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Rizzo JF, Shah MP, Krasniqi D, Lu YR, Sinclair DA, Ksander BR. The Role of Epigenetics in Accelerated Aging: A Reconsideration of Later-Life Visual Loss After Early Optic Neuropathy. J Neuroophthalmol 2024; 44:16-21. [PMID: 37938114 DOI: 10.1097/wno.0000000000002041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND In 2005, we reported 3 patients with bilateral optic nerve damage early in life. These patients had stable vision for decades but then experienced significant bilateral vision loss with no obvious cause. Our hypothesis, novel at that time, was that the late decline of vision was due to age-related attrition of retinal ganglion cells superimposed on a reduced neuronal population due to the earlier injury. EVIDENCE ACQUISITION The field of epigenetics provides a new paradigm with which to consider the normal aging process and the impact of neuronal injury, which has been shown to accelerate aging. Late-in-life decline in function after early neuronal injury occurs in multiple sclerosis due to dysregulated inflammation and postpolio syndrome. Recent studies by our group in mice have also demonstrated the possibility of partial reversal of cellular aging and the potential to mitigate anatomical damage after injury and even improve visual function. RESULTS The results in mice and nonhuman primates published elsewhere have shown enhanced neuronal survival and visual function after partial epigenetic reprogramming. CONCLUSIONS Injury promotes epigenetic aging , and this finding can be observed in several clinically relevant scenarios. An understanding of the epigenetic mechanisms at play opens the opportunity to restore function in the nervous system and elsewhere with cellular rejuvenation therapies. Our earlier cases exemplify how reconsideration of previously established concepts can motivate inquiry of new paradigms.
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Affiliation(s)
- Joseph F Rizzo
- Department of Ophthalmology and the Neuro-Ophthalmology Service (JFR), Massachusetts Eye and Ear and the Harvard Medical School, Boston, Massachusetts; Avedisian and Chobanian School of Medicine (MPS), Boston University, Boston, Massachusetts; Department of Ophthalmology (MPS, DK, BRK), Harvard Medical School, Schepens Eye Research Institute of Mass Eye & Ear, Boston, Massachusetts; Department of Biology (YRL), Whitehead Institute for Biomedical Sciences, MIT, Cambridge, Massachusetts; and Paul F. Glenn Center for Biology of Aging Research (DAS), Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
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Cox JT, Minkus CL, Li A, Han S, Liu R, Shah P, Stanwyck LK, Rizzo JF, Sobrin L. Autoimmune Retinopathy: Intravenous Immunoglobulin Treatment versus Natural History. Ophthalmol Retina 2024:S2468-6530(24)00080-0. [PMID: 38428458 DOI: 10.1016/j.oret.2024.02.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Jacob T Cox
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Caroline L Minkus
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Ophthalmology, Park Nicollet Clinic, St. Louis Park, Minnesota
| | - Ashley Li
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Samuel Han
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Renee Liu
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Priya Shah
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lynn K Stanwyck
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Lucia Sobrin
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
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Chen A, Quinn C, Alexander MJ, Rizzo JF, Matiello M. Unilateral Internuclear Ophthalmoplegia and Upbeat Nystagmus Due to a Rapidly Enlarging Cavernous Malformation and Associated Developmental Venous Anomaly. J Neuroophthalmol 2024:00041327-990000000-00578. [PMID: 38376925 DOI: 10.1097/wno.0000000000002107] [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: 02/21/2024]
Affiliation(s)
- Amalie Chen
- Department of Neurology (AC, CQ), Massachusetts General Hospital, Brigham and Women's Hospital, Boston, Massachusetts; Department of Neurosurgery (MJA), Cedars-Sinai Medical Center, Los Angeles, California; Neuro-Ophthalmology Service, Department of Ophthalmology (JFR), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; and Department of Neurology (MM), Massachusetts General Hospital, Boston, Massachusetts
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Shah MP, Chen A, Rizzo JF. Leber's Hereditary Optic Neuropathy in a Nonagenarian. J Neuroophthalmol 2023:00041327-990000000-00515. [PMID: 37991885 DOI: 10.1097/wno.0000000000002040] [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: 11/24/2023]
Affiliation(s)
- Madhura P Shah
- Chobanian and Avedisian School of Medicine (MPS), Boston University, Boston, Massachusetts; and Neuro-Ophthalmology Service (MPS, AC, JFR), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Rizzo JF, Sanders DT, Castelbuono AC. Orbital Vasculopathy With Unexpected Finding of Calcium Oxalosis in the Context of a Clinical Diagnosis of Optic Neuropathy. J Neuroophthalmol 2023:00041327-990000000-00451. [PMID: 37643017 DOI: 10.1097/wno.0000000000001906] [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] [Indexed: 08/31/2023]
Abstract
BACKGROUND There are few reports of histopathology of any form of optic neuropathy. This article provides histopathologic findings of an adult-onset, nonprogressive optic neuropathy that was diagnosed clinically as nonacute, nonarteritic anterior ischemic optic neuropathy (NAION) but which was found by a pathological study to be associated with diffuse calcium oxalosis that was confined in the involved orbit. METHODS This is a case report that includes results of a neuro-ophthalmologic examination and histopathology of a complete autopsy, including en bloc removal of both orbits and the brain. The unaffected orbit/optic nerve served as a control. The affected orbit was serially sectioned into 2,550 increments each separated by 10 μm; the uninvolved orbit was sectioned into 150 equally spaced sections. The main outcome measures were derived from the autopsy, especially from the thin-section histopathologic study of both orbits that focused on blood vessels and the site of neural damage within the optic nerve. RESULTS The neuro-ophthalmologic examination revealed a unilateral optic neuropathy with pallor of the left optic nerve head that had been documented just before death. The general autopsy showed acute bacterial endocarditis and a recent cerebral hematoma that caused death. Histopathology revealed sectoral loss of optic nerve axons in the left eye. Numerous arterial walls in the left orbit, including short posterior ciliary arteries and the central retinal artery, contained hundreds of crystals with anisotropic, colorful birefringence consistent with calcium oxalosis. Crystals were not found in the right, control orbit or elsewhere in the body. CONCLUSIONS The patient developed an optic neuropathy late in life that was diagnosed by an experienced neuro-ophthalmologist as being most consistent with nonacute, nonarteritic anterior ischemic optic neuropathy. The autopsy identified sectoral loss of optic nerve fibers consistent with that diagnosis. However, the unexpected discovery of calcium oxalate crystals in blood vessels of the involved orbit, which curiously were not present elsewhere in the body, raises a question of their etiological role in this particular optic neuropathy. Whether the crystals were causal, epiphenomenal, or purely incidental to the optic neuropathy cannot be answered by our study.
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Affiliation(s)
- Joseph F Rizzo
- Neuro-Ophthalmology Service at the Massachusetts Eye and Ear and the Department of Ophthalmology (JFR), Harvard Medical School, Boston, Massachusetts; Mount Auburn Hospital and Harvard Medical School (DTS), Cambridge, Massachusetts; and Krieger Eye Institute at Sinai Hospital (ACC), Baltimore, Maryland
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Cubero Z, Chiou CA, Mukharesh L, Rizzo JF. A 61-Year-Old Man With Blepharoptosis, Ophthalmoplegia, Dysphagia, and Trouble Focusing His Eyes. J Neuroophthalmol 2023:00041327-990000000-00345. [PMID: 37171902 DOI: 10.1097/wno.0000000000001882] [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: 05/14/2023]
Affiliation(s)
- Zoe Cubero
- Juan Bautista School of Medicine (ZC), Caguas, Puerto Rico; Neuro-Ophthalmology Service (CAC, LM, JFR), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and Department of Neurology (LM), University of North Carolina, Chapel Hill, North Carolina
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Labowsky MT, Rizzo JF. The Controversy of Chronotherapy: Emerging Evidence regarding Bedtime Dosing of Antihypertensive Medications in Non-Arteritic Anterior Ischemic Optic Neuropathy. Semin Ophthalmol 2023; 38:99-104. [PMID: 36625504 DOI: 10.1080/08820538.2022.2152709] [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: 01/11/2023]
Abstract
"Blindness upon awakening" occurs in a significant proportion of patients with non-arteritic anterior ischemic optic neuropathy (NAION). This observation has led to a notion that nocturnal hypotension is a significant contributor and, perhaps, the final insult in a multifactorial process leading to the development of NAION, as has been proposed in other ischemic events like strokes, myocardial infarction, and ischemic rest pain. An extension of this concept has led to the recommendation that patients who have experienced NAION avoid taking blood pressure medications at bedtime. However, mounting evidence in the cardiology literature suggests that nocturnal hypertension is associated with increased risk of cardiovascular morbidity. In two prospective blood pressure monitoring studies in 1994 and 1999, Hayreh observed an extreme dipping pattern in nocturnal systolic blood pressure in NAION patients compared to reported normal values. Yet, two subsequent ambulatory blood pressure studies found either normal or non-dipping patterns in NAION patients. The majority of clinical trials published since 1976 that have studied nocturnal administration of antihypertensives have reported enhanced blood pressure control and reduced cardiovascular risk. Most notably, the large, prospective 2020 Hygia Chronotherapy Trial reported a statistically-significant beneficial effect of nocturnal antihypertensive dosing on cardiovascular outcomes and mortality. The controversy regarding nocturnal hypotension and NAION is of increasing relevance as there is new evidence to suggest a beneficial effect of nocturnal antihypertensive dosing in cardiovascular risk. This new information should prompt a re-evaluation of the relevant risk-to-benefit of reducing the risk of NAION on one hand, and the potential increase of cardiovascular risk on the other. Definitive resolution of this question would require a prospective, randomized control study with input from both cardiology and ophthalmology.
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Affiliation(s)
- Mary T Labowsky
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Boston, MA, USA
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Gaier ED, Rasool N, Rizzo JF. Sectoral Sparing Associated With a Cilioretinal Artery in Arteritic Anterior Ischemic Optic Neuropathy. J Neuroophthalmol 2022; 42:e514-e516. [PMID: 34860740 PMCID: PMC10311077 DOI: 10.1097/wno.0000000000001418] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Giant cell arteritis (GCA) is a life-threatening vasculitis occurring in older adults that can cause blindness by ischemia of the choroid, retina, and optic nerve. We report a case of a patient who presented with "occult" GCA with severe anterior ischemic optic neuropathy affecting both optic nerves, delayed choroidal filling, and a concomitant cilioretinal artery occlusion in the left eye. The retinal territory supplied by the affected cilioretinal artery was hypoperfused, yet this retinal territory at least partially corresponded to the only preserved visual field in that eye. The sector of the optic disc corresponding to the emergence of the cilioretinal artery was the only sector spared by pallid edema. This pattern of sectoral sparing associated with a cilioretinal artery has been observed in other patients with GCA and in animal models of posterior ciliary artery occlusion. This case serves as a clear example of an incompletely understood phenomenon in posterior pole circulation in vascular occlusive disease that deserves further study.
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Affiliation(s)
- Eric D Gaier
- Department of Ophthalmology (EDG), Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School (EDG, JFR), Boston, Massachusetts; Department of Ophthalmology (EDG, JFR), Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Picower Institute for Learning and Memory (EDG), Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts; Departments of Ophthalmology and Neurology (NR), University of California San Francisco, San Francisco, California
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Dohlman JC, Rizzo JF. Diagnostics for Infectious Orbital and Ocular Adnexal Disease. Int Ophthalmol Clin 2022; 62:87-100. [PMID: 35325912 DOI: 10.1097/iio.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waxman S, Brazile BL, Yang B, Lee PY, Hua Y, Gogola AL, Lam P, Voorhees AP, Rizzo JF, Jakobs TC, Sigal IA. Lamina cribrosa vessel and collagen beam networks are distinct. Exp Eye Res 2022; 215:108916. [PMID: 34973204 PMCID: PMC8923914 DOI: 10.1016/j.exer.2021.108916] [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: 10/04/2021] [Revised: 11/29/2021] [Accepted: 12/23/2021] [Indexed: 02/03/2023]
Abstract
Our goal was to analyze the spatial interrelation between vascular and collagen networks in the lamina cribrosa (LC). Specifically, we quantified the percentages of collagen beams with/without vessels and of vessels inside/outside of collagen beams. To do this, the vasculature of six normal monkey eyes was labeled by perfusion post-mortem. After enucleation, coronal cryosections through the LC were imaged using fluorescence and polarized light microscopy to visualize the blood vessels and collagen beams, respectively. The images were registered to form 3D volumes. Beams and vessels were segmented, and their spatial interrelationship was quantified in 3D. We found that 22% of the beams contained a vessel (range 14%-32%), and 21% of vessels were outside beams (13%-36%). Stated differently, 78% of beams did not contain a vessel (68%-86%), and 79% of vessels were inside a beam (64%-87%). Individual monkeys differed significantly in the fraction of vessels outside beams (p < 0.01 by linear mixed effect analysis), but not in the fraction of beams with vessels (p > 0.05). There were no significant differences between contralateral eyes in the percent of beams with vessels and of vessels outside beams (p > 0.05). Our results show that the vascular and collagenous networks of the LC in monkey are clearly distinct, and the historical notions that each LC beam contains a vessel and all vessels are within beams are inaccurate. We postulate that vessels outside beams may be relatively more vulnerable to mechanical compression by elevated IOP than are vessels shielded inside of beams.
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Affiliation(s)
- Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Bryn L. Brazile
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Bin Yang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA,Department of Engineering, Duquesne University, Pittsburgh, PA, USA
| | - Po-Yi Lee
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh PA, USA
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Alexandra L. Gogola
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Po Lam
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Andrew P. Voorhees
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
| | - Joseph F. Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA,Neuro-Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Tatjana C. Jakobs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary/Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Ian A. Sigal
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh PA, USA,Correspondence: Ian A. Sigal, Ph.D., Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh Medical Center, 203 Lothrop St. Rm. 930, Pittsburgh, PA, USA. 15213, Phone: (412) 864-2220; fax: (412) 647-5880, www.OcularBiomechanics.org
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Brazile BL, Yang B, Waxman S, Lam P, Voorhees AP, Hua Y, Loewen RT, Loewen NA, Rizzo JF, Jakobs T, Sigal IA. Lamina Cribrosa Capillaries Straighten as Intraocular Pressure Increases. Invest Ophthalmol Vis Sci 2021; 61:2. [PMID: 33001158 PMCID: PMC7545063 DOI: 10.1167/iovs.61.12.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/14/2023] Open
Abstract
Purpose The purpose of this study was to visualize the lamina cribrosa (LC) capillaries and collagenous beams, measure capillary tortuosity (path length over straight end-to-end length), and determine if capillary tortuosity changes when intraocular pressure (IOP) increases. Methods Within 8 hours of sacrifice, 3 pig heads were cannulated via the external ophthalmic artery, perfused with PBS to remove blood, and then perfused with a fluorescent dye to label the capillaries. The posterior pole of each eye was mounted in a custom-made inflation chamber for control of IOP with simultaneous imaging. Capillaries and collagen beams were visualized with structured light illumination enhanced imaging at IOPs from 5 to 50 mm Hg at each 5 mm Hg increment. Capillary tortuosity was measured from the images and paired two-sample t-tests were used to assess for significant changes in relation to changes in IOP. Results Capillaries were highly tortuous at 15 mm Hg (up to 1.45). In all but one eye, tortuosity decreased significantly as IOP increased from 15 to 25 mm Hg (P < 0.01), and tortuosity decreased significantly in every eye as IOP increased from 15 to 40 mm Hg (P < 0.01). In only 16% of capillaries, tortuosity increased with elevated IOP. Capillaries had a surprisingly different topology from the collagen beams. Conclusions Although high capillary tortuosity is sometimes regarded as potentially problematic because it can reduce blood flow, LC capillary tortuosity may provide slack that mitigates against reduced flow and structural damage caused by excessive stretch under elevated IOP. We speculate that low capillary tortuosity could be a risk factor for damage under high IOP.
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Affiliation(s)
- Bryn L Brazile
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Bin Yang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States.,Department of Engineering, Duquesne University, Pittsburgh Pennsylvania, United States
| | - Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Po Lam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Andrew P Voorhees
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Yi Hua
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Ralitsa T Loewen
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, United States
| | - Tatjana Jakobs
- Department of Ophthalmology, Harvard Medical School, Boston Massachusetts, United States
| | - Ian A Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh Pennsylvania, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh Pennsylvania, United States
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Abbasi B, Rizzo JF. Advances in Neuroscience, Not Devices, Will Determine the Effectiveness of Visual Prostheses. Semin Ophthalmol 2021; 36:168-175. [PMID: 33734937 DOI: 10.1080/08820538.2021.1887902] [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: 10/21/2022]
Abstract
Background: Innovations in engineering and neuroscience have enabled the development of sophisticated visual prosthetic devices. In clinical trials, these devices have provided visual acuities as high as 20/460, enabled coarse navigation, and even allowed for reading of short words. However, long-term commercial viability arguably rests on attaining even better vision and more definitive improvements in tasks of daily living and quality of life. Purpose: Here we review technological and biological obstacles in the implementation of visual prosthetics. Conclusions: Research in the visual prosthetic field has tackled significant technical challenges, including biocompatibility, signal spread through neural tissue, and inadvertent activation of passing axons; however, significant gaps in knowledge remain in the realm of neuroscience, including the neural code of vision and visual plasticity. We assert that further optimization of prosthetic devices alone will not provide markedly improved visual outcomes without significant advances in our understanding of neuroscience.
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Affiliation(s)
- Bardia Abbasi
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
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Rossin EJ, Gilbert AL, Koen N, Leslie-Mazwi TM, Cunnane ME, Rizzo JF. Site of Origin of the Ophthalmic Artery Influences the Risk for Retinal Versus Cerebral Embolic Events. J Neuroophthalmol 2021; 41:24-28. [PMID: 31985565 DOI: 10.1097/wno.0000000000000883] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Embolic events leading to retinal ischemia or cerebral ischemia share common risk factors; however, it has been well documented that the rate of concurrent cerebral infarction is higher in patients with a history of transient ischemic attack (TIA) than in those with monocular vision loss (MVL) due to retinal ischemia. Despite the fact that emboli to the ophthalmic artery (OA) and middle cerebral artery share the internal carotid artery (ICA) as a common origin or transit for emboli, the asymmetry in their final destination has not been fully explained. We hypothesize that the anatomic location of the OA takeoff from the ICA may contribute to the differential flow of small emboli to the retinal circulation vs the cerebral circulation. METHODS We report a retrospective, comparative, case-control study on 28 patients with retinal ischemia and 26 patients with TIA or cerebral infarction caused by embolic events. All subjects underwent either computed tomography angiography or MRA. The location of the ipsilateral OA origin off the ICA was then graded in a blinded fashion and compared between cohorts. Vascular risk factors were collected for all patients, including age, sex, hypertension, hyperlipidemia, arrhythmia, diabetes, coronary artery disease, and smoking. RESULTS We find that in patients with retinal ischemia of embolic etiology, the ipsilateral OA takeoff from the ICA is more proximal than in patients with cerebral infarcts or TIA (P = 0.0002). We found no statistically significant differences in demographic, vascular, or systemic risk factors. CONCLUSIONS We find that the mean anatomical location of the OA takeoff from the ICA is significantly more proximal in patients with MVL due to retinal ischemia compared with patients with TIA or cerebral ischemia. This finding contributes significantly to our understanding of a long observed but poorly understood phenomenon that patients with MVL are less likely to have concurrent cerebral ischemia than are patients with TIA.
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Affiliation(s)
- Elizabeth J Rossin
- Neuro-Ophthalmology Service (EJR, ALG, JFR), Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Vitreoretinal Surgery Service (EJR), Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Neuro-Ophthalmology (ALG), Kaiser Permanente, Oakland, Northern California; Department of Otolaryngology (NK), Massachusetts Eye and Ear, Boston, Massachusetts; The Warren Alpert Medical School (NK), Brown University, Providence, Rhode Island; Neurointerventional Service (TML-M), Massachusetts General Hospital, Boston, Massachusetts; and Department of Radiology (MEC), Harvard Medical School Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
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Douglas VP, Douglas KAA, Rizzo JF, Chwalisz BK. Reply to: Cluster headache by orbital myositis. Comment: Orbital myositis triggering oxygen-responsive cluster headache. Cephalalgia 2020; 40:1680. [DOI: 10.1177/0333102420961561] [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: 11/16/2022]
Affiliation(s)
| | | | - Joseph F Rizzo
- Massachusetts Eye and Ear Infirmary – Ophthalmology, Boston, MA, USA
| | - Bart K Chwalisz
- Massachusetts Eye and Ear Infirmary – Ophthalmology, Boston, MA, USA
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Shire DB, Gingerich MD, Wong PI, Skvarla M, Cogan SF, Chen J, Wang W, Rizzo JF. Micro-Fabrication of Components for a High-Density Sub-Retinal Visual Prosthesis. Micromachines (Basel) 2020; 11:mi11100944. [PMID: 33086504 PMCID: PMC7603138 DOI: 10.3390/mi11100944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 01/30/2023]
Abstract
We present a retrospective of unique micro-fabrication problems and solutions that were encountered through over 10 years of retinal prosthesis product development, first for the Boston Retinal Implant Project initiated at the Massachusetts Institute of Technology and at Harvard Medical School’s teaching hospital, the Massachusetts Eye and Ear—and later at the startup company Bionic Eye Technologies, by some of the same personnel. These efforts culminated in the fabrication and assembly of 256+ channel visual prosthesis devices having flexible multi-electrode arrays that were successfully implanted sub-retinally in mini-pig animal models as part of our pre-clinical testing program. We report on the processing of the flexible multi-layered, planar and penetrating high-density electrode arrays, surgical tools for sub-retinal implantation, and other parts such as coil supports that facilitated the implantation of the peri-ocular device components. We begin with an overview of the implantable portion of our visual prosthesis system design, and describe in detail the micro-fabrication methods for creating the parts of our system that were assembled outside of our hermetically-sealed electronics package. We also note the unique surgical challenges that sub-retinal implantation of our micro-fabricated components presented, and how some of those issues were addressed through design, materials selection, and fabrication approaches.
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Affiliation(s)
- Douglas B. Shire
- Bionic Eye Technologies, Inc., Ithaca, NY 14850, USA; (M.D.G.); (P.I.W.)
- Correspondence: ; Tel.: +1-607-339-7085
| | | | - Patricia I. Wong
- Bionic Eye Technologies, Inc., Ithaca, NY 14850, USA; (M.D.G.); (P.I.W.)
| | - Michael Skvarla
- Cornell NanoScale Science and Technology Facility, Ithaca, NY 14853, USA;
| | - Stuart F. Cogan
- Department of Bioengineering, University of Texas, Dallas, Richardson, TX 75080, USA;
| | - Jinghua Chen
- Department of Ophthalmology, University of Florida, Gainesville, FL 32611, USA;
| | - Wei Wang
- Department of Ophthalmology, University of Louisville, Louisville, KY 40292, USA;
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Ayton LN, Rizzo JF, Bailey IL, Colenbrander A, Dagnelie G, Geruschat DR, Hessburg PC, McCarthy CD, Petoe MA, Rubin GS, Troyk PR. Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce. Transl Vis Sci Technol 2020; 9:25. [PMID: 32864194 PMCID: PMC7426586 DOI: 10.1167/tvst.9.8.25] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 05/16/2019] [Accepted: 12/08/2019] [Indexed: 01/05/2023] Open
Abstract
Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International “Eye and the Chip” meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.
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Affiliation(s)
- Lauren N Ayton
- Department of Optometry and Vision Sciences and Department of Surgery (Ophthalmology), The University of Melbourne, Parkville, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Joseph F Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ian L Bailey
- School of Optometry, University of California-Berkeley, Berkeley, CA, USA
| | - August Colenbrander
- Smith-Kettlewell Eye Research Institute and California Pacific Medical Center, San Francisco, CA, USA
| | - Gislin Dagnelie
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Duane R Geruschat
- Lions Vision Research and Rehabilitation Center, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Philip C Hessburg
- Detroit Institute of Ophthalmology, Henry Ford Health System, Grosse Pointe Park, MI, USA
| | - Chris D McCarthy
- Department of Computer Science & Software Engineering, Swinburne University of Technology, Melbourne, Australia
| | | | - Gary S Rubin
- University College London Institute of Ophthalmology, London, UK
| | - Philip R Troyk
- Armour College of Engineering, Illinois Institute of Technology, Chicago, IL, USA
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Chen J, Poulaki V, Kim SJ, Eldred WD, Kane S, Gingerich M, Shire DB, Jensen R, DeWalt G, Kaplan HJ, Rizzo JF. Implantation and Extraction of Penetrating Electrode Arrays in Minipig Retinas. Transl Vis Sci Technol 2020; 9:19. [PMID: 32821491 PMCID: PMC7401973 DOI: 10.1167/tvst.9.5.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 09/03/2018] [Accepted: 12/31/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose This work was motivated by the goals of demonstrating methods to fabricate and implant large numbers of penetrating arrays into the retina and the feasibility of extraction. Methods Arrays of inactive, three-dimensional (3D) SU-8 structures were microfabricated onto 13-µm polyimide substrates. Standard vitreoretinal surgical techniques were used with an ab externo approach for subretinal implantation of arrays in 12 mini-pigs. In the first three surgeries, different post-geometries were explored, while a preferred design (128-µm tall, 30-µm diameter, 200-µm spacing) was used for the remaining nine implantations. Two arrays were extracted. Funduscopy, optical coherence tomography (OCT) and immunohistochemistry of the retinae were performed. The unoperated eyes and tissue far from implantation served as controls. A thirteenth pig was implanted with a planar array. Results Ten implant surgeries had no significant complication, and two arrays were successfully extracted. One retinal tear occurred after implantation due to too long posts in an early surgery. In “successful” cases, OCT showed close apposition of the arrays to the retina and integration of the posts, the tops of which were positioned at the junction of the inner plexiform and ganglion cells, without significant gliosis. Conclusions These results provide a proof-of-concept that relatively large numbers of 3D posts can be implanted into, and extracted from, the retina of mini-pigs. Our surgical numbers were relatively small, especially for the extractions, and our conclusions must be viewed with that limitation. Our methods are applicable for human surgeries. Translational Relevance This study provides results of implantation and extraction of relatively large numbers of 3D posts from the retina of minipig eyes. If similar technology were used in humans, a 3D array of this type should lower perceptual thresholds, provide safer long-term stimulation, and perhaps provide better perceptual outcomes.
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Affiliation(s)
- Jinghua Chen
- Department of Ophthalmology, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Vasiliki Poulaki
- Boston VA Healthcare System, Ophthalmology, Jamaica Plain, Boston, MA, USA
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | - Ralph Jensen
- Boston VA Healthcare System, Ophthalmology, Jamaica Plain, Boston, MA, USA
| | - Gloria DeWalt
- Department of Biology, Boston University, Boston, MA, USA
| | - Henry J Kaplan
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear, Boston, MA, USA
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Affiliation(s)
- Michael K Yoon
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.,Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
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Abstract
BACKGROUND Orbital myositis is an idiopathic, non-infectious condition, typically seen in young females and usually affecting one extraocular muscle. Orbital myositis mimicking cluster headache is a rare clinical entity, and this is the first description of a case of a secondary trigeminal autonomic cephalalgia from orbital myositis responsive to high-flow oxygen. CASE A young woman presented with new-onset, oxygen-responsive headache, periorbital pain and autonomic features. She had associated vertical diplopia on downgaze and subtle ocular misalignment. An initial diagnosis of cluster headache was made. Initial brain MRI was unrevealing, but dedicated MRI of the orbits showed enhancement of orbital muscles. The diplopia and the imaging findings were consistent with orbital myositis. CONCLUSION Orbital myositis mimicking cluster headache is rare, and not previously reported as an oxygen-responsive headache.
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Affiliation(s)
- Vivian P Douglas
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Konstantinos Aa Douglas
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Bart K Chwalisz
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Emer R McGrath
- From the Department of Neurology (E.R.M., A.B., A.D.L., A.J.C.), Massachusetts General Hospital; Department of Neurology (E.R.M., A.B.), Brigham and Women's Hospital; Departments of Neurology (E.R.M., A.B., A.D.L., A.J.C.) and Ophthalmology (J.F.R.), Harvard Medical School; and Massachusetts Eye and Ear Infirmary (J.F.R.), Boston.
| | - Ayush Batra
- From the Department of Neurology (E.R.M., A.B., A.D.L., A.J.C.), Massachusetts General Hospital; Department of Neurology (E.R.M., A.B.), Brigham and Women's Hospital; Departments of Neurology (E.R.M., A.B., A.D.L., A.J.C.) and Ophthalmology (J.F.R.), Harvard Medical School; and Massachusetts Eye and Ear Infirmary (J.F.R.), Boston
| | - Alice D Lam
- From the Department of Neurology (E.R.M., A.B., A.D.L., A.J.C.), Massachusetts General Hospital; Department of Neurology (E.R.M., A.B.), Brigham and Women's Hospital; Departments of Neurology (E.R.M., A.B., A.D.L., A.J.C.) and Ophthalmology (J.F.R.), Harvard Medical School; and Massachusetts Eye and Ear Infirmary (J.F.R.), Boston
| | - Joseph F Rizzo
- From the Department of Neurology (E.R.M., A.B., A.D.L., A.J.C.), Massachusetts General Hospital; Department of Neurology (E.R.M., A.B.), Brigham and Women's Hospital; Departments of Neurology (E.R.M., A.B., A.D.L., A.J.C.) and Ophthalmology (J.F.R.), Harvard Medical School; and Massachusetts Eye and Ear Infirmary (J.F.R.), Boston
| | - Andrew J Cole
- From the Department of Neurology (E.R.M., A.B., A.D.L., A.J.C.), Massachusetts General Hospital; Department of Neurology (E.R.M., A.B.), Brigham and Women's Hospital; Departments of Neurology (E.R.M., A.B., A.D.L., A.J.C.) and Ophthalmology (J.F.R.), Harvard Medical School; and Massachusetts Eye and Ear Infirmary (J.F.R.), Boston
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Gaier ED, Wang M, Gilbert AL, Rizzo JF, Cestari DM, Miller JB. Quantitative analysis of optical coherence tomographic angiography (OCT-A) in patients with non-arteritic anterior ischemic optic neuropathy (NAION) corresponds to visual function. PLoS One 2018; 13:e0199793. [PMID: 29953490 PMCID: PMC6023180 DOI: 10.1371/journal.pone.0199793] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 12/08/2017] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common cause of non-glaucomatous optic neuropathy in older adults. Optical coherence tomographic angiography (OCT-A) is an emerging, non-invasive method to study the microvasculature of the posterior pole, including the optic nerve head. The goal of this study was to assess the vascular changes in the optic nerve head and peripapillary area associated with NAION using OCT-A. Design Retrospective comparative case series. Methods We performed OCT-A in 25 eyes (7 acute and 18 non-acute) in 19 patients with NAION. Fellow, unaffected eyes were analyzed for comparison. Patent macro- and microvascular densities were quantified in the papillary and peripapillary regions of unaffected, acutely affected, and non-acutely affected eyes and compared across these groups according to laminar segment and capillary sampling region, and with respect to performance on automated visual field testing. Results In acutely affected eyes, OCT-A revealed a reduction in the signal from the major retinal vessels and dilation of patent superficial capillaries in the peripapillary area. By contrast, non-acutely affected eyes showed attenuation of patent capillaries. The peripapillary choriocapillaris was obscured by edema in acute cases, but was similar between non-acute and unaffected eyes. The degree of dilation of the superficial microvasculature in the acute phase and attenuation in the non-acute phase each correlated inversely with visual field performance. The region of reduced patent capillary density correlated with the location of visual field defects in 80% of acute cases and 80% of non-acute cases. Conclusions OCT-A reveals a dynamic shift in the superficial capillary network of the optic nerve head with strong functional correlates in both the acute and non-acute phases of NAION. Further study may validate OCT-A as a useful adjunctive diagnostic tool in the evaluation of ischemic optic neuropathy.
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Affiliation(s)
- Eric D. Gaier
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Mengyu Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States of America
| | - Aubrey L. Gilbert
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Joseph F. Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - Dean M. Cestari
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
| | - John B. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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22
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Affiliation(s)
- Ivana Vodopivec
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joseph F Rizzo
- Neuro-Ophthalmology Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Neuro-Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Affiliation(s)
- Dean M Cestari
- From the Departments of Ophthalmology (D.M.C., J.F.R.) and Radiology (M.E.C.), Massachusetts Eye and Ear, the Department of Medicine, Massachusetts General Hospital (J.H.S.), and the Departments of Ophthalmology (D.M.C., J.F.R.), Radiology (M.E.C.), and Medicine (J.H.S.), Harvard Medical School - all in Boston
| | - Mary E Cunnane
- From the Departments of Ophthalmology (D.M.C., J.F.R.) and Radiology (M.E.C.), Massachusetts Eye and Ear, the Department of Medicine, Massachusetts General Hospital (J.H.S.), and the Departments of Ophthalmology (D.M.C., J.F.R.), Radiology (M.E.C.), and Medicine (J.H.S.), Harvard Medical School - all in Boston
| | - Joseph F Rizzo
- From the Departments of Ophthalmology (D.M.C., J.F.R.) and Radiology (M.E.C.), Massachusetts Eye and Ear, the Department of Medicine, Massachusetts General Hospital (J.H.S.), and the Departments of Ophthalmology (D.M.C., J.F.R.), Radiology (M.E.C.), and Medicine (J.H.S.), Harvard Medical School - all in Boston
| | - John H Stone
- From the Departments of Ophthalmology (D.M.C., J.F.R.) and Radiology (M.E.C.), Massachusetts Eye and Ear, the Department of Medicine, Massachusetts General Hospital (J.H.S.), and the Departments of Ophthalmology (D.M.C., J.F.R.), Radiology (M.E.C.), and Medicine (J.H.S.), Harvard Medical School - all in Boston
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Affiliation(s)
- Kavin Vanikieti
- From the Department of Ophthalmology (K.V.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and Department of Ophthalmology (J.F.R.), Harvard Medical School and the Massachusetts Eye and Ear Infirmary, Boston.
| | - Joseph F Rizzo
- From the Department of Ophthalmology (K.V.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and Department of Ophthalmology (J.F.R.), Harvard Medical School and the Massachusetts Eye and Ear Infirmary, Boston
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25
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Gaier ED, Boudreault K, Nakata I, Janessian M, Skidd P, DelBono E, Allen KF, Pasquale LR, Place E, Cestari DM, Stacy RC, Rizzo JF, Wiggs JL. Diagnostic genetic testing for patients with bilateral optic neuropathy and comparison of clinical features according to OPA1 mutation status. Mol Vis 2017; 23:548-560. [PMID: 28848318 PMCID: PMC5561143] [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: 04/01/2017] [Accepted: 08/08/2017] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Inherited optic neuropathy is genetically heterogeneous, and genetic testing has an important role in risk assessment and counseling. The purpose of this study is to determine the prevalence and spectrum of mutations in a group of patients referred for genetic testing to a tertiary center in the United States. In addition, we compared the clinical features of patients with and without mutations in OPA1, the gene most commonly involved in dominantly inherited optic atrophy. METHODS Clinical data and genetic testing results were reviewed for 74 unrelated, consecutive patients referred with a history of insidious, relatively symmetric, bilateral visual loss secondary to an optic neuropathy. Patients were evaluated for disease-causing variants in OPA1, OPA3, WFS1, and the entire mitochondrial genome with DNA sequencing and copy number variation (CNV) testing. RESULTS Pathogenic DNA variants were found in 25 cases, with the majority (24 patients) located in OPA1. Demographics, clinical history, and clinical features for the group of patients with mutations in OPA1 were compared to those without disease-causing variants. Compared to the patients without mutations, cases with mutations in OPA1 were more likely to have a family history of optic nerve disease (p = 0.027); however, 30.4% of patients without a family history of disease also had mutations in OPA1. OPA1 mutation carriers had less severe mean deviation and pattern standard deviation on automated visual field testing than patients with optic atrophy without mutations in OPA1 (p<0.005). Other demographic and ocular features were not statistically significantly different between the two groups, including the fraction of patients with central scotomas (42.9% of OPA1 mutation positive and 66.0% of OPA1 mutation negative). CONCLUSIONS Genetic testing identified disease-causing mutations in 34% of referred cases, with the majority of these in OPA1. Patients with mutations in OPA1 were more likely to have a family history of disease; however, 30.4% of patients without a family history were also found to have an OPA1 mutation. This observation, as well as similar frequencies of central scotomas in the groups with and without mutations in OPA1, underscores the need for genetic testing to establish an OPA1 genetic diagnosis.
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Affiliation(s)
- Eric D. Gaier
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Katherine Boudreault
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Isao Nakata
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Maria Janessian
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Philip Skidd
- Departments of Ophthalmology and Neurology, University of Vermont College of Medicine, Burlington, MA
| | - Elizabeth DelBono
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Keri F. Allen
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Louis R. Pasquale
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA,Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Emily Place
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Dean M. Cestari
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Rebecca C. Stacy
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Joseph F. Rizzo
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
| | - Janey L. Wiggs
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston, MA
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Vanikieti K, Poonyathalang A, Jindahra P, Bouzika P, Rizzo JF, Cestari DM. Clinical characteristics and long-term visual outcome of optic neuritis in neuromyelitis optica spectrum disorder: A comparison between Thai and American-Caucasian cohorts. Mult Scler Relat Disord 2017; 17:87-91. [PMID: 29055481 DOI: 10.1016/j.msard.2017.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/19/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) occurs more commonly in Asian than Caucasian populations. Few studies have examined the clinical features and visual outcome of optic neuritis (ON) within NMOSD in different racial populations. The objective of this study was to compare the clinical characteristics and long-term visual outcome of a Thai and an American-Caucasian cohort with NMOSD-related ON. METHODS Medical records including brain and orbital magnetic resonance imaging (MRI) of 16 consecutive subjects who developed visual loss due to ON as part of NMOSD evaluated at a single American tertiary referral center between 2006 and 2015 were reviewed and compared to those of 16 consecutive similar subjects evaluated at a single Thai tertiary referral center between 2010 and 2016. These cohorts represented the total number of NMOSD-related ON subjects seen during that time at those institutions. Statistical analyses were used for continuous and categorical data sets, and multiple regression analysis was used to adjust for differences in duration of follow-up and number of episodes of ON in each affected eye. RESULTS All subjects within the Thai cohort were Asian, while the American cohort initially consisted of 14 Caucasian, 1 Asian and 1 African-American subject, but the latter two were excluded from analysis. In the Thai cohort, ON occurred in 21 eyes, with a total of 19 episodes, while in the American-Caucasian cohort ON occurred in 22 eyes, with a total of 21 episodes. Aquaporin 4 (AQP4)-antibody was positive in all subjects except for one American-Caucasian subject. The mean follow-up time was 17.8 (± 16.0) and 52.8 (± 51.9) months for the Thai and American-Caucasian populations, respectively. There was no difference between the two cohorts with respect to gender, age of NMOSD and NMOSD-related ON onset, initial clinical presentation of NMOSD, initial visual acuity and automated visual fields, prevalence of swollen optic disc in the acute phase, presence of pain on the affected side, mean time of onset of ON symptoms to MRI examination, distribution of segmental involvement of the anterior visual pathway abnormalities based on MRI findings, mean time of onset of ON symptoms to treatment, final visual acuity and automated visual fields. However, a higher proportion of Thai affected eyes were found to have an initial visual acuity of 20/200 or worse compared with the American-Caucasian cohort. Azathioprine was the most common maintenance treatment (75%) used among Thai subjects in contrast to rituximab (78.6%) among American-Caucasian subjects. CONCLUSION Despite the different prevalence among Thai and American-Caucasian populations, the clinical characteristics of ON in the NMOSD were very similar across these two populations, other than for more severe visual loss initially among Thai subjects. Notably, long-term visual outcome did not differ between these cohorts despite significant difference in the maintenance treatment regimen. This study did not assess neurological status or outcome.
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Affiliation(s)
- Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand; Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Anuchit Poonyathalang
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok 10400, Thailand.
| | - Peggy Bouzika
- Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
| | - Dean M Cestari
- Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, United States.
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Scott NL, Stryjewski TP, Rizzo JF. A Young Woman With Headaches and Blurry Vision. JAMA Ophthalmol 2017; 135:663-664. [PMID: 28301650 DOI: 10.1001/jamaophthalmol.2016.4895] [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: 11/14/2022]
Affiliation(s)
- Nathan L Scott
- Massachusetts Eye and Ear Infirmary, Boston2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tomasz P Stryjewski
- Massachusetts Eye and Ear Infirmary, Boston2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joseph F Rizzo
- Massachusetts Eye and Ear Infirmary, Boston2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Chun BY, Rizzo JF. Dominant Optic Atrophy and Leber's Hereditary Optic Neuropathy: Update on Clinical Features and Current Therapeutic Approaches. Semin Pediatr Neurol 2017; 24:129-134. [PMID: 28941528 DOI: 10.1016/j.spen.2017.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Dominant optic atrophy (DOA) and Leber hereditary optic neuropathy (LHON) are the two most common inherited optic neuropathies encountered in clinical practice. This review provides a summary of recent advances in the understanding of the clinical manifestations, current treatments, and ongoing clinical trials of these two optic neuropathies. Substantial progress has been made in the understanding of the clinical, genetic, and pathophysiological basis of DOA and LHON. Pathogenic OPA1 gene mutations in DOA and 3 primary mutations of mitochondrial DNA in LHON-induced mitochondrial dysfunction, which in turn leads to increased reactive oxygen species levels in mitochondria and possibly insufficient ATP production. The pathologic hallmark of these inherited optic neuropathies is primary degeneration of retinal ganglion cells, preferentially in the papillomacular bundle, which results in temporal optic disc pallor and central or cecocentral visual loss. There are no effective treatments for patients with LHON and DOA, although clinical trials are underway for the former. Translational research for these diseases is entering an accelerated phase with the availability of animal models, and a variety of pharmacological and genetic therapies are being developed.
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Affiliation(s)
- Bo Young Chun
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea; Brain Science & Engineering Institute, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joseph F Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
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Affiliation(s)
- Ivana Vodopivec
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Dean M. Cestari
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
| | - Joseph F. Rizzo
- Massachusetts Eye and Ear Infirmary, Neuro-Ophthalmology Service, Boston, MA, USA
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Cestari DM, Gaier ED, Bouzika P, Blachley TS, De Lott LB, Rizzo JF, Wiggs JL, Kang JH, Pasquale LR, Stein JD. Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmology 2016; 123:2446-2455. [PMID: 27659545 DOI: 10.1016/j.ophtha.2016.08.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network. METHODS Enrollees were monitored continuously for ≥2 years between 2001 and 2014 to identify those newly diagnosed with NAION (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 377.41). All persons were under ophthalmic surveillance and all cases had ≥1 confirmatory ICD-9-CM code for NAION during follow-up. MAIN OUTCOME MEASURES Multivariable Cox regression modeling was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs) to describe the statistical relationship between selected demographic characteristics, systemic and ocular conditions, and the hazard of developing NAION. RESULTS Of 1 381 477 eligible enrollees, 977 (0.1%) developed NAION during a mean ± standard deviation (SD) follow-up of 7.8±3.1 years. The mean ± SD age for NAION cases at the index date was 64.0±9.2 years vs. 58.4±9.4 years for the remainder of the beneficiaries. After adjustment for confounding factors, each additional year older was associated with a 2% increased hazard of NAION (HR = 1.02; 95% CI: 1.01-1.03). Female subjects had a 36% decreased hazard of developing NAION (HR = 0.64; 95% CI: 0.55-0.74) compared with male subjects. Compared with whites, Latinos had a 46% decreased hazard of developing NAION (HR = 0.54; 95% CI: 0.36-0.82), whereas African ancestry was not significantly associated with NAION (HR = 0.91; 95% CI: 0.72-1.15). Systemic diseases associated with NAION included hypertension (HR = 1.62; 95% CI: 1.26-2.07) and hypercoagulable states (HR = 2.46; 95% CI: 1.51-4.00). Although diabetes mellitus (DM) was not significantly associated with NAION compared with those without DM (P = 0.45), patients with end-organ involvement from DM had a 27% increased hazard of NAION relative to those with uncomplicated DM (HR = 1.27; 95% CI: 1.01-1.59). Ocular diseases associated with NAION were age-related macular degeneration (HR = 1.29; 95% CI: 1.08-1.54) and retinal vein occlusion (HR = 3.94; 95% CI: 3.11-4.99). CONCLUSIONS Our study identified several modifiable risk factors that may be associated with NAION. Should future studies confirm these findings, they may offer opportunities to prevent or treat this debilitating condition.
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Affiliation(s)
- Dean M Cestari
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Eric D Gaier
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Peggy Bouzika
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Taylor S Blachley
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jae H Kang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
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Sweitzer R, Scholz C, Montezuma S, Rizzo JF. Evaluation of Subretinal Implants Coated with Amorphous Aluminum Oxide and Diamond-like Carbon. J BIOACT COMPAT POL 2016. [DOI: 10.1177/0883911506060202] [Citation(s) in RCA: 11] [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: 11/15/2022]
Abstract
Retinal prostheses may be used to support patients suffering from age-related macular degeneration (AMD) or retinitis pigmentosa (RP). A hermetic encapsulation of the poly(imide) (PI)-based prosthesis is important in order to prevent the leakage of water and ions into the electric circuitry embedded in the poly(imide) matrix. The deposition of amorphous aluminum oxide (by sputtering) and diamond like carbon (by pulsed laser ablation) were made for applications in retinal prostheses. The thin films obtained were characterized for composition, thickness, adhesion and smoothness by scanning electron microscopy-energy dispersive spectroscopy, atomic force microscopy, profilometry and light microscopy. Biocompatibility was tested in vivo by implanting coated specimen subretinally in the eye of Yucatan pigs. While amorphous aluminum oxide is more readily deposited with sufficient adhesion quality, superior biocompatibility behavior was shown by diamond-like carbon. Amorphous aluminum oxide had more adverse effects and caused more severe damage to the retinal tissue.
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Affiliation(s)
- Robyn Sweitzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899
| | - Carmen Scholz
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899, and VA Center for Innovative Visual Rehabilitation, Boston, MA
| | - Sandra Montezuma
- Department of Ophthalmology, Massachusetts Eye&Ear Infirmary, Boston, MA
| | - Joseph F. Rizzo
- Department of Ophthalmology, Massachusetts Eye&Ear Infirmary, Boston, MA and VA Center for Innovative Visual Rehabilitation, Boston, MA
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Abstract
Diseases of the retina and optic nerve are common causes of irreversible blindness. Given the lack of effective treatments, several laboratories are utilizing microelectronic technology to develop either a cortical or retinal prosthesis. Each strategy offers certain advantages, but both face numerous and formidable chal lenges. Consequently, a clinically useful device of either type is still conceptual. The technological means to build prostheses are available, but the ultimate obstacle is the integration of the technology with the brain. This article reviews achievements of the ongoing efforts and focuses on our project to develop a retinal prosthesis. NEUROSCIENTIST 3:251-262, 1997
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Affiliation(s)
| | - John Wyatt
- Keck Neural Prosthesis Center, Research Laboratory of Electronics, Department of Electrical
Engineering and Computer Science Massachusetts Institute of Technology Cambridge,
Massachusetts
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Vodopivec I, Venna N, Rizzo JF, Prasad S. Clinical features, diagnostic findings, and treatment of Susac syndrome: A case series. J Neurol Sci 2015; 357:50-7. [DOI: 10.1016/j.jns.2015.06.063] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022]
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Kelly SK, Ellersick WF, Krishnan A, Doyle P, Shire DB, Wyatt JL, Rizzo JF. Redundant safety features in a high-channel-count retinal neurostimulator. IEEE Biomed Circuits Syst Conf 2014; 2014:216-219. [PMID: 27231724 DOI: 10.1109/biocas.2014.6981701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Safety features embedded in a 256-channel retinal prosthesis integrated circuit are presented. The biology of the retina and the electrochemistry of the electrode-tissue interface demand careful planning and design of the safety features of an implantable retinal stimulation device. We describe the internal limits and communication safety features of our ASIC, but we focus on monitoring and protection circuits for the electrode-tissue interface. Two independent voltage monitoring circuits for each channel measure the electrode polarization voltage at two different times in the biphasic stimulation cycle. The monitors ensure that the charged electrode stays within the electrochemical water window potentials, and that the discharged electrode is within a small window near the counter electrode potential. A switch to connect each electrode to the counter electrode between pulses protects against a wide range of device failures. Additionally, we describe work on an active feedback system to ensure that the electrode voltage is at zero.
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Affiliation(s)
- Shawn K Kelly
- Department of Veterans Affairs and Carnegie Mellon University, Pittsburgh, PA, USA,
| | | | | | | | | | - John L Wyatt
- Massachusetts Institute of Technology, Cambridge, MA, USA
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Rizzo JF, Ayton LN. Psychophysical testing of visual prosthetic devices: a call to establish a multi-national joint task force. J Neural Eng 2014; 11:020301. [PMID: 24556526 DOI: 10.1088/1741-2560/11/2/020301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shire DB, Ellersick W, Kelly SK, Doyle P, Priplata A, Drohan W, Mendoza O, Gingerich M, McKee B, Wyatt JL, Rizzo JF. ASIC design and data communications for the Boston retinal prosthesis. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:292-5. [PMID: 23365888 DOI: 10.1109/embc.2012.6345927] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report on the design and testing of a custom application-specific integrated circuit (ASIC) that has been developed as a key component of the Boston retinal prosthesis. This device has been designed for patients who are blind due to age-related macular degeneration or retinitis pigmentosa. Key safety and communication features of the low-power ASIC are described, as are the highly configurable neural stimulation current waveforms that are delivered to its greater than 256 output electrodes. The ASIC was created using an 0.18 micron Si fabrication process utilizing standard 1.8 volt CMOS transistors as well as 20 volt lightly doped drain FETs. The communication system receives frequency-shift keyed inputs at 6.78 MHz from an implanted secondary coil, and transmits data back to the control unit through a lower-bandwidth channel that employs load-shift keying. The design's safety is ensured by on-board electrode voltage monitoring, stimulus charge limits, error checking of data transmitted to the implant, and comprehensive self-test and performance monitoring features. Each stimulus cycle is initiated by a transmitted word with a full 32-bit error check code. Taken together, these features allow researchers to safely and wirelessly tailor retinal stimulation and vision recovery for each patient.
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Affiliation(s)
- Douglas B Shire
- Boston VA Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, USA.
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Callahan AB, Rizzo JF. Twenty-four-year-old woman with a droopy eyelid-quiz case. JAMA Ophthalmol 2013; 131:401-2. [PMID: 23494047 DOI: 10.1001/jamaophthalmol.2013.52a] [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: 11/14/2022]
Affiliation(s)
- Alison B Callahan
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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Abstract
Optical coherence tomography (OCT) has been routinely used to obtain high spatial resolution images of the retina and choroid non-invasively. Within the past decade, a fourth-generation OCT device using Fourier domain (FD) analysis has been developed that provides higher velocity and higher axial resolution images with better reproducibility than the previous generation time domain (TD) OCT technology. This review addresses the use of fourth-generation, FD ocular OCT in patients with multiple sclerosis.
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Affiliation(s)
- Cristiano Oliveira
- Neuro-Ophthalmology Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Rizzo JF, Shire DB, Kelly SK, Troyk P, Gingerich M, McKee B, Priplata A, Chen J, Drohan W, Doyle P, Mendoza O, Theogarajan L, Cogan S, Wyatt JL. Development of the boston retinal prosthesis. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:3135-8. [PMID: 22255004 DOI: 10.1109/iembs.2011.6090855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A small, hermetic, wirelessly-controlled retinal prosthesis was developed for pre-clinical studies in Yucatan mini-pigs. The device was implanted on the outside of the eye in the orbit, and it received both power and data wirelessly from external sources. The prosthesis drove a sub-retinal thin-film array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing the 16-channel stimulator chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by a power amplifier. Power was delivered by a 500 KHz carrier, and data were delivered by frequency shift keying. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. Through an 'outbound' telemetry channel, electrode impedances were monitored by an on-board analog to digital converter that sampled the output voltage waveforms. The final assembly was tested in vitro in physiological saline and in vivo in two mini-pigs for up to three months by measuring stimulus artifacts generated by the implant's current drivers.
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Affiliation(s)
- Joseph F Rizzo
- Boston VA Healthcare System, 150 S Huntington Ave, Boston, MA 02130, USA. joseph_rizzo @meei.harvard.edu
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Rizzo JF, Shire DB, Kelly SK, Troyk P, Gingerich M, McKee B, Priplata A, Chen J, Drohan W, Doyle P, Mendoza O, Theogarajan L, Cogan S, Wyatt JL. Overview of the boston retinal prosthesis: challenges and opportunities to restore useful vision to the blind. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:7492-5. [PMID: 22256071 DOI: 10.1109/iembs.2011.6093610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A small, hermetic, wirelessly-controlled retinal prosthesis was developed for pre-clinical studies in Yucatan mini-pigs. The device was implanted on the outside of the eye in the orbit, and it received both power and data wirelessly from external sources. The prosthesis drove a sub-retinal thin-film array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing the 16-channel stimulator chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by a power amplifier. Power was delivered by a 500 KHz carrier, and data were delivered by frequency shift keying. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. Through an 'outbound' telemetry channel, electrode impedances were monitored by an on-board analog to digital converter that sampled the output voltage waveforms. The final assembly was tested in vitro in physiological saline and in vivo in two mini-pigs for up to three months by measuring stimulus artifacts generated by the implant's current drivers.
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Affiliation(s)
- Joseph F Rizzo
- Boston VA Healthcare System, 150 S Huntington Ave, Boston, MA 02130, USA.
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43
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Affiliation(s)
- Ivey L Thornton
- Neuro-Ophthalmology Service, Department of Ophthalmology, Harvard Medical School and the Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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44
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Kelly SK, Shire DB, Chen J, Doyle P, Gingerich MD, Cogan SF, Drohan WA, Theogarajan LS, Wyatt JL, Rizzo JF. Communication and Control System for a 15-Channel Hermetic Retinal Prosthesis. Biomed Signal Process Control 2011; 6:356-363. [PMID: 21927618 DOI: 10.1016/j.bspc.2011.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A small, hermetic, wirelessy-controlled retinal prosthesis has been developed for pre-clinical studies in Yucatan minipigs. The device was attached conformally to the outside of the eye in the socket and received both power and data wirelessly from external sources. Based on the received image data, the prosthesis drove a subretinal thin-film polyimide array of sputtered iridium oxide stimulating electrodes. The implanted device included a hermetic titanium case containing a 15-channel stimulator and receiver chip and discrete circuit components. Feedthroughs in the hermetic case connected the chip to secondary power- and data-receiving coils, which coupled to corresponding external power and data coils driven by power amplifiers. Power was delivered by a 125 KHz carrier, and data were delivered by amplitude shift keying of a 15.5 MHz carrier at 100 Kbps. Stimulation pulse strength, duration and frequency were programmed wirelessly from an external computer system. The final assembly was tested in vitro in physiological saline and in vivo in two minipigs for up to five and a half months by measuring stimulus artifacts generated by the implant's current drivers.
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Affiliation(s)
- Shawn K Kelly
- Center for Innovative Visual Rehabilitation, Boston VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA
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Kelly SK, Shire DB, Chen J, Doyle P, Gingerich MD, Cogan SF, Drohan WA, Behan S, Theogarajan L, Wyatt JL, Rizzo JF. A hermetic wireless subretinal neurostimulator for vision prostheses. IEEE Trans Biomed Eng 2011; 58:3197-205. [PMID: 21859595 DOI: 10.1109/tbme.2011.2165713] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A miniaturized, hermetically encased, wirelessly operated retinal prosthesis has been developed for preclinical studies in the Yucatan minipig, and includes several design improvements over our previously reported device. The prosthesis attaches conformally to the outside of the eye and electrically drives a microfabricated thin-film polyimide array of sputtered iridium oxide film electrodes. This array is implanted into the subretinal space using a customized ab externo surgical technique. The implanted device includes a hermetic titanium case containing a 15-channel stimulator chip and discrete circuit components. Feedthroughs in the case connect the stimulator chip to secondary power and data receiving coils on the eye and to the electrode array under the retina. Long-term in vitro pulse testing of the electrodes projected a lifetime consistent with typical devices in industry. The final assembly was tested in vitro to verify wireless operation of the system in physiological saline using a custom RF transmitter and primary coils. Stimulation pulse strength, duration, and frequency were programmed wirelessly from a Peripheral Component Interconnect eXtensions for Instrumentation (PXI) computer. Operation of the retinal implant has been verified in two pigs for up to five and a half months by detecting stimulus artifacts generated by the implanted device.
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Affiliation(s)
- Shawn K Kelly
- Center for Innovative Visual Rehabilitation, VA Boston Healthcare System, Boston, MA 02130, USA.
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Cai C, Ren Q, Desai NJ, Rizzo JF, Fried SI. Response variability to high rates of electric stimulation in retinal ganglion cells. J Neurophysiol 2011; 106:153-62. [PMID: 21490287 PMCID: PMC3295376 DOI: 10.1152/jn.00956.2010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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: 11/05/2010] [Accepted: 04/05/2011] [Indexed: 11/22/2022] Open
Abstract
To improve the quality of prosthetic vision, it is important to understand how retinal neurons respond to electric stimulation. Previous studies present conflicting reports as to the maximum rate at which retinal ganglion cells can "follow" pulse trains, i.e., generate one spike for each pulse of the train. In the present study, we measured the response of 5 different types of rabbit retinal ganglion cells to pulse trains of 100-700 Hz. Surprisingly, we found significant heterogeneity in the ability of different types to follow pulse trains. For example, brisk transient (BT) ganglion cells could reliably follow pulse rates up to 600 pulses per second (PPS). In contrast, other types could not even follow rates of 200 PPS. There was additional heterogeneity in the response patterns across those types that could not follow high-rate trains. For example, some types generated action potentials in response to approximately every other pulse, whereas other types generated one spike per pulse for a few consecutive pulses and then did not generate any spikes in response to the next few pulses. Interestingly, in the types that could not follow high-rate trains, we found a second type of response: many pulses of the train elicited a biphasic waveform with an amplitude much smaller than that of standard action potentials. This small waveform was often observed following every pulse for which a standard spike was not elicited. A possible origin of the small waveform and its implication for effective retinal stimulation are discussed.
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Affiliation(s)
- Changsi Cai
- Institute for Laser Medicine and Bio-Photonics, Department of Biomedical Engineering, Shanghai Jiao-Tong University, Shanghai, China
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Abstract
Retinal prostheses aim to restore functional vision to those blinded by outer retinal diseases using electric stimulation of surviving retinal neurons. The ability to replicate the spatiotemporal pattern of ganglion cell spike trains present under normal viewing conditions is presumably an important factor for restoring high-quality vision. In order to replicate such activity with a retinal prosthesis, it is important to consider both how visual information is encoded in ganglion cell spike trains, and how retinal neurons respond to electric stimulation. The goal of the current review is to bring together these two concepts in order to guide the development of more effective stimulation strategies. We review the experiments to date that have studied how retinal neurons respond to electric stimulation and discuss these findings in the context of known retinal signaling strategies. The results from such in vitro studies reveal the advantages and disadvantages of activating the ganglion cell directly with the electric stimulus (direct activation) as compared to activation of neurons that are presynaptic to the ganglion cell (indirect activation). While direct activation allows high temporal but low spatial resolution, indirect activation yields improved spatial resolution but poor temporal resolution. Finally, we use knowledge gained from in vitro experiments to infer the patterns of elicited activity in ongoing human trials, providing insights into some of the factors limiting the quality of prosthetic vision.
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Affiliation(s)
- Daniel K Freeman
- Center for Innovative Visual Rehabilitation, Boston VA Healthcare System, 150 South Huntington Ave, Boston, MA 02130, USA.
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Jensen RJ, Rizzo JF. Effects of GABA receptor antagonists on thresholds of P23H rat retinal ganglion cells to electrical stimulation of the retina. J Neural Eng 2011; 8:035002. [PMID: 21593547 DOI: 10.1088/1741-2560/8/3/035002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An electronic retinal prosthesis may provide useful vision for patients suffering from retinitis pigmentosa (RP). In animal models of RP, the amount of current needed to activate retinal ganglion cells (RGCs) is higher than in normal, healthy retinas. In this study, we sought to reduce the stimulation thresholds of RGCs in a degenerate rat model (P23H-line 1) by blocking GABA receptor mediated inhibition in the retina. We examined the effects of TPMPA, a GABA(C) receptor antagonist, and SR95531, a GABA(A) receptor antagonist, on the electrically evoked responses of RGCs to biphasic current pulses delivered to the subretinal surface through a 400 µm diameter electrode. Both TPMPA and SR95531 reduced the stimulation thresholds of ON-center RGCs on average by 15% and 20% respectively. Co-application of the two GABA receptor antagonists had the greatest effect, on average reducing stimulation thresholds by 32%. In addition, co-application of the two GABA receptor antagonists increased the magnitude of the electrically evoked responses on average three-fold. Neither TPMPA nor SR95531, applied alone or in combination, had consistent effects on the stimulation thresholds of OFF-center RGCs. We suggest that the effects of the GABA receptor antagonists on ON-center RGCs may be attributable to blockage of GABA receptors on the axon terminals of ON bipolar cells.
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Affiliation(s)
- Ralph J Jensen
- The Center for Innovative Visual Rehabilitation, VA Boston Healthcare System, Mail Stop 151E, 150 South Huntington Avenue, Boston, MA 02130, USA.
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Abstract
Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, describes a condition of elevated intracranial pressure (ICP) that typically presents in obese women of childbearing age with symptoms and signs of posture-dependent headaches, pulsatile tinnitus, visual changes, and papilledema. Optical coherence tomography (OCT) has begun to be utilized as an adjunctive, quantitative tool in the evaluation of patients with IIH to help distinguish between true optic nerve head edema and pseudopapilledema, and to contribute to our understanding of the consequences of prolonged optic nerve edema. Although few longitudinal studies of patients with IIH have been published to date, it appears that there may be a correlation between retinal nerve fiber layer (RNFL) thickness and visual function. With the new spectral domain OCT, additional parameters of the optic nerve imaging, including volume and height measurements, might provide greater sensitivity of the response to treatment and the long-term visual outcome in patients with IIH.
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Affiliation(s)
- Gena Heidary
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
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