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Simonelli F, Sodi A, Falsini B, Bacci G, Iarossi G, Di Iorio V, Giorgio D, Placidi G, Andrao A, Reale L, Fiorencis A, Aoun M. Care Pathway of RPE65-Related Inherited Retinal Disorders from Early Symptoms to Genetic Counseling: A Multicenter Narrative Medicine Project in Italy. Clin Ophthalmol 2021; 15:4591-4605. [PMID: 34880596 PMCID: PMC8648274 DOI: 10.2147/opth.s331218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Timely detection and multidisciplinary management of RPE65-related inherited retinal disorders (IRDs) can significantly improve both disease management and patient care. Thus, this Narrative Medicine (NM) project aimed to investigate the evolution of the care pathway and the expectations on genetic counseling and gene therapy by patients, caregivers, and healthcare professionals. Patients and Methods This project was conducted between July and December 2020, involving five Italian eye clinics specialized in IRDs, targeted pediatric and adult patients, their caregivers, attending retinologists and multidisciplinary healthcare professionals. Narratives and parallel charts, together with a sociodemographic survey, were collected through the project webpage. In-depth interviews were conducted with Patient Association (PA) members and multidisciplinary healthcare professionals. All data were entered into the Nvivo Software for coding and analysis. Results Three pediatric and five adult patients with early-onset RPE65-related IRDs as well as eight caregivers were enrolled; 11 retinologists globally wrote 27 parallel charts; in-depth interviews were done with five multidisciplinary healthcare professionals and one PA member. Early diagnosis remains challenging, and patients reported to have changed up to 10 healthcare professionals before accessing their specialized center. Despite the oftentimes lack of awareness of patients and caregivers on the purpose of genetic testing, participants generally consider gene therapy as a therapeutic chance and a historic breakthrough for the management of RPE65-related IRDs. Well-organized networks to support the patient’s referral to specialized centers – as well as a proper communication of the clinical and genetic diagnosis and the multidisciplinary approach – emerge as crucial aspects in facilitating an early diagnosis and management and a timely initiation of the rehabilitation pathway. Conclusion The project investigated the RPE65-related IRDs care pathway while integrating the different perspectives involved through NM. The analysis explored the patient’s pathway in Italy and confirmed the need for a well-organized network and multidisciplinary care while highlighting several preliminary areas of improvement in the management of RPE65-related IRDs.
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Affiliation(s)
- Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Benedetto Falsini
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Bacci
- Paediatric Ophthalmology Unit, Children's Hospital "A. Meyer", University of Florence, Florence, Italy
| | - Giancarlo Iarossi
- Ophthalmology Department, Bambino Gesù IRCCS Paediatric Hospital, Rome, Italy
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Giorgio Placidi
- UOC Oftalmologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Testa-collo e organi di senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Luigi Reale
- Healthcare Department, Fondazione ISTUD, Milan, Italy
| | | | - Manar Aoun
- Medical Department, Novartis Farma, Origgio, Italy
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Suppiej A, Marino S, Reffo ME, Maritan V, Vitaliti G, Mailo J, Falsaperla R. Early onset retinal dystrophies: clinical clues to diagnosis for pediatricians. Ital J Pediatr 2019; 45:168. [PMID: 31864384 PMCID: PMC6925422 DOI: 10.1186/s13052-019-0760-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Inherited retinal dystrophies are major cause of severe progressive vision loss in children. Early recognition and diagnosis are essential for timely visual rehabilitation during the appropriate stages of the visual development, as well as for genetic diagnosis and possible gene therapy. The aim of this study is to characterize a pattern of the initial visual symptoms, which could help the pediatricians and the primary care providers to suspect an inherited retinal disorder in its early stage. Methods We analyzed the initial clinical symptoms, based on parental report during the first visit to specialist, in 50 children diagnosed with retinal dystrophy confirmed by full-field electroretinography. The analysis included the age of symptoms onset and the type of visual symptoms, both in the total population and in the following diagnostic subgroups: rod-cone dystrophy (n.17), cone-rod dystrophy (n.12), achromatopsia (n.13), congenital stationary night blindness (n.6) and Leber’s congenital amaurosis (n.2). Results The majority of children (80%) had the onset of clinical symptoms before one year of age. The most frequent visual complaints reported by parents were nystagmus (76%), visual loss (28%) and photophobia (8%). Nystagmus was the first symptom reported by parents if the disease onset was before the age of six months, while the onset after the six months of age was more likely associated with the complain of vision loss. Conclusions Low vision and nystagmus observed by parents, particularly in the first year of life, may represent a red flag, prompting an appropriate ophthalmological workup for inherited retinal dystrophy.
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Affiliation(s)
- Agnese Suppiej
- Department of Medical Sciences - Pediatric Section, University of Ferrara, Ferrara, Italy. .,Robert Hollman Foundation, Padua, Italy.
| | - Silvia Marino
- Paediatric Operative Unit and Acute and Emergency, Policlinico Vittorio Emanuele University Hospital of Catania, Catania, Italy
| | | | | | - Giovanna Vitaliti
- Paediatric Operative Unit and Acute and Emergency, Policlinico Vittorio Emanuele University Hospital of Catania, Catania, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, Stoller Children's Hospital, Edmonton, Alberta, Canada
| | - Raffaele Falsaperla
- Paediatric Operative Unit and Acute and Emergency, Policlinico Vittorio Emanuele University Hospital of Catania, Catania, Italy
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