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Heath Jeffery RC, Thompson JA, Lo J, Chelva ES, Armstrong S, Pulido JS, Procopio R, Vincent AL, Bianco L, Battaglia Parodi M, Ziccardi L, Antonelli G, Barbano L, Marques JP, Geada S, Carvalho AL, Tang WC, Chan CM, Boon CJF, Hensman J, Chen TC, Lin CY, Chen PL, Vincent A, Tumber A, Heon E, Grigg JR, Jamieson RV, Cornish EE, Nash BM, Borooah S, Ayton LN, Britten-Jones AC, Edwards TL, Ruddle JB, Sharma A, Porter RG, Lamey TM, McLaren TL, McLenachan S, Roshandel D, Chen FK. Retinal Dystrophies Associated With Peripherin-2: Genetic Spectrum and Novel Clinical Observations in 241 Patients. Invest Ophthalmol Vis Sci 2024; 65:22. [PMID: 38743414 DOI: 10.1167/iovs.65.5.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Purpose To describe the clinical, electrophysiological and genetic spectrum of inherited retinal diseases associated with variants in the PRPH2 gene. Methods A total of 241 patients from 168 families across 15 sites in 9 countries with pathogenic or likely pathogenic variants in PRPH2 were included. Records were reviewed for age at symptom onset, visual acuity, full-field ERG, fundus colour photography, fundus autofluorescence (FAF), and SD-OCT. Images were graded into six phenotypes. Statistical analyses were performed to determine genotype-phenotype correlations. Results The median age at symptom onset was 40 years (range, 4-78 years). FAF phenotypes included normal (5%), butterfly pattern dystrophy, or vitelliform macular dystrophy (11%), central areolar choroidal dystrophy (28%), pseudo-Stargardt pattern dystrophy (41%), and retinitis pigmentosa (25%). Symptom onset was earlier in retinitis pigmentosa as compared with pseudo-Stargardt pattern dystrophy (34 vs 44 years; P = 0.004). The median visual acuity was 0.18 logMAR (interquartile range, 0-0.54 logMAR) and 0.18 logMAR (interquartile range 0-0.42 logMAR) in the right and left eyes, respectively. ERG showed a significantly reduced amplitude across all components (P < 0.001) and a peak time delay in the light-adapted 30-Hz flicker and single-flash b-wave (P < 0.001). Twenty-two variants were novel. The central areolar choroidal dystrophy phenotype was associated with 13 missense variants. The remaining variants showed marked phenotypic variability. Conclusions We described six distinct FAF phenotypes associated with variants in the PRPH2 gene. One FAF phenotype may have multiple ERG phenotypes, demonstrating a discordance between structure and function. Given the vast spectrum of PRPH2 disease our findings are useful for future clinical trials.
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Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Enid S Chelva
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sean Armstrong
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jose S Pulido
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, United States
| | - Rebecca Procopio
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, PA, United States
| | - Andrea L Vincent
- Department of Ophthalmology, FMHS, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Lorenzo Bianco
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | - João P Marques
- Ophthalmology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Clinical and Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Sara Geada
- Ophthalmology Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Clinical and Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Ana L Carvalho
- Medical Genetics Unit, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Wei C Tang
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Choi M Chan
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Jonathan Hensman
- Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Center of Frontier Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Yu Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lung Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ajoy Vincent
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anupreet Tumber
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elise Heon
- Department of Ophthalmology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elisa E Cornish
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Shyamanga Borooah
- University of California San Diego, La Jolla, California
- The Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, CA, United States
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas L Edwards
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan B Ruddle
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Abhishek Sharma
- Ophthalmology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rowan G Porter
- Southern Queensland Centre of Excellence, Inala, Australia
| | - Tina M Lamey
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Samuel McLenachan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Ocular Tissue Engineering Laboratory, Lions Eye Institute, Nedlands, Western Australia, Australia
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Britten-Jones AC, McGuinness MB, Chen FK, Grigg JR, Mack HG, Ayton LN. A multinational survey of potential participant perspectives on ocular gene therapy. Gene Ther 2024; 31:314-323. [PMID: 38565634 DOI: 10.1038/s41434-024-00450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
Amidst rapid advancements in ocular gene therapy, understanding patient perspectives is crucial for shaping future treatment choices and research directions. This international cross-sectional survey evaluated knowledge, attitudes, and perceptions of ocular genetic therapies among potential recipients with inherited retinal diseases (IRDs). Survey instruments included the Attitudes to Gene Therapy-Eye (AGT-Eye), EQ-5D-5L, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25), and Patient Attitudes to Clinical Trials (PACT-22) instruments. This study included 496 participant responses (89% adults with IRDs; 11% parents/guardians/carers) from 35 countries, with most from the United States of America (USA; 69%) and the United Kingdom (11%). Most participants (90%) indicated they would likely accept gene therapy if it was available, despite only 45% agreeing that they had good knowledge of gene therapy. The main sources of information were research registries (60% of participants) and the internet (61%). Compared to data from our recently published Australian national survey of people with IRDs (n = 694), USA respondents had higher knowledge of gene therapy outcomes, and Australian respondents indicated a higher perceived value of gene therapy treatments. Addressing knowledge gaps regarding outcomes and financial implications will be central to ensuring informed consent, promoting shared decision-making, and the eventual clinical adoption of genetic therapies.
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Affiliation(s)
- Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Myra B McGuinness
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Fred K Chen
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, WA, Australia
- Royal Perth Hospital and Perth Children's Hospital, Perth, WA, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Heather G Mack
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
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Sakti DH, Cornish EE, Ali H, Retsas S, Raza M, Saakova N, Carvalho LS, Nash BM, Jamieson RV, Grigg JR. Natural history and biomarkers of KCNV2-associated retinopathy. Clin Exp Ophthalmol 2024. [PMID: 38443311 DOI: 10.1111/ceo.14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND KCNV2-associated retinopathy is an autosomal recessive inherited retinal disease classically named cone dystrophy with supernormal rod response (CDSRR). This study aims to identify the best biomarker for evaluating the condition. METHODS A retrospective review of eight patients from seven families with genetically confirmed KCNV2-associated retinopathy was performed. The best corrected visual acuity (BCVA), full-field electroretinogram (ffERG), pattern ERG (pERG), fundus imaging: retinal photograph and fundus autofluorescence (FAF), and optical coherence tomography (OCT) were analysed. RESULTS There was a disproportionate increase in b-wave amplitude with a relatively small light intensity increase, especially between the two dimmest stimuli of DA 0.002 and 0.01 (-2.7 and -2.0 log cd.s/m2 ). The a-wave amplitude was normal. The a-wave peak time was delayed in all stimuli. The b-wave peak time was delayed compared to normal, but the gap tightened as intensity increased. The b:a wave ratio was above or at the upper limit for the reference values. FAF bull's eye maculopathy pattern was prominent and variable foveal disruption on OCT was apparent in all patients. Legal blindness was reached before the age of 25. CONCLUSIONS We identified three potential electrophysiology biomarkers to assist in evaluating future therapies: the disproportionate b-wave amplitude jump, delayed a-wave and b-wave peak time, and the higher than normal b:a wave ratio. Any of these biomarkers found with photoreceptor ellipsoid zone foveal-perifoveal disruption should prompt consideration for KCNV2 retinopathy. The BCVA natural history data suggests the probable optimum therapeutic window in the first three decades of life.
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Affiliation(s)
- Dhimas H Sakti
- Save Sight Institute, University of Sydney, New South Wales, Australia
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elisa E Cornish
- Save Sight Institute, University of Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Haipha Ali
- Save Sight Institute, University of Sydney, New South Wales, Australia
| | - Stephanie Retsas
- Save Sight Institute, University of Sydney, New South Wales, Australia
| | - Marium Raza
- Save Sight Institute, University of Sydney, New South Wales, Australia
| | - Nonna Saakova
- Save Sight Institute, University of Sydney, New South Wales, Australia
| | - Livia S Carvalho
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, The University of Western Australia, Nedlands, Australia
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, University of Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, University of Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Jolly JK, Grigg JR, McKendrick AM, Fujinami K, Cideciyan AV, Thompson DA, Matsumoto C, Asaoka R, Johnson C, Dul MW, Artes PH, Robson AG. ISCEV and IPS guideline for the full-field stimulus test (FST). Doc Ophthalmol 2024; 148:3-14. [PMID: 38238632 PMCID: PMC10879267 DOI: 10.1007/s10633-023-09962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024]
Abstract
The full-field stimulus test (FST) is a psychophysical technique designed for the measurement of visual function in low vision. The method involves the use of a ganzfeld stimulator, as used in routine full-field electroretinography, to deliver full-field flashes of light. This guideline was developed jointly by the International Society for Clinical Electrophysiology of Vision (ISCEV) and Imaging and Perimetry Society (IPS) in order to provide technical information, promote consistency of testing and reporting, and encourage convergence of methods for FST. It is intended to aid practitioners and guide the formulation of FST protocols, with a view to future standardisation.
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Affiliation(s)
- J K Jolly
- Vision and Eye Research Institute, Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK.
| | - J R Grigg
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - A M McKendrick
- Lions Eye Institute, University of Western Australia, Perth, Australia
- School of Allied Health, University of Western Australia, Crawley, Australia
| | - K Fujinami
- Laboratory of Visual Physiology, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Institute of Ophthalmology, University College London, London, UK
| | - A V Cideciyan
- Center for Hereditary Retinal Degenerations, Scheie Eye Institute, University of Pennsylvania, Philadelphia, USA
| | - D A Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic, Department of Ophthalmology, Sight and Sound Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C Matsumoto
- Department of Ophthalmology, Kindai University, Osakasayama, Japan
| | - R Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan
| | - C Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
- School of Optometry, The Ohio State University, Columbus, IA, USA
| | - M W Dul
- Department of Biological and Vision Science, College of Optometry, State University of New York, New York, USA
| | - P H Artes
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - A G Robson
- Institute of Ophthalmology, University College London, London, UK
- Department of Electrophysiology, Moorfields Eye Hospital, London, UK
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5
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McGuinness MB, Ayton LN, Schofield D, Britten-Jones AC, Chen FK, Grigg JR, Qi Z, Kraindler J, Shrestha R, Mack HG. EQ-5D-5L health utility scores in Australian adults with inherited retinal diseases: A cross-sectional survey. Acta Ophthalmol 2024. [PMID: 38226448 DOI: 10.1111/aos.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
PURPOSE Economic evaluations of interventions for ocular disease require utility scores that accurately represent quality of life in the target population. This study aimed to describe the distribution of EQ-5D-5L utility values among Australian adults with symptomatic inherited retinal diseases (IRDs) and to assess the relationship between these scores and vision-related quality of life. METHODS A survey was administered predominantly online in 2021. Participants completed the EQ-5D-5L general health utility instrument, the EQ vertical visual analogue scale (EQ-VAS) and the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). Self-reported IRD diagnoses were classified as being associated with central or widespread retinal involvement. RESULTS Responses from 647 participants aged 18-93 years were included, 50.1% were men and 77.6% had an IRD associated with widespread retinal involvement. The majority reported no problems with self-care and no pain/discomfort but did report anxiety/depression and problems with work, study, housework, or family/leisure activities. Most people with widespread involvement reported problems with mobility. Median EQ-5D-5L utility was 0.88 and 0.91 among people with widespread and central involvement, respectively (age and sex-adjusted p = 0.029); and median EQ-VAS was 75 and 80, respectively (adjusted p = 0.003). A moderate curvilinear correlation was observed between EQ-5D-5L and NEI-VFQ-25 composite score (Spearman's ρ 0.69), but not all people with poor vision-related quality of life had low EQ-5D-5L utility values. CONCLUSIONS EQ-5D-5L health utility values are correlated with vision-related quality of life among adults with IRDs. However, the EQ-5D-5L may not be sensitive to the full impact of vision impairment on quality of life.
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Affiliation(s)
- Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis Ceecee Britten-Jones
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Ziyi Qi
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Rupendra Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Heather G Mack
- Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Scopelliti AJ, Jamieson RV, Barnes EH, Nash B, Rajagopalan S, Cornish EL, Grigg JR. A natural history study of autosomal dominant GUCY2D-associated cone-rod dystrophy. Doc Ophthalmol 2023; 147:189-201. [PMID: 37775646 PMCID: PMC10638150 DOI: 10.1007/s10633-023-09954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To describe the natural history of autosomal dominant (AD) GUCY2D-associated cone-rod dystrophies (CRDs), and evaluate associated structural and functional biomarkers. METHODS Retrospective analysis was conducted on 16 patients with AD GUCY2D-CRDs across two sites. Assessments included central macular thickness (CMT) and length of disruption to the ellipsoid zone (EZ) via optical coherence tomography (OCT), electroretinography (ERG) parameters, best corrected visual acuity (BCVA), and fundus autofluorescence (FAF). RESULTS At first visit, with a mean age of 30 years (range 5-70 years), 12 patients had a BCVA below Australian driving standard (LogMAR ≥ 0.3 bilaterally), and 1 patient was legally blind (LogMAR ≥ 1). Longitudinal analysis demonstrated a deterioration of LogMAR by - 0.019 per year (p < 0.001). This accompanied a reduction in CMT of - 1.4 µm per year (p < 0.0001), lengthened EZ disruption by 42 µm per year (p = < 0.0001) and increased area of FAF by 0.05 mm2 per year (p = 0.027). Similarly, cone function decreased with increasing age, as demonstrated by decreasing b-wave amplitude of the light-adapted 30 Hz flicker and fused flicker (p = 0.005 and p = 0.018, respectively). Reduction in CMT and increased EZ disruption on OCT were associated with functional changes including poorer BCVA and decreased cone function on ERG. CONCLUSION We have described the natural long-term decline in vision and cone function associated with mutations in GUCY2D and identified a set of functional and structural biomarkers that may be useful as outcome parameters for future therapeutic clinical trials.
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Affiliation(s)
- Amanda J Scopelliti
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Benjamin Nash
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Sulekha Rajagopalan
- Department of Clinical Genetics, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW, Australia
| | - Elisa L Cornish
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia.
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7
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Constable PA, Loh L, Grigg JR. Suspected case of benign familial fleck retina with functional loss. Clin Case Rep 2023; 11:e8362. [PMID: 38130850 PMCID: PMC10733792 DOI: 10.1002/ccr3.8362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Key Clinical Message Inherited retinal dystrophies typically affect vision in early childhood; however, this case highlights a late onset retinal dystrophy presenting in midlife and the need for extended visual electrophysiology testing to determine the etiology. Abstract A 53-year-old female was referred for visual electrophysiology following a routine optometric eye examination in which yellow flecks were noted in both fundi and the patient had reported a recent near accident whilst driving at night. There was no reported family history of eye disease. Retinal examination identified bilateral yellow punctate and irregularly shaped lesions throughout the posterior poles sparing the macula region. Fundus autofluorescence showed coinciding hyperfluorescence with the lesions and bilateral hypofluorescent crescents superior to the macular with corresponding retinal thinning. Visual fields and color vision were normal. ISCEV standard 20 min and extended 60-min dark adapted electroretinograms were recorded. Recovery to normal b-wave amplitudes was noted in the DA0.01 flash but reduced a-wave amplitudes were noted in the DA3 and DA10 flash following both dark adapted periods. Cone function was reduced but within normal limits. Genetic screening revealed a previously unreported variant of unknown significance in the gene PLA2G5:c.40 + 5del (rs1364254561) which is a member of the phospholipase A2 family and is associated with familial benign flecked retina.
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Affiliation(s)
- Paul A. Constable
- Flinders University, College of Nursing and Health SciencesCaring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Lynne Loh
- Flinders University, College of Nursing and Health SciencesCaring Futures InstituteAdelaideSouth AustraliaAustralia
| | - John R. Grigg
- Save Sight Institute, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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8
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Sakti DH, Cornish EE, Nash BM, Jamieson RV, Grigg JR. IMPDH1-associated autosomal dominant retinitis pigmentosa: natural history of novel variant Lys314Gln and a comprehensive literature search. Ophthalmic Genet 2023; 44:437-455. [PMID: 37259572 DOI: 10.1080/13816810.2023.2215310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Inosine monophosphate dehydrogenase (IMPDH) is a key regulatory enzyme in the de novo synthesis of the purine base guanine. Mutations in the inosine monophosphate dehydrogenase 1 gene (IMPDH1) are causative for RP10 autosomal dominant retinitis pigmentosa (adRP). This study reports a novel variant in a family with IMPDH1-associated retinopathy. We also performed a comprehensive review of all reported IMPDH1 disease causing variants with their associated phenotype. MATERIALS AND METHODS Multimodal imaging and functional studies documented the phenotype including best-corrected visual acuity (BCVA), fundus photograph, fundus autofluorescence (FAF), full field electroretinogram (ffERG), optical coherence tomography (OCT) and visual field (VF) data were collected. A literature search was performed in the PubMed and LOVD repositories. RESULTS We report 3 cases from a 2-generation family with a novel heterozygous likely pathogenic variant p. (Lys314Gln) (exon 10). The ophthalmic phenotype showed diffuse outer retinal atrophy with mild pigmentary changes with sparse pigmentary changes. FAF showed early macular involvement with macular hyperautofluorescence (hyperAF) surrounded by hypoAF. Foveal ellipsoid zone island can be found in the youngest patient but not in the older ones. The literature review identified a further 56 heterozygous, 1 compound heterozygous, and 2 homozygous variant. The heterozygous group included 43 missense, 3 in-frame, 1 nonsense, 2 frameshift, 1 synonymous, and 6 intronic variants. Exon 10 was noted as a hotspot harboring 18 variants. CONCLUSIONS We report a novel IMPDH1 variant. IMPDH1-associated retinopathy presents most frequently in the first decade of life with early macular involvement.
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Affiliation(s)
- Dhimas H Sakti
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elisa E Cornish
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Robyn V Jamieson
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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9
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Lo-Cao E, Crofts S, Geering K, Jamieson RV, Grigg JR. Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital. Clin Exp Ophthalmol 2023; 51:546-558. [PMID: 37147905 DOI: 10.1111/ceo.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/07/2023] [Accepted: 04/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital. METHODS The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018. RESULTS The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%). CONCLUSIONS The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.
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Affiliation(s)
- Edward Lo-Cao
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Stephanie Crofts
- Department of Orthoptics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Katie Geering
- Department of Orthoptics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Discipline of Genetic Medicine, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Eye Genetics Research Unit, Children's Medical Research Institute, Save Sight Institute, The University of Sydney and Sydney Eye Hospital, Sydney, New South Wales, Australia
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10
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Wood A, Lim B, Matthews J, Karaconji T, Zagora SL, Jamieson RV, Grigg JR, Jones M, Rowe N, Hing S, Donaldson C, Smith JEH. Prevalence of Glaucoma Following Paediatric Cataract Surgery in an Australian Tertiary Referral Centre. Clin Ophthalmol 2023; 17:2171-2179. [PMID: 37547173 PMCID: PMC10402721 DOI: 10.2147/opth.s400512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Secondary glaucoma following childhood cataract surgery remains the most common complication in the paediatric population. This study aimed to determine the incidence, time to progression and risk factors associated with the development of secondary glaucoma following childhood cataract surgery in a paediatric population. Outcome measures were the detection of secondary glaucoma, postoperative time frame to development of glaucoma and risk factors in its development. Patients and Methods A retrospective case series was conducted between 2003 and 2017 at a tertiary children's hospital in Sydney. The patient population included those 16 years or less of age who underwent congenital cataract extraction, with or without an intraocular lens implantation and who had been followed up for a minimum of six months following surgery. Patients were excluded if they had cataract aetiology other than congenital idiopathic cataract. Multivariate Cox Regression analysis was used to determine relevant risk factors. Results A total of 320 eyes in 216 patients were included in the study. Secondary glaucoma developed in 11.9% of eyes. In those that developed secondary glaucoma, the average time to onset from surgery was 3.2 years (median 2.75 years). The mean age of diagnosis of secondary glaucoma was 4.58 years (median 3.5 years, range 2.5 months to 13.23 years). Microcornea was the only adverse characteristic significantly associated with an increased risk of secondary glaucoma (HR 6.30, p 0.003). Conclusion Despite modern surgical techniques, glaucoma remains a significant long-term sequela in children following cataract surgery.
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Affiliation(s)
- Alanna Wood
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Benjamin Lim
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Jim Matthews
- Sydney Informatics Hub, The University of Sydney, Sydney, NSW, Australia
| | - Tanya Karaconji
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Sophia L Zagora
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
- Eye Genetics Research, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW, Australia
- Disciplines of Genetic Medicine, and Child and Adolescent, Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
- Eye Genetics Research, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Michael Jones
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Neil Rowe
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Stephen Hing
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - Craig Donaldson
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
| | - James E H Smith
- Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney, Australia
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11
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Schofield D, Kraindler J, Tan O, Shrestha RN, West S, Hart N, Tan L, Ma A, Grigg JR, Jamieson RV. The health care and societal costs of inherited retinal diseases in Australia: a microsimulation modelling study. Med J Aust 2023; 219:70-76. [PMID: 37301731 PMCID: PMC10952471 DOI: 10.5694/mja2.51997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To estimate the health care and societal costs of inherited retinal diseases (IRDs) in Australia. DESIGN, SETTING, PARTICIPANTS Microsimulation modelling study based on primary data - collected in interviews of people with IRDs who had ophthalmic or genetic consultations at the Children's Hospital at Westmead or the Save Sight Institute (both Sydney) during 1 January 2019 - 31 December 2020, and of their carers and spouses - and linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Schedule (PBS) data. MAIN OUTCOME MEASURES Annual and lifetime costs for people with IRDs and for their carers and spouses, grouped by payer (Australian government, state governments, individuals, private health insurance) and type (health care costs; societal costs: social support, National Disability Insurance Scheme (NDIS), income and taxation, costs associated with caring for family members with IRDs); estimated annual national cost of IRDs. RESULTS Ninety-four people (74 adults, 20 people under 18 years; 55 girls and women [59%]) and 30 carers completed study surveys (participation rate: adults, 66%; children, 66%; carers, 63%). Total estimated lifetime cost was $5.2 million per person with an IRD, of which 87% were societal and 13% health care costs. The three highest cost items were lost income for people with IRDs ($1.4 million), lost income for their carers and spouses ($1.1 million), and social spending by the Australian government (excluding NDIS expenses: $1.0 million). Annual costs were twice as high for people who were legally blind as for those with less impaired vision ($83 910 v $41 357 per person). The estimated total annual cost of IRDs in Australia was $781 million to $1.56 billion. CONCLUSION As the societal costs associated with IRDs are much larger than the health care costs, both contributors should be considered when assessing the cost-effectiveness of interventions for people with IRDs. The increasing loss of income across life reflects the impact of IRDs on employment and career opportunities.
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Affiliation(s)
- Deborah Schofield
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Joshua Kraindler
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Owen Tan
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Rupendra N Shrestha
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Sarah West
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Natalie Hart
- GenIMPACT: Centre for Economic Impacts of Genomic Medicine, Macquarie Business SchoolMacquarie UniversitySydneyNSW
| | - Liny Tan
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
| | - Alan Ma
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
| | - John R Grigg
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
| | - Robyn V Jamieson
- Children's Medical Research Institute, Sydney Children's Hospitals NetworkUniversity of SydneySydneyNSW
- Save Sight InstituteUniversity of SydneySydneyNSW
- The University of SydneySydneyNSW
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12
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Sakti DH, Cornish EE, Fraser CL, Nash BM, Sandercoe TM, Jones MM, Rowe NA, Jamieson RV, Johnson AM, Grigg JR. Early recognition of CLN3 disease facilitated by visual electrophysiology and multimodal imaging. Doc Ophthalmol 2023:10.1007/s10633-023-09930-1. [PMID: 36964447 DOI: 10.1007/s10633-023-09930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/07/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Neuronal ceroid lipofuscinosis is a group of neurodegenerative disorders with varying visual dysfunction. CLN3 is a subtype which commonly presents with visual decline. Visual symptomatology can be indistinct making early diagnosis difficult. This study reports ocular biomarkers of CLN3 patients to assist clinicians in early diagnosis, disease monitoring, and future therapy. METHODS Retrospective review of 5 confirmed CLN3 patients in our eye clinic. Best corrected visual acuity (BCVA), electroretinogram (ERG), ultra-widefield (UWF) fundus photography and fundus autofluorescence (FAF), and optical coherence tomography (OCT) studies were undertaken. RESULTS Five unrelated children, 4 females and 1 male, with median age of 6.2 years (4.6-11.7) at first assessment were investigated at the clinic from 2016 to 2021. Four homozygous and one heterozygous pathogenic CLN3 variants were found. Best corrected visual acuities (BCVAs) ranged from 0.18 to 0.88 logMAR at first presentation. Electronegative ERGs were identified in all patients. Bull's eye maculopathies found in all patients. Hyper-autofluorescence ring surrounding hypo-autofluorescence fovea on FAF was found. Foveal ellipsoid zone (EZ) disruptions were found in all patients with additional inner and outer retinal microcystic changes in one patient. Neurological problems noted included autism, anxiety, motor dyspraxia, behavioural issue, and psychomotor regression. CONCLUSIONS CLN3 patients presented at median age 6.2 years with visual decline. Early onset maculopathy with an electronegative ERG and variable cognitive and motor decline should prompt further investigations including neuropaediatric evaluation and genetic assessment for CLN3 disease. The structural parameters such as EZ and FAF will facilitate ocular monitoring.
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Affiliation(s)
- Dhimas H Sakti
- Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney Eye Hospital Campus, 8 Macquarie St, Sydney, NSW, 2001, Australia
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elisa E Cornish
- Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney Eye Hospital Campus, 8 Macquarie St, Sydney, NSW, 2001, Australia
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Clare L Fraser
- Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney Eye Hospital Campus, 8 Macquarie St, Sydney, NSW, 2001, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
- Sydney Genome Diagnostics, Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Trent M Sandercoe
- Department of Ophthalmology, Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Michael M Jones
- Department of Ophthalmology, Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Neil A Rowe
- Department of Ophthalmology, Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney Eye Hospital Campus, 8 Macquarie St, Sydney, NSW, 2001, Australia
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Alexandra M Johnson
- Department of Neurology, Sydney Children's Hospital, University of New South Wales, Sydney, Australia
| | - John R Grigg
- Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney Eye Hospital Campus, 8 Macquarie St, Sydney, NSW, 2001, Australia.
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia.
- Department of Ophthalmology, Sydney Children's Hospital Network (Westmead), Sydney, Australia.
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13
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Mack HG, Britten-Jones AC, McGuinness MB, Chen FK, Grigg JR, Jamieson RV, Edwards TL, De Roach J, O'Hare F, Martin KR, Ayton LN. Survey of perspectives of people with inherited retinal diseases on ocular gene therapy in Australia. Gene Ther 2022; 30:336-346. [PMID: 36183012 PMCID: PMC10113139 DOI: 10.1038/s41434-022-00364-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022]
Abstract
Many gene therapies are in development for treating people with inherited retinal diseases (IRD). We hypothesized that potential recipients of gene therapy would have knowledge gaps regarding treatment. We aimed to assess knowledge, attitudes, and perceptions of genetic therapies among potential recipients with IRD, using a novel instrument we designed (Attitudes to Gene Therapy-Eye (AGT-Eye)) and their associations with demographic data, self-reported visual status, and tools assessing quality of life and attitudes toward clinical trials using a community-based cross-sectional survey of Australian adults with IRD. AGT-Eye, overall quality of life EQ-5D-5L, National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and Patient Attitudes to Clinical Trials (PACT-22) instruments were administered. Six hundred and eighty-one people completed the study, 51.7% women of mean age 53.5 years (SD ± 15.8). Most participants (91.6%) indicated they would likely accept gene therapy if it was available to them or family members. However, only 28.3% agreed that they had good knowledge of gene therapy. Most obtained information about gene therapy from the internet (49.3%). Respondents with post-graduate degrees scored highest compared to other educational levels on methods (p < 0.001) and outcomes (p = 0.003) and were more likely to see economic value of treatment (p = 0.043). Knowledge gaps were present regarding methods and outcomes of gene therapy. This survey has shown high level of interest in the IRD community for gene therapies, and highlights areas for improved clinician and patient education.
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Affiliation(s)
- Heather G Mack
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia. .,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
| | - Alexis Ceecee Britten-Jones
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Fred K Chen
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, WA, Australia.,Royal Perth Hospital and Perth Children's Hospital, Perth, WA, Australia
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Thomas L Edwards
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - John De Roach
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Perth, WA, Australia.,The Australian Inherited Retinal Disease Registry and DNA Bank, Perth, WA, Australia
| | - Fleur O'Hare
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Keith R Martin
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Lauren N Ayton
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, VIC, Australia
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14
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Tsang TW, Finlay-Jones A, Perry K, Grigg JR, Popova S, Cheung MMY, Bower C, Tam P, Jamieson RV, Elliott EJ. Eye Abnormalities in Children with Fetal Alcohol Spectrum Disorders: A Systematic Review. Ophthalmic Epidemiol 2022:1-12. [DOI: 10.1080/09286586.2022.2123004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tracey W Tsang
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - Amy Finlay-Jones
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
- Curtin University, West Perth, Australia
| | - Kerrin Perry
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Melissa Mei Yin Cheung
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
| | - Carol Bower
- Alcohol & Pregnancy and FASD Research, Telethon Kids Institute, West Perth, Australia
| | - Patrick Tam
- Embryology Research Unit, Children’s Medical Research Institute, the University of Sydney, Westmead, NSW, Australia; and School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Robyn V Jamieson
- Sydney Eye Hospital, Sydney, Australia
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, NSW, Australia, and Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Westmead, Australia
| | - Elizabeth J Elliott
- The University of Sydney Children’s Hospital Westmead Clinical School, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Westmead, NSW, Australia, and Sydney Children’s Hospital Network, Kids Research, Westmead, Australia
- Australian Paediatric Surveillance Unit, Kids Research, Westmead, Australia
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15
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Waldie AM, Hobby AE, Chow I, Cornish EE, Indusegaran M, Pekacka A, Nguyen P, Fraser C, Binns AM, Stanford MR, Hammond CJ, McCluskey PJ, Grigg JR, Mahroo OA. Electrophysiological Assessment in Birdshot Chorioretinopathy: Flicker Electroretinograms Recorded With a Handheld Device. Transl Vis Sci Technol 2022; 11:23. [PMID: 35594040 PMCID: PMC9145202 DOI: 10.1167/tvst.11.5.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The flicker electroretinogram (ERG) is a sensitive indicator of retinal dysfunction in birdshot chorioretinopathy (BCR). We explored recordings from a handheld device in BCR, comparing these with conventional recordings in the same patients and with handheld ERGs from healthy individuals. Methods Non-mydriatic flicker ERGs, using the handheld RETeval system (LKC Technologies), were recorded with skin electrodes at two centers. At one center (group 1), the stimuli (85 Td·s, 850 Td background) delivered retinal illuminance equivalent to international standards; at the other center (group 2), a different protocol was used (32 Td·s, no background). Patients also underwent international standard flicker ERG recordings with conventional electrodes following mydriasis. Portable ERGs from patients were also compared with those from healthy individuals. Results Thirty-two patients with BCR (mean age ± SD, 56.4 ± 11.3 years) underwent recordings. Portable and standard ERG parameters correlated strongly (r > 0.75, P < 0.01) in both groups. Limits of agreement for peak times were tighter in group 1 (n = 21; -4.3 to +2.0 ms [right eyes], -3.9 to 1.5 ms [left eyes]) than in group 2 (n = 11; -3.4 to +6.9 ms [right eyes], -4.8 to +9.0 ms [left eyes]). Compared with healthy controls (n = 66 and n = 90 for groups 1 and 2, respectively), patients with BCR showed smaller mean amplitudes and longer peak times. Conclusions Portable ERGs correlated strongly with conventional recordings, suggesting potential in rapid assessment of cone system function in office settings. Translational Relevance Flicker ERGs, known to be useful in BCR, can be obtained rapidly with a portable device with skin electrodes and natural pupils.
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Affiliation(s)
- Anna M. Waldie
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Angharad E. Hobby
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
- Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - Isabelle Chow
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Elisa E. Cornish
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Mathura Indusegaran
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | | | - Phuc Nguyen
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Clare Fraser
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Alison M. Binns
- Division of Optometry and Visual Sciences, City, University of London, London, UK
| | - Miles R. Stanford
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Christopher J. Hammond
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Peter J. McCluskey
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - John R. Grigg
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Speciality of Ophthalmology Faculty of Medicine and Health University of Sydney, Camperdown, New South Wales, Australia
| | - Omar A. Mahroo
- Section of Ophthalmology, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas’ Hospital NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
- Institute of Ophthalmology, University College London, London, UK
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16
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Sakti DH, Ali H, Korsakova M, Saakova N, Mustafic N, Fraser CL, Jamieson RV, Cornish EE, Grigg JR. Electronegative electroretinogram in the modern multimodal imaging era. Clin Exp Ophthalmol 2022; 50:429-440. [PMID: 35212129 PMCID: PMC9544723 DOI: 10.1111/ceo.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Background The electronegative electroretinogram (ERG) reflecting inner retinal dysfunction can assist as a diagnostic tool to determine the anatomical location in eye disease. The aim of this study is to determine the frequency and aetiology of electronegative ERG in a tertiary ophthalmology centre and to develop a clinical algorithm to assist patient management. Methods Retrospective review of ERGs performed at the Save Sight Institute from January 2011 to December 2020. ERGs were performed according to ISCEV standard. The b:a ratio was analysed in dark adapted (DA) 3.0 or 12.0 recordings. Patients with ratio of ≤1.0 were included. Results A total of 4421 patients had ERGs performed during study period, of which 139 patients (3.1%) had electronegative ERG. The electronegative ERG patients' median age at referral time was 37 (0.7–90.6) years. The causative aetiologies were photoreceptor dystrophy (48, 34.5%), Congenital Stationary Night Blindness (CSNB) (33, 23.7%), retinal ischemia (18, 12.9%), retinoschisis (15, 10.8%), paraneoplastic autoimmune retinopathy (PAIR) and nonPAIR (14, 10.1%), batten disease (4, 2.9%), and inflammatory retinopathy (4, 2.9%). There were three patients with an unclassified diagnosis. Thirty‐two patients (23%) had good vision and a normal fundus appearance. Eleven patients (7.9%) had good vision and normal results in all multimodal imaging. Conclusions The frequency of electronegative ERG in our referral centre was 3.1% with photoreceptor dystrophy as the main aetiology. A significant number of the cases had good vision with normal fundus or normal multimodal imaging. This further highlights the value of an ERG in this modern multimodal imaging era.
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Affiliation(s)
- Dhimas H. Sakti
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute Children's Medical Research Institute, The University of Sydney Sydney New South Wales Australia
- Department of Ophthalmology, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada Yogyakarta Indonesia
| | - Haipha Ali
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Maria Korsakova
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Nonna Saakova
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Nina Mustafic
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Clare L. Fraser
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Sydney Eye Hospital Sydney New South Wales Australia
| | - Robyn V. Jamieson
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute Children's Medical Research Institute, The University of Sydney Sydney New South Wales Australia
- Specialty of Genetic Medicine, Faculty of Medicine and Health, Sydney Medical School The University of Sydney Sydney New South Wales Australia
- Department of Clinical Genetics, The Children's Hospital at Westmead Sydney Children's Hospital Network Sydney New South Wales Australia
| | - Elisa E. Cornish
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute Children's Medical Research Institute, The University of Sydney Sydney New South Wales Australia
- Sydney Eye Hospital Sydney New South Wales Australia
| | - John R. Grigg
- Visual electrophysiology Unit, Save Sight Institute, Speciality of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute Children's Medical Research Institute, The University of Sydney Sydney New South Wales Australia
- Sydney Eye Hospital Sydney New South Wales Australia
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17
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Chahine Karam F, Loi TH, Ma A, Nash BM, Grigg JR, Parekh D, Riley LG, Farnsworth E, Bennetts B, Gonzalez-Cordero A, Jamieson RV. Human iPSC-Derived Retinal Organoids and Retinal Pigment Epithelium for Novel Intronic RPGR Variant Assessment for Therapy Suitability. J Pers Med 2022; 12:jpm12030502. [PMID: 35330501 PMCID: PMC8951517 DOI: 10.3390/jpm12030502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
The RPGR gene encodes Retinitis Pigmentosa GTPase Regulator, a known interactor with ciliary proteins, which is involved in maintaining healthy photoreceptor cells. Variants in RPGR are the main contributor to X-linked rod-cone dystrophy (RCD), and RPGR gene therapy approaches are in clinical trials. Hence, elucidation of the pathogenicity of novel RPGR variants is important for a patient therapy opportunity. Here, we describe a novel intronic RPGR variant, c.1415 − 9A>G, in a patient with RCD, which was classified as a variant of uncertain significance according to current clinical diagnostic criteria. The variant lay several base pairs intronic to the canonical splice acceptor site, raising suspicion of an RPGR RNA splicing abnormality and consequent protein dysfunction. To investigate disease causation in an appropriate disease model, induced pluripotent stem cells were generated from patient fibroblasts and differentiated to retinal pigment epithelium (iPSC-RPE) and retinal organoids (iPSC-RO). Abnormal RNA splicing of RPGR was demonstrated in patient fibroblasts, iPSC-RPE and iPSC-ROs, leading to a predicted frameshift and premature stop codon. Decreased RPGR expression was demonstrated in these cell types, with a striking loss of RPGR localization at the ciliary transitional zone, critically in the photoreceptor cilium of the patient iPSC-ROs. Mislocalisation of rhodopsin staining was present in the patient’s iPSC-RO rod photoreceptor cells, along with an abnormality of L/M opsin staining affecting cone photoreceptor cells and increased photoreceptor apoptosis. Additionally, patient iPSC-ROs displayed an increase in F-actin expression that was consistent with an abnormal actin regulation phenotype. Collectively, these studies indicate that the splicing abnormality caused by the c.1415 − 9A>G variant has an impact on RPGR function. This work has enabled the reclassification of this variant to pathogenic, allowing the consideration of patients with this variant having access to gene therapy clinical trials. In addition, we have identified biomarkers of disease suitable for the interrogation of other RPGR variants of uncertain significance.
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Affiliation(s)
- Fidelle Chahine Karam
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
| | - To Ha Loi
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
| | - Alan Ma
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney 2145, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney 2145, Australia; (E.F.); (B.B.)
| | - Benjamin M. Nash
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney 2145, Australia; (E.F.); (B.B.)
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney 2145, Australia
| | - John R. Grigg
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
- Specialty of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Darshan Parekh
- Rare Diseases Functional Genomics Laboratory, Sydney Children’s Hospitals Network and Children’s Medical Research Institute, Westmead, Sydney 2145, Australia; (D.P.); (L.G.R.)
| | - Lisa G. Riley
- Rare Diseases Functional Genomics Laboratory, Sydney Children’s Hospitals Network and Children’s Medical Research Institute, Westmead, Sydney 2145, Australia; (D.P.); (L.G.R.)
- Specialty of Child and Adolescent Health, University of Sydney, Westmead, Sydney 2145, Australia
| | - Elizabeth Farnsworth
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney 2145, Australia; (E.F.); (B.B.)
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney 2145, Australia
| | - Bruce Bennetts
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney 2145, Australia; (E.F.); (B.B.)
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney 2145, Australia
| | - Anai Gonzalez-Cordero
- Stem Cell Medicine Group, Children’s Medical Research Institute, University of Sydney, Westmead, Sydney 2145, Australia;
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Robyn V. Jamieson
- Eye Genetics Research Unit, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, Save Sight Institute, University of Sydney, Westmead, Sydney 2145, Australia; (F.C.K.); (T.H.L.); (A.M.); (B.M.N.); (J.R.G.)
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney 2145, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Westmead, Sydney 2145, Australia; (E.F.); (B.B.)
- Correspondence: ; Tel.: +61-2-9687-2800; Fax: +61-2-9687-2120
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18
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Karaconji T, Zagora S, Grigg JR. Approach to childhood glaucoma: A review. Clin Exp Ophthalmol 2022; 50:232-246. [PMID: 35023613 DOI: 10.1111/ceo.14039] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 12/15/2022]
Abstract
Childhood glaucoma represents a heterogenous group of rare ocular conditions that may result in significant sight threatening complications related to elevated intraocular pressure (IOP). It can be classified as either primary or secondary and the latter may have systemic associations. This review will be based on the work of the childhood glaucoma research network (CGRN) and will focus on the diagnosis and management of the most common types of childhood glaucoma. These include primary congenital glaucoma (PCG) and juvenile open angle glaucoma (JOAG) as well as secondary causes of glaucoma associated with non-acquired ocular anomalies (Axenfeld-Rieger anomaly; Peters anomaly and Aniridia), glaucoma associated with systemic disease (Sturge Weber syndrome and Neurofibromatosis), those due to acquired conditions (Uveitic glaucoma, trauma and tumours) and importantly glaucoma following cataract surgery.
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Affiliation(s)
- Tanya Karaconji
- Speciality of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Ophthalmology, The Children's Hospital, Westmead, Australia
| | - Sophia Zagora
- Speciality of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Ophthalmology, The Children's Hospital, Westmead, Australia
| | - John R Grigg
- Speciality of Ophthalmology, Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Ophthalmology, The Children's Hospital, Westmead, Australia.,Eye Genetics Research Group Children's Medical Research Institute, The Children's Hospital at Westmead and Eye Genetics Clinics, The Children's Hospital at Westmead, Westmead, Australia
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19
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Nash BM, Loi TH, Fernando M, Sabri A, Robinson J, Cheng A, Eamegdool SS, Farnsworth E, Bennetts B, Grigg JR, Chung SK, Gonzalez-Cordero A, Jamieson RV. Evaluation for Retinal Therapy for RPE65 Variation Assessed in hiPSC Retinal Pigment Epithelial Cells. Stem Cells Int 2021; 2021:4536382. [PMID: 34938339 PMCID: PMC8687838 DOI: 10.1155/2021/4536382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022] Open
Abstract
Human induced pluripotent stem cells (hiPSCs) generated from patients and the derivative retinal cells enable the investigation of pathological and novel variants in relevant cell populations. Biallelic pathogenic variants in RPE65 cause early-onset severe retinal dystrophy (EOSRD) or Leber congenital amaurosis (LCA). Increasingly, regulatory-approved in vivo RPE65 retinal gene replacement therapy is available for patients with these clinical features, but only if they have biallelic pathological variants and sufficient viable retinal cells. In our cohort of patients, we identified siblings with early-onset severe retinal degeneration where genomic studies revealed compound heterozygous variants in RPE65, one a known pathogenic missense variant and the other a novel synonymous variant of uncertain significance. The synonymous variant was suspected to affect RNA splicing. Since RPE65 is very poorly expressed in all tissues except the retinal pigment epithelium (RPE), we generated hiPSC-derived RPE cells from the parental carrier of the synonymous variant. Sequencing of RNA obtained from hiPSC-RPE cells demonstrated heterozygous skipping of RPE65 exon 2 and the introduction of a premature stop codon in the mRNA. Minigene studies confirmed the splicing aberration. Results from this study led to reclassification of the synonymous variant to a pathogenic variant, providing the affected patients with access to RPE65 gene replacement therapy.
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Affiliation(s)
- Benjamin M. Nash
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
| | - To Ha Loi
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Milan Fernando
- Stem Cell Medicine Group and Stem Cell and Organoid Facility, Children's Medical Research Institute, University of Sydney, Faculty of Medicine & Health, Sydney NSW, Australia
| | - Amin Sabri
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - James Robinson
- Department of Ophthalmology, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
- Specialty of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anson Cheng
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Steven S. Eamegdool
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Farnsworth
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
| | - Bruce Bennetts
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Sydney Genome Diagnostics, Western Sydney Genetics Program, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
| | - John R. Grigg
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
- Specialty of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Seo-Kyung Chung
- Translational Neurogenomics Group, Kids Research, Sydney Children's Hospitals Network-Westmead, Sydney NSW, Australia
- Brain and Mind Centre, Faculty of Medicine & Health, University of Sydney, Sydney NSW, Australia
| | - Anai Gonzalez-Cordero
- Stem Cell Medicine Group and Stem Cell and Organoid Facility, Children's Medical Research Institute, University of Sydney, Faculty of Medicine & Health, Sydney NSW, Australia
| | - Robyn V. Jamieson
- Eye Genetics Research Unit, Sydney Children's Hospitals Network-Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children's Hospitals Network-Westmead, Sydney, New South Wales, Australia
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20
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Yosar JC, Zagora SL, Grigg JR. Cataract Surgery in Short Eyes, Including Nanophthalmos: Visual Outcomes, Complications and Refractive Results. Clin Ophthalmol 2021; 15:4543-4551. [PMID: 34866899 PMCID: PMC8636843 DOI: 10.2147/opth.s344465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/19/2021] [Indexed: 01/23/2023] Open
Abstract
Background To report the visual outcomes, complications and refractive results of phacoemulsification surgery and intraocular lens implantation in a large series of adult patients with short and nanophthalmic eyes. Methods The records of all patients with axial length <21.0 mm undergoing phacoemulsification with intraocular lens implantation at an adult teaching hospital were retrospectively reviewed. The main outcome measures were corrected distance visual acuity and refraction at 90 days after surgery and intra- and postoperative complications occurring during the follow-up period. Results A total of 71 eyes of 51 patients (median age 71 years, interquartile range 62–75.5) were included. Surgery resulted in an improvement in corrected distance visual acuity in 53 eyes (74.6%) (95% confidence interval, logMAR 0.11–0.29) and was logMAR 0.30 or better in 47 eyes (66.2%). Worsening of corrected distance visual acuity occurred in 9 eyes (12.7%). Median postoperative refractive error was −0.75 dioptres. SRK/T and Kane formula were more accurate in predicting postoperative refraction than Barrett Universal II and Hoffer Q when based on mean absolute error (P < 0.005). Complications occurred in 18 eyes (25.4%). The most frequent complications were iris prolapse, Descemet’s membrane and/or endothelial trauma, transient severe corneal edema and cystoid macular edema. There was no statistically significant difference in complication rates between senior surgeons and senior trainees (P = 0.66). Conclusion Cataract surgery in short and nanophthalmic eyes is challenging with a higher complication rate than routine cataract surgery, but frequently results in good visual outcomes. Postoperative refractive outcomes are more difficult to predict in this cohort.
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Affiliation(s)
- Jason C Yosar
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - Sophia L Zagora
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Sydney, NSW, Australia
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21
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Watson MJG, McCluskey PJ, Grigg JR, Kanagasingam Y, Daire J, Estai M. Barriers and facilitators to diabetic retinopathy screening within Australian primary care. BMC Fam Pract 2021; 22:239. [PMID: 34847874 PMCID: PMC8630186 DOI: 10.1186/s12875-021-01586-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Background Despite recent incentives through Medicare (Australia’s universal health insurance scheme) to increase retinal screening rates in primary care, comprehensive diabetic retinopathy (DR) screening has not been reached in Australia. The current study aimed to identify key factors affecting the delivery of diabetic retinopathy (DR) screening in Australian general practices. Methods A descriptive qualitative study involving in-depth interviews was carried out from November 2019 to March 2020. Using purposive snowballing sampling, 15 general practitioners (GPs) were recruited from urban and rural general practices in New South Wales and Western Australia. A semi-structured interview guide was used to collect data from participants. All interviews were conducted over the phone by one facilitator, and each interview lasted up to 45 min. The Socio-Ecological Model was used to inform the content of the interview topic guides and subsequent data analysis. Recorded data were transcribed verbatim, and thematic analysis was conducted to identify and classify recurrent themes. Results Of 15 GPs interviewed, 13 were male doctors, and the mean age was 54.7 ± 15.5 years. Seven participants were practising in urban areas, while eight were practising in regional or remote areas. All participants had access to a direct ophthalmoscope, but none owned retinal cameras. None of the participants reported performing DR screening. Only three participants were aware of the Medicare Benefits Schedule (MBS) items 12,325 and 12,326 that allow GPs to bill for retinal screening. Seven themes, a combination of facilitators and barriers, emerged from interviews with the GPs. Despite the strong belief in their role in managing chronic diseases, barriers such as costs of retinal cameras, time constraints, lack of skills to make DR diagnosis, and unawareness of Medicare incentives for non-mydriatic retinal photography made it difficult to conduct DR screening in general practice. However, several enabling strategies to deliver DR screening within primary care include increasing GPs’ access to continuing professional development, subsidising the cost of retinal cameras, and the need for a champion ace to take the responsibility of retinal photography. Conclusion This study identified essential areas at the system level that require addressing to promote the broader implementation of DR screening, in particular, a nationwide awareness campaign to maximise the use of MBS items, improve GPs’ competency, and subsidise costs of the retinal cameras for small and rural general practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01586-7.
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Affiliation(s)
- Matthew J G Watson
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat, WA, 6014, Australia.,Save Sight Institute, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Peter J McCluskey
- Save Sight Institute, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - John R Grigg
- Save Sight Institute, The Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Yogesan Kanagasingam
- School of Medicine, University of Notre Dame Australia, Fremantle, Australia.,St John of God Public and Private Hospitals, Midland, Australia
| | - Judith Daire
- School of Population Health, The Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Mohamed Estai
- The Australian e-Health Research Centre, CSIRO, 147 Underwood Avenue, Floreat, WA, 6014, Australia. .,School of Human Sciences, The University of Western Australia, Perth, Australia.
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22
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Lawlor M, Nguyen V, Brooks A, Clement C, Craig JE, Danesh-Meyer H, Goldberg I, Graham SL, Grigg JR, Howes F, Lim R, Skalicky SE, White AJ, Gillies M. Efficient capture of high-quality real-world data on treatments for glaucoma: the Fight Glaucoma Blindness! Registry. BMJ Open Ophthalmol 2021; 6:e000903. [PMID: 34796271 PMCID: PMC8573655 DOI: 10.1136/bmjophth-2021-000903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/03/2021] [Indexed: 02/01/2023] Open
Abstract
Objective To describe the development and implementation of a web-based high-quality data collection tool to track the outcomes of glaucoma treatments in routine practice. Methods and analysis This is a prospective observational registry study. An international steering committee undertook an iterative structured process to define a minimum, patient-centred data set designed to track outcomes of glaucoma treatment. The outcomes were coded into a web-based programme allowing easy access for rapid data entry. Clinicians receive personal reports enabling instant audit of their outcomes. Analyses of aggregated anonymised data on real-world outcomes are analysed and periodically reported with the goal of improving patient care. Results The minimum data set developed by the international steering committee includes the following: a baseline visit captures 13 mandatory fields in order to accurately phenotype each patient's subtype of glaucoma and to allow comparison between services, and a follow-up visit includes only four mandatory fields to allow completion within 30 s.Currently, there are 157 surgeons in 158 ophthalmology practices across Australia and New Zealand who are registered. These surgeons are tracking 5570 eyes of 3001 patients and have recorded 67 074 visits. The median number of eyes per surgeon is 22 eyes with a range of 1-575. The most common glaucoma procedure, excluding cataract surgery, is iStent inject, with 2316 cases. Conclusion This software tool effectively facilitates data collection on safety and efficacy outcomes of treatments for different subgroups of glaucoma within a real-world setting. It provides a template to evaluate new treatments as they are introduced into practice.
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Affiliation(s)
- Mitchell Lawlor
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Anne Brooks
- Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia.,Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Colin Clement
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Jamie E Craig
- Eye and Vision, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Helen Danesh-Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Ivan Goldberg
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stuart L Graham
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John R Grigg
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Frank Howes
- Eye and Laser Centre, Gold Coast, Queensland, Australia
| | - Ridia Lim
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Glaucoma Unit, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Simon E Skalicky
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Andrew J White
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Gillies
- Clinical Ophthalmology & Eye Health, The University of Sydney, Sydney, New South Wales, Australia
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23
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Eggenberger SC, James NL, Ho C, Eamegdool SS, Tatarinoff V, Craig NA, Gow BS, Wan S, Dodds CWD, La Hood D, Gilmour A, Donahoe SL, Krockenberger M, Tumuluri K, da Cruz MJ, Grigg JR, McCluskey P, Lovell NH, Madigan MC, Fung AT, Suaning GJ. Implantation and long-term assessment of the stability and biocompatibility of a novel 98 channel suprachoroidal visual prosthesis in sheep. Biomaterials 2021; 279:121191. [PMID: 34768150 DOI: 10.1016/j.biomaterials.2021.121191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
Severe visual impairment can result from retinal degenerative diseases such as retinitis pigmentosa, which lead to photoreceptor cell death. These pathologies result in extensive neural and glial remodelling, with survival of excitable retinal neurons that can be electrically stimulated to elicit visual percepts and restore a form of useful vision. The Phoenix99 Bionic Eye is a fully implantable visual prosthesis, designed to stimulate the retina from the suprachoroidal space. In the current study, nine passive devices were implanted in an ovine model from two days to three months. The impact of the intervention and implant stability were assessed using indirect ophthalmoscopy, infrared imaging, and optical coherence tomography to establish the safety profile of the surgery and the device. The biocompatibility of the device was evaluated using histopathological analysis of the tissue surrounding the electrode array, with a focus on the health of the retinal cells required to convey signals to the brain. Appropriate stability of the electrode array was demonstrated, and histological analysis shows that the fibrotic and inflammatory response to the array was mild. Promising evidence of the safety and potential of the Phoenix99 Bionic Eye to restore a sense of vision to the severely visually impaired was obtained.
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Affiliation(s)
- Samuel C Eggenberger
- School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, Australia
| | - Natalie L James
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Cherry Ho
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Steven S Eamegdool
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia
| | - Veronika Tatarinoff
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Naomi A Craig
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Barry S Gow
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Susan Wan
- The Westmead Institute for Medical Research, Westmead, Australia
| | - Christopher W D Dodds
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Donna La Hood
- Brien Holden Vision Institute, Sydney, Australia; School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia
| | - Aaron Gilmour
- School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, Australia; Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Shannon L Donahoe
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
| | - Mark Krockenberger
- Veterinary Pathology Diagnostic Services, Sydney School of Veterinary Science, University of Sydney, Sydney, Australia
| | - Krishna Tumuluri
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia; Westmead Clinical School, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Melville J da Cruz
- Department of Otolaryngology, Westmead Hospital, University of Sydney, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia
| | - Michele C Madigan
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia; School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia
| | - Adrian T Fung
- Save Sight Institute, The University of Sydney, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Australia; Westmead Clinical School, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Gregg J Suaning
- School of Biomedical Engineering, Faculty of Engineering, University of Sydney, Sydney, Australia; Graduate School of Biomedical Engineering, University of New South Wales (UNSW), Sydney, Australia.
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24
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Whist E, Symes RJ, Chang JH, Chowdhury V, Lim LA, Grigg JR, Lin ML, Karaconji T, Giblin M, Symons A, Lim LL, McCluskey PJ. UVEITIS CAUSED BY TREATMENT FOR MALIGNANT MELANOMA: A CASE SERIES. Retin Cases Brief Rep 2021; 15:718-723. [PMID: 31274846 PMCID: PMC8542090 DOI: 10.1097/icb.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE To report the largest case series to date of uveitis occurring in association with immunomodulatory therapy for malignant melanoma. METHODS A retrospective multicenter case review. Twenty-two patients with uveitis occurring in association with either immunotherapy or targeted immune therapy for malignant melanoma were identified. RESULTS Of 22 patients, 11 had anterior uveitis in isolation. The remainder showed a variety of clinical features including panuveitis, ocular hypotony, papillitis, cystoid macular edema, and melanoma-associated retinopathy. Most patients responded well to treatment. CONCLUSION We report the largest case series to date of patients with uveitis secondary to drug treatment for malignant melanoma. These cases are likely to increase in number in the future as newer immunomodulatory therapies for cancers are developed and the indications for these drugs increase. A dilemma arises when patients respond well to these drugs but develop vision-threatening side effects.
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Affiliation(s)
- Eline Whist
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Richard J. Symes
- Sydney Eye Hospital, Sydney, New South Wales, Australia
- Save Sight Institute, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - John H. Chang
- Retina and Vitreous Centre, Strathfield, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Vivek Chowdhury
- Crows Nest Eye Surgery, Crows Nest, New South Wales, Australia
| | - Li-Anne Lim
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - John R. Grigg
- Sydney Eye Hospital, Sydney, New South Wales, Australia
- Save Sight Institute, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Ming-Lee Lin
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | | | - Andrew Symons
- Royal Melbourne Hospital, Parkville, Victoria, Australia; and
| | - Lyndell L. Lim
- Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Royal Melbourne Hospital, Parkville, Victoria, Australia; and
- Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
| | - Peter J. McCluskey
- Sydney Eye Hospital, Sydney, New South Wales, Australia
- Save Sight Institute, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
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25
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Zada M, Cornish EE, Fraser CL, Jamieson RV, Grigg JR. Natural history and clinical biomarkers of progression in X-linked retinitis pigmentosa: a systematic review. Acta Ophthalmol 2021; 99:499-510. [PMID: 33258268 DOI: 10.1111/aos.14662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
X-linked retinitis pigmentosa (XLRP) accounts for a significant proportion of certifiable blindness in working-age adults. The objectives of this study were to: (1) synthesize the best available evidence regarding the natural history of disease progression and (2) identify the best current clinical biomarkers for monitoring disease progression, which will be important in planned gene therapy trials for this condition. Patient population: XLRP affected males. Main outcomes: A systematic review of the literature was undertaken with data sought on overall annual progression for clinical biomarkers using optical coherence tomography (OCT), fundus autofluorescence (FAF), visual acuity, electroretinography and visual fields. To assess which outcome was best for monitoring progression, data on reliability, interocular correlation and structure-function correlation were extracted. A total of 17 studies met the inclusion criteria. Studies estimated progression at between 4% to 19% per year with longitudinal data. Where an overall model was produced with cross-sectional data, the trend was usually best fit by a logarithmic function with an annual exponential decline rate between 4.7% and 8.0%. The evidence suggested the ellipsoid zone (EZ) width on OCT and outer ring area (ORA) on FAF as the most useful biomarkers having excellent interocular symmetry, reproducibility and functional correlation. Using different clinical biomarkers, XLRP progresses at a rate of 4 to 19% per year. Ellipsoid zone (EZ) width and ORA are the most robust biomarkers with the potential to be used in trials where one eye serves as a control for the other.
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Affiliation(s)
- Mark Zada
- Save Sight Institute Discipline of Ophthalmology Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Elisa E Cornish
- Save Sight Institute Discipline of Ophthalmology Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
- Genetic Eye Research Unit Children's Medical Research Institute Save Sight Institute Faculty of Medicine and Health The University of Sydney and Children's Hospital Westmead Sydney NSW Australia
- Sydney Eye Hospital Foundation Sydney NSW Australia
| | - Clare L Fraser
- Save Sight Institute Discipline of Ophthalmology Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Robyn V Jamieson
- Save Sight Institute Discipline of Ophthalmology Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
- Genetic Eye Research Unit Children's Medical Research Institute Save Sight Institute Faculty of Medicine and Health The University of Sydney and Children's Hospital Westmead Sydney NSW Australia
| | - John R Grigg
- Save Sight Institute Discipline of Ophthalmology Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
- Genetic Eye Research Unit Children's Medical Research Institute Save Sight Institute Faculty of Medicine and Health The University of Sydney and Children's Hospital Westmead Sydney NSW Australia
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26
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Sakti DH, Cornish EE, Mustafic N, Zaheer A, Retsas S, Rajagopalan S, Chung CW, Ewans L, McCluskey P, Nash BM, Jamieson RV, Grigg JR. MERTK retinopathy: biomarkers assessing vision loss. Ophthalmic Genet 2021; 42:706-716. [PMID: 34289798 DOI: 10.1080/13816810.2021.1955278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Mer tyrosine kinase-retinitis pigmentosa (MERTK-RP) causes a primary defect in the retinal pigment epithelium, which subsequently affects rod and cone photoreceptors. The study aims to identify the most appropriate MERTK-RP biomarkers to measure disease progression for deciding the optimum therapeutic trial intervention time. MATERIALS AND METHODS Patients' data from baseline (BL) and last follow-up (LFU) were reviewed. Best corrected visual acuity (BCVA), spectral domain-optical coherence tomography (SD-OCT), ultra-widefield fundus autofluorescence (UWF-FAF) patterns, kinetic perimetry (KP), and electroretinography (ERG) parameters were analyzed. RESULTS Five patients were included with the mean age of 17.7 ± 14.4 years old (6.7-42.3) at BL and mean BCVA follow-up of 8.4 ± 5.1 years. Mean BCVA at BL and LFU were 0.84 ± 0.86 LogMAR and 1.14 ± 0.86 LogMAR, respectively. The BCVA decline rate was 0.05 ± 0.03 LogMAR units/year. Ellipzoid zones (EZ) were measurable in eight eyes with mean BL length of 1293.75 ± 421.07 µm and reduction of 140.95 ± 69.28 µm/year and mean BL CMT of 174.2 ± 37.52 µm with the rate of 11.2 ± 12.77 µm declining/year. Full-field ERG (ffERG) and pattern ERG (pERG) were barely recordable. UWF-FAF showed central macular hyper-autofluorescence (hyperAF). KP (III4e and V4e) was normal in two eyes, restricted nasally in four eyes, superior wedge defect in two eyes and undetectable in two eyes. The four restricted nasally KPs became worse, while the others stayed almost unchanged. CONCLUSIONS This cohort showed early visual loss, moderately rapid EZ reduction and macular hyperAF. EZ, CMT, and BCVA were consistently reduced. Relative rapid decline in these biomarkers reflecting visual function suggests an early and narrow timespan for intervention.
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Affiliation(s)
- Dhimas H Sakti
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing; Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elisa E Cornish
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, the Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Nina Mustafic
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Afsah Zaheer
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Retsas
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sulekha Rajagopalan
- Department of Clinical Genetics, Liverpool Hospital, Liverpool BC, NSW, Australia
| | - Clara Wt Chung
- Department of Clinical Genetics, Liverpool Hospital, Liverpool BC, NSW, Australia.,School of Women's & Children's Health, University of NSW, Sydney, NSW, Australia
| | - Lisa Ewans
- Department of Clinical Genetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Faculty of Medicine and Health Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter McCluskey
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, Children's Medical Research Institute, the Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Disciplines of Genomic Medicine & Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Sydney Genome Diagnostics, Western Sydney Genetics Program, the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, the Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Disciplines of Genomic Medicine & Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Clinical Genetics, Western Sydney Genetics Program, the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, the Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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27
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Ma A, Grigg JR, Flaherty M, Smith J, Minoche AE, Cowley MJ, Nash BM, Ho G, Gayagay T, Lai T, Farnsworth E, Hackett EL, Slater K, Wong K, Holman KJ, Jenkins G, Cheng A, Martin F, Brown NJ, Leighton SE, Amor DJ, Goel H, Dinger ME, Bennetts B, Jamieson RV. Genome sequencing in congenital cataracts improves diagnostic yield. Hum Mutat 2021; 42:1173-1183. [PMID: 34101287 DOI: 10.1002/humu.24240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/11/2023]
Abstract
Congenital cataracts are one of the major causes of childhood-onset blindness around the world. Genetic diagnosis provides benefits through avoidance of unnecessary tests, surveillance of extraocular features, and genetic family information. In this study, we demonstrate the value of genome sequencing in improving diagnostic yield in congenital cataract patients and families. We applied genome sequencing to investigate 20 probands with congenital cataracts. We examined the added value of genome sequencing across a total cohort of 52 probands, including 14 unable to be diagnosed using previous microarray and exome or panel-based approaches. Although exome or genome sequencing would have detected the variants in 35/52 (67%) of the cases, specific advantages of genome sequencing led to additional diagnoses in 10% (5/52) of the overall cohort, and we achieved an overall diagnostic rate of 77% (40/52). Specific benefits of genome sequencing were due to detection of small copy number variants (2), indels in repetitive regions (2) or single-nucleotide variants (SNVs) in GC-rich regions (1), not detectable on the previous microarray, exome sequencing, or panel-based approaches. In other cases, SNVs were identified in cataract disease genes, including those newly identified since our previous study. This study highlights the additional yield of genome sequencing in congenital cataracts.
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Affiliation(s)
- Alan Ma
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialties of Genomic Medicine & Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - John R Grigg
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialty of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Maree Flaherty
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialty of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - James Smith
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialty of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Andre E Minoche
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia
| | - Mark J Cowley
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Randwick, New South Wales, Australia.,St Vincent's Clinical School, Faculty of Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Benjamin M Nash
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Specialties of Genomic Medicine & Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gladys Ho
- Specialties of Genomic Medicine & Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Thet Gayagay
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Tiffany Lai
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth Farnsworth
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Emma L Hackett
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katrina Slater
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karen Wong
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Katherine J Holman
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gemma Jenkins
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Anson Cheng
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Frank Martin
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialty of Ophthalmology, University of Sydney, Sydney, New South Wales, Australia
| | - Natasha J Brown
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - David J Amor
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Himanshu Goel
- Hunter Genetics, Newcastle, New South Wales, Australia
| | - Marcel E Dinger
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia.,School of Biotechnology and Biomolecular Sciences, Faculty of Science, UNSW, Sydney, New South Wales, Australia
| | - Bruce Bennetts
- Specialties of Genomic Medicine & Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Robyn V Jamieson
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Specialties of Genomic Medicine & Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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28
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Nash BM, Watson CJG, Hughes E, Hou AL, Loi TH, Bennetts B, Jelovic D, Polkinghorne PJ, Gorbatov M, Grigg JR, Vincent AL, Jamieson RV. Heterozygous COL9A3 variants cause severe peripheral vitreoretinal degeneration and retinal detachment. Eur J Hum Genet 2021; 29:881-886. [PMID: 33633367 PMCID: PMC8110976 DOI: 10.1038/s41431-021-00820-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/11/2021] [Accepted: 01/26/2021] [Indexed: 01/31/2023] Open
Abstract
The COL9A3 gene encodes one of the three alpha chains of Type IX collagen, with heterozygous variants reported to cause multiple epiphyseal dysplasia, and suggested as contributory in some cases of sensorineural hearing loss. Patients with homozygous variants have midface hypoplasia, myopia, sensorineural hearing loss, epiphyseal changes and carry a diagnosis of Stickler syndrome. Variants in COL9A3 have not previously been reported to cause vitreoretinal degeneration and/or retinal detachments. This report describes two families with autosomal dominant inheritance and predominant features of peripheral vitreoretinal lattice degeneration and retinal detachment. Genomic sequencing revealed a heterozygous splice variant in COL9A3 [NG_016353.1(NM_001853.4):c.1107 + 1G>C, NC_000020.10(NM_001853.4):c.1107 + 1G>C, LRG1253t1] in Family 1, and a heterozygous missense variant [NG_016353.1(NM_001853.4):c.388G>A p.(Gly130Ser)] in Family 2, each segregating with disease. cDNA studies of the splice variant demonstrated an in-frame deletion in the COL2 domain, and the missense variant occurred in the COL3 domain, both indicating the critical role of Type IX collagen in the vitreous base of the eye.
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Affiliation(s)
- Benjamin M. Nash
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia ,Disciplines of Genomic Medicine and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children’s Hospital at Westmead, Sydney, NSW Australia
| | - Christopher J. G. Watson
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia ,Disciplines of Genomic Medicine and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Edward Hughes
- Sydney Eye Hospital, Sydney, NSW Australia ,Department of Ophthalmology, Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Alec L. Hou
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Health and Medical Science, University of Auckland, Auckland, New Zealand
| | - To Ha Loi
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia
| | - Bruce Bennetts
- Disciplines of Genomic Medicine and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children’s Hospital at Westmead, Sydney, NSW Australia
| | - Diana Jelovic
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia ,Disciplines of Genomic Medicine and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Philip J. Polkinghorne
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Health and Medical Science, University of Auckland, Auckland, New Zealand ,Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | | | - John R. Grigg
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia ,Sydney Eye Hospital, Sydney, NSW Australia ,Discipline of Ophthalmology, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - Andrea L. Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Health and Medical Science, University of Auckland, Auckland, New Zealand ,Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Robyn V. Jamieson
- Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney, NSW Australia ,Disciplines of Genomic Medicine and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia ,Department of Clinical Genetics, Western Sydney Genetics Program, The Children’s Hospital at Westmead, Sydney, NSW Australia
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Arsiwalla TA, Cornish EE, Nguyen PV, Korsakova M, Ali H, Saakova N, Fraser CL, Jamieson RV, Grigg JR. Assessing Residual Cone Function in Retinitis Pigmentosa Patients. Transl Vis Sci Technol 2020; 9:29. [PMID: 33364083 PMCID: PMC7746956 DOI: 10.1167/tvst.9.13.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/29/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to investigate cone function deterioration in patients with retinitis pigmentosa (RP) using full field electroretinogram (ffERG), pattern electroretinogram (pERG), and optical coherence tomography (OCT) and their correlation with visual acuity (VA). Methods Clinical records (2008–2018) of patients with RP undergoing repeat electrophysiology were reviewed. Results of ffERG (30 Hz flicker and fused flicker amplitude [FFAmp]), pERG [p50 and n95], and macular OCT (ellipsoid zone [EZ] and outer segment thickness) were collected. Results One hundred twenty-six eyes from 63 patients (33 women, mean age 35 years) were included. The mean decline in VA was 0.11 ± 0.14 logarithm of minimum angle of resolution (logMAR). The FFAmp decreased by 3.01 ± 5.9 µV with global cone function deteriorating by 18.7% annually. The percentage change in FFAmp (RE [r = 0.553], LE [r = 0.531]), and 30 Hz flicker amplitude (RE [r = 0.615], LE [r = 0.529]) strongly correlated with VA (P < 0.00001). The pERG p50 (15 and 30 degrees) change analyzed in 34 patients showed reduction by 23% and 23.4%, respectively. The percentage change in p50 30 degrees (r = 0.397) correlated with VA and EZ layer (P < 0.05). The EZ layer change was calculated in 45 patients and the shortening and thinning rate was 4.3% and 4.4% annually, respectively. The EZ length percentage change correlated with VA (RE [r = 0.34] and LE [r = 0.466; P < 0.05). Conclusions We quantified the decline in cone function in patients with RP utilizing ffERG and FFAmp measures of residual cone function. These parameters correlated with VA and OCT when measurable. These objective measures may assist in monitoring disease progression. Translational Relevance Residual cone function provides an objective estimate of residual visual function, which aids in counselling patients regarding prognosis.
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Affiliation(s)
- Tasneem A Arsiwalla
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital Foundation, University of Sydney, Sydney, New South Wales, Australia
| | - Elisa E Cornish
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.,Sydney Eye Hospital Foundation, University of Sydney, Sydney, New South Wales, Australia
| | - Phuc Vuong Nguyen
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Korsakova
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Haipha Ali
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nonna Saakova
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn V Jamieson
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - John R Grigg
- Save Sight Institute, The Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
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30
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Hoang TT, Van Bui A, Nguyen V, McCluskey PJ, Grigg JR, Skalicky SE. Response to: "Comment on: 'Comparison of perimetric glaucoma staging systems in Asians with primary glaucoma'". Eye (Lond) 2020; 35:2327-2328. [PMID: 32826995 DOI: 10.1038/s41433-020-01149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/30/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tung Thanh Hoang
- Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam. .,Save Sight Institute, The University of Sydney School of Medicine, Sydney, NSW, Australia.
| | - Anh Van Bui
- Glaucoma Department, Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Vuong Nguyen
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Peter J McCluskey
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, NSW, Australia
| | - Simon Edward Skalicky
- Save Sight Institute, The University of Sydney School of Medicine, Sydney, NSW, Australia.,Department of Surgery and Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
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31
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Hoang TT, Van Bui A, Nguyen V, McCluskey PJ, Grigg JR, Skalicky SE. Comparison of perimetric Glaucoma Staging Systems in Asians with primary glaucoma. Eye (Lond) 2020; 35:973-978. [PMID: 32518400 DOI: 10.1038/s41433-020-1012-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To compare functional staging classifications in Vietnamese patients with primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (PACG). METHODS A retrospective cross-section study was conducted at a national setting. Two hundred seven eyes of 207 patients were recruited. Patients were tested with standard automated perimetry. Field loss was generally classified in four stages (normal, early, moderate, and severe), using four classification strategies: (1) Hodapp-Parrish-Anderson (HPA), (2) enhanced Glaucoma Staging System (eGSS), (3) modified Glaucoma Staging System (mGSS) and (4) the Advanced Glaucoma Intervention Study (AGIS). AGIS as a standard method was used to judge the staging performance of the other three classifications in terms of agreement (Cohen Kappa-K) and association (Chi-Square Test-Cramer's V). RESULTS The agreement between AGIS and mGSS (K = 0.687; p < 0.001) and HPA (K = 0.686; p < 0.001) was substantial while that between AGIS and eGSS was slight (K = 0.103; p < 0.001). The association between AGIS and mGSS (V = 0.748; p < 0.001) and HPA (V = 0.748; p < 0.001) was greater than eGSS (V = 0.594; p < 0.001). CONCLUSIONS MGSS and HPA showed stronger agreement and closer association with AGIS than eGSS. We recommend mGSS should be used in managing a glaucoma clinic because of its simplicity and convenience over HPA and AGIS.
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Affiliation(s)
- Tung Thanh Hoang
- Department of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam. .,Save Sight Institute, The University of Sydney School of Medicine, Camperdown, NSW, Australia.
| | - Anh Van Bui
- Glaucoma Department, Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Vuong Nguyen
- Save Sight Institute, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Peter J McCluskey
- Save Sight Institute, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney School of Medicine, Camperdown, NSW, Australia
| | - Simon Edward Skalicky
- Save Sight Institute, The University of Sydney School of Medicine, Camperdown, NSW, Australia.,Department of Surgery and Ophthalmology, University of Melbourne, Parkville, VIC, Australia
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32
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Grigg JR, Hooper CY, Fraser CL, Cornish EE, McCluskey PJ, Jamieson RV. Outcome measures in juvenile X-linked retinoschisis: A systematic review. Eye (Lond) 2020; 34:1760-1769. [PMID: 32313171 PMCID: PMC7608480 DOI: 10.1038/s41433-020-0848-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 01/06/2020] [Accepted: 03/01/2020] [Indexed: 01/01/2023] Open
Abstract
X-linked retinoschisis (XLRS) is a leading cause of hereditary juvenile macular degeneration in males resulting in significant vision impairment. Outcome measures to monitor disease progression or therapeutic interventions have evolved with technology. A systematic review was undertaken to evaluate outcome measures for XLRS. Inclusion criteria were all publications examining outcome measures for natural history studies or following an interventional approach for patients with XLRS. Studies which did not present follow-up data were excluded. We searched medical databases including CENTRAL, Ovid Medline, pre-Medline and ahead of Print up to February 2019. Two authors independently assessed the risk of bias. Twelve studies meet the inclusion criteria with four prospective and eight retrospective case series. Five series were natural history observational studies and seven were interventional series using either topical or systemic carbonic anhydrase inhibitors. Visual acuity (VA) declined very slowly in the natural history studies equivalent to 0.22-0.5 letters per year. Five of the six interventional studies showed an improvement in VA and four a reduction in spectral domain optical coherence tomography (SD-OCT) parameters for central macular thickness (CMT). The full-field electroretinogram identified the 30-Hz latency as a further parameter to monitor function. VA was the measure most likely to show a statistically significant outcome. How functionally meaningful this is, requires further evaluation. CMT SD-OCT outcomes are variable depending on cystic changes. More refined measures are required to better correlate structure with function.
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Affiliation(s)
- John R Grigg
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia. .,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia. .,Sydney Eye Hospital, Macquarie Street, Sydney, NSW, Australia.
| | - Claire Y Hooper
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia.,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Clare L Fraser
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia.,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Macquarie Street, Sydney, NSW, Australia
| | - Elisa E Cornish
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia.,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Macquarie Street, Sydney, NSW, Australia
| | - Peter J McCluskey
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia.,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Sydney Eye Hospital, Macquarie Street, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Save Sight Institute, 8 Macquarie Street, Sydney, NSW, 2001, Australia.,Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Disciplines of Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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33
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Karaconji T, Grigg JR. The changing face of the ciliary body in the paediatric population. Clin Exp Ophthalmol 2019; 47:435-436. [PMID: 31207051 DOI: 10.1111/ceo.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tanya Karaconji
- Discipline of Ophthalmology, Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - John R Grigg
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Ophthalmology, Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health University of Sydney, Eye Genetics Research Group Children's Medical Research Institute, The Children's Hospital at Westmead, & Save Sight Institute & Eye Genetics Clinics, The Children's Hospital at Westmead, & Sydney Eye Hospital, Sydney, New South Wales, Australia
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34
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Williams LB, Javed A, Sabri A, Morgan DJ, Huff CD, Grigg JR, Heng XT, Khng AJ, Hollink IHIM, Morrison MA, Owen LA, Anderson K, Kinard K, Greenlees R, Novacic D, Nida Sen H, Zein WM, Rodgers GM, Vitale AT, Haider NB, Hillmer AM, Ng PC, Shankaracharya, Cheng A, Zheng L, Gillies MC, van Slegtenhorst M, van Hagen PM, Missotten TOAR, Farley GL, Polo M, Malatack J, Curtin J, Martin F, Arbuckle S, Alexander SI, Chircop M, Davila S, Digre KB, Jamieson RV, DeAngelis MM. ALPK1 missense pathogenic variant in five families leads to ROSAH syndrome, an ocular multisystem autosomal dominant disorder. Genet Med 2019; 21:2103-2115. [PMID: 30967659 PMCID: PMC6752478 DOI: 10.1038/s41436-019-0476-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/25/2019] [Indexed: 01/07/2023] Open
Abstract
Purpose To identify the molecular cause in five unrelated families with a distinct autosomal dominant ocular systemic disorder we called ROSAH syndrome due to clinical features of retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache. Methods Independent discovery exome and genome sequencing in families 1, 2, and 3, and confirmation in families 4 and 5. Expression of wild-type messenger RNA and protein in human and mouse tissues and cell lines. Ciliary assays in fibroblasts from affected and unaffected family members. Results We found the heterozygous missense variant in the ɑ-kinase gene, ALPK1, (c.710C>T, [p.Thr237Met]), segregated with disease in all five families. All patients shared the ROSAH phenotype with additional low-grade ocular inflammation, pancytopenia, recurrent infections, and mild renal impairment in some. ALPK1 was notably expressed in retina, retinal pigment epithelium, and optic nerve, with immunofluorescence indicating localization to the basal body of the connecting cilium of the photoreceptors, and presence in the sweat glands. Immunocytofluorescence revealed expression at the centrioles and spindle poles during metaphase, and at the base of the primary cilium. Affected family member fibroblasts demonstrated defective ciliogenesis. Conclusion Heterozygosity for ALPK1, p.Thr237Met leads to ROSAH syndrome, an autosomal dominant ocular systemic disorder.
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Affiliation(s)
- Lloyd B Williams
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Asif Javed
- Genome Institute of Singapore, Singapore, Singapore.,School of Biomedical Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Amin Sabri
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Denise J Morgan
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chad D Huff
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John R Grigg
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia.,Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia
| | | | | | | | - Margaux A Morrison
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leah A Owen
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Krista Kinard
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rebecca Greenlees
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Danica Novacic
- National Institutes of Health, National Human Genome Research Institute, Undiagnosed Diseases Network, Bethesda, MD, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Wadih M Zein
- National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - George M Rodgers
- Department of Hematology, Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Albert T Vitale
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Neena B Haider
- Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Pauline C Ng
- Genome Institute of Singapore, Singapore, Singapore
| | - Shankaracharya
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anson Cheng
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Linda Zheng
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Mark C Gillies
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | - Michael Polo
- Drs. Farley, Polo and Ho, Colonial Heights, VA, USA
| | - James Malatack
- Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Julie Curtin
- Department of Haematology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Frank Martin
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Susan Arbuckle
- Department of Pathology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Stephen I Alexander
- Department of Nephrology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Megan Chircop
- Cell Cycle Unit, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Sonia Davila
- Genome Institute of Singapore, Singapore, Singapore
| | - Kathleen B Digre
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robyn V Jamieson
- Eye Genetics Research Unit, Children's Medical Research Institute, The Children's Hospital at Westmead, Save Sight Institute, University of Sydney, Sydney, NSW, Australia. .,Disciplines of Genomic Medicine, and Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia.
| | - Margaret M DeAngelis
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA. .,Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA. .,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Oh LJ, Nguyen CL, Phan K, Wong E, Zagora S, Singh-Grewal D, Chaitow J, Grigg JR, McCluskey P. Changing biological disease modifying treatment for paediatric uveitis in the real world. Clin Exp Ophthalmol 2019; 47:741-748. [PMID: 30834650 DOI: 10.1111/ceo.13494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/07/2019] [Accepted: 02/24/2019] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Paediatric uveitis is a severe sight-threatening uveitis due to disease progression and treatment failure. Biological agents are a promising new treatment. This study provides real-world data on their use from Sydney, Australia. BACKGROUND Traditionally corticosteroids and non-biological immunosuppressive agents were used to treat paediatric uveitis, often with poor outcomes. DESIGN Retrospective, chart review over an 8-year period at a tertiary referral eye hospital. PARTICIPANTS A total of 27 paediatric uveitis patients treated with biological agents. METHODS Chart review of demographic data and treatment outcomes. MAIN OUTCOME MEASURES Treatment efficacy (corticosteroid-sparing effect, topical steroid cessation/reduction, reduction in systemic-steroid sparing agents, change in intraocular inflammation, visual acuity and central macular thickness); treatment failure; and adverse events. Data were collected at biological initiation, 6 weeks, 6 months and 12 months. RESULTS Biological therapy over 1 year was effective with prednisolone dose reduced to <5 mg/day in five of six patients (83%), number of systemic steroid-sparing agents was reduced to ≤1 in two of four patients (50%) and cessation of topical steroid achieved in 12/41 of eyes (29%). Improvement of anterior chamber cells by two grades occurred in 20/25 eyes (80%), improvement of logMAR to ≤0.3 occurred in 12/18 eyes (67%) and macular oedema decreased in 4/5 eyes (80%). Treatment failure occurred in six eyes (13.01%) and five patients (18.5%) developed an adverse reaction. CONCLUSIONS AND RELEVANCE Biological therapy was effective in paediatric patients with uveitis. Intraocular inflammation improved with maintained visual acuity, systemic corticosteroid dose decreased and there was a low frequency of adverse events.
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Affiliation(s)
- Lawrence J Oh
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Chu L Nguyen
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Kevin Phan
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Eugene Wong
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Sophia Zagora
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
| | - Davinder Singh-Grewal
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Sydney Children's Hospital, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Children's Hospital at Westmead, Sydney, Australia
| | - Jeffrey Chaitow
- Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Sydney Children's Hospital, Sydney, Australia
| | - John R Grigg
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia.,Department of Ophthalmology, Department of Rheumatology, The Children's Hospital at Westmead, Sydney, Australia
| | - Peter McCluskey
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Department of Ophthalmology, Paediatric Uveitis Study Group, Save Sight Institute, Sydney, Australia.,Department of Ophthalmology, Sydney University, Sydney, Australia
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Wang SB, Cornish EE, Grigg JR, McCluskey PJ. Anterior segment optical coherence tomography and its clinical applications. Clin Exp Optom 2019; 102:195-207. [PMID: 30635934 DOI: 10.1111/cxo.12869] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/05/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) has become one of the cornerstones of non-contact imaging modalities for assessing such structures as the cornea, anterior chamber angle, aqueous outflow pathway, sclera, and ocular surface structures. As such, it has a broad range of clinical applications, which have been independently reported in the literature. This paper aims to present a review of extant literature on the utility of AS-OCT and its efficacy in clinical applications, and to evaluate the quality of available evidence. The following databases were searched from inception to 24 June 2018: Medline via Ovid, Cochrane Central Register of Controlled Trials, PubMed, World Health Organization International Clinical Trials Registry Platform, EMBASE, and CINAHL. Bibliographies of identified papers were hand searched. Inclusion criteria: articles describing or assessing the use of OCT for visualising the AS. The authors excluded studies without an identified primary outcome variable. One author independently selected studies, extracted data, and assessed for risk of bias using PRISMA guidelines. This review included 82 studies, of which there were 11 cohort studies, 37 case series, 10 case studies, 21 comparative observational studies, and three non-systematic review articles. Primary outcome variables included anterior chamber angle, angle opening distance, angle recess area, trabecular iris angle, trabecula-iris space area, corneal thickness, tear meniscus height, tear meniscus area, tear meniscus volume, and the morphology of AS structures, including the ocular surface, blebs, flaps, and graft sites. This review attempts to encompass the breadth and depth of evidence for AS-OCT in the arena of diagnostics, therapeutics, and prognostics. At the same time, it brings to light the dearth of high-level evidence on this topic, suggesting the important role of randomised controlled trials and meta-analyses for the future validation of this technology.
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Affiliation(s)
- Sarah B Wang
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Elisa E Cornish
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Sydney Eye Hospital Foundation, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - John R Grigg
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Peter J McCluskey
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Choo MM, Yeong CM, Grigg JR, Khaliddin N, Kadir AJ, Barnes EH, Kamalden TA, Watson SL. Central corneal thickness changes and horizontal corneal diameter in premature infants: A prospective analysis. Medicine (Baltimore) 2018; 97:e13357. [PMID: 30508927 PMCID: PMC6283202 DOI: 10.1097/md.0000000000013357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
To report observations of horizontal corneal diameter (HCD) and central corneal thickness (CCT) changes in premature infants with stable optic disc cupping and intraocular pressures (IOPs). The HCD and CCT at term serve as a baseline for premature infants.Sixty-three premature infants were enrolled in a prospective case series. HCD, CCT, and IOP were measured. RetCam images of the optic discs were used to evaluate the cup-disc ratio (CDR) and read by an independent masked observer. Data were collected at between preterm (32-36 weeks) and again at term (37-41 weeks) postconceptual age. Left eye measurements were used for statistical analysis. Left eye findings were combined to construct predictive models for HCD and CCT.The mean HCD was 9.1 mm (standard deviation [SD] = 0.7 mm) at preterm and 10.0 mm (SD = 0.52 mm) at term. The mean CCT preterm was 618.8 (SD = 72.9) μm and at term 563.9 (SD = 50.7) μm, respectively. The average preterm CDR was 0.31 and at maturity was 0.33. Average IOP of preterm and term was 13.1 and 14.11 mm Hg, respectively. There was significant linear correlation between HCD with the postmenstrual age (r = 0.40, P < .01) and the head circumference (r = 0.33, P < .05). Predictive models were constructed for HCD (R = 0.52, 0.2 mm/wk) and CCT (R = 0.23, -11.4 μm/wk) with postconceptual ages.The HCD and CCT variation did not affect IOP reading over time. CCT was not correlated with birth parameters and decreased as the infant reached term. Corneal diameter correlated with gestational age at birth and head circumference.
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Affiliation(s)
- May May Choo
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
- Central Clinical School, Camperdown
| | - Choo Mee Yeong
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
| | - John R. Grigg
- Central Clinical School, Camperdown
- Save Sight Institute
| | - Nurliza Khaliddin
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
| | - Azida Juana Kadir
- Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
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38
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Hoang LN, McCluskey PJ, Grigg JR, Lee AJ. Spectrum of new patients presenting to a tertiary glaucoma unit in Vietnam. Clin Exp Ophthalmol 2018; 47:548-550. [PMID: 30350449 DOI: 10.1111/ceo.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Lam N Hoang
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, Australia.,Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
| | - Peter J McCluskey
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, Australia.,Sydney Eye Hospital, Sydney, Australia
| | - John R Grigg
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, Australia.,Sydney Eye Hospital, Sydney, Australia
| | - Anne J Lee
- Save Sight Institute & Discipline of Clinical Ophthalmology, University of Sydney, Sydney, Australia.,Sydney Eye Hospital, Sydney, Australia
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39
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Broadhead GK, Grigg JR, McCluskey P, Hong T, Schlub TE, Chang AA. Saffron therapy for the treatment of mild/moderate age-related macular degeneration: a randomised clinical trial. Graefes Arch Clin Exp Ophthalmol 2018; 257:31-40. [PMID: 30343354 DOI: 10.1007/s00417-018-4163-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of oral saffron, a natural antioxidant, in treating mild/moderate age-related macular degeneration (AMD). METHODS Randomised, double-blinded, placebo-controlled crossover trial of 100 adults (> 50 years) with mild/moderate AMD and vision > 20/70 Snellen equivalent in at least one eye. Exclusion criteria included confounding visual lesions, or significant gastrointestinal disease impairing absorption. Participants were given oral saffron supplementation (20 mg/day) for 3 months or placebo for 3 months, followed by crossover for 3 months. Participants already consuming Age-Related Eye Diseases Study (AREDS) supplements or equivalent maintained these. Primary outcomes included changes in best-corrected visual acuity (BCVA) and changes in multifocal electroretinogram (mfERG) response density and latency. Secondary outcomes included safety outcomes and changes in mfERG and BCVA amongst participants on AREDS supplements. RESULTS Mean BCVA improved 0.69 letters (p = 0.001) and mean-pooled mfERG latency reduced 0.17 ms (p = 0.04) on saffron compared to placebo. Amongst participants on AREDS supplements, mean BCVA improved 0.73 letters p = 0.006) and mean-pooled mfERG response density improved 2.8% (p = 0.038). There was no significant difference in adverse event occurrence (p > 0.10). CONCLUSION Saffron supplementation modestly improved visual function in participants with AMD, including those using AREDS supplements. Given the chronic nature of AMD, longer-term supplementation may produce greater benefits.
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Affiliation(s)
- Geoffrey K Broadhead
- Save Sight Institute, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia.,Sydney Institute of Vision Science, Sydney, Australia.,Sydney Retina Clinic & Day Surgery, Sydney, Australia
| | - John R Grigg
- Save Sight Institute, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia
| | - Thomas Hong
- Sydney Institute of Vision Science, Sydney, Australia.,Sydney Retina Clinic & Day Surgery, Sydney, Australia
| | - Timothy E Schlub
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Andrew A Chang
- Save Sight Institute, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia. .,Sydney Institute of Vision Science, Sydney, Australia. .,Sydney Retina Clinic & Day Surgery, Sydney, Australia.
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40
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Kelman JC, Kamien BA, Murray NC, Goel H, Fraser CL, Grigg JR. A sibling study of isolated optic neuropathy associated with novel variants in the ACO2 gene. Ophthalmic Genet 2018; 39:648-651. [PMID: 30118607 DOI: 10.1080/13816810.2018.1509353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Inherited optic neuropathy is a rare cause of debilitating vision loss. It may occur in constellation with other syndromic features of neurological impairment, or present as an isolated finding. We describe a sibling pair, without a family history of vision loss, who developed visual impairment in early childhood consistent with optic neuropathy. Genetic testing identified novel compound heterozygous variants in the aconitase 2 (ACO2) gene. To date, seven families hosting ACO2 variants have been described in the literature. We describe the second family with ACO2 variants to have an isolated optic neuropathy highlighting the importance of including this gene in genomic panels assessing inherited optic neuropathies.
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Affiliation(s)
| | | | - Natalia C Murray
- b Hunter Genetics , Waratah , NSW , Australia.,c The University of Newcastle, University Dr , Callaghan , NSW , Australia
| | - Himanshu Goel
- b Hunter Genetics , Waratah , NSW , Australia.,c The University of Newcastle, University Dr , Callaghan , NSW , Australia
| | | | - John R Grigg
- a Save Sight Institute , Sydney , NSW , Australia
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41
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Lim LAS, Fernandez-Sanz G, Levasseur S, Grigg JR, Hunyor AP. Idiopathic full thickness macular hole in a 10-year-old girl. Int J Retina Vitreous 2018; 4:25. [PMID: 30002912 PMCID: PMC6040079 DOI: 10.1186/s40942-018-0128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Macular holes in children are generally associated with trauma. CASE PRESENTATION We report the first case of an idiopathic full thickness macular hole in a 10-year-old girl. 23-gauge transconjunctival pars plana vitrectomy, induction of a posterior vitreous detachment, ILM blue-assisted internal limiting membrane peel, fluid-air exchange and air-26% sulfur hexafluoride (SF6) exchange was performed with subsequent macular hole closure. CONCLUSION This is the first reported case of an idiopathic full thickness macular hole in a child. Treatment with pars plana vitrectomy with peeling of the ILM resulted in significant anatomic and functional improvement.
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Affiliation(s)
- Li-Anne S. Lim
- Sydney Hospital and Sydney Eye Hospital, Macquarie Street, Sydney, NSW Australia
- Discipline of Ophthalmology, Sydney Eye Hospital Campus, University of Sydney, Macquarie Street, Sydney, NSW Australia
| | | | - Steven Levasseur
- Sydney Hospital and Sydney Eye Hospital, Macquarie Street, Sydney, NSW Australia
| | - John R. Grigg
- Sydney Hospital and Sydney Eye Hospital, Macquarie Street, Sydney, NSW Australia
- Discipline of Ophthalmology, Sydney Eye Hospital Campus, University of Sydney, Macquarie Street, Sydney, NSW Australia
| | - Alex P. Hunyor
- Sydney Hospital and Sydney Eye Hospital, Macquarie Street, Sydney, NSW Australia
- Discipline of Ophthalmology, Sydney Eye Hospital Campus, University of Sydney, Macquarie Street, Sydney, NSW Australia
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42
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Jayanetti V, Klistorner AI, Graham SL, Dexter M, Flaherty MP, Jones K, Billson FA, Wilson M, North K, Grigg JR, Fraser CL. Monitoring of optic nerve function in Neurofibromatosis 2 children with optic nerve sheath meningiomas using multifocal visual evoked potentials. J Clin Neurosci 2018; 50:262-267. [PMID: 29398196 DOI: 10.1016/j.jocn.2018.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
Monitoring optic nerve sheath meningiomas (ONSM) in Neurofibromatosis type 2 (NF2) patients remains difficult. Other ocular manifestations of NF2 may obscure ophthalmic assessment of optic nerve function in these patients. Serial magnetic resonance imaging (MRI) used to assess the optic nerve is not without limitations, being expensive and often requiring general anaesthetic in children, with associated risks. This study was undertaken to describe the use of multifocal visual evoked potentials (multifocal VEP, mfVEP) in the regular monitoring of NF2 patients with ONSM. This study involved three NF2 patients with ONSM who undertook mfVEP testing at an academic ophthalmic centre. Same day mfVEP and routine ophthalmic testing were undertaken. Topographical function of the optic nerve was assessed, utilising tools such as asymmetry deviation and accumap severity index. Results were assessed alongside MRI and visual acuity (VA). From the three patients, five eyes had ONSMs, of which two caused unilateral blindness. The remaining three affected eyes had initial VAs 6/6, 6/24, and 6/18. Over follow up, ranging from 5 to 12 years, all tumours progressed, and VA declined for all patients. Multifocal VEP detected optic nerve functional loss corresponding with visual decline. This case series suggests mfVEP is effective in the objective topographic monitoring of optic nerve function in NF2 patients with ONSM. Due also to its safety in a paediatric population, the test may be considered in the routine monitoring of these patients, to be used to assist regular ophthalmic review and MRI scans.
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Affiliation(s)
- V Jayanetti
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia.
| | - A I Klistorner
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia
| | - S L Graham
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia; Macquarie University, Australia
| | - M Dexter
- The Department of Neurosurgery, The Children's Hospital Westmead, Australia
| | - M P Flaherty
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia; The Department of Ophthalmology, The Children's Hospital Westmead, Australia
| | - K Jones
- The Department of Clinical Genetics, The Children's Hospital Westmead, Australia
| | - F A Billson
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia
| | - M Wilson
- The Department of Clinical Genetics, The Children's Hospital Westmead, Australia
| | - K North
- Murdoch Institute, Australia
| | - J R Grigg
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia; The Department of Ophthalmology, The Children's Hospital Westmead, Australia
| | - C L Fraser
- Save Sight Institute Discipline of Ophthalmology, The University of Sydney, Australia
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43
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Nash BM, Symes R, Goel H, Dinger ME, Bennetts B, Grigg JR, Jamieson RV. NMNAT1 variants cause cone and cone-rod dystrophy. Eur J Hum Genet 2017; 26:428-433. [PMID: 29184169 DOI: 10.1038/s41431-017-0029-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/13/2017] [Accepted: 10/10/2017] [Indexed: 11/09/2022] Open
Abstract
Cone and cone-rod dystrophies (CD and CRD, respectively) are degenerative retinal diseases that predominantly affect the cone photoreceptors. The underlying disease gene is not known in approximately 75% of autosomal recessive cases. Variants in NMNAT1 cause a severe, early-onset retinal dystrophy called Leber congenital amaurosis (LCA). We report two patients where clinical phenotyping indicated diagnoses of CD and CRD, respectively. NMNAT1 variants were identified, with Case 1 showing an extremely rare homozygous variant c.[271G > A] p.(Glu91Lys) and Case 2 compound heterozygous variants c.[53 A > G];[769G > A] p.(Asn18Ser);(Glu257Lys). The detailed variant analysis, in combination with the observation of an associated macular atrophy phenotype, indicated that these variants were disease-causing. This report demonstrates that the variants in NMNAT1 may cause CD or CRD associated with macular atrophy. Genetic investigations of the patients with CD or CRD should include NMNAT1 in the genes examined.
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Affiliation(s)
- Benjamin M Nash
- Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Disciplines of Genetic Medicine, and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Richard Symes
- Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | | | - Marcel E Dinger
- Kinghorn Centre for Clinical Genomics, Garvan Institute for Medical Research, Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Bruce Bennetts
- Sydney Genome Diagnostics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - John R Grigg
- Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia.,Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Eye Genetics Research, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, NSW, Australia. .,Disciplines of Genetic Medicine, and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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44
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Ma AS, Grigg JR, Prokudin I, Flaherty M, Bennetts B, Jamieson RV. New mutations in GJA8 expand the phenotype to include total sclerocornea. Clin Genet 2017; 93:155-159. [PMID: 28455998 DOI: 10.1111/cge.13045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 01/05/2023]
Abstract
This project expands the disease spectrum for mutations in GJA8 to include total sclerocornea, rudimentary lenses and microphthalmia, in addition to this gene's previously known role in isolated congenital cataracts. Ophthalmic findings revealed bilateral total sclerocornea in 3 probands, with small abnormal lenses in 2 of the cases, and cataracts and microphthalmia in 1 case. Next-generation sequencing revealed de novo heterozygous mutations affecting the same codon of GJA8 : (c.281G>A; p.(Gly94Glu) and c.280G>C; p.(Gly94Arg)) in 2 of the probands, in addition to the c.151G>A; p.(Asp51Asn) mutation we had previously identified in the third case. In silico analysis predicted all of the mutations to be pathogenic. These cases show that deleterious, heterozygous mutations in GJA8 can lead to a severe ocular phenotype of total sclerocornea, abnormal lenses, and/or cataracts with or without microphthalmia, broadening the phenotype associated with this gene. GJA8 should be included when investigating patients with the severe anterior segment abnormality of total sclerocornea.
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Affiliation(s)
- A S Ma
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, Australia.,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Disciplines of Genetic Medicine & Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - J R Grigg
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, Australia.,Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - I Prokudin
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, Australia
| | - M Flaherty
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, Australia.,Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - B Bennetts
- Disciplines of Genetic Medicine & Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Molecular Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia
| | - R V Jamieson
- Eye Genetics Research Unit, The Children's Hospital at Westmead, Save Sight Institute, Children's Medical Research Institute, University of Sydney, Sydney, Australia.,Department of Clinical Genetics, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Disciplines of Genetic Medicine & Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
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45
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Broadhead GK, Hong T, McCluskey P, Grigg JR, Schlub TE, Chang AA. Choroidal Thickness and Microperimetry Sensitivity in Age-Related Macular Degeneration. Ophthalmic Res 2017; 58:27-34. [DOI: 10.1159/000464447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022]
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46
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Zheng L, Do HHJ, Sandercoe T, Jamieson RV, Grigg JR. Changing patterns in paediatric optic atrophy aetiology: 1979 to 2015. Clin Exp Ophthalmol 2016; 44:574-581. [DOI: 10.1111/ceo.12734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Linda Zheng
- Department of Ophthalmology; The Children's Hospital at Westmead; Westmead Australia
| | - Helen Hyun-Jin Do
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - Trent Sandercoe
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - Robyn V Jamieson
- Eye Genetics Research Group; Children's Medical Research Institute, The Children's Hospital at Westmead; Westmead Australia
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
| | - John R Grigg
- Department of Ophthalmology; The Children's Hospital at Westmead; Westmead Australia
- Eye Genetics Research Group; Children's Medical Research Institute, The Children's Hospital at Westmead; Westmead Australia
- Discipline of Ophthalmology, Save Sight Institute; University of Sydney; Sydney New South Wales Australia
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47
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Ma AS, Grigg JR, Ho G, Prokudin I, Farnsworth E, Holman K, Cheng A, Billson FA, Martin F, Fraser C, Mowat D, Smith J, Christodoulou J, Flaherty M, Bennetts B, Jamieson RV. Sporadic and Familial Congenital Cataracts: Mutational Spectrum and New Diagnoses Using Next-Generation Sequencing. Hum Mutat 2016; 37:371-84. [PMID: 26694549 PMCID: PMC4787201 DOI: 10.1002/humu.22948] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
Congenital cataracts are a significant cause of lifelong visual loss. They may be isolated or associated with microcornea, microphthalmia, anterior segment dysgenesis (ASD) and glaucoma, and there can be syndromic associations. Genetic diagnosis is challenging due to marked genetic heterogeneity. In this study, next-generation sequencing (NGS) of 32 cataract-associated genes was undertaken in 46 apparently nonsyndromic congenital cataract probands, around half sporadic and half familial cases. We identified pathogenic variants in 70% of cases, and over 68% of these were novel. In almost two-thirds (20/33) of these cases, this resulted in new information about the diagnosis and/or inheritance pattern. This included identification of: new syndromic diagnoses due to NHS or BCOR mutations; complex ocular phenotypes due to PAX6 mutations; de novo autosomal-dominant or X-linked mutations in sporadic cases; and mutations in two separate cataract genes in one family. Variants were found in the crystallin and gap junction genes, including the first report of severe microphthalmia and sclerocornea associated with a novel GJA8 mutation. Mutations were also found in rarely reported genes including MAF, VIM, MIP, and BFSP1. Targeted NGS in presumed nonsyndromic congenital cataract patients provided significant diagnostic information in both familial and sporadic cases.
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Affiliation(s)
- Alan S. Ma
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - John R. Grigg
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Gladys Ho
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Ivan Prokudin
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Elizabeth Farnsworth
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Katherine Holman
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Anson Cheng
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Frank A. Billson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Frank Martin
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Clare Fraser
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - David Mowat
- Department of Medical GeneticsSydney Children's HospitalSydneyNew South WalesAustralia
| | - James Smith
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - John Christodoulou
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Maree Flaherty
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of OphthalmologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of OphthalmologySydney Medical SchoolUniversity of SydneyNew South WalesAustralia
| | - Bruce Bennetts
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
- Department of Molecular GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Robyn V. Jamieson
- Eye Genetics ResearchThe Children's Hospital at WestmeadSave Sight InstituteChildren's Medical Research InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Clinical GeneticsThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Western Sydney Genetics ProgramThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Paediatrics and Child Healthand Discipline of Genetic MedicineSydney Medical SchoolUniversity of SydneyNew South WalesAustralia
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Greenlees R, Mihelec M, Yousoof S, Speidel D, Wu SK, Rinkwitz S, Prokudin I, Perveen R, Cheng A, Ma A, Nash B, Gillespie R, Loebel DA, Clayton-Smith J, Lloyd IC, Grigg JR, Tam PP, Yap AS, Becker TS, Black GC, Semina E, Jamieson RV. Mutations inSIPA1L3cause eye defects through disruption of cell polarity and cytoskeleton organization. Hum Mol Genet 2015; 24:5789-804. [DOI: 10.1093/hmg/ddv298] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/21/2015] [Indexed: 01/27/2023] Open
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Broadhead GK, Grigg JR, Chang AA, McCluskey P. Dietary modification and supplementation for the treatment of age-related macular degeneration. Nutr Rev 2015; 73:448-62. [PMID: 26081455 DOI: 10.1093/nutrit/nuv005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Age-related macular degeneration (AMD) causes a significant proportion of visual loss in the developed world. Currently, little is known about its pathogenesis, and treatment options are limited. Dietary intake is one of the few modifiable risk factors for this condition. The best-validated therapies remain oral antioxidant supplements based on those investigated in the Age-Related Eye Disease Study (AREDS) and the recently completed Age-Related Eye Disease Study 2 (AREDS2). In this review, current dietary guidelines related to AMD, along with the underlying evidence to support them, are presented in conjunction with current treatment recommendations. Both AREDS and AREDS2 are discussed, as are avenues for further research, including supplementation with vitamin D and saffron. Despite the considerable disease burden of atrophic AMD, few effective therapies are available to treat it, and further research is required.
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Affiliation(s)
- Geoffrey K Broadhead
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia.
| | - John R Grigg
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Andrew A Chang
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
| | - Peter McCluskey
- G.K. Broadhead, J. Grigg, A.A Chang, and P. McCluskey are with the Save Sight Institute, Department of Ophthalmology, The University of Sydney, Sydney, New South Wales, 2000, Australia. G.K. Broadhead and A.A Chang are with the Sydney Institute of Vision Science, Sydney, New South Wales, 2000, Australia
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Zagora SL, Funnell CL, Martin FJ, Smith JEH, Hing S, Billson FA, Veillard AS, Jamieson RV, Grigg JR. Primary congenital glaucoma outcomes: lessons from 23 years of follow-up. Am J Ophthalmol 2015; 159:788-96. [PMID: 25634533 DOI: 10.1016/j.ajo.2015.01.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine in primary congenital glaucoma whether age of presentation influences surgical success, the degrees of angle surgery needed to achieve glaucoma control, and whether there are critical ages where glaucoma progresses, requiring further surgical management. DESIGN Retrospective cohort study. METHODS The medical records of patients with primary congenital glaucoma over a 23-year period were reviewed: 192 procedures were performed on 117 eyes (70 patients). The number and age of angle procedures and final visual acuity was analyzed. Surgical success was defined as stable intraocular pressure and optic disc appearance. RESULTS Procedures involving 83 of the 110 eyes (75.5%) undergoing angle surgery were successful, with 2-, 4-, 6-, and 10-year success rates of 92%, 86%, 84%, and 75%, respectively. Subgroup analysis (<3 months; 3-6 months; >6 months) comparing age of diagnosis to visual outcome (<20/200, 20/200-20/40, >20/40) was significant (P = .04). The age at first operation (P = .94), the number of angle operations (P = .43), and their effect on angle surgery success was not significant. Seven of 192 operations were performed after the age of 8 years (3.6%). After the initial angle surgeries within the first year of life, the third procedure occurred at a median age of 2.4 years (interquartile ratio [IQR] 0.6-3.8 years) and the fourth procedure occurred at a median age of 5.3 years (IQR 2.5-6.1 years). CONCLUSIONS Children diagnosed at <3 months of age had a visual outcome of <20/200 despite successful glaucoma control. Age of presentation did not affect surgical success. A total of 78.9% of cases undergoing primary trabeculotomy were controlled with 1 operation: 4 clock hours of angle (120 degrees). Analysis of glaucoma progression suggests critical ages where further glaucoma surgery is required at around 2 and 5 years of age.
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Affiliation(s)
- Sophia L Zagora
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia.
| | - Charlotte L Funnell
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia; Epsom and St Helier University Hospitals, National Hospital Service Trust, London, United Kingdom
| | - Frank J Martin
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - James E H Smith
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Stephen Hing
- Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Francis A Billson
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anne-Sophie Veillard
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Robyn V Jamieson
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia; Eye and Developmental Genetics Research Group, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia; Children's Medical Research Institute, Westmead, Sydney, NSW, Australia
| | - John R Grigg
- Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; Eye and Developmental Genetics Research Group, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Ophthalmology, The Children's Hospital at Westmead, Sydney, NSW, Australia
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