Adaptive Optics Scanning Laser Ophthalmoscopy Images in a Family with the Mitochondrial DNA T8993C Mutation

Department of Ophthalmology, University of California, San Francisco, California 94143-0730, USA.
Investigative ophthalmology & visual science (Impact Factor: 3.4). 12/2008; 50(4):1838-47. DOI: 10.1167/iovs.08-2029
Source: PubMed


This study was designed to assess the effect of mitochondrial DNA (mtDNA) mutation T8993C on cone structure in a family expressing neurogenic muscle weakness, ataxia, and retinitis pigmentosa (NARP) syndrome.
Five family members were studied, using clinical examination, nerve conduction studies, perimetry, optical coherence tomography (OCT) measures of central retinal thickness, and electroretinography. High-resolution images of cone structure using adaptive optics scanning laser ophthalmoscopy (AOSLO) were obtained in four subjects with stable fixation. Cone spacing was compared to 18 age-similar normal subjects and converted to z-scores at each location where unambiguous cones were identified. Tissue levels of T8993C mutant heteroplasmy in blood and hair follicles were quantified using real-time allele-refractory mutations system (ARMS) quantitative polymerase chain reaction (qPCR).
Subjects expressing the T8993C mutation showed varying levels of disease severity. The subject with the lowest mutant load (42%-54%) showed no neurologic or retinal abnormalities. The remaining four subjects with over 77% mutant load all expressed severe neurologic and/or retinal abnormalities. AOSLO images revealed three patterns of cone spacing: pattern 1, normal; pattern 2, increased cone spacing within a contiguous cone mosaic; and pattern 3, patchy cone loss with increased cone spacing. Visual function was most severely affected in pattern 3.
High levels of T8993C mutant load were associated with severe neurologic or visual dysfunction, while lower levels caused no detectable abnormalities. Visual function was better in patients with a contiguous and regular cone mosaic. Patients expressing high levels of the mtDNA T8993C mutation show abnormal cone structure, suggesting normal mitochondrial DNA is necessary for normal waveguiding by cones.

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    • "That said, it is difficult to reconcile what (if not cones) these structures could be. Correlating microperimetry with highresolution images certainly appears to be the way forward in interpreting difficult images like these (Yoon et al. 2009). "
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    ABSTRACT: Recent years have seen an explosion in the development of novel ophthalmic imaging devices, delivering noninvasive views of the living retina. Adaptive optics (AO) imaging systems enable resolution of individual cells in the living retina. Analysis of these images has been limited to measures of cone density and regularity. Here, we introduce a small case series where the information in the high-resolution image extends beyond these standard metrics. These images should serve as the basis for evolving discussion as to how best to interpret AO retinal images.
    Advances in Experimental Medicine and Biology 01/2012; 723:451-8. DOI:10.1007/978-1-4614-0631-0_57 · 1.96 Impact Factor
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    • "These results argue against a fundamental barrier to imaging rods in vivo, provided the optical system [37] and image registration software [38] are sufficiently optimized. These findings open the door for examining rod involvement in retinal disease using AO imaging, as has been done for eye conditions involving the cone photoreceptors [18–21,23,26,27]. "
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    ABSTRACT: The rod photoreceptors are implicated in a number of devastating retinal diseases. However, routine imaging of these cells has remained elusive, even with the advent of adaptive optics imaging. Here, we present the first in vivo images of the contiguous rod photoreceptor mosaic in nine healthy human subjects. The images were collected with three different confocal adaptive optics scanning ophthalmoscopes at two different institutions, using 680 and 775 nm superluminescent diodes for illumination. Estimates of photoreceptor density and rod:cone ratios in the 5°-15° retinal eccentricity range are consistent with histological findings, confirming our ability to resolve the rod mosaic by averaging multiple registered images, without the need for additional image processing. In one subject, we were able to identify the emergence of the first rods at approximately 190 μm from the foveal center, in agreement with previous histological studies. The rod and cone photoreceptor mosaics appear in focus at different retinal depths, with the rod mosaic best focus (i.e., brightest and sharpest) being at least 10 μm shallower than the cones at retinal eccentricities larger than 8°. This study represents an important step in bringing high-resolution imaging to bear on the study of rod disorders.
    Biomedical Optics Express 07/2011; 2(7):1864-76. DOI:10.1364/BOE.2.001864 · 3.65 Impact Factor
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    • "All subjects underwent a comprehensive ophthalmological evaluation, including slit lamp and dilated fundus examination, best-corrected visual acuity using a standard eye chart, visual field testing, color vision testing, high-resolution spectral domain optical coherence tomography (SD-OCT, Spectralis® HRA + OCT system, Spectralis® 3.1 software; Heidelberg Engineering, Vista, CA) and full-field electroretinography (ERG), as reported previously [17]. Those with stable fixation also underwent multifocal ERG (mfERG, VERIS 5.1.10X; "
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    ABSTRACT: Point mutations at m.8993T>C and m.8993T>G of the mtDNA ATPase 6 gene cause the neurogenic weakness, ataxia and retinitis pigmentosa (NARP) syndrome, a mitochondrial disorder characterized by retinal, central and peripheral neurodegeneration. We performed detailed neurological, neuropsychological and ophthalmological phenotyping of a mother and four daughters with NARP syndrome from the mtDNA m.8993T>C ATPase 6 mutation, including 3-T brain MRI, spectral domain optical coherence tomography (SD-OCT), adaptive optics scanning laser ophthalmoscopy (AOSLO), electromyography and nerve conduction studies (EMG-NCS) and formal neuropsychological testing. The degree of mutant heteroplasmy for the m.8993T>C mutation was evaluated by real-time allele refractory mutation system quantitative PCR of mtDNA from hair bulbs (ectoderm) and blood leukocytes (mesoderm). There were marked phenotypic differences between family members, even between individuals with the greatest degrees of ectodermal and mesodermal heteroplasmy. 3-T MRI revealed cerebellar atrophy and cystic and cavitary T2 hyperintensities in the basal ganglia. SD-OCT demonstrated similarly heterogeneous areas of neuronal and axonal loss in inner and outer retinal layers. AOSLO showed increased cone spacing due to photoreceptor loss. EMG-NCS revealed varying degrees of length-dependent sensorimotor axonal polyneuropathy. On formal neuropsychological testing, there were varying deficits in processing speed, visual–spatial functioning and verbal fluency and high rates of severe depression. Many of these cognitive deficits likely localize to cerebellar and/or basal ganglia dysfunction. High-resolution retinal and brain imaging in NARP syndrome revealed analogous patterns of tissue injury characterized by heterogeneous areas of neuronal loss. Electronic supplementary material The online version of this article (doi:10.1007/s00415-010-5775-1) contains supplementary material, which is available to authorized users.
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