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Matheu Fabra A, Saint-Gerons Trecu M, Quiroz Quiroga MJ, Armentia Pérez de Mendiola J, Martínez Palmer A, Martín Baranera M. Discrimination of glaucomatous from non-glaucomatous optic neuropathy with swept-source optical coherence tomography. J Fr Ophtalmol 2023; 46:941-948. [PMID: 37210297 DOI: 10.1016/j.jfo.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To assess the ability of optic nerve head (ONH) parameters, peripapillary retinal nerve fiber layer (pRNFL), and macular ganglion cell layer (GCL) thickness measurements with swept-source optical coherence tomography (SS-OCT), to discriminate between glaucomatous and non-glaucomatous optic neuropathy (GON and NGON). METHODS This retrospective cross-sectional study involved 189 eyes of 189 patients, 133 with GON and 56 with NGON. The NGON group included ischemic optic neuropathy, previous optic neuritis, and compressive, toxic-nutritional, and traumatic optic neuropathy. Bivariate analyses of SS-OCT pRNFL and GCL thickness and ONH parameters were performed. Multivariable logistic regression analysis was employed to obtain predictor variables from OCT values, and the area under the receiver operating characteristic curve (AUROC) was calculated to differentiate between NGON and GON. RESULTS Bivariate analyses showed that the overall and inferior quadrant of the pNRFL was thinner in the GON group (P=0.044 and P<0.01), while patients with NGON had thinner temporal quadrants (P=0.044). Significant differences between the GON and NGON groups were identified in almost all the ONH topographic parameters. Patients with NGON had thinner superior GCL (P=0.015), but there were no significant differences in GCL overall and inferior thickness. Multivariate logistic regression analysis demonstrated that vertical cup-to-disc ratio (CDR), cup volume, and superior GCL provided independent predictive value for differentiating GON from NGON. The predictive model of these variables along with disc area and age achieved an AUROC=0.944 (95% CI 0.898-0.991). CONCLUSIONS SS-OCT is useful in discriminating GON from NGON. Vertical CDR, cup volume, and superior GCL thickness show the highest predictive value.
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Affiliation(s)
- A Matheu Fabra
- Neuro-ophthalmology unit, Ophthalmology department, Consorci Mar Parc de Salut de Barcelona, Passeig Marítim, 25-29, 08003 Barcelona, Spain; Department of Ophthalmology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - M Saint-Gerons Trecu
- Neuro-ophthalmology unit, Ophthalmology department, Consorci Mar Parc de Salut de Barcelona, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
| | - M J Quiroz Quiroga
- Glaucoma Unit, Ophthalmology Deparment, Consorci Mar Parc de Salut de Barcelona, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
| | - J Armentia Pérez de Mendiola
- Ophthalmology Department, Consorci Mar Parc de Salut de Barcelona, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
| | - A Martínez Palmer
- Department of Ophthalmology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Ophthalmology Department, Consorci Mar Parc de Salut de Barcelona, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
| | - M Martín Baranera
- Clinical Epidemiology Deparment. Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, Spain; Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Zhang Y, Sun X, Tian G, Chen Y. Comparison of the clinical and genetic features of autosomal dominant optic atrophy and normal tension glaucoma in young Chinese adults. Eye (Lond) 2023; 37:624-630. [PMID: 35273349 PMCID: PMC9998393 DOI: 10.1038/s41433-022-01990-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/30/2022] [Accepted: 02/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare the clinical and optical coherence tomography (OCT) characteristics of autosomal dominant optic atrophy (ADOA) and normal tension glaucoma (NTG) in Chinese patients. SUBJECTS/METHODS Twenty-four unrelated patients with ADOA and 21 unrelated patients with NTG, younger than 30 years, were enrolled in this study. Data regarding the demographic and clinical characteristics of the patients were collected, and their peripapillary retinal nerve fibre layer (RNFL) and macular ganglion cell complex (GCC) thicknesses were evaluated using OCT. Sequencing of genes associated with neuro-ophthalmic disorders was performed for all patients. RESULTS The average age at onset of the ADOA group (13.92 ± 10.73 years) was significantly younger than that of the NTG group (23.67 ± 4.98 years, P = 0.002). Best-corrected visual acuity was significantly poorer in the ADOA group (0.75 ± 0.32) than in the NTG group (0.16 ± 0.19, P < 0.001). The average peripapillary RNFL thickness and the RNFL thicknesses in the temporal upper, temporal lower, and nasal lower sectors were significantly thinner in the ADOA group than in the NTG group (all P < 0.05). Moreover, the macular GCC thickness of the ADOA group was significantly thinner than that of the NTG group (P < 0.001). Twenty-three OPA1 variants (11 novel OPA1 variants) and one OPA3 variant were detected in 24 patients with ADOA. CONCLUSIONS Our study revealed a distinct difference between the patterns of RNFL and GCC loss in ADOA and NTG, which will help to differentiate ADOA from NTG in young patients. Additionally, this study expanded the genetic spectrum of ADOA.
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Affiliation(s)
- Youjia Zhang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
| | - Guohong Tian
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Yuhong Chen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
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Soares RM, Braga JF, da Silva Fernandes J, Ferreira CC, Ribeiro L, Alves H, Meira D. Automated macular segmentation can distinguish glaucomatous from compressive optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:1701-1712. [PMID: 36625929 DOI: 10.1007/s00417-022-05962-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/30/2022] [Accepted: 12/24/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To compare macular damage in glaucomatous optic neuropathy (GON) and compressive optic neuropathy (CON) and assess its diagnostic accuracy in distinguishing between diseases. METHODS Observational, cross-sectional, single-center study. Patients with GON, CON, and healthy controls were included according to the eligibility criteria. An automated spectral-domain optical coherence tomography (SD-OCT) algorithm was used to segment the circumpapilary retinal nerve fiber layer (cpRNFL) and macula. The layer thickness was measured in each sector according to the Early Treatment Diabetic Retinopathy Study and the 6-sector Garway-Heath-based grids. Data was compared across all study groups, and the significance level was set at 0.05. RESULTS Seventy-five eyes of 75 participants, 25 with GON, 25 with CON, and 25 healthy controls (CG), were included. Macular thickness was diminished in the ganglion cell complex of GON and CON patients compared to CG (p<0.05). The best Garway-Heath-based grid parameters for distinguishing GON and CON were the nasal-inferior (NI) and nasal-superior sectors and the NI/temporal inferior (TI) damage ratios in the macular ganglion cell (mGCL) and inner plexiform (IPL) layers. Moreover, the combination of the NI sector and NI/TI damage ratios in both layers had higher discriminative power (AUC 0.909; 95% CI 0.830-0.988; p<0.001) than combining parameters in each layer separately. CONCLUSION Our findings suggest that the evaluation of macular segmented layers damage by SD-OCT may be a helpful add-on tool in the differential diagnosis between GON and CON.
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Affiliation(s)
- Ricardo Machado Soares
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal.
| | - Joana Figueiredo Braga
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Joana da Silva Fernandes
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Catarina Cunha Ferreira
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Lígia Ribeiro
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
| | - Hélio Alves
- Department of Biomedicine - Faculty of Medicine of University of Porto, Porto, Portugal
| | - Dália Meira
- Department of Ophthalmology - Centro Hospitalar de Vila Nova de Gaia e Espinho EPE, Porto, Portugal
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Somvanshi RK, Zou S, Kadhim S, Padania S, Hsu E, Kumar U. Cannabinol modulates neuroprotection and intraocular pressure: A potential multi-target therapeutic intervention for glaucoma. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166325. [DOI: 10.1016/j.bbadis.2021.166325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 12/31/2022]
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Waisberg E, Micieli JA. Neuro-Ophthalmological Optic Nerve Cupping: An Overview. Eye Brain 2021; 13:255-268. [PMID: 34934377 PMCID: PMC8684388 DOI: 10.2147/eb.s272343] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/02/2021] [Indexed: 11/23/2022] Open
Abstract
Optic nerve cupping or enlargement of the cup-to-disc ratio is widely recognized as a feature of glaucoma, however it may also occur in non-glaucomatous optic neuropathies. The most well-recognized non-glaucomatous optic neuropathies that cause cupping include compressive optic neuropathies, arteritic anterior ischemic optic neuropathies, hereditary optic neuropathies, and optic neuritis. Cupping is thought to consist of two main components: prelaminar and laminar thinning. The former is a shallow form of cupping and related to loss of retinal ganglion cells, whereas the latter involves damage to the lamina cribrosa and peripapillary scleral connective tissue. Differentiating glaucomatous and non-glaucomatous optic nerve cupping remains challenging even for experienced observers. Classically, the optic nerve in non-glaucomatous causes has pallor of the neuroretinal rim, but the optic nerve should not be examined in isolation. The patient’s medical history, history of presenting illness, visual function (visual acuity, color vision and visual field testing) and ocular examination also need to be considered. Ancillary testing such as optical coherence tomography of the retinal nerve fiber layer and ganglion cell layer-inner plexiform layer may also be helpful in localizing the disease. In this review, we review the non-glaucomatous causes of cupping and provide an approach to evaluating a patient that presents with an enlarged cup-to-disc ratio.
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Affiliation(s)
- Ethan Waisberg
- UCD School of Medicine, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Kensington Vision and Research Centre, Toronto, Ontario, Canada
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Milanowski P, Kosior-Jarecka E, Łukasik U, Wróbel-Dudzińska D, Milanowska J, Khor CC, Aung T, Kocki J, Żarnowski T. Associations between OPA1, MFN1, and MFN2 polymorphisms and primary open angle glaucoma in Polish participants of European ancestry. Ophthalmic Genet 2021; 43:42-47. [PMID: 34425738 DOI: 10.1080/13816810.2021.1970197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Glaucomatous optic nerve damage is caused by selective death of retinal ganglion cells (RGCs). Another condition with underlying loss of RGCs is autosomal dominant optic atrophy (ADOA). Majority of ADOA patients have mutations in OPA1, gene responsible for mitochondrial fusion final steps. Clinical resemblance between the two diseases make genes involved in mitochondrial fusion good candidates as glaucoma genes. In this study, we investigated if selected polymorphisms of OPA1, MFN1, and MFN2 were associated with glaucoma in Polish population. METHODS Four OPA1 (rs166850, rs10451941, rs7624750, rs9851685), one MFN1 (rs2111534), and two MFN2 (rs873458, rs2295281) single nucleotide polymorphisms were investigated in 304 primary open angle glaucoma patients (204 with normal tension glaucoma, 100 with high-tension glaucoma) and 258 control subjects using RT-PCR method. RESULTS There was a significant difference in genotype frequencies of rs9851685 and rs2111534 polymorphisms between glaucoma patients and control subjects. Several genotype combinations comprising SNPs at OPA1 and MFN1 were significantly differently distributed in a three-way comparison between controls, patients with NTG and patients with HTG. None of the studied MFN2 polymorphisms was significantly associated with HTG or NTG. CONCLUSIONS In studied population, genotype CC and allele C of rs9851685 OPA1 polymorphism are NTG risk factors, whereas TT genotype and T allele of this polymorphism are protective factors against NTG. Genotype GA of rs2111534 MFN1 polymorphism is an HTG risk factor and AA genotype of this polymorphism is a protective factor against HTG. Several OPA1 and MFN2 genotype combinations are significantly associated with either increased or decreased risk of glaucoma in this population.
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Affiliation(s)
- Piotr Milanowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Urszula Łukasik
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Joanna Milanowska
- Department of Applied Psychology, Medical University of Lublin, Lublin, Poland
| | - Chiea Chuen Khor
- Laboratory of Complex Disease Genetics, Genome Institute of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
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7
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Abri Aghdam K, Aghajani A, Razi-Khosroshahi M, Soltan Sanjari M, Chaibakhsh S, Falavarjani KG. Optical Coherence Tomography Angiography and Structural Analyses of the Pale Optic Discs: Is It Possible to Differentiate the Cause? Curr Eye Res 2021; 46:1876-1885. [PMID: 33980086 DOI: 10.1080/02713683.2021.1929331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: To compare the optic nerve head (ONH) structure and microvasculature in patients with optic atrophy due to non-arteritic anterior ischemic optic neuropathy (NAION), compressive optic neuropathy (CON), methanol-induced optic neuropathy (MION), and traumatic optic neuropathy (TON) using optical coherence tomography angiography.Methods: In this comparative, cross-sectional study, 32 eyes with NAION, 18 eyes with CON, 32 eyes with MION, 23 eyes with TON, and 55 normal eyes were enrolled. Radial peripapillary capillary (RPC) vessel density, peripapillary retinal nerve fiber layer (RNFL) thickness, disc area, cup volume, and cup/disc area ratio were obtained using the RTVue XR Avanti system (Optovue Inc., Fremont, CA, USA).Results: RPC vessel density and peripapillary RNFL thickness in all patients were significantly lower than normal subjects. A positive correlation was found between the RPC vessel density and peripapillary RNFL thickness in normal subjects and all study groups. The positive correlation between the inside and outside disc RPC vessel density was only found in the NAION (r = 0.36, P = .042) and MION (r = 0.42, P = .018) groups. No significant difference was found among the groups in terms of peripapillary and inside disc vascular densities (all P > .05). Disc area and cup volume in patients with MION was larger than the values in patients with NAION (P = .018) and TON (P = .044) and normal subjects (P = .015). The discriminating features among the study groups were the larger cup volume and cup/disc area ratio in patients with MION, and lower RNFL thickness in patients with TON.Conclusions: There was a positive correlation between the RNFL thickness and peripapillary RPC vessel density regardless of the cause of optic disc pallor. Structural evaluation of the ONH seems to be a better way to differentiate the cause of optic nerve head atrophy than the microangiographic changes.
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Affiliation(s)
- Kaveh Abri Aghdam
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Marjan Razi-Khosroshahi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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Leaney JC, Nguyen V, Miranda E, Barnett Y, Ahmad K, Wong S, Lawlor M. Bruch's Membrane Opening Minimum Rim Width Provides Objective Differentiation between Glaucoma and Nonglaucomatous Optic Neuropathies. Am J Ophthalmol 2020; 218:164-172. [PMID: 32574771 DOI: 10.1016/j.ajo.2020.05.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE A challenging clinical scenario is distinguishing between normal tension glaucoma (NTG) and non-glaucomatous optic neuropathies (NGON). The key to the assessment remains identifying the presence of optic nerve head cupping. Recent optical coherence tomography (OCT) measurements now allow objective assessment of cupping by minimum rim width at Bruch's membrane opening (MRW-BMO). This study assessed the hypothesis that the MRW-BMO measurement quantifies cupping and therefore can differentiate between NTG and NGON. DESIGN Diagnostic evaluation with area under the curve. METHODS Setting: multicenter tertiary hospitals and outpatient clinics. PATIENT POPULATION 81 eyes of 81 patients were enrolled, 27 with NTG and 54 with NGON, including ischemic optic neuropathy, previous optic neuritis, and compressive and inherited optic neuropathies. All NGON patients with intraocular pressure >21 mm Hg, narrow drainage angles, or a family history of glaucoma were excluded. Observational procedure: optic disc OCT images were obtained of both the retinal nerve fiber layer thickness and the MRW-BMO. MAIN OUTCOME MEASUREMENTS the utility of the MRW-BMO in differentiating GON from NGON was assessed using the area under the curve (AUC) estimated from a logistic regression model. RESULTS The 5-fold cross-validated AUC for glaucoma versus nonglaucoma from logistic regression models using MRW-BMO values from all sectors was 0.95 (95% confidence interval: 0.86-1.00). CONCLUSIONS The measurement of MRW-BMO effectively differentiates between NTG and NGON with a high level of sensitivity and specificity. Incorporating this measurement into routine glaucoma assessment may provide a robust method of assisting clinicians to improve diagnosis and therefore treatment of optic nerve diseases.
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9
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Kim GN, Kim JA, Kim MJ, Lee EJ, Hwang JM, Kim TW. Comparison of Lamina Cribrosa Morphology in Normal Tension Glaucoma and Autosomal-Dominant Optic Atrophy. Invest Ophthalmol Vis Sci 2020; 61:9. [PMID: 32392317 PMCID: PMC7405716 DOI: 10.1167/iovs.61.5.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare lamina cribrosa (LC) morphology in patients with normal tension glaucoma (NTG) and autosomal-dominant optic atrophy (ADOA). Methods This cross-sectional study matched 24 patients diagnosed with ADOA (24 eyes) by age and retinal nerve fiber layer thickness with 48 patients diagnosed with NTG (48 eyes) by age with 48 healthy controls (48 eyes). Optic nerve heads were scanned by enhanced-depth imaging (EDI) optical coherence tomography (OCT). The LC curvature index (LCCI) and LC depth (LCD) on B-scan images obtained using EDI-OCT were measured at seven locations spaced equidistantly across the vertical optic disc diameter and compared among the NTG, ADOA, and control groups. Results Mean LCCI and LCD were significantly greater in NTG than in ADOA and healthy eyes (P < 0.001 each) but did not differ significantly in ADOA and healthy eyes. Conclusions NTG eyes have a more posteriorly curved and deeper LC than ADOA and healthy eyes. This finding provides insight into the role of LC morphology in NTG and provides a clinical clue to distinguish between NTG and ADOA.
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10
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Xiao H, Liu X, Lian P, Liao LL, Zhong YM. Different damage patterns of retinal nerve fiber layer and ganglion cell-inner plexiform layer between early glaucoma and non-glaucomatous optic neuropathy. Int J Ophthalmol 2020; 13:893-901. [PMID: 32566499 DOI: 10.18240/ijo.2020.06.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/14/2020] [Indexed: 12/23/2022] Open
Abstract
AIM To compare the damage pattern of the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell-inner plexiform layer (mGCIPL) between early glaucomatous and non-glaucomatous optic neuropathy (EGON and NGON). METHODS It is a cross-sectional study. Thirty-eight healthy controls, 74 EGONs and 70 NGONs with comparable average pRNFL loss were included. The NGON group included 23 eyes of optic neuritis (ON), 13 eyes of hereditary optic neuropathy (HON), 19 eyes of toxic optic neuropathy (TON) and 15 eyes of compressive neuropathy (CON). The sectoral pRNFL and mGCIPL thickness obtained by high definition optical coherence tomography were analyzed. RESULTS Compared to normal controls, the pRNFL thickness in all quadrants showed a decrease in both EGON and NGON group (P<0.001), but the average pRNFL thickness of EGON group was not different to that of NGON group (P=0.94). The inferior and superior pRNFL was thinner in EGON group compared to NGON group (P<0.001). The temporal pRNFL was thinner in NGON group compared to EGON group (P<0.001). No statistically significant difference was found in nasal pRNFL between EGON and NGON. While the nasal pRNFL was thinner in CON than other three types of NGON (P=0.01), no statistically significant difference was found in other three quadrantal pRNFL among the four types of NGON (P>0.05). The mGCIPL of EGON and NGON group were thinner than control group (P<0.001). In EGON group the severest sites of mGCIPL reduction was located at inferotemporal and inferior sectors. While, compared to EGON group, the average mGCIPL of NGON group were significantly thinner, especially in superonasal and inferonasal sectors (P<0.001). CONCLUSION The damage pattern of pRNFL and mGCIPL caused by glaucoma is distinct from other NGON such as ON, TON, HON and CON, and this characteristic damage pattern is helpful in differentiating early glaucoma from other NGON.
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Affiliation(s)
- Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ping Lian
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Ling-Ling Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | - Yi-Min Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
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11
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Workup for Optic Atrophy. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Davies IJ, Muir KW, Halabis JA, Stinnett SS, Allingham RR, Shields MB. Gray Optic Disc Crescent: Evaluation of Anatomic Correlate by Spectral-Domain OCT. Ophthalmol Glaucoma 2018; 2:120-125. [PMID: 32672605 DOI: 10.1016/j.ogla.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To test the hypothesis that the anatomic correlate of the gray optic disc crescent is pigmentation of externally oblique border tissue of Elschnig. DESIGN Retrospective study. PARTICIPANTS African-American adult men with or without clinically apparent gray optic disc crescents. METHODS McNemar's test for paired data and kappa statistic with 95% confidence intervals were used to examine the relationships between eyes with or without gray optic disc crescents and corresponding spectral-domain (SD) OCT images with enhanced depth imaging (EDI). MAIN OUTCOME MEASURES Correlation between clinical gray optic disc crescents and hyperreflectivity of externally oblique border tissue of Elschnig by SD OCT with EDI. RESULTS Twenty-five eyes had clinically apparent gray optic disc crescents, of which SD OCT with EDI revealed hyperreflectivity (interpreted as increased pigmentation) of externally oblique (obtuse angle) border tissue of Elschnig in 22 eyes, that is, extending into Bruch's membrane opening and presumably visible by funduscopy. Thirty-two eyes from matched participants had no apparent gray optic disc crescent, of which SD OCT with EDI revealed hyperreflectivity of the border tissue of Elschnig in 23 eyes, but with a nonoblique (right angle) or internal (acute angle) angle, which would presumably obstruct funduscopic visualization. CONCLUSIONS Observations by SD OCT with EDI suggest that the anatomic correlate of the gray optic disc crescent is pigmentation of externally oblique border tissue of Elschnig.
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Affiliation(s)
- Isaiah J Davies
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Kelly W Muir
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Veteran's Administration Hospital, Durham, North Carolina.
| | | | - Sandra S Stinnett
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - R Rand Allingham
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Veteran's Administration Hospital, Durham, North Carolina
| | - M Bruce Shields
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut; Veteran's Administration Hospital, Durham, North Carolina
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13
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Fard MA, Moghimi S, Sahraian A, Ritch R. Optic nerve head cupping in glaucomatous and non-glaucomatous optic neuropathy. Br J Ophthalmol 2018; 103:374-378. [PMID: 29793928 DOI: 10.1136/bjophthalmol-2018-312161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/29/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Enlargement of optic disc cupping is seen both in glaucoma and in neurological disorders. We used enhanced depth imaging with spectral-domain optical coherence tomography to differentiate glaucoma from non-glaucomatous optic neuropathy. METHODS The optic discs were scanned in this prospective comparative study, and the lamina cribrosa (LC) thickness and anterior laminar depth (ALD) in the central, superior and inferior optic nerve head, and peripapillary choroidal thicknesses, were measured. RESULTS There were 31 eyes of 31 patients with severe glaucoma and 33 eyes of 19 patients with non-glaucomatous cupping. Eyes of 29 healthy controls were also enrolled. There was no significant difference in the cup-to-disc ratio and in the average peripapillary nerve fibre layer thickness between the glaucoma and non-glaucomatous cupping groups (p>0.99). The average peripapillary choroidal thickness was thinner in glaucoma eyes than in the control eyes after adjusting for age and axial length. Glaucomatous and non-glaucomatous eyes had greater ALD and thinner LC than the control eyes (p<0.001 for both). ALDs of glaucoma eyes were deeper than non-glaucomatous eyes (p=0.01 for central ALD) when age, axial length and peripapillary choroidal thickness were included in the linear mixed model. Prelaminar thickness and LC thickness of glaucoma eyes were not different from non-glaucomatous eyes after adjusting. CONCLUSION Deeper ALD was observed in glaucoma than non-glaucomatous cupping after adjusting for choroidal thickness.
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Affiliation(s)
- Masoud Aghsaei Fard
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Moghimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Sahraian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York City, New York, USA
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14
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Edington M, Siempis T, Montgomery D, Venkatesh P. Dolichoectasia of the internal carotid artery: a report of two cases masquerading as glaucoma. Clin Exp Optom 2018; 101:308-310. [DOI: 10.1111/cxo.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Thomas Siempis
- Department of Ophthalmology, Glasgow Royal Infirmary, Glasgow, UK,
| | | | - Prem Venkatesh
- Department of Ophthalmology, Inverclyde Royal Hospital, Greenock, UK,
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15
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Hata M, Miyamoto K, Oishi A, Makiyama Y, Gotoh N, Kimura Y, Akagi T, Yoshimura N. Comparison of optic disc morphology of optic nerve atrophy between compressive optic neuropathy and glaucomatous optic neuropathy. PLoS One 2014; 9:e112403. [PMID: 25375855 PMCID: PMC4223062 DOI: 10.1371/journal.pone.0112403] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/05/2014] [Indexed: 12/03/2022] Open
Abstract
Objectives To compare the optic nerve head (ONH) structure between compressive optic neuropathy (CON) and glaucomatous optic neuropathy (GON), and to determine whether selected ONH quantitative parameters effectively discriminate between GON and CON, especially CON cases presenting with a glaucoma-like disc. Methods We prospectively assessed 34 patients with CON, 34 age-matched patients with moderate or severe GON, and 34 age-matched healthy control subjects. The quantitative parameters of ONH structure were compared using the Heidelberg Retina Tomograph 2 (HRT2) and Spectralis optical coherence tomography with an enhanced depth imaging method. Results The mean and maximum cup depths of CON were significantly smaller than those with GON (P<0.001 and P<0.001, respectively). The distance between Bruch's membrane opening and anterior surface of the lamina cribrosa (BMO-anterior LC) of CON was also significantly smaller than that of glaucoma but was similar to that of the healthy group (P<0.001 and P = 0.47, respectively). Based on Moorfields regression analysis of the glaucoma classification of HRT2, 15 eyes with CON were classified with a glaucoma-like disc. The cup/disc area ratio did not differ between cases of CON with a glaucoma-like disc and cases of GON (P = 0.16), but the BMO-anterior LC and mean and maximum cup depths of CON cases with a glaucoma-like disc were smaller than those in GON (P = 0.005, P = 0.003, and P = 0.001, respectively). Conclusions Measurements of the cup depths and the LC depth had good ability to differentiate between CON with a glaucoma-like disc and glaucoma. There was no laminar remodeling detected by laminar surface position in the patients with CON compared to those with GON.
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Affiliation(s)
- Masayuki Hata
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Kazuaki Miyamoto
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Oishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukiko Makiyama
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Norimoto Gotoh
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yugo Kimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Abstract
Normal tension glaucoma (NTG) is a progressive optic neuropathy that mimics primary open-angle glaucoma, but lacks the findings of elevated intraocular pressure or other mitigating factors that can lead to optic neuropathy. The present review summarized the causes, genetics, and mechanisms underlying NTG in both animal models and human patients. We also proposed that the neurovascular unit is a therapeutic target for NTG management.
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Affiliation(s)
- Xue-Song Mi
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Guangzhou, People's Republic of China ; Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Ti-Fei Yuan
- School of Psychology, Nanjing Normal University, Nanjing, People's Republic of China ; Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Kwok-Fai So
- Department of Anatomy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China ; Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China ; GHM Institute of CNS Regeneration, Jinan University, Guangzhou, People's Republic of China
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17
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Arora S, Rayat J, Damji KF. Optic nerve gray crescent can confound neuroretinal rim interpretation: review of the literature. Can J Ophthalmol 2014; 49:238-42. [PMID: 24862768 DOI: 10.1016/j.jcjo.2014.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Abstract
The optic nerve gray crescent can be of clinical significance if unrecognized during assessment for glaucoma. It has a characteristic appearance of a slate gray area of pigmentation within the disc margins and commonly appears along the inferotemporal or temporal neuroretinal rim areas. This type of disc rim pigmentation can create the impression of neuroretinal rim thinning, and thus lead to the misdiagnosis of glaucoma or "glaucoma suspect" with attendant implications for overtreatment or unnecessary close monitoring of such patients. The gray crescent is more common in African Americans than whites (prevalence rate 27% vs 7%) and is bilateral in at least 58% of cases. It has been reported in association with Kjer optic atrophy type 1. Suggested causes of the gray crescent include an accumulation of melanocytes, or retinal pigment epithelium cells partially located in the optic nerve head region if Bruch's membrane extends internal to the peripapillary scleral ring. Other causes of pigmentation that may resemble gray crescent are conus pigmentosus and variations of peripapillary atrophy. When a gray crescent is present, clinicians should endeavour to identify the true anatomical disc margins via the scleral lip and, if necessary, evaluate the patient further with imaging and visual field studies.
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Affiliation(s)
- Sourabh Arora
- Department of Ophthalmology, University of Alberta, Edmonton, Alta
| | - Jaspreet Rayat
- Department of Ophthalmology, University of Alberta, Edmonton, Alta
| | - Karim F Damji
- Department of Ophthalmology, University of Alberta, Edmonton, Alta.
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18
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Lee TE, Youm JH, Kim YY, Yoo C. Characteristics of the Gray Optic Disc Crescent and Associated Factors. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.3.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Eun Lee
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Jie Hyun Youm
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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19
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Russo A, Delcassi L, Marchina E, Semeraro F. Correlation between visual acuity and OCT-measured retinal nerve fiber layer thickness in a family with ADOA and an OPA1 mutation. Ophthalmic Genet 2012; 34:69-74. [DOI: 10.3109/13816810.2012.702259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Capo H, Repka MX, Edmond JC, Drack AV, Blumenfeld L, Siatkowski RM. Optic nerve abnormalities in children: a practical approach. J AAPOS 2011; 15:281-90. [PMID: 21683634 DOI: 10.1016/j.jaapos.2011.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/25/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
Evaluation of children with optic nerve abnormalities is challenging. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, and genetic testing are helpful in the diagnosis and management of these patients. Importantly, many optic nerve problems are not isolated but occur in association with systemic and central nervous system anomalies. The ophthalmologist thus plays a critical role in recognizing patients who warrant systemic and neurologic assessment.
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Affiliation(s)
- Hilda Capo
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33136, USA.
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21
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Yu-Wai-Man P, Griffiths PG, Chinnery PF. Mitochondrial optic neuropathies - disease mechanisms and therapeutic strategies. Prog Retin Eye Res 2011; 30:81-114. [PMID: 21112411 PMCID: PMC3081075 DOI: 10.1016/j.preteyeres.2010.11.002] [Citation(s) in RCA: 440] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Leber hereditary optic neuropathy (LHON) and autosomal-dominant optic atrophy (DOA) are the two most common inherited optic neuropathies in the general population. Both disorders share striking pathological similarities, marked by the selective loss of retinal ganglion cells (RGCs) and the early involvement of the papillomacular bundle. Three mitochondrial DNA (mtDNA) point mutations; m.3460G>A, m.11778G>A, and m.14484T>C account for over 90% of LHON cases, and in DOA, the majority of affected families harbour mutations in the OPA1 gene, which codes for a mitochondrial inner membrane protein. Optic nerve degeneration in LHON and DOA is therefore due to disturbed mitochondrial function and a predominantly complex I respiratory chain defect has been identified using both in vitro and in vivo biochemical assays. However, the trigger for RGC loss is much more complex than a simple bioenergetic crisis and other important disease mechanisms have emerged relating to mitochondrial network dynamics, mtDNA maintenance, axonal transport, and the involvement of the cytoskeleton in maintaining a differential mitochondrial gradient at sites such as the lamina cribosa. The downstream consequences of these mitochondrial disturbances are likely to be influenced by the local cellular milieu. The vulnerability of RGCs in LHON and DOA could derive not only from tissue-specific, genetically-determined biological factors, but also from an increased susceptibility to exogenous influences such as light exposure, smoking, and pharmacological agents with putative mitochondrial toxic effects. Our concept of inherited mitochondrial optic neuropathies has evolved over the past decade, with the observation that patients with LHON and DOA can manifest a much broader phenotypic spectrum than pure optic nerve involvement. Interestingly, these phenotypes are sometimes clinically indistinguishable from other neurodegenerative disorders such as Charcot-Marie-Tooth disease, hereditary spastic paraplegia, and multiple sclerosis, where mitochondrial dysfunction is also thought to be an important pathophysiological player. A number of vertebrate and invertebrate disease models has recently been established to circumvent the lack of human tissues, and these have already provided considerable insight by allowing direct RGC experimentation. The ultimate goal is to translate these research advances into clinical practice and new treatment strategies are currently being investigated to improve the visual prognosis for patients with mitochondrial optic neuropathies.
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MESH Headings
- Animals
- DNA, Mitochondrial/genetics
- Disease Models, Animal
- Humans
- Optic Atrophy, Autosomal Dominant/pathology
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Autosomal Dominant/therapy
- Optic Atrophy, Hereditary, Leber/pathology
- Optic Atrophy, Hereditary, Leber/physiopathology
- Optic Atrophy, Hereditary, Leber/therapy
- Optic Nerve/pathology
- Phenotype
- Point Mutation
- Retinal Ganglion Cells/pathology
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Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, Institute for Ageing and Health, The Medical School, Newcastle University, UK.
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22
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Gupta PK, Asrani S, Freedman SF, El-Dairi M, Bhatti MT. Differentiating glaucomatous from non-glaucomatous optic nerve cupping by optical coherence tomography. Open Neurol J 2011; 5:1-7. [PMID: 21532867 PMCID: PMC3083760 DOI: 10.2174/1874205x01105010001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 08/20/2010] [Accepted: 09/01/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In clinical practice, the differentiation of glaucomatous from non-glaucomatous cupping can be difficult, even for experienced observers. The purpose of this study was to evaluate the role of optical coherence tomography (OCT) in differentiating glaucomatous from non-glaucomatous optic nerve cupping in a cross-sectional pilot study. METHODS Eleven consecutive patients presenting to the Duke Eye Center from September 2007 to July 2008 with non-glaucomatous optic nerve cupping and 12 patients with glaucomatous optic nerve cupping were identified. All patients underwent Stratus® OCT imaging: fast macular map, fast retinal nerve fiber layer (RNFL) 3.4 thickness, and fast optic disc protocols. Automated visual field perimetry was performed on the date of OCT scan in non-glaucomatous cupping patients, and from 0-9 months of scan date in glaucoma patients. Eyes were matched by optic nerve cup-to-disc area ratio; average and mean deviation were calculated for each variable. RESULTS For a similar average RNFL, patients with non-glaucomatous optic nerve cupping had lower nasal and temporal RNFL thickness, as well as lower macular thickness and volume compared to patients with glaucomatous optic nerve cupping. CONCLUSION OCT appears to be a useful technology in differentiating glaucomatous from non-glaucomatous optic nerve cupping. The pattern of RNFL loss appears more diffuse in non-glaucomatous optic nerve cupping compared to glaucomatous optic nerve cupping. Future studies with larger sample size and specific neuro-ophthalmic causes of optic nerve cupping may further elucidate the role of OCT in this clinical setting.
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Affiliation(s)
- Preeya K Gupta
- Departments of Ophthalmology Duke University Eye Center and Duke University Medical Center, USA
| | - Sanjay Asrani
- Departments of Ophthalmology Duke University Eye Center and Duke University Medical Center, USA
| | - Sharon F Freedman
- Departments of Ophthalmology Duke University Eye Center and Duke University Medical Center, USA
| | - Mays El-Dairi
- Departments of Ophthalmology Duke University Eye Center and Duke University Medical Center, USA
| | - M Tariq Bhatti
- Departments of Ophthalmology Duke University Eye Center and Duke University Medical Center, USA
- Medicine (Division of Neurology), Duke University Eye Center and Duke University Medical Center, USA
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23
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Optic disc evaluation in optic neuropathies: the optic disc assessment project. Ophthalmology 2010; 118:964-70. [PMID: 21126771 DOI: 10.1016/j.ophtha.2010.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 09/08/2010] [Accepted: 09/08/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Optic nerve morphology is affected by genetic and acquired disease. Glaucoma is the most common optic neuropathy; autosomal-dominant optic atrophy (ADOA) and Leber's hereditary optic neuropathy (LHON) are the most prevalent hereditary optic neuropathies. These 3 entities can exhibit similar topographical changes at the optic nerve head. Both ADOA and LHON have been reported to be misdiagnosed as glaucoma. Our aim was to determine whether glaucoma subspecialists and neuro-ophthalmologists can distinguish these diagnoses on optic disc assessment alone. DESIGN Observational study. PARTICIPANTS Twenty-three optic nerve experts. METHODS We randomized and masked 60 high-resolution stereoscopic optic disc photographs (15 ADOA images, 15 LHON, 15 glaucoma, and 15 normal controls). Experts were asked to assess the discs on 12 conventional topographic features and assign a presumptive diagnosis. Intra- and interanalysis was performed using the index of qualitative variation and absolute deviation. MAIN OUTCOME MEASURES Can glaucoma specialists and neuro-ophthalmologists distinguish among the disease entities by optic nerve head phenotype. RESULTS The correct diagnosis was identified in 85%, 75%, 27%, and 16% of the normal, glaucoma, ADOA, and LHON disc groups, respectively. The proportion of correct diagnoses within the ADOA and LHON groups was significantly lower than both normal and glaucomatous (P<0.001). Where glaucoma was chosen as the most likely diagnosis, 61% were glaucomatous, 34% were pathologic but nonglaucomatous discs, and 5% were normal. There was greater agreement for individual parameters assessed within the normal disc set when compared with pathologic discs (P<0.05). The only parameter to have a significantly greater agreement within the glaucomatous disc set when compared with ADOA or LHON disc sets was pallor, whereby experts agreed on is absence in the glaucomatous discs but were not in agreement on its presence or its absence in the ADOA and LHON discs (P<0.01). CONCLUSIONS Optic neuropathies can result in similar topographic changes at the optic disc, particularly in late-stage disease, making it difficult to differentiate ADOA and LHON from glaucoma based on disc assessment alone. Other clinical parameters such as acuity, color vision, history of visual loss, and family history are required to make an accurate diagnosis.
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24
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Genetic screening for OPA1 and OPA3 mutations in patients with suspected inherited optic neuropathies. Ophthalmology 2010; 118:558-63. [PMID: 21036400 DOI: 10.1016/j.ophtha.2010.07.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 06/11/2010] [Accepted: 07/29/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Autosomal-dominant optic atrophy (DOA) is one of the most common inherited optic neuropathies, and it is genetically heterogeneous, with mutations in both OPA1 and OPA3 known to cause disease. Approximately 60% of cases harbor OPA1 mutations, whereas OPA3 mutations have been reported in only 2 pedigrees with DOA and premature cataracts. The aim of this study was to determine the yield of OPA1 and OPA3 screening in a cohort of presumed DOA cases referred to a tertiary diagnostic laboratory. DESIGN Retrospective case series. PARTICIPANTS One hundred eighty-eight probands with bilateral optic atrophy referred for molecular genetic investigations at a tertiary diagnostic facility: 38 patients with an autosomal-dominant pattern of inheritance and 150 sporadic cases. METHODS OPA1 and OPA3 genetic testing was initially performed using polymerase chain reaction-based sequencing methods. The presence of large-scale OPA1 and OPA3 genomic rearrangements was assessed further with a targeted comparative genomic hybridization microarray platform. The 3 primary Leber hereditary optic neuropathy (LHON) mutations, m.3460G→>A, m.11778G→A, and m.14484T→C, also were screened in all patients. MAIN OUTCOME MEASURES The proportion of patients with OPA1 and OPA3 pathogenic mutations. The clinical profile observed in molecularly confirmed DOA cases. RESULTS Twenty-one different OPA1 mutations were found in 27 (14.4%) of the 188 probands screened. The mutations included 6 novel pathogenic variants and the first reported OPA1 initiation codon mutation at c.1A→T. An OPA1 missense mutation, c.239A→G (p.Y80C), was identified in an 11-year-old black girl with optic atrophy and peripheral sensorimotor neuropathy in her lower limbs. The OPA1 detection rate was significantly higher among individuals with a positive family history of visual failure (50.0%) compared with sporadic cases (5.3%). The primary LHON screen was negative in the patient cohort, and additional molecular investigations did not reveal any large-scale OPA1 rearrangements or OPA3 genetic defects. The mean baseline visual acuity for the OPA1-positive group was 0.48 logarithm of the minimum angle of resolution (units mean Snellen equivalent, 20/61; range, 20/20-20/400; 95% confidence interval, 20/52-20/71), and visual deterioration occurred in 54.2% of patients during follow-up. CONCLUSIONS OPA1 mutations are the most common genetic defects identified in patients with suspected DOA, whereas OPA3 mutations are very rare in isolated optic atrophy cases.
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25
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Williams PA, Morgan JE, Votruba M. Mouse models of dominant optic atrophy: what do they tell us about the pathophysiology of visual loss? Vision Res 2010; 51:229-34. [PMID: 20801145 DOI: 10.1016/j.visres.2010.08.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/20/2010] [Accepted: 08/20/2010] [Indexed: 11/29/2022]
Abstract
Dominant optic atrophy (DOA) is the most common inherited optic neuropathy affecting one in every 12,000 people. It presents with bilateral visual loss, central visual fields defects, colour vision disturbance and optic disc pallor. OPA1 has been identified as the responsible gene and its locus mapped to chromosome 3q28-q29. Mutations in this gene are responsible for the clinical phenotype in over 70% of patients with DOA. Histopathological studies in tissues from patients reveal loss of retinal ganglion cells but the paucity of viable human tissue has raised the importance of an animal model to study the pathophysiology of the disease. In the last decade considerable work has gone into the generation of animal, most notably mouse, models of Opa1 DOA. Two murine models of DOA have been published, designated B6;C3-Opa1(Q285STOP) and B6;C3-Opa1(329-355del) and they provide valuable insights with respect to neurological and visual phenotyping, mitochondrial dysfunction, optic nerve and axonal changes, retinal ganglion cell depletion and dendritic atrophy. Here we summarise the current state of knowledge of the mechanisms of disease based on data from these models of Opa1 DOA.
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Affiliation(s)
- P A Williams
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4LU, United Kingdom
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26
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Milea D, Sander B, Wegener M, Jensen H, Kjer B, Jørgensen TM, Lund-Andersen H, Larsen M. Axonal loss occurs early in dominant optic atrophy. Acta Ophthalmol 2010; 88:342-6. [PMID: 19302076 DOI: 10.1111/j.1755-3768.2008.01469.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE This study set out to investigate retinal nerve fibre layer (RNFL) thickness and best corrected visual acuity (BCVA) in relation to age in healthy subjects and patients with OPA1 autosomal dominant optic atrophy (DOA). METHODS We carried out a cross-sectional investigation of RNFL thickness and ganglion cell layer density in 30 healthy subjects and 10 patients with OPA1 DOA using optical coherence tomography (OCT). We then performed a regression analysis of RNFL thickness and BCVA versus age. RESULTS Both healthy subjects and DOA patients demonstrated a gradual reduction in RNFL thickness with age; the relationship was best described statistically by a model that assumed a constant offset between the two groups. Best corrected VA decreased significantly with age in DOA patients, in whom BCVA was correlated with peripapillary RNFL thickness in the inferior and superior peripapillary quadrants and with total macular thickness at eccentricities of 500-3000 microm. The observations were best described by a constant offset of 41.9 microm separating the two groups and an annual decrease in RNFL thickness of 0.48 microm (p < 0.0001). In patients with DOA, increasing age was associated with decreasing BCVA (p = 0.046). CONCLUSIONS This cross-sectional study found evidence of comparable age-related decreases in RNFL thickness in healthy subjects and in DOA patients, where the deficit in DOA patients is best described using a model that assumes the deficit between the groups does not vary with age. The gradual reduction of BCVA with age may be a consequence of a relative deficit in RNFL thickness that is established before the second decade of life.
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27
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Abstract
Hereditary optic neuropathies are caused by mutations either in the nuclear or mitochondrial genome and lead to retinal ganglion cell death mediated by reduced oxidative phosphorylation, fragmentation of the mitochondrial network, and increased sensitivity to apoptosis. Nuclear mutations result in autosomal dominant optic atrophy, autosomal recessive optic atrophy, or X-linked recessive optic atrophy, whereas mitochondrial mutations result in Leber's hereditary optic neuropathy, which is maternally inherited. A tentative diagnosis of a hereditary optic neuropathy can usually be made on the grounds of a thorough patient and family history, visual field and color vision tests, and a detailed assessment of the optic nerve head. The rarity of hereditary optic neuropathies makes it difficult to include these disorders in the differential diagnosis. Molecular genetic testing of a blood DNA sample should be performed on every patient, with implications for future genetic counseling and prediction of the disease course.
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28
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O'Neill EC, Mackey DA, Connell PP, Hewitt AW, Danesh-Meyer HV, Crowston JG. The optic nerve head in hereditary optic neuropathies. Nat Rev Neurol 2009; 5:277-87. [DOI: 10.1038/nrneurol.2009.40] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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29
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Yu-Wai-Man P, Griffiths PG, Hudson G, Chinnery PF. Inherited mitochondrial optic neuropathies. J Med Genet 2009; 46:145-58. [PMID: 19001017 PMCID: PMC2643051 DOI: 10.1136/jmg.2007.054270] [Citation(s) in RCA: 287] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 09/08/2008] [Accepted: 10/07/2008] [Indexed: 02/02/2023]
Abstract
Leber hereditary optic neuropathy (LHON) and autosomal dominant optic atrophy (DOA) are the two most common inherited optic neuropathies and they result in significant visual morbidity among young adults. Both disorders are the result of mitochondrial dysfunction: LHON from primary mitochondrial DNA (mtDNA) mutations affecting the respiratory chain complexes; and the majority of DOA families have mutations in the OPA1 gene, which codes for an inner mitochondrial membrane protein critical for mtDNA maintenance and oxidative phosphorylation. Additional genetic and environmental factors modulate the penetrance of LHON, and the same is likely to be the case for DOA which has a markedly variable clinical phenotype. The selective vulnerability of retinal ganglion cells (RGCs) is a key pathological feature and understanding the fundamental mechanisms that underlie RGC loss in these disorders is a prerequisite for the development of effective therapeutic strategies which are currently limited.
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MESH Headings
- DNA, Mitochondrial
- Female
- GTP Phosphohydrolases/genetics
- Humans
- Male
- Optic Atrophy, Autosomal Dominant/diagnosis
- Optic Atrophy, Autosomal Dominant/epidemiology
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/pathology
- Optic Atrophy, Hereditary, Leber/diagnosis
- Optic Atrophy, Hereditary, Leber/epidemiology
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/pathology
- Point Mutation
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Affiliation(s)
- P Yu-Wai-Man
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P G Griffiths
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Hudson
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - P F Chinnery
- Mitochondrial Research Group, The Medical School, Newcastle University, Newcastle upon Tyne, UK
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
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Abstract
PURPOSE To describe the Stratus optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness profile of dominant optic atrophy (DOA), to differentiate it from that of glaucoma. METHODS RNFL thickness was measured using Stratus OCT in 32 eyes of 16 DOA patients. RESULTS The temporal-most clock hour measurement was outside the 95% normal limit in 29 of the 32 DOA eyes (90.6%). The pattern of RNFL damage was bilaterally symmetrical in location and severity in all subjects. CONCLUSION Stratus OCT shows characteristic findings differentiating DOA from glaucoma.
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Higginbotham L, Shafranov G, Shields MB. Gray optic disc crescent: influence of ethnicity in a glaucoma population. J Glaucoma 2007; 16:572-6. [PMID: 17873721 DOI: 10.1097/ijg.0b013e31805342cb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the prevalence of the gray optic disc crescent within a glaucoma population and the influence of ethnicity and other variables. PATIENTS AND METHODS Consecutive patients of white or African American ethnicity, seen in the Glaucoma Service of Yale Eye Center, were included in the study. The 2 ethnic groups were not matched for refractive error, age, or stage of glaucoma. Stereodisc photos, suitable for detailed evaluation of disc and parapapillary features, of 1 or both eyes were selected by 1 investigator. The photos were masked to the other 2 investigators, who independently interpreted the disc and parapapillary features. The prevalence of the gray crescent in the 2 ethnic groups was compared by chi analysis. Correlation with age, sex, refractive error, intraocular pressure, and the presence and degree of glaucomatous optic neuropathy were also analyzed. RESULTS Of 225 patients (447 eyes), the gray crescent was seen in one or both eyes of 32 patients (14.2%), which included 21 of the 77 [27.3%, 95% confidence intervals (CI) 9.95] African Americans and 11 of the 148 (7.4%, 95% CI 4.23) whites. The difference in prevalence of the gray crescent between the 2 ethnic groups was significant (P<0.0001). The prevalence of the gray crescent did not correlate with age, sex, refractive error, intraocular pressure or the presence or degree of glaucomatous optic neuropathy. CONCLUSIONS The gray optic disc crescent is a common finding within a glaucoma population, especially among persons of African heritage, but does not correlate with the presence or degree of glaucomatous optic neuropathy nor other patient variables.
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Affiliation(s)
- Lenora Higginbotham
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520, USA
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Hayashi T, Takeuchi T, Gekka T, Kitahara K. Dominant optic atrophy in a Japanese family with OPA1 frameshift mutation (V942fsX966). Eur J Ophthalmol 2007; 17:253-8. [PMID: 17415700 DOI: 10.1177/112067210701700216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The authors report the ophthalmic characteristics of a male proband in a Japanese family with autosomal dominant optic atrophy (DOA) harboring a frameshift mutation in the OPA1 gene. METHODS Conventional ophthalmologic examinations including static automated perimetry were performed, as well as assessment of the three-generation family history. The peripapillary retinal nerve fiber layer (RNFL) was evaluated using scanning laser polarimetry. Mutation screening of the OPA1 gene was performed with polymerase chain reaction amplification and direct sequencing. RESULTS A frameshift mutation (p.V942fsX966) was identified in the proband and his mother. In comparison with the adolescent onset of visual loss in the proband and his maternal grandfather, the mother presented with only subtle temporal disc pallor and has never been aware of any visual disturbances. Symmetric thinned peripapillary RNFL was detected in the proband, whose visual field abnormalities were limited to central scotomas and were without mean deviation worsening between 11 to 17 years of age in both eyes. The proband's logMAR visual acuity (0.52 to 0.7) has remained almost unchanged for more than 10 years since initial evaluation at age 10. CONCLUSIONS The OPA1 mutation may be correlated with slow progression of DOA, and with phenotypic variations within the family. Further study is necessary to determine whether symmetric thinned peripapillary RNFL represents a feature of DOA.
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Affiliation(s)
- T Hayashi
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Mabuchi F, Tang S, Kashiwagi K, Yamagata Z, Iijima H, Tsukahara S. The OPA1 gene polymorphism is associated with normal tension and high tension glaucoma. Am J Ophthalmol 2007; 143:125-130. [PMID: 17188046 DOI: 10.1016/j.ajo.2006.09.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 08/26/2006] [Accepted: 09/12/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess whether genetic polymorphisms of optic atrophy 1 (OPA1) are associated with primary open-angle glaucoma (POAG). DESIGN Prospective case control association study. METHODS Japanese patients with normal tension glaucoma (NTG, n = 194), and high tension glaucoma (HTG, n = 191), and 185 control subjects were analyzed for the OPA1 intervening sequence (IVS) 8+4 cystosine thymine (C/T) and IVS 8+32 thymine cystosine (T/C) polymorphisms using pyrosequencing technique. RESULTS There was a significant difference in the OPA1 IVS 8 +32 T/C genotype frequencies between the NTG patients and control subjects (P = .0074), and the frequency of the cystosine (C) allele was significantly higher in the NTG patients compared with the control subjects (19.3% vs 11.6%, P = .0036). Adjusted for age, gender, refractive error, and intraocular pressure, an almost two-fold increased risk of NTG (P = .004, odds ratio 2.27, 95% confidence interval 1.30 to 3.97) was found with the OPA1 IVS 8 +32 C allele. Although there was no significant difference in the OPA1 IVS 8 +32 T/C genotype frequencies between the HTG patients and control subjects (P = .24), the age at the time of diagnosis (53 +/- 11.0 years, median value +/- median absolute deviation) in the HTG patients with the OPA1 IVS 8 +32 C allele was significantly younger than that (57 +/- 12.0 years) in the HTG patients without C allele (P = .048). CONCLUSIONS The OPA1 IVS 8 +32 T/C polymorphism is associated with NTG, and may be used as a marker for this disease association. This polymorphism also influences the phenotypic feature in patients with HTG and should be considered to be a genetic risk factor not only for NTG, but also for HTG.
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Affiliation(s)
- Fumihiko Mabuchi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan.
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36
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Inagaki Y, Mashima Y, Fuse N, Ohtake Y, Fujimaki T, Fukuchi T. Mitochondrial DNA Mutations with Leber's Hereditary Optic Neuropathy in Japanese Patients with Open-Angle Glaucoma. Jpn J Ophthalmol 2006; 50:128-34. [PMID: 16604388 DOI: 10.1007/s10384-005-0290-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 06/28/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE Abnormal optic disc excavations are found in patients with Leber's hereditary optic neuropathy (LHON). The purpose of this study was to determine whether heteroplasmy for the major three LHON mutations or for the rare LHON mutations are risk factors for open-angle glaucoma. METHODS Blood samples from 835 Japanese subjects were screened with the Invader assay for ten LHON-associated mutations: three major mutations (G3460A, G11778A, T14484C) and seven rare mutations (T9101C, G9804A, C14482A, C14482G, G14459A, T14498C, and A14510G). Of the 835 subjects, 241 were patients with primary open-angle glaucoma (POAG), 310 were patients with normal-tension glaucoma (NTG), and 284 were healthy controls. RESULTS Five POAG patients and three NTG patients had one of five mutations, C9099A, T9101G, T9101C, G9804A, or G11778A, but none of these patients had LHON. The C9099A (Ile191Met) and T9101G (Ile192Ser) mutations were novel and identified within the probes by lack of signal in the assay. Two patients with the G11778A mutation showed heteroplasmy, with 15% mutant mtDNA in the male patient and 80% in the female patient. The remaining LHON-associated mutations were not detected in any of the subjects. A case-control study did not show a significant difference (P = 0.099): eight potentially disease-associated variants in 551 patients versus zero variants in the 284 controls. CONCLUSIONS Rare LHON-associated mitochondrial DNA mutations were found in Japanese patients with open-angle glaucoma (OAG). However, whether mitochondrial DNA mutations are risk factors for OAG is still open to question.
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MESH Headings
- Aged
- DNA Mutational Analysis
- DNA, Mitochondrial/genetics
- Female
- Genotype
- Glaucoma, Open-Angle/complications
- Glaucoma, Open-Angle/epidemiology
- Glaucoma, Open-Angle/genetics
- Humans
- Japan/epidemiology
- Male
- Middle Aged
- Mutation, Missense
- Optic Atrophy, Hereditary, Leber/complications
- Optic Atrophy, Hereditary, Leber/epidemiology
- Optic Atrophy, Hereditary, Leber/genetics
- Risk Factors
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Affiliation(s)
- Yoko Inagaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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37
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Osborne NN, Lascaratos G, Bron AJ, Chidlow G, Wood JPM. A hypothesis to suggest that light is a risk factor in glaucoma and the mitochondrial optic neuropathies. Br J Ophthalmol 2006; 90:237-41. [PMID: 16424541 PMCID: PMC1860161 DOI: 10.1136/bjo.2005.082230] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The authors propose that light entering the eye interacts with retinal ganglion cell (RGC) axon mitochondria to generate reactive oxygen intermediates (ROI) and that when these neurons are in an energetically low state, their capacity to remove these damaging molecules is exceeded and their survival is compromised. They suggest that in the initial stages of glaucoma, RGCs exist at a low energy level because of a reduced blood flow at the optic nerve head and that in the mitochondrial optic neuropathies (MONs), this results from a primary, genetic defect in aerobic metabolism. In these states RGCs function at a reduced energy level and incident light on the retina becomes a risk factor. Preliminary laboratory studies support this proposition. Firstly, the authors have shown that light is detrimental to isolated mitochondria in an intensity dependent manner. Secondly, light triggers apoptosis of cultured, transformed RGCs and this effect is exacerbated when the cells are nutritionally deprived. Detailed studies are under way to strengthen the proposed theory. On the basis of this proposal, the authors suggest that patients with optic neuropathies such as glaucoma or at risk of developing a MON may benefit from the use of spectral filters and reducing the intensity of light entering the eye.
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Affiliation(s)
- N N Osborne
- Nuffield Laboratory of Ophthalmology, University of Oxford, Walton Street, Oxford OX2 6AW, UK.
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38
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Abstract
AIMS To provide a clinical update on the hereditary optic neuropathies. METHODS Review of the literature. RESULTS The hereditary optic neuropathies comprise a group of disorders in which the cause of optic nerve dysfunction appears to be hereditable, based on familial expression or genetic analysis. In some hereditary optic neuropathies, optic nerve dysfunction is typically the only manifestation of the disease. In others, various neurologic and systemic abnormalities are regularly observed. CONCLUSION The most common hereditary optic neuropathies are autosomal dominant optic atrophy (Kjer's disease) and maternally inherited Leber's hereditary optic neuropathy. We review the clinical phenotypes of these and other inherited disorders with optic nerve involvement.
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MESH Headings
- Dysautonomia, Familial/complications
- Dysautonomia, Familial/genetics
- Female
- Friedreich Ataxia/complications
- Friedreich Ataxia/genetics
- Humans
- Male
- Muscular Dystrophies/complications
- Muscular Dystrophies/genetics
- Optic Atrophies, Hereditary/complications
- Optic Atrophies, Hereditary/genetics
- Optic Atrophies, Hereditary/physiopathology
- Optic Atrophy, Autosomal Dominant/complications
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Hereditary, Leber/complications
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/physiopathology
- Pedigree
- Spinocerebellar Ataxias/complications
- Spinocerebellar Ataxias/genetics
- Vision Disorders/etiology
- Vision Disorders/genetics
- Vision Disorders/physiopathology
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Affiliation(s)
- N J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30022, USA.
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39
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Acaroglu G, Alanay Y, Reynier P, Amati-Bonneau P, Men G. Clinical Heterogeneity of Hereditary Optic Atrophy in a Turkish Family. Neuroophthalmology 2005. [DOI: 10.1080/01658100490900719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Abstract
AIM To review the molecular genetic basis of primary inherited optic neuropathies. METHODS Medline and Embase search. RESULTS Inherited optic neuropathies are a genetically diverse group of disorders that present with reduced visual acuity and the clinical appearance of optic atrophy. The inherited optic neuropathies may be sporadic or familial, in which case the mode of inheritance may be Mendelian (autosomal dominant, autosomal recessive, X-linked recessive) or non-Mendelian (mitochondrial). Two genes for dominantly inherited optic atrophy have been mapped (OPA1 and OPA4), of which the gene has been identified in one (OPA1). A gene for recessive optic atrophy (OPA3) has also been identified. X-linked optic atrophy (OPA2) has been mapped but to date no gene has been identified. Mutations in mitochondrial DNA have been identified in Leber's hereditary optic neuropathy. CONCLUSIONS Mutations in genes from both the nuclear and mitochondrial genomes appear to be responsible. Mitochondrial dysfunction, in the broadest sense, is emerging as central to the pathogenesis of this group of conditions.
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Affiliation(s)
- M Votruba
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
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41
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Abstract
Optic nerve disorders range from the manifestations of life-threatening intracranial or systemic disease, to minor congenital anomalies. Careful clinical assessment, which relies upon a thorough evaluation of symptoms as well as signs, is essential for effective and timely investigation and treatment. Examination methods and pitfalls to be avoided are discussed.
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Affiliation(s)
- P Riordan-Eva
- Department of Ophthalmology, King's College Hospital, London, UK.
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42
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Abstract
INTRODUCTION Early diagnosis of chronic open-angle glaucoma is difficult: early changes in the optic disc often precede troubles in the field of vision, which occur gradually with no typical initial aspect. We report here the results of optic disc observations in normal subjects who became glaucomatous. OBSERVATIONS AND METHODS A study was conducted on 64 eyes of 51 subjects followed on average over 12 years. At the start these eyes were normal or at risk for glaucoma for various reasons. Doubtful, difficult cases (severe myopia, dysversion or with associated pathology) were eliminated. Eventually, all the eyes presented open-angle glaucoma. All patients underwent clinical and paraclinical examinations by the same examiner. The optic discs of 78 dilated eyes were examined with a slit lamp and a 78-dioptre lens and the results systematically tabulated. Of the 78 optic discs, 40% had initial morphological characteristics (including cup/disc ratios) that were difficult to identify precisely. Preference was given to certain criteria that were easy to evaluate and likely to change. RESULTS The classic aspects of glaucomatous papillary excavation appearance were observed. Forty-four discs showed notable changes (19 typical changes, 25 atypical), which were observed before visual field abnormalities. The size of the disc influences how the disease develops. Also noted were the frequency of changes in the slope of the papillary profile curve (third moment) and the frequency of changes in the quality of the papillary tissue, which takes on a translucent character locally. CONCLUSION Documented and comparative observation of the optic disc remains a good and simple means for supervising subjects at risk for and in early diagnosis of chronic open-angle glaucoma. The evaluation of changes in the optic disc is greatly aided by the collection and the systematic recording of observations.
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Affiliation(s)
- E Esmenjaud
- Centre d'Ophtalmologie du Lez, Chemin de Fescau, Montferrier sur Lez.
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43
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Sadun F, De Negri AM, Carelli V, Salomao SR, Berezovsky A, Andrade R, Moraes M, Passos A, Belfort R, da Rosa AB, Quiros P, Sadun AA. Ophthalmologic findings in a large pedigree of 11778/Haplogroup J Leber hereditary optic neuropathy. Am J Ophthalmol 2004; 137:271-7. [PMID: 14962416 DOI: 10.1016/j.ajo.2003.08.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2003] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the ophthalmologic characteristics of a newly identified seven-generation pedigree of 11778/Haplogroup J Leber hereditary optic neuropathy consisting of 328 living individuals, 111 of whom are maternally related. DESIGN Observational population cohort study. METHODS This prospective study of a large Brazilian Leber hereditary optic neuropathy pedigree was carried out as a field investigation in Brazil. We describe the ophthalmologic findings of 192 eyes from 96 maternally related individuals of this pedigree. Spouses were used as control subjects. We conducted comprehensive neuro-ophthalmologic examinations with psychophysical tests, Humphrey visual fields, and fundus photographs. We also correlated the ophthalmologic findings with the previously published epidemiologic assessment of risk factors. RESULTS We examined 76 carriers and 20 affected individuals. The affected individuals showed severe disease with a mean visual acuity of 2.04 logarithm of the minimal angle of resolution and without evidence of recovery. All the affected individuals showed diffuse optic atrophy with a cup-to-disk ratio greater than 0.5 in 55% of cases. Moreover, among Affected individuals, smokers had a poorer visual acuity (P =.002). Among carriers there were several subclinical abnormalities, including microangiopathy, swelling of nerve fibers, and visual field abnormalities that did not correlate with tobacco or alcohol consumption. CONCLUSIONS Our results demonstrate a significant influence of environmental risk factors, particularly smoking, for developing Leber hereditary optic neuropathy and for the severity of its clinical expression. However, smoking did not correlate with the subclinical abnormalities detected in carriers. Moreover, subclinical abnormalities were equally distributed between gender.
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Aung T, Okada K, Poinoosawmy D, Membrey L, Brice G, Child AH, Bhattacharya SS, Lehmann OJ, Garway-Heath DF, Hitchings RA. The phenotype of normal tension glaucoma patients with and without OPA1 polymorphisms. Br J Ophthalmol 2003; 87:149-52. [PMID: 12543739 PMCID: PMC1771514 DOI: 10.1136/bjo.87.2.149] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM Polymorphisms in OPA1, the gene responsible for autosomal dominant optic atrophy, were recently found to be strongly associated with normal tension glaucoma (NTG). The aim of this study was to determine whether OPA1 polymorphisms affect the phenotype of NTG patients. METHODS A retrospective analysis was performed of 108 well characterised NTG patients who had been genotyped for OPA1 variations, and who had previously undergone automated perimetry and Heidelberg retina tomography (HRT). 25 NTG patients had the at-risk OPA1 genotype (IVS 8 +4 C/T; +32 T/C) and 83 NTG patients did not. Differences between groups were sought in a wide range of structural, psychophysical, and demographic factors. These included sex, age at diagnosis, family history of glaucoma, history of ischaemic risk factors and vasospasm, laterality of glaucoma, presenting and highest diurnal intraocular pressure (IOP), initial cup-disc (CD) ratio, baseline visual field global indices, and optic disc parameters as measured by HRT. For a subgroup of patients with at least 5 years of follow up and 10 visual field tests, pointwise linear regression analysis (PROGRESSOR for Windows software) was applied to the visual field series. RESULTS There was no significant difference in the two groups with respect to sex, age at diagnosis, family history of glaucoma, history of ischaemic risk factors and vasospasm, or laterality of glaucoma. The comparison of IOP, CD ratio and visual field global indices, MD and CPSD in the two groups showed no significant difference. There were no differences in the mean values for any of the HRT parameters analysed. For the subgroup of patients with at least 5 years of follow up, there was also no significant difference in the number of patients with progressing locations, the mean number of progressing locations per subject, the mean slope of the progressing locations or the mean slope for whole visual field. CONCLUSIONS The absence of phenotypic differences in normal tension glaucoma patients with and without the OPA1 polymorphisms IVS 8 +4 C/T; +32 T/C suggest that these OPA1 polymorphisms do not underlie any major phenotypic diversity in these patients.
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Affiliation(s)
- T Aung
- Moorfields Eye Hospital, London, UK.
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45
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Abstract
The primary inherited optic neuropathies are a heterogeneous group of disorders that result in loss of retinal ganglion cells, leading to the clinical appearance of optic atrophy. They affect between 1:10,000 to 1:50,000 people. The main clinical features are a reduction in visual acuity, colour vision abnormalities, centro-caecal visual field defects and pallor of the optic nerve head. Electrophysiological testing shows a normal flash electroretinogram, absent or delayed pattern visually evoked potentials suggestive of a conduction deficit and N95 waveform reduction on the pattern electroretinogram, consistent with a primary ganglion cell pathology. The primary inherited optic neuropathies may be sporadic or familial. The mode of inheritance may be autosomal dominant, autosomal recessive, X-linked recessive or mitochondrial. Within each of these groups, the phenotypic characteristics vary in such features as the mode and age of onset, the severity of the visual loss, the colour deficit and the overall prognosis. A number of different genes (most as yet unidentified) in both nuclear and mitochondrial genomes, underlie these disorders. The elucidation of the role of the encoded proteins will improve our understanding of basic mechanisms of ganglion cell development, physiology and metabolism and further our understanding of the pathophysiology of optic nerve disease. It will also improve diagnosis, counselling and management of patients, and eventually lead to the development of new therapeutic modalities.
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Affiliation(s)
- M Votruba
- Department of Molecular Genetics, Institute of Ophthalmology, London, UK.
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46
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Affiliation(s)
- W L M Alward
- Department of Ophthalmology, The University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA;
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47
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Votruba M, Thiselton D, Bhattacharya SS. Optic disc morphology of patients with OPA1 autosomal dominant optic atrophy. Br J Ophthalmol 2003; 87:48-53. [PMID: 12488262 PMCID: PMC1771445 DOI: 10.1136/bjo.87.1.48] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Patients with autosomal dominant optic atrophy (ADOA) are genetically heterogeneous, but all have disc pallor. A degree of cupping in ADOA can make the distinction from normal tension glaucoma (NTG) clinically difficult. This study aimed to clarify the features of the optic nerve of patients with ADOA at the OPA1 locus. METHODS 29 patients (58 eyes), from 12 families, were identified in a prospective observational study of patients with ADOA examined by a single observer between 1995 and 1998, in whom genetic analysis showed either evidence for linkage to chromosome 3q28 or mutations in the ADOA gene, OPA1. All of the patients had disc and fundal photographs available for retrospective analysis. Clinical data collected included disc appearance, intraocular pressure, Snellen visual acuity, Hardy-Rand-Rittler colour vision plates, and Humphrey 30-2 visual fields. RESULTS Mean age at time of examination was 37 years and mean visual acuity was 6/24. Disc morphology showed temporal disc pallor in 30 eyes (52%) and total disc pallor in 28 eyes (48%). At least one disc showed a cup to disc ratio of more than 0.5 in 18 patients (28 discs, 48%). The temporal neuroretinal rim always showed pallor and shallow shelving (or saucerisation) was seen in 46 eyes (79%). Only 12 discs (21%) had deep excavation and baring of blood vessels. All of the patients had normal intraocular pressure and no family history of glaucoma. There was a temporal grey, pigmentary crescent in 12 patients (18 eyes, 31%) and peripapillary atrophy in 20 patients (40 eyes, 69%), but disc margin haemorrhages were not seen. There was no maculopathy or retinopathy. CONCLUSION The optic disc morphology, described for the first time in this genetically homogeneous population of patients with OPA1 ADOA, shows a distinctive absence of a healthy neuroretinal rim and shallow saucerisation of the optic disc cup, with frequent peripapillary atrophy.
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Affiliation(s)
- M Votruba
- Department of Molecular Genetics, Institute of Ophthalmology, UCL, Bath Street, London EC1V 9EL, UK.
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48
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Buono LM, Foroozan R, Sergott RC, Savino PJ. Is normal tension glaucoma actually an unrecognized hereditary optic neuropathy? New evidence from genetic analysis. Curr Opin Ophthalmol 2002; 13:362-70. [PMID: 12441838 DOI: 10.1097/00055735-200212000-00004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Normal tension glaucoma and dominant optic atrophy share many overlapping clinical features, and differentiating between these two diseases is often difficult. The gene responsible for dominant optic atrophy is the OPA1 gene located on chromosome 3. This gene encodes for a protein product that is involved in mitochondrial metabolic function. Recent genetic linkage analysis of patients with normal tension glaucoma has shown an association with polymorphisms of the OPA1 gene. This association suggests that normal tension glaucoma may actually be a hereditary optic neuropathy with a pathophysiology based in mitochondrial dysfunction.
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Affiliation(s)
- Lawrence M Buono
- Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson Medical College, Philadelphia, PA, USA
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