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Sheth V, McLean RJ, Tu Z, Ather S, Gottlob I, Proudlock FA. Visual Field Deficits in Albinism in Comparison to Idiopathic Infantile Nystagmus. Invest Ophthalmol Vis Sci 2024; 65:13. [PMID: 38319668 PMCID: PMC10854418 DOI: 10.1167/iovs.65.2.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose This is the first systematic comparison of visual field (VF) deficits in people with albinism (PwA) and idiopathic infantile nystagmus (PwIIN) using static perimetry. We also compare best-corrected visual acuity (BCVA) and optical coherence tomography measures of the fovea, parafovea, and circumpapillary retinal nerve fiber layer in PwA. Methods VF testing was performed on 62 PwA and 36 PwIIN using a Humphrey Field Analyzer (SITA FAST 24-2). Mean detection thresholds for each eye were calculated, along with quadrants and central measures. Retinal layers were manually segmented in the macular region. Results Mean detection thresholds were significantly lower than normative values for PwA (-3.10 ± 1.67 dB, P << 0.0001) and PwIIN (-1.70 ± 1.54 dB, P < 0.0001). Mean detection thresholds were significantly lower in PwA compared to PwIIN (P < 0.0001) and significantly worse for left compared to right eyes in PwA (P = 0.0002) but not in PwIIN (P = 0.37). In PwA, the superior nasal VF was significantly worse than other quadrants (P < 0.05). PwIIN appeared to show a mild relative arcuate scotoma. In PwA, central detection thresholds were correlated with foveal changes in the inner and outer retina. VF was strongly correlated to BCVA in both groups. Conclusions Clear peripheral and central VF deficits exist in PwA and PwIIN, and static VF results need to be interpreted with caution clinically. Since PwA exhibit considerably lower detection thresholds compared to PwIIN, VF defects are unlikely to be due to nystagmus in PwA. In addition to horizontal VF asymmetry, PwA exhibit both vertical and interocular asymmetries, which needs further exploration.
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Affiliation(s)
- Viral Sheth
- Health Sciences School, University of Sheffield, Sheffield, Yorkshire, United Kingdom
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Rebecca J. McLean
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Zhanhan Tu
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxfordshire, United Kingdom
| | - Irene Gottlob
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
- Department of Neurology, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, United States
| | - Frank A. Proudlock
- The University of Leicester Ulverscroft Eye Unit, Psychology and Vision Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom
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Muns SM, Villegas VM, Schwartz SG. Clinical spectrum of blunted foveal contour. Ther Adv Ophthalmol 2022; 14:25158414211070864. [PMID: 35083420 PMCID: PMC8785340 DOI: 10.1177/25158414211070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
Foveal hypoplasia is the absence of a foveal depression and the presence of the ganglion cell layer in the foveola. A spectrum of clinical characteristics, including normal or variably decreased visual acuity, has been described in patients with blunted foveal contours. Multiple systemic and ophthalmologic conditions including albinism, aniridia, nanophthalmos, prematurity, and fovea plana have been associated with this anomaly. This article illustrates select clinical conditions characterized by a blunted foveal contour. Given the heterogeneity of findings, a thorough medical history and detailed physical and ocular examinations are usually sufficient for the clinician to make the correct diagnosis.
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Affiliation(s)
- Sofía M. Muns
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Victor M. Villegas
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Department of Surgery, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, 3880 Tamiami Trail North, Naples, FL 34103, USA
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Welton T, Constantinescu CS, Auer DP, Dineen RA. Graph Theoretic Analysis of Brain Connectomics in Multiple Sclerosis: Reliability and Relationship with Cognition. Brain Connect 2020; 10:95-104. [PMID: 32079409 PMCID: PMC7196369 DOI: 10.1089/brain.2019.0717] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Research suggests that disruption of brain networks might explain cognitive deficits in multiple sclerosis (MS). The reliability and effectiveness of graph theoretic network metrics as measures of cognitive performance were tested in 37 people with MS and 23 controls. Specifically, relationships with cognitive performance (linear regression against the paced auditory serial addition test-3 seconds [PASAT-3], symbol digit modalities test [SDMT], and attention network test) and 1-month reliability (using the intraclass correlation coefficient [ICC]) of network metrics were measured using both resting-state functional and diffusion magnetic resonance imaging data. Cognitive impairment was directly related to measures of brain network segregation and inversely related to network integration (prediction of PASAT-3 by small worldness, modularity, characteristic path length, R2 = 0.55; prediction of SDMT by small worldness, global efficiency, and characteristic path length, R2 = 0.60). Reliability of the measures for 1 month in a subset of nine participants was mostly rated as good (ICC >0.6) for both controls and MS patients in both functional and diffusion data, but was highly dependent on the chosen parcellation and graph density, with the 0.2–0.5 density range being the most reliable. This suggests that disrupted network organization predicts cognitive impairment in MS and its measurement is reliable for a 1-month period. These new findings support the hypothesis of network disruption as a major determinant of cognitive deficits in MS and the future possibility of the application of derived metrics as surrogate outcomes in trials of therapies for cognitive impairment.
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Affiliation(s)
- Thomas Welton
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,Sydney Translational Imaging Laboratory, Heart Research Institute, University of Sydney, Camperdown, Australia
| | - Cris S Constantinescu
- Clinical Neurology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Rob A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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Brücher VC, Heiduschka P, Grenzebach U, Eter N, Biermann J. Distribution of macular ganglion cell layer thickness in foveal hypoplasia: A new diagnostic criterion for ocular albinism. PLoS One 2019; 14:e0224410. [PMID: 31738774 PMCID: PMC6860421 DOI: 10.1371/journal.pone.0224410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background/Aims To analyse the distribution of macular ganglion cell layer thickness (GCLT) in patients with foveal hypoplasia (FH) with or without albinism to obtain new insights into visual pathway anomalies in albinos. Methods Patients with FH who presented at our institution between 2013 and 2018 were retrospectively drawn for analysis. Mean GCLT was calculated after automated segmentation of spectral domain-optical coherence tomography (SD-OCT) scans. Patients with FH due to albinism (n = 13, termed ‘albinism FH’) or other kinds (n = 10, termed ‘non-albinism FH’) were compared with control subjects (n = 15). The areas: fovea (central), parafovea (nasal I, temporal I) and perifovea (nasal II, temporal II) along the horizontal meridian were of particular interest. Primary endpoints of this study were the ratios (GCLT-I- and GCLT-II-Quotient) between the GCLT measured in the temporal I or II and nasal I or II areas. Results There was a significant difference between the GCLT-I-Quotient of healthy controls and albinism FH (p<0.001), as well as between non-albinism FH and albinism FH (p = 0.004). GCLT-II-Quotient showed significant differences between healthy controls and albinism FH (p<0.001) and between non-albinism FH and albinism FH (p = 0.006). The best measure for distinguishing between non-albinism FH and albinism FH was the calculation of GCLT-II-Quotient (area temporal II divided by area nasal II), indicating albinism at a cut-off of <0.7169. The estimated specificity and sensitivity for this cut-off were 84.6% and 100.0%, respectively. The estimated area under the curve (AUC) was 0.892 [95%CI: 0.743–1.000, p = 0.002]. Conclusion Macular GCLT-distribution showed a characteristic temporal to central shift in patients with FH due to albinism. Calculation of the GCLT-II-Quotient at a cut-off of <0.7169 presents a new diagnostic criterion for identification of ocular albinism.
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Affiliation(s)
- Viktoria C. Brücher
- Dept. of Ophthalmology, University of Muenster Medical Centre, Muenster, Germany
| | - Peter Heiduschka
- Dept. of Ophthalmology, University of Muenster Medical Centre, Muenster, Germany
| | - Ulrike Grenzebach
- Dept. of Ophthalmology, University of Muenster Medical Centre, Muenster, Germany
| | - Nicole Eter
- Dept. of Ophthalmology, University of Muenster Medical Centre, Muenster, Germany
| | - Julia Biermann
- Dept. of Ophthalmology, University of Muenster Medical Centre, Muenster, Germany
- * E-mail:
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Ather S, Proudlock FA, Welton T, Morgan PS, Sheth V, Gottlob I, Dineen RA. Aberrant visual pathway development in albinism: From retina to cortex. Hum Brain Mapp 2019; 40:777-788. [PMID: 30511784 PMCID: PMC6865554 DOI: 10.1002/hbm.24411] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/08/2018] [Accepted: 09/18/2018] [Indexed: 12/27/2022] Open
Abstract
Albinism refers to a group of genetic abnormalities in melanogenesis that are associated neuronal misrouting through the optic chiasm. We perform quantitative assessment of visual pathway structure and function in 23 persons with albinism (PWA) and 20 matched controls using optical coherence tomography (OCT), volumetric magnetic resonance imaging (MRI), diffusion tensor imaging and visual evoked potentials (VEP). PWA had a higher streamline decussation index (percentage of total tractography streamlines decussating at the chiasm) compared with controls (Z = -2.24, p = .025), and streamline decussation index correlated weakly with inter-hemispheric asymmetry measured using VEP (r = .484, p = .042). For PWA, a significant correlation was found between foveal development index and total number of streamlines (r = .662, p < .001). Significant positive correlations were found between peri-papillary retinal nerve fibre layer thickness and optic nerve (r = .642, p < .001) and tract (r = .663, p < .001) width. Occipital pole cortical thickness was 6.88% higher (Z = -4.10, p < .001) in PWA and was related to anterior visual pathway structures including foveal retinal pigment epithelium complex thickness (r = -.579, p = .005), optic disc (r = .478, p = .021) and rim areas (r = .597, p = .003). We were unable to demonstrate a significant relationship between OCT-derived foveal or optic nerve measures and MRI-derived chiasm size or streamline decussation index. Our novel tractographic demonstration of altered chiasmatic decussation in PWA corresponds to VEP measured cortical asymmetry and is consistent with chiasmatic misrouting in albinism. We also demonstrate a significant relationship between retinal pigment epithelium and visual cortex thickness indicating that retinal pigmentation defects in albinism lead to downstream structural reorganisation of the visual cortex.
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Affiliation(s)
- Sarim Ather
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUnited Kingdom
| | - Frank Anthony Proudlock
- University of Leicester Ulverscroft Eye UnitRobert Kilpatrick Clinical Sciences BuildingLeicesterUnited Kingdom
| | - Thomas Welton
- Radiological Sciences, Division of Clinical NeuroscienceUniversity of Nottingham, Queen's Medical CentreNottinghamUnited Kingdom
- Sir Peter Mansfield Imaging Centre, University of NottinghamQueen's Medical CentreNottinghamUnited Kingdom
| | - Paul S. Morgan
- Sir Peter Mansfield Imaging Centre, University of NottinghamQueen's Medical CentreNottinghamUnited Kingdom
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS TrustQueen's Medical CentreNottinghamUnited Kingdom
| | - Viral Sheth
- University of Leicester Ulverscroft Eye UnitRobert Kilpatrick Clinical Sciences BuildingLeicesterUnited Kingdom
| | - Irene Gottlob
- University of Leicester Ulverscroft Eye UnitRobert Kilpatrick Clinical Sciences BuildingLeicesterUnited Kingdom
| | - Rob A. Dineen
- Radiological Sciences, Division of Clinical NeuroscienceUniversity of Nottingham, Queen's Medical CentreNottinghamUnited Kingdom
- Sir Peter Mansfield Imaging Centre, University of NottinghamQueen's Medical CentreNottinghamUnited Kingdom
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