplasia. Ophthalmic findings include best-corrected visual acuity (BCVA), biomicroscopic examination, cycloplegic refraction, retinal examination, macular optical coherence tomography, and electroretinography. Genetic information was retrieved from the participating genetic clinics and included ethnicity and molecular diagnosis.Results: Thirty-one individuals met the inclusion criteria and had a secure molecular diagnosis. Mutations in two genes predominated, constituting 77.4% of all the represented genes: SLC38A8 (45.1%) and PAX6 (32.3%). Seventy-eight percent of the subjects who had a measurable BCVA had moderate and severe visual impairment (range 20/80 to 20/270). Most patients with a mutation in SLC38A8 had mild to moderate astigmatism, while most patients with PAX6 mutation had moderate and severe myopia. Patients in the PAX6 group had variable degrees of anterior segment manifestations.Conclusion: In our cohort, the main causative genes for congenital nystagmus and foveal hypoplasia in normally pigmented eyes were SLC38A8 and PAX6. A mild phenotype in PAX6 mutations may be an under-diagnosed cause of nystagmus and foveal hypoplasia. Reaching an accurate genetic diagnosis is essential for both the patients and their family members. This enables predicting disease prognosis, tailoring correct follow-up, and providing genetic counseling and family planning to affected families.
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Affiliation(s)
- Miriam Ehrenberg
- Ophthalmology Unit, Schneider Children's Medical Center in Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Anne B Fulton
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Naama Orenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Genetic Department, Children's Medical Center in Israel, Petach Tikva, Israel
| | - Claudia Yahalom
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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22
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Ambrosio L, Hansen RM, Moskowitz A, Oza A, Barrett D, Manganella J, Medina G, Kawai K, Fulton AB, Kenna M. Dark-adapted threshold and electroretinogram for diagnosis of Usher syndrome. Doc Ophthalmol 2021; 143:39-51. [PMID: 33511521 DOI: 10.1007/s10633-021-09818-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine the utility of ophthalmology evaluation, dark-adapted threshold, and full-field electroretinogram for early detection of Usher syndrome in young patients with bilateral sensorineural hearing loss. METHODS We identified 39 patients with secure genetic diagnoses of Usher Syndrome. Visual acuity, spherical equivalent, fundus appearance, dark-adapted threshold, and full-field electroretinogram results were summarized and compared to those in a group of healthy controls with normal hearing. In those Usher patients with repeated measures, regression analysis was done to evaluate for change in visual acuity and dark-adapted threshold with age. Spherical equivalent and full-field electroretinogram responses from dark- and light-adapted eyes were evaluated as a function of age. RESULTS The majority of initial visual acuity and spherical equivalent results were within normal limits for age. Visual acuity and dark-adapted threshold worsened significantly with age in Usher type 1 but not in Usher type 2. At initial test, full-field electroretinogram responses from dark- and light-adapted eyes were abnormal in 53% of patients. Remarkably, nearly half of our patients (17% of Usher type 1 and 30% of Usher type 2) would have been missed by tests of retinal function alone if evaluated before age 10. CONCLUSIONS Although there is an association of abnormal dark-adapted threshold and full-field electroretinogram at young ages in Usher patients, it appears that a small but important proportion of patients would not be detected by tests of retinal function alone. Thus, genetic testing is needed to secure a diagnosis of Usher syndrome.
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Affiliation(s)
- Lucia Ambrosio
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Andrea Oza
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, 65 Landsdowne Street, Cambridge, MA, 02139, USA
| | - Devon Barrett
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Juliana Manganella
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Genevieve Medina
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Ophthalmology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.,Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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23
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Ambrosio L, Williams JS, Gutierrez A, Swanson EA, Munro RJ, Ferguson RD, Fulton AB, Akula JD. Carbonic anhydrase inhibition in X-linked retinoschisis: An eye on the photoreceptors. Exp Eye Res 2020; 202:108344. [PMID: 33186570 DOI: 10.1016/j.exer.2020.108344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/01/2020] [Accepted: 10/26/2020] [Indexed: 12/28/2022]
Abstract
The retinoschisin protein is encoded on the short arm of the X-chromosome by RS1, is expressed abundantly in photoreceptor inner segments and in bipolar cells, and is secreted as an octamer that maintains the structural integrity of the retina. Mutations in RS1 lead to X-linked retinoschisis (XLRS), a disease characterized by the formation of cystic spaces between boys' retinal layers that frequently present in ophthalmoscopy as a "spoke-wheel" pattern on their maculae and by progressively worsening visual acuity (VA). There is no proven therapy for XLRS, but there is mixed evidence that carbonic anhydrase inhibitors (CAIs) produce multiple beneficial effects, including improved VA and decreased volume of cystic spaces. Consequently, linear mixed-effects (LME) models were used to evaluate the effects of CAI therapy on VA and central retinal thickness (CRT, a proxy for cystic cavity volume) in a review of 19 patients' records. The mechanism of action of action of CAIs is unclear but, given that misplaced retinoschisin might accumulate in the photoreceptors, it is possible-perhaps even likely-that CAIs act to benefit the function of photoreceptors and the neighboring retinal pigment epithelium by acidification of the extracellular milieu; patients on CAIs have among the most robust photoreceptor responses. Therefore, a small subset of five subjects were recruited for imaging on a custom multimodal adaptive optics retinal imager for inspection of their parafoveal cone photoreceptors. Those cones that were visible, which numbered far fewer than in controls, were enlarged, consistent with the retinoschisin accumulation hypothesis. Results of the LME modeling found that there is an initial benefit to both VA and CRT in CAI therapy, but these wane, in both cases, after roughly two years. That said, even a short beneficial effect of CAIs on the volume of the cystic spaces may give CAI therapy an important role as pretreatment before (or immediately following) administration of gene therapy.
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Affiliation(s)
- Lucia Ambrosio
- Ophthalmology, Boston Children's Hospital, USA; Ophthalmology, Harvard Medical School, USA
| | - Jacqueline S Williams
- Ophthalmology, Boston Children's Hospital, USA; Biology, Northeastern University, USA
| | - Alfredo Gutierrez
- Ophthalmology, Boston Children's Hospital, USA; Community Health, Tufts University, USA
| | | | | | | | - Anne B Fulton
- Ophthalmology, Boston Children's Hospital, USA; Ophthalmology, Harvard Medical School, USA
| | - James D Akula
- Ophthalmology, Boston Children's Hospital, USA; Ophthalmology, Harvard Medical School, USA; Psychology, Northeastern University, USA.
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24
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Abstract
Purpose To assess retinal function in young patients with X-linked juvenile retinoschisis (XLRS), a disorder that is known to alter ERG postreceptor retinal components and also possibly photoreceptor components. Methods ERG responses to full-field stimuli were recorded under scotopic and photopic conditions in 12 XLRS patients aged 1 to 15 (median 8) years. A- and b-wave amplitudes and implicit times were examined over a range of stimulus intensities. Rod and cone photoreceptor (SROD, RROD, SCONE, RCONE) and rod-driven postreceptor (log σ, VMAX) response parameters were calculated from the a- and b-waves. Data from XLRS patients were evaluated for significant change with age. Results A- and b-wave amplitudes were smaller in XLRS patients compared with controls under both scotopic and photopic conditions. Saturated photoresponse amplitude (RROD), postreceptor b-wave (log σ), and saturated b-wave amplitude (VMAX) were significantly lower in XLRS patients than in controls; SROD did not differ between the two groups. SCONE and RCONE values were normal. In XLRS patients, neither a- and b-wave amplitudes nor calculated parameters (SROD, RROD, log σ, VMAX,SCONE, and RCONE) changed with age. Conclusions In these young XLRS patients, RROD and a-wave amplitudes were significantly smaller than in controls. Thus, in addition to XLRS causing postreceptor dysfunction, an effect of XLRS on rod photoreceptors cannot be ignored.
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Affiliation(s)
- Lucia Ambrosio
- Department of Ophthalmology, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States
| | - Rotem Kimia
- Department of Ophthalmology, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts, United States
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25
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Nguyen JQN, Resnick CM, Chang YH, Hansen RM, Fulton AB, Moskowitz A, Calabrese CE, Dagi LR. Impact of Obstructive Sleep Apnea on Optic Nerve Function in Patients With Craniosynostosis and Recurrent Intracranial Hypertension. Am J Ophthalmol 2019; 207:356-362. [PMID: 31228466 DOI: 10.1016/j.ajo.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Assessment of combined impact of intracranial hypertension (ICH) and obstructive sleep apnea (OSA) on optic nerve function in children with craniosynostosis (CS). DESIGN Retrospective cross-sectional study. METHODS Patients treated at Boston Children's Hospital for CS who had an ophthalmic examination that included pattern reversal (pr)VEP (2013-2014) and history of ICH based on direct measurement, papilledema, or classic features on neuroimaging and during cranial vault expansion were included. History of OSA was determined by polysomnography and associated conditions, including apnea and (adeno)tonsillectomy. Subjects were divided into 4 groups: group 1, resolved ICH absent history of OSA; group 2, resolved ICH with history of OSA; group 3, recurrent ICH absent history of OSA; and group 4, recurrent ICH with history of OSA. Predictor variables included latency of P100 component of pattern-reversal visual evoked potential, best-corrected visual acuity, optic nerve appearance, visual fields, and global retinal nerve fiber layer. Primary outcome was association of prolonged P100 latency with resolved vs recurrent ICH and OSA. RESULTS Twenty-eight children met inclusion criteria (mean age 11.6 ± 6.9 years): group 1 (n = 3), group 2 (n = 6), group 3 (n = 8), and group 4 (n = 11). P100 latencies were not prolonged in groups 1 and 2. Three of 8 in group 3 and 9 of 11 in group 4 had prolonged P100 latency. Group 4 was significantly worse than group 3 (P = .005). CONCLUSIONS History of OSA, in addition to recurrent ICH, is associated with greatest risk of optic neuropathy with CS. Ophthalmologists should encourage early management of OSA as well as ICH to optimize ophthalmic outcomes.
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Affiliation(s)
- Josephine Q N Nguyen
- Department of Plastic and Oral Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Yoon-Hee Chang
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Carly E Calabrese
- Department of Plastic and Oral Surgery, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
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26
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Akula JD, Ambrosio L, Howard FI, Hansen RM, Fulton AB. Extracting the ON and OFF contributions to the full-field photopic flash electroretinogram using summed growth curves. Exp Eye Res 2019; 189:107827. [PMID: 31600486 DOI: 10.1016/j.exer.2019.107827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
Under cone-mediated (photopic) conditions, an "instantaneous" flash of light, including both stimulus onset and offset, will simultaneously activate both "ON" and "OFF" bipolar cells, which either depolarize (ON) or hyperpolarize (OFF) in response and, respectively, produce positive-going and negative-going deflections in the electroretinogram (ERG). The stimulus-response (SR) relationship of the photopic ON response demonstrates logistic growth, like that manifested in the rod-mediated (scotopic) b-wave, which is driven by a single class of depolarizing bipolar cell. However, the photopic b-wave SR function is importantly shaped by OFF responses, leading to a "photopic hill." Furthermore, both on and off stimuli elicit activity in both ON and OFF bipolar cells. This has made it difficult to produce meaningful parameters for ready interpretation of the photopic b-wave SR relationship. Therefore, we evaluated whether the sum of sigmoidal SR functions, as descriptors of the depolarizing and hyperpolarizing components of the photopic flash ERG, could be used to elucidate and quantitate the mechanisms that produce the photopic hill. We used a novel fitting routine to optimize a sum of simple sigmoidal curves to SR data in five groups of subjects: Healthy adult, 10-week-old infant, congenital stationary night blindness (CSNB), X-linked juvenile retinoschisis (XJR), and preterm-born, both without and with a history of retinopathy of prematurity (ROP). Differences in ON and OFF amplitude, sensitivity, and implicit time among the groups were then compared using parameters extracted from these fits. We found that our modeling procedure enabled plausible derivations of ON and OFF pathway contributions to the ERG, and that the parameters produced appeared to have physiological relevance. In adult subjects, the ON and OFF amplitudes were similar in magnitude with respectively longer and shorter implicit times. Infant, CSNB, and XJR subjects showed significant ON pathway deficits. History of preterm-birth, without or with a diagnosis of ROP, did not much affect cone responses.
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Affiliation(s)
- James D Akula
- Ophthalmology, Boston Children's Hospital, Boston, MA, United States; Ophthalmology, Harvard Medical School, Boston, MA, United States.
| | - Lucia Ambrosio
- Ophthalmology, Boston Children's Hospital, Boston, MA, United States; Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Fiona I Howard
- Ophthalmology, Boston Children's Hospital, Boston, MA, United States; Psychology, Northeastern University, Boston, MA, United States
| | - Ronald M Hansen
- Ophthalmology, Boston Children's Hospital, Boston, MA, United States; Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Anne B Fulton
- Ophthalmology, Boston Children's Hospital, Boston, MA, United States; Ophthalmology, Harvard Medical School, Boston, MA, United States
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27
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Affiliation(s)
| | - Ronald M. Hansen
- Ophthalmology Department, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Anne B. Fulton
- Ophthalmology Department, Boston Children’s Hospital/Harvard Medical School, Boston, MA, USA
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28
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Abstract
BACKGROUND Photophobia is commonly associated with migraine, meningitis, concussion, and a variety of ocular diseases. Advances in our ability to trace multiple brain pathways through which light information is processed have paved the way to a better understanding of the neurobiology of photophobia and the complexity of the symptoms triggered by light. PURPOSE The purpose of this review is to summarize recent anatomical and physiological studies on the neurobiology of photophobia with emphasis on migraine. RECENT FINDINGS Observations made in blind and seeing migraine patients, and in a variety of animal models, have led to the discovery of a novel retino-thalamo-cortical pathway that carries photic signal from melanopsinergic and nonmelanopsinergic retinal ganglion cells (RGCs) to thalamic neurons. Activity of these neurons is driven by migraine and their axonal projections convey signals about headache and light to multiple cortical areas involved in the generation of common migraine symptoms. Novel projections of RGCs into previously unidentified hypothalamic neurons that regulate parasympathetic and sympathetic functions have also been discovered. Finally, recent work has led to a novel understanding of color preference in migraine-type photophobia and of the roles played by the retina, thalamus, and cortex. SUMMARY The findings provide a neural substrate for understanding the complexity of aversion to light in patients with migraine and neuro-ophthalmologic other disorders.
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Affiliation(s)
- Rami Burstein
- Department of Anesthesia and Critical Care (RB, RN), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology (ABF), Children's Hospital Boston, Boston, Massachusetts
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Bronstad PM, Peli E, Liu R, Doherty A, Fulton AB. High prevalence of strabismic visual field expansion in pediatric homonymous hemianopia. PLoS One 2018; 13:e0209213. [PMID: 30566507 PMCID: PMC6300329 DOI: 10.1371/journal.pone.0209213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/30/2018] [Indexed: 11/18/2022] Open
Abstract
If homonymous hemianopia develops in childhood it is frequently accompanied by strabismus. In some of these cases the strabismus increases the size of the binocular visual field. We determined how prevalent visual-field-expanding strabismus is in children who have homonymous hemianopia. Medical records were examined from 103 hemianopic patients with exotropia (XT) or esotropia (ET). For each participant, we determined whether their strabismus was in a direction that resulted in visual field expansion (i.e. left exotropia with left homonymous hemianopia). Ages at which hemianopia and strabismus were first noted were compared to determine which developed first. The prevalence of XT (24%) and ET (9%) with homonymous hemianopia were both much higher than in the general population (1.5% and 5%, respectively). More strabismic eyes pointed to the blind than seeing side (62 vs 41, 60% vs. 40%, p = 0.02). Exotropic eyes were five times more likely to point to the blind side than esotropic eyes (85% vs 15%). Strabismus, especially exotropia, is much more common in pediatric homonymous hemianopia than in the general population. The strabismus is significantly more often in a visual field-expanding direction. These results support an adaptive role for the strabismus. Patients with HH and exotropia or esotropia should be aware that their visual field could be reduced by strabismus surgery.
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Affiliation(s)
- P. Matthew Bronstad
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rui Liu
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Amy Doherty
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States of America
| | - Anne B. Fulton
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States of America
- Boston Children’s Hospital, Boston, Massachusetts, United States of America
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Robson AG, Nilsson J, Li S, Jalali S, Fulton AB, Tormene AP, Holder GE, Brodie SE. ISCEV guide to visual electrodiagnostic procedures. Doc Ophthalmol 2018; 136:1-26. [PMID: 29397523 PMCID: PMC5811581 DOI: 10.1007/s10633-017-9621-y] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
Clinical electrophysiological testing of the visual system incorporates a range of noninvasive tests and provides an objective indication of function relating to different locations and cell types within the visual system. This document developed by the International Society for Clinical Electrophysiology of Vision provides an introduction to standard visual electrodiagnostic procedures in widespread use including the full-field electroretinogram (ERG), the pattern electroretinogram (pattern ERG or PERG), the multifocal electroretinogram (multifocal ERG or mfERG), the electrooculogram (EOG) and the cortical-derived visual evoked potential (VEP). The guideline outlines the basic principles of testing. Common clinical presentations and symptoms are described with illustrative examples and suggested investigation strategies.
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Affiliation(s)
- Anthony G Robson
- Department of Electrophysiology, Moorfields Eye Hospital, 162 City Road, London, UK. .,Institute of Ophthalmology, University College London, London, UK.
| | - Josefin Nilsson
- Department of Clinical Neurophysiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Shiying Li
- Southwest Hospital, Southwest Eye Hospital, Third Military Medical University, Chongqing Institute of Retina, Chongqing, China
| | - Subhadra Jalali
- Srimati Kanuri Santhamma Centre for Vitreoretinal Diseases, Jasti V. Ramanamma Childrens' Eye Care Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, USA
| | | | - Graham E Holder
- Department of Electrophysiology, Moorfields Eye Hospital, 162 City Road, London, UK.,Institute of Ophthalmology, University College London, London, UK.,National University of Singapore, National University Hospital, Singapore City, Singapore
| | - Scott E Brodie
- The Mount Sinai Hospital, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
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Men CJ, Bujakowska KM, Comander J, Place E, Bedoukian EC, Zhu X, Leroy BP, Fulton AB, Pierce EA. The importance of genetic testing as demonstrated by two cases of CACNA1F-associated retinal generation misdiagnosed as LCA. Mol Vis 2017; 23:695-706. [PMID: 29062221 PMCID: PMC5640518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/08/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe in detail cases with an initial diagnosis of Leber congenital amaurosis that were later found to have a hemizygous mutation in the CACNA1F gene. METHODS The patients underwent a detailed ophthalmological evaluation and full-field electroretinography (ERG). Selective targeted capture and whole-exome next-generation sequencing (NGS) were used to find the disease-causing mutations. RESULTS Patient 1 presented at age 3 months with nystagmus, normal visual attention, and a normal fundus exam. ERG responses were severely decreased. Patient 2 presented with nystagmus, severe hyperopia, esotropia, and visual acuity of 20/360 oculus dexter (OD) and 20/270 oculus sinister (OS) at age 5 months. His fundus exam showed slightly increased pigmentation around the foveae. The scotopic ERG responses were severely decreased and photopic responses mildly decreased. Based on the initial presentation, both patients received the clinical diagnosis of Leber congenital amaurosis (LCA). However, genetic testing showed no mutations in known LCA genes. Instead, broader genetic testing using NGS showed point mutations in the CACNA1F gene, which is reported to be associated with type 2 congenital stationary night blindness (CSNB2). CONCLUSIONS These two cases demonstrate the clinical overlap between LCA and CSNB in infants and young children. Genetic testing is an essential tool in these cases and provides a more accurate diagnosis and prognosis for patients with inherited retinal degenerative disorders.
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Affiliation(s)
- Clara J. Men
- Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Kinga M. Bujakowska
- Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Jason Comander
- Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Emily Place
- Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Emma C. Bedoukian
- Ophthalmic Genetics & Visual Electrophysiology, Division of Ophthalmology, The Children’s Hospital of Philadelphia, PA
| | - Xiaosong Zhu
- Ophthalmic Genetics & Visual Electrophysiology, Division of Ophthalmology, The Children’s Hospital of Philadelphia, PA
| | - Bart P. Leroy
- Ophthalmic Genetics & Visual Electrophysiology, Division of Ophthalmology, The Children’s Hospital of Philadelphia, PA,Department of Ophthalmology & Center for Medical Genetics, Ghent University Hospital & Ghent University, Ghent, Belgium
| | - Anne B. Fulton
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
| | - Eric A. Pierce
- Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
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Abstract
Purpose The purpose of this study is to assess cone-mediated central retinal function in children with a history of preterm birth, including subjects with and without retinopathy of prematurity (ROP). The multifocal electroretinogram (mfERG) records activity of the postreceptor retinal circuitry. Methods mfERG responses were recorded to an array of 103 hexagonal elements that subtended 43° around a central fixation target. The amplitude and latency of the first negative (N1) and first positive (P1) response were evaluated in six concentric rings centered on the fovea. Responses were recorded from 40 subjects with a history of preterm birth (severe ROP, mild ROP, no ROP) and 19 term-born control subjects. Results The amplitude of N1 and P1 varied significantly with eccentricity and ROP severity. For all four groups, these amplitudes were largest in the center and decreased with eccentricity. At all eccentricities, N1 amplitude was significantly smaller in severe ROP and did not differ significantly among the other three groups (mild ROP, no ROP, term-born controls). P1 amplitude in all preterm groups was significantly smaller than in controls; P1 amplitude was similar in no ROP and mild ROP and significantly smaller in severe ROP. Conclusions These results provide evidence that premature birth alone affects cone-mediated central retinal function and that the magnitude of the effect varies with severity of the antecedent ROP. The lack of difference in mfERG amplitude between the mild and no ROP groups is evidence that the effect of ROP on the neurosensory retina may not depend solely on appearance of abnormal retinal vasculature.
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Affiliation(s)
- Pablo Altschwager
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States 2Departamento de Oftalmologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
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Abstract
PURPOSE To assess scotopic background adaptation in subjects with a history of preterm birth and retinopathy of prematurity (ROP). Retinopathy of prematurity is known to have long-term effects on rod photoreceptor and rod mediated postreceptor retinal function. METHODS Rod-mediated thresholds for detection of 3° diameter, 50 ms stimuli presented 20° from fixation were measured using a spatial forced choice method in 36 subjects (aged 9-17 years) with a history of preterm birth and 11 age similar term-born subjects. Thresholds were measured first in the dark-adapted condition and then in the presence of 6 steady background lights (-2.8 to +2.0 log scot td). A model of the increment threshold function was fit to each subject's thresholds to estimate the dark-adapted threshold (TDA) and the Eigengrau (A0, the background that elevates threshold 0.3 log unit above TDA). RESULTS In subjects with a history of severe ROP, both TDA and A0 were significantly elevated relative to those in former preterms who never had ROP and term-born control subjects. Subjects who had mild ROP had normal TDA but elevated A0. Neither TDA nor A0 differed significantly between former preterms who never had ROP and term-born controls. CONCLUSIONS The results suggest that in severe ROP, threshold is affected at a preadaptation site, possibly the rod outer segment. In mild ROP, changes in the Eigengrau may reflect increased intrinsic noise in the photoreceptor or postreceptor circuitry or both.
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Fulton AB, Hansen RM, Akula JD, Moskowitz A. The developing retina: typical and in retinopathy of prematurity (ROP). J Vis 2017. [DOI: 10.1167/17.7.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
In this article, we review the following 3 common juvenile macular degenerations: Stargardt disease, X-linked retinoschisis, and Best vitelliform macular dystrophy. These are inherited disorders that typically present during childhood, when vision is still developing. They are sufficiently common that they should be included in the differential diagnosis of visual loss in pediatric patients. Diagnosis is secured by a combination of clinical findings, optical coherence tomography imaging, and genetic testing. Early diagnosis promotes optimal management. Although there is currently no definitive cure for these conditions, therapeutic modalities under investigation include pharmacologic treatment, gene therapy, and stem cell transplantation.
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Affiliation(s)
- Pablo Altschwager
- Departamento de Oftalmología, Escuela de Medicina, Pontificia, Universidad Católica de Chile, Santiago, Chile.
| | - Lucia Ambrosio
- Department of Ophthalmology, Children's Hospital, Boston, MA 02115 USA,Department of Ophthalmology, Harvard Medical School, Boston, MA 02115 USA
| | - Emily A. Swanson
- Department of Ophthalmology, Children's Hospital, Boston, MA 02115 USA
| | - Anne Moskowitz
- Department of Ophthalmology, Children's Hospital, Boston, MA 02115 USA,Department of Ophthalmology, Harvard Medical School, Boston, MA 02115 USA
| | - Anne B. Fulton
- Department of Ophthalmology, Children's Hospital, Boston, MA 02115 USA,Department of Ophthalmology, Harvard Medical School, Boston, MA 02115 USA
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36
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Gradstein L, Hansen RM, Cox GF, Altschwager P, Fulton AB. Progressive retinal degeneration in a girl with Knobloch syndrome who presented with signs of ocular albinism. Doc Ophthalmol 2017; 134:135-140. [DOI: 10.1007/s10633-017-9574-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
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Abstract
Leber congenital amaurosis (LCA) is a group of severe inherited retinal dystrophies that lead to early childhood blindness. In the last decade, interest in LCA has increased as advances in genetics have been applied to better identify, classify, and treat LCA. To date, 23 LCA genes have been identified. Gene replacement in the RPE65 form of LCA represents a major advance in treatment, although limitations have been recognized. In this article, we review the clinical and genetic features of LCA and evaluate the evidence available for gene therapy in RPE65 disease.
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Affiliation(s)
- Maan Alkharashi
- a Boston Children's Hospital, Harvard Medical School , Boston , MA , USA.,b Department of Ophthalmology , King Saud University , Riyadh , Saudi Arabia
| | - Anne B Fulton
- b Department of Ophthalmology , King Saud University , Riyadh , Saudi Arabia
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Hansen RM, Moskowitz A, Akula JD, Fulton AB. The neural retina in retinopathy of prematurity. Prog Retin Eye Res 2016; 56:32-57. [PMID: 27671171 DOI: 10.1016/j.preteyeres.2016.09.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/15/2016] [Accepted: 09/20/2016] [Indexed: 12/26/2022]
Abstract
Retinopathy of prematurity (ROP) is a neurovascular disease that affects prematurely born infants and is known to have significant long term effects on vision. We conducted the studies described herein not only to learn more about vision but also about the pathogenesis of ROP. The coincidence of ROP onset and rapid developmental elongation of the rod photoreceptor outer segments motivated us to consider the role of the rods in this disease. We used noninvasive electroretinographic (ERG), psychophysical, and retinal imaging procedures to study the function and structure of the neurosensory retina. Rod photoreceptor and post-receptor responses are significantly altered years after the preterm days during which ROP is an active disease. The alterations include persistent rod dysfunction, and evidence of compensatory remodeling of the post-receptor retina is found in ERG responses to full-field stimuli and in psychophysical thresholds that probe small retinal regions. In the central retina, both Mild and Severe ROP delay maturation of parafoveal scotopic thresholds and are associated with attenuation of cone mediated multifocal ERG responses, significant thickening of post-receptor retinal laminae, and dysmorphic cone photoreceptors. These results have implications for vision and control of eye growth and refractive development and suggest future research directions. These results also lead to a proposal for noninvasive management using light that may add to the currently invasive therapeutic armamentarium against ROP.
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Affiliation(s)
- Ronald M Hansen
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - Anne Moskowitz
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - James D Akula
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
| | - Anne B Fulton
- Department of Ophthalmology, Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115-5737, USA.
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Ramamirtham R, Akula JD, Soni G, Swanson MJ, Bush JN, Moskowitz A, Swanson EA, Favazza TL, Tavormina JL, Mujat M, Ferguson RD, Hansen RM, Fulton AB. Extrafoveal Cone Packing in Eyes With a History of Retinopathy of Prematurity. Invest Ophthalmol Vis Sci 2016; 57:467-75. [PMID: 26868749 PMCID: PMC4758295 DOI: 10.1167/iovs.15-17783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose To study the density and packing geometry of the extrafoveal cone photoreceptors in eyes with a history of retinopathy of prematurity (ROP). We used a multimodal combination of adaptive optics (AO) scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT). Methods Cones were identified in subjects (aged 14–26 years) with a history of ROP that was either severe and treated by laser ablation of avascular peripheral retina (TROP; n = 5) or mild and spontaneously resolved, untreated (UROP; n = 5), and in term-born controls (CT; n = 8). The AO-SLO images were obtained at temporal eccentricities 4.5°, 9°, 13.5°, and 18° using both confocal and offset apertures with simultaneous, colocal OCT images. Effects of group, eccentricity, and aperture were evaluated and the modalities compared. Results In the SLO images, cone density was lower and the packing pattern less regular in TROP, relative to CT and UROP retinae. Although SLO image quality appeared lower in TROP, root mean square (RMS) wavefront error did not differ among the groups. In TROP eyes, cone discrimination was easier in offset aperture images. There was no evidence of cone loss in the TROP OCT images. Conclusions Low cone density in TROP confocal SLO images may have resulted from lower image quality. Since AO correction in these eyes was equivalent to that of the control group, and OCT imaging showed no significant cone loss, the optical properties of the inner retina or properties of the cones themselves are likely altered in a way that affects photoreceptor imaging.
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Affiliation(s)
- Ramkumar Ramamirtham
- Boston Children's Hospital, Boston, Massachusetts, United States 2Harvard Medical School, Boston, Massachusetts, United States
| | - James D Akula
- Boston Children's Hospital, Boston, Massachusetts, United States 2Harvard Medical School, Boston, Massachusetts, United States
| | - Garima Soni
- Boston Children's Hospital, Boston, Massachusetts, United States 3Northeastern University, Boston, Massachusetts, United States
| | - Matthew J Swanson
- Boston Children's Hospital, Boston, Massachusetts, United States 4Air Force Academy, Colorado, United States
| | - Jennifer N Bush
- Boston Children's Hospital, Boston, Massachusetts, United States
| | - Anne Moskowitz
- Boston Children's Hospital, Boston, Massachusetts, United States 2Harvard Medical School, Boston, Massachusetts, United States
| | - Emily A Swanson
- Boston Children's Hospital, Boston, Massachusetts, United States
| | - Tara L Favazza
- Boston Children's Hospital, Boston, Massachusetts, United States
| | - Jena L Tavormina
- Boston Children's Hospital, Boston, Massachusetts, United States
| | - Mircea Mujat
- Physical Sciences, Inc., Andover, Massachusetts, United States
| | | | - Ronald M Hansen
- Boston Children's Hospital, Boston, Massachusetts, United States 2Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Boston Children's Hospital, Boston, Massachusetts, United States 2Harvard Medical School, Boston, Massachusetts, United States
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Abstract
The pivotal role of the neurosensory retina in retinopathy of prematurity (ROP) disease processes has been amply demonstrated in rat models. We have hypothesized that analogous cellular processes are operative in human ROP and have evaluated these presumptions in a series on non-invasive investigations of the photoreceptor and post-receptor peripheral and central retina in infants and children. Key results are slowed kinetics of phototransduction and deficits in photoreceptor sensitivity that persist years after ROP has completely resolved based on clinical criteria. On the other hand, deficits in post-receptor sensitivity are present in infancy regardless of the severity of the ROP but are not present in older children if the ROP was so mild that it never required treatment and resolved without a clinical trace. Accompanying the persistent deficits in photoreceptor sensitivity, there is increased receptive field size and thickening of the post-receptor retinal laminae in the peripheral retina of ROP subjects. In the late maturing central retina, which mediates visual acuity, attenuation of multifocal electroretinogram activity in the post-receptor retina led us to the discovery of a shallow foveal pit and significant thickening of the post-receptor retinal laminae in the macular region; this is most likely due to failure of the normal centrifugal movement of the post-receptor cells during foveal development. As for refractive development, myopia, at times high, is more common in ROP subjects than in control subjects, in accord with refractive findings in other populations of former preterms. This information about the neurosensory retina enhances understanding of vision in patients with a history of ROP, and taken as a whole, raises the possibility that the neurosensory retina is a target for therapeutic intervention.
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Affiliation(s)
- Anne Moskowitz
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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Noseda R, Bernstein CA, Nir RR, Lee AJ, Fulton AB, Bertisch SM, Hovaguimian A, Cestari DM, Saavedra-Walker R, Borsook D, Doran BL, Buettner C, Burstein R. Migraine photophobia originating in cone-driven retinal pathways. Brain 2016; 139:1971-86. [PMID: 27190022 DOI: 10.1093/brain/aww119] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/03/2016] [Indexed: 01/03/2023] Open
Abstract
Migraine headache is uniquely exacerbated by light. Using psychophysical assessments in patients with normal eyesight we found that green light exacerbates migraine headache significantly less than white, blue, amber or red lights. To delineate mechanisms, we used electroretinography and visual evoked potential recording in patients, and multi-unit recording of dura- and light-sensitive thalamic neurons in rats to show that green activates cone-driven retinal pathways to a lesser extent than white, blue and red; that thalamic neurons are most responsive to blue and least responsive to green; and that cortical responses to green are significantly smaller than those generated by blue, amber and red lights. These findings suggest that patients' experience with colour and migraine photophobia could originate in cone-driven retinal pathways, fine-tuned in relay thalamic neurons outside the main visual pathway, and preserved by the cortex. Additionally, the findings provide substrate for the soothing effects of green light.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02215, USA Harvard Medical School, Boston, MA 02115, USA
| | - Carolyn A Bernstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02215, USA Harvard Medical School, Boston, MA 02115, USA
| | - Rony-Reuven Nir
- Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel, 31096
| | - Alice J Lee
- Harvard Catalyst Clinical Research Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Anne B Fulton
- Harvard Medical School, Boston, MA 02115, USA Department of Ophthalmology, Children's Hospital Boston, Boston MA 02115, USA
| | - Suzanne M Bertisch
- Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Alexandra Hovaguimian
- Harvard Medical School, Boston, MA 02115, USA Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Dean M Cestari
- Harvard Medical School, Boston, MA 02115, USA Department of Neuro-ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | - Rodrigo Saavedra-Walker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02215, USA
| | - David Borsook
- Harvard Medical School, Boston, MA 02115, USA Center for Pain and the Brain, Department of Anesthesia Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | | | - Catherine Buettner
- Harvard Medical School, Boston, MA 02115, USA Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02215, USA Harvard Medical School, Boston, MA 02115, USA
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Tanimoto N, Akula JD, Fulton AB, Weber BHF, Seeliger MW. Differentiation of murine models of “negative ERG” by single and repetitive light stimuli. Doc Ophthalmol 2016; 132:101-9. [DOI: 10.1007/s10633-016-9534-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/03/2016] [Indexed: 02/03/2023]
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Munro RJ, Fulton AB, Chui TYP, Moskowitz A, Ramamirtham R, Hansen RM, Prabhu SP, Akula JD. Eye growth in term- and preterm-born eyes modeled from magnetic resonance images. Invest Ophthalmol Vis Sci 2015; 56:3121-31. [PMID: 26024095 DOI: 10.1167/iovs.14-15980] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We generated a model of eye growth and tested it against an eye known to develop abnormally, one with a history of retinopathy of prematurity (ROP). METHODS We reviewed extant magnetic resonance images (MRIs) from term and preterm-born patients for suitable images (n = 129). We binned subjects for analysis based upon postmenstrual age at birth (in weeks) and ROP history ("Term" ≥ 37, "Premature" ≤ 32 with no ROP, "ROP" ≤ 32 with ROP). We measured the axial positions and curvatures of the cornea, anterior and posterior lens, and inner retinal surface. We fit anterior chamber depth (ACD), posterior segment depth (PSD), axial length (AL), and corneal and lenticular curvatures with logistic growth curves that we then evaluated for significant differences. We also measured the length of rays from the centroid to the surface of the eye at 5° intervals, and described the length versus age relationship of each ray, L(ray)(x), using the same logistic growth curve. We determined the rate of ray elongation, E(ray)(x), from L(ray)dy/dx. Then, we estimated the scleral growth that accounted for E(ray)(x), G(x), at every age and position. RESULTS Relative to Term, development of ACD, PSD, AL, and corneal and lenticular curvatures was delayed in ROP eyes, but not Premature eyes. In Term infants, G(x) was fast and predominantly equatorial; in age-matched ROP eyes, maximal G(x) was offset by approximately 90°. CONCLUSIONS We produced a model of normal eye growth in term-born subjects. Relative to normal, the ROP eye is characterized by delayed, abnormal growth.
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Affiliation(s)
- Robert J Munro
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Toco Y P Chui
- Department of Optometry, Indiana University Bloomington, Bloomington, Indiana, United States 4Department of Ophthalmology, New York Eye and Ear Infirmary, New York, New York, United States
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ramkumar Ramamirtham
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, United States 6Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States
| | - James D Akula
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States 2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Akula JD, Noonan ER, Di Nardo A, Favazza TL, Zhang N, Sahin M, Hansen RM, Fulton AB. Vigabatrin can enhance electroretinographic responses in pigmented and albino rats. Doc Ophthalmol 2015; 131:1-11. [PMID: 25761928 DOI: 10.1007/s10633-015-9491-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/23/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effects of the antiepileptic medication vigabatrin (VGB) on the retina of pigmented rats. METHODS Scotopic and photopic electroretinograms were recorded from dark- and light-adapted Long-Evans (pigmented) and Sprague Dawley (albino) rats administered, daily, 52-55 injections of 250 mg·kg(-1)·day(-1) VGB or 25-26 injections of 500 mg·kg(-1)·day(-1) VGB, or a corresponding number of sham injections. Sensitivity and saturated amplitude of the rod photoresponse (S, Rm(P3)) and postreceptor response (1/σ, Vm) were derived, as were sensitivity and amplitude of the cone-mediated postreceptor response (1/σ(cone), Vm(cone)). The oscillatory potentials and responses to a series of flickering lights (6.25, 12.5, 25 and 50 Hz) were studied in the time and frequency domains. A subset of rats' eyes was harvested for Western blotting or histology. RESULTS Of the parameters derived from dark-adapted ERG responses, in both pigmented and albino rats, VGB repeatedly and reliably enhanced electroretinographic parameters; no significant ERG deficits were noted. No significant alterations were observed in ER/oxidative stress or in the Akt cell death/survival pathway. There were migrations of photoreceptor nuclei toward the RPE and outgrowths of bipolar cell dendrites into the outer nuclear layer in VGB-treated rats; these were never observed in sham-treated animals. CONCLUSIONS Although VGB is associated with retinal dysfunction in patients and VGB toxicity has been demonstrated by other laboratories in the albino rat, in our pigmented and albino rats, VGB did not induce deficits in, but rather enhanced, retinal function. Nonetheless, retinal neuronal dysplasia was observed.
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Hansen RM, Moskowitz A, Tavormina JL, Bush JN, Soni G, Fulton AB. Temporal summation in children with a history of retinopathy of prematurity. Invest Ophthalmol Vis Sci 2015; 56:914-7. [PMID: 25604681 DOI: 10.1167/iovs.14-16102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess temporal summation in children with a history of retinopathy of prematurity (ROP) by determining the critical duration (tCRIT) for complete temporal summation under rod-mediated conditions. From prior ERG studies, it is known that the kinetics of activation of phototransduction are prolonged in the ROP rod photoreceptor. METHODS Dark-adapted thresholds for detecting 10° diameter stimuli with durations from 10 to 640 ms were measured. A two-alternative, spatial, forced-choice psychophysical procedure was used. The tCRIT for complete summation was estimated in former preterm subjects with a history of severe ROP (n = 7), mild ROP (n = 23), and no ROP (n = 15). The subjects ranged in age from 10.4 to 17.6 (median 15.6) years. Age-similar term-born control subjects (n = 5) were also tested. RESULTS Critical duration was significantly longer in subjects with a history of ROP than in subjects who never had ROP or who were born at term. Mean tCRIT in the mild ROP group [127.5 (SD = 19.9) ms] and severe group [147.6 (SD = 18.9) ms] did not differ significantly, but both were significantly longer than in former preterms who never had ROP [101.1 (SD = 16.5) ms] and in term-born controls [101.0 (SD = 19.5) ms]. CONCLUSIONS In ROP subjects, tCRIT is significantly prolonged. This is likely due to abnormal kinetics in the rod outer segment.
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Affiliation(s)
- Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Jena L Tavormina
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Jennifer N Bush
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Garima Soni
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
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Abstract
PURPOSE To evaluate scotopic retinal organization in retinopathy of prematurity (ROP) through a study of spatial summation. METHODS Thresholds for a range of stimulus diameters (0.4°-10°) were measured using a two alternative, spatial, forced choice psychophysical procedure. The critical diameter (DCRIT) for complete summation was estimated in subjects with a history of severe ROP (N = 7) and mild ROP (N = 17). Subjects who were born preterm and never had ROP (N = 16) and term-born subjects (N = 7) were also tested. The subjects ranged in age from 9 to 17 (median 13.5) years. RESULTS Critical diameter for complete spatial summation was significantly larger in ROP subjects than in subjects who never had ROP and in term-born control subjects. Critical diameter varied significantly with severity of ROP. CONCLUSIONS The larger DCRIT values in ROP are consistent with altered organization of the post receptor retina. This may offer the ROP retina a strategy for achieving noise reduction and good dark-adapted visual sensitivity.
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Affiliation(s)
- Ronald M Hansen
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Jena L Tavormina
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Anne Moskowitz
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Anne B Fulton
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
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Abstract
Mutations in the CRB1 gene cause severe retinal degenerations, which may present as Leber congenital amaurosis, early onset retinal dystrophy, retinitis pigmentosa, or cone-rod dystrophy. Some clinical features should alert the ophthalmologist to the possibility of CRB1 disease. These features are nummular pigmentation of the retina, atrophic macula, retinal degeneration associated with Coats disease, and a unique form of retinitis pigmentosa named para-arteriolar preservation of the retinal pigment epithelium (PPRPE). Retinal degenerations associated with nanophthalmos and hyperopia, or with keratoconus, can serve as further clinical cues to mutations in CRB1. Despite this, no clear genotype-phenotype relationship has been established in CRB1 disease. In CRB1-disease, as in other inherited retinal degenerations (IRDs), it is essential to diagnose the specific disease-causing gene for the disease as genetic therapy has progressed considerably in the last few years and might be applicable.
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Affiliation(s)
- Miriam Ehrenberg
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
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Abstract
The Hermansky-Pudlak Syndrome (HPS) is a rare, autosomal recessive condition comprising nine genetically heterogeneous entities that feature oculocutaneous albinism (OCA) and bleeding tendency as their principal clinical manifestations. The pathogenesis of HPS involves disturbances in the biogenesis and trafficking of lysosome-related organelles. While the ophthalmologist is trained to address the ocular manifestations of OCA, it is critical for the provider to consider HPS when examining OCA patients as its systemic sequelae may be associated with morbidity and mortality. If there is suspicion of HPS in a patient with albinism, the ophthalmologist should enlist the aid of consultants to confirm the diagnosis and monitor for systemic features. As the nine HPS subtypes explored in this article vary widely in the character and severity of their associated systemic manifestations, some authors advocate determining the specific gene defect in each HPS patient in order to optimize care and provide anticipatory guidance.
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Affiliation(s)
- Andrew J Schneier
- Department of Ophthalmology, Children's Hospital Boston, Harvard Medical School, Boston , Massachusetts , USA
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Abstract
Mutations in the CRB1 gene cause severe retinal degenerations, which may present as Leber congenital amaurosis, early onset retinal dystrophy, retinitis pigmentosa, or cone-rod dystrophy. Some clinical features should alert the ophthalmologist to the possibility of CRB1 disease. These features are nummular pigmentation of the retina, atrophic macula, retinal degeneration associated with Coats disease, and a unique form of retinitis pigmentosa named para-arteriolar preservation of the retinal pigment epithelium (PPRPE). Retinal degenerations associated with nanophthalmos and hyperopia, or with keratoconus, can serve as further clinical cues to mutations in CRB1. Despite this, no clear genotype-phenotype relationship has been established in CRB1 disease. In CRB1-disease, as in other inherited retinal degenerations (IRDs), it is essential to diagnose the specific disease-causing gene for the disease as genetic therapy has progressed considerably in the last few years and might be applicable.
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Affiliation(s)
- Miriam Ehrenberg
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston , Massachusetts , USA
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McCulloch DL, Fulton AB. Introduction to the special issue: vision after premature birth. Doc Ophthalmol 2014; 127:1-2. [PMID: 23900583 DOI: 10.1007/s10633-013-9402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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