A T Moore

Moorfields Eye Hospital NHS Foundation Trust, Londinium, England, United Kingdom

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Publications (103)452.72 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: AimsTo report the clinical phenotype in a series of four children from three families with the rare association of high myopia, central macular atrophy, and normal full-field electroretinography (ERG).Methods Four male patients were ascertained with reduced vision, nystagmus, and atrophy of the macula from early childhood. Patients underwent full ophthalmic examination, electrophysiological testing, and retinal imaging.ResultsMinimum duration of follow-up was 8 years. At last review, visual acuity ranged from 0.22 to 1.20 logMAR (6/9.5-6/95 Snellen) at a mean age of 10.5 years (median 9.5 years, range 9-14 years). Refractive error ranged from a spherical equivalent of -7.40 D to -24.00 D. Three had convergent squint. Fundus examination and imaging demonstrated bilateral macular atrophy in all patients that varied from mild atrophy of the retinal pigment epithelium (RPE) to well-demarcated, punched-out atrophic lesions of retina, RPE, and choroid. Flash ERG was normal under photopic and scotopic conditions in all patients. Pattern ERG, performed in three patients, was consistent with mild to severe macular dysfunction. Progression of the area of atrophy was evident in one patient and of the myopia in two patients but all patients had stable visual acuity.Conclusions Patients with congenital high myopia and macular atrophy present in infancy with reduced visual acuity and nystagmus. The macular atrophic lesions vary in size and severity but electrophysiological testing is consistent with dysfunction confined to the macula. There was no deterioration in visual acuity over 8-10 years of monitoring.Eye advance online publication, 22 May 2015; doi:10.1038/eye.2015.53.
    Eye (London, England) 05/2015; DOI:10.1038/eye.2015.53 · 1.90 Impact Factor
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    ABSTRACT: PurposeThe purpose of this study is to describe the phenotype of a family with de novo mutation in the GUCY2D.Materials and methodsFive subjects, including two monozygotic twins, underwent ophthalmic clinical examination while some had autofluorescence imaging (AF) and optical coherence tomography (OCT). Symptomatic individuals underwent electrophysiological testing. The youngest subject (21 years) was also evaluated psychophysically. DNA obtained from the individuals was screened for mutations in GUCY2D. Microsatellite markers were used to determine the haplotype of 17p surrounding the GUCY2D gene.ResultsThe youngest subject had 6/18 visual acuity, an annulus of hyper-autofluorescence in the perifoveal region, and a subfoveal absence of outer segments on OCT. In the older individuals, severe thinning of inner retina and a patchy loss of photoreceptors and retinal pigment epithelium were observed in the perifoveal region. All three showed generalised cone system dysfunction with preserved rod function on electrophysiology. Psychophysical evaluation was consistent with poor cone function. Screening of the GUCY2D gene revealed the mutation p.R838H in all the affected individuals and was absent in the asymptomatic patients. Haplotyping showed that the mutation originated from the unaffected mother.Conclusions Autosomal dominant cone dystrophy due to GUCY2D can occur without a history in the antecedents due to a de novo mutation. This is important to consider in any simplex case with a similar phenotype. The phenotype description of this disorder is expanded with detailed description of the OCT findings. This paper describes the concordance of the phenotypic findings in the monozygotic twins.Eye advance online publication, 31 January 2014; doi:10.1038/eye.2014.7.
    Eye (London, England) 01/2014; DOI:10.1038/eye.2014.7 · 1.90 Impact Factor
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    ABSTRACT: Abstract To investigate the prevalence of sequence variants in LCA5 in patients with Leber congenital amaurosis (LCA), early onset rod-cone dystrophy (EORD) and autosomal recessive retinitis pigmentosa (RP), to delineate the ocular phenotypes, and to provide an overview of all published LCA5 variants in an online database. Patients underwent standard ophthalmic evaluations after providing informed consent. In selected patients, optical coherence tomography (OCT) and fundus autofluorescence imaging was possible. DNA samples from 797 unrelated patients with LCA and 211 with the various types of RP were screened by Sanger sequence analysis of all LCA5 exons and intron/exon junctions. Some LCA patients were pre-screened by APEX technology or selected based on homozygosity mapping. In silico analyses were performed to assess the pathogenicity of the variants. Segregation analysis was performed where possible. Published and novel LCA5 variants were collected, amended for their correct nomenclature, and listed in a Leiden Open Variation Database (LOVD). Sequence analysis identified 18 new probands with 19 different LCA5 variants. Seventeen of the 19 LCA5 variants were novel. Except for two missense variants and one splice site variant, all variants were protein-truncating mutations. Most patients expressed a severe phenotype, typical of LCA. However, some LCA subjects had better vision and intact inner segment/outer segment (IS/OS) junctions on OCT imaging. In two families with LCA5 variants, the phenotype was more compatible with EORD with affected individuals displaying preserved islands of RPE. One of these milder families harbored a homozygous splice site mutation, a second family was found to have a combination of a stop mutation and a missense mutation. This is the largest LCA5 study to date. We sequenced 1008 patients (797 with LCA, 211 with arRP) and identified 18 probands with LCA5 mutations. Mutations in LCA5 are a rare cause of childhood retinal dystrophy accounting for ∼2% of disease in this cohort and the majority of LCA5 mutations are likely null. The LCA5 protein truncating mutations are predominantly associated with LCA. However, in two families with the milder EORD, the LCA5 gene analysis revealed a homozygous splice site mutation in one and a stop mutation in combination with a missense mutation in a second family, suggesting that this milder phenotype is due to residual function of lebercilin and expanding the currently known phenotypic spectrum to include the milder early onset RP. Some patients have remaining foveal cone structures (intact IS/OS junctions on OCT imaging) and remaining visual acuities, which may bode well for upcoming treatment trials.
    Human Mutation 01/2013; · 5.05 Impact Factor
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    ABSTRACT: X-linked megalocornea (MGC1) is an ocular anterior segment disorder characterized by an increased cornea diameter and deep anterior chamber evident at birth and later onset of mosaic corneal degeneration (shagreen), arcus juvenilis, and presenile cataracts. We identified copy-number variation, frameshift, missense, splice-site and nonsense mutations in the Chordin-like 1 gene (CHRDL1) on Xq23 as the cause of the condition in seven MGC1 families. CHRDL1 encodes ventroptin, a bone morphogenic protein antagonist with a proposed role in specification of topographic retinotectal projections. Electrophysiological evaluation revealed mild generalized cone system dysfunction and, in one patient, an interhemispheric asymmetry in visual evoked potentials. We show that CHRDL1 is expressed in the developing human cornea and anterior segment in addition to the retina. We explored the impact of loss of ventroptin function on brain function and morphology in vivo. CHRDL1 is differentially expressed in the human fetal brain, and there is high expression in cerebellum and neocortex. We show that MGC1 patients have a superior cognitive ability despite a striking focal loss of myelination of white matter. Our findings reveal an unexpected requirement for ventroptin during anterior segment development and the consequences of a lack of function in the retina and brain.
    The American Journal of Human Genetics 02/2012; 90(2):247-59. DOI:10.1016/j.ajhg.2011.12.019 · 10.99 Impact Factor
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    Eye (London, England) 01/2012; 26(5):753-5. DOI:10.1038/eye.2011.344 · 1.90 Impact Factor
  • International Journal of Epidemiology 01/2012; · 9.20 Impact Factor
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    Eye (London, England) 04/2011; 25(8):1098-101. DOI:10.1038/eye.2011.88 · 1.90 Impact Factor
  • Journal of Vision 12/2010; 10(15):59-59. DOI:10.1167/10.15.59 · 2.73 Impact Factor
  • Journal of Vision 06/2010; 6(6):120-120. DOI:10.1167/6.6.120 · 2.73 Impact Factor
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    Eye (London, England) 10/2009; 23(9):1876-8. DOI:10.1038/eye.2008.358 · 1.90 Impact Factor
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    ABSTRACT: Autosomal dominant vitreoretinochoroidopathy (ADVIRC), a retinal dystrophy often associated with glaucoma and cataract, forms part of a phenotypic spectrum of 'bestrophinopathies'. It has been shown previously that ADVIRC results from BEST1 mutations that cause exon skipping and lead to the production of shortened and internally deleted isoforms. This study describes a novel ADVIRC mutation and show that it disrupts an exonic splice enhancer (ESE) site, altering the binding of a splicing-associated SR protein. As with previous ADVIRC mutations, the novel c.704T-->C mutation in exon 6 altered normal splicing in an ex vivo splicing assay. Both this and another exon 6 ADVIRC-causing mutation (c.707G-->A) either weakened or abolished splicing in an ESE-dependent splice assay compared with a nearby exon 6 mutation associated with Best disease (c.703G-->C). Gel shift assays were undertaken with RNA oligonucleotides encompassing the ADVIRC and Best disease mutations with four of the most commonly investigated SR proteins. Although SC35, SRp40 and SRp55 proteins all bound to the wild-type and mutated sequences with similar intensities, there was increased binding of ASF/SF2 to the two ADVIRC-mutated sequences compared with the wild-type or Best disease-mutated sequences. The exon skipping seen for these two exon 6 ADVIRC mutations and their affinity for ASF/SF2 suggests that the region encompassing these mutations may form part of a CERES (composite exonic regulatory elements of splicing) site.
    Journal of Medical Genetics 07/2008; 46(9):620-5. DOI:10.1136/jmg.2008.059881 · 5.64 Impact Factor
  • S Sivaprasad, A T Moore
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    ABSTRACT: Choroidal neovascularisation (CNV) is a rare but important cause of visual impairment in children. There have been considerable recent advances in our understanding of both the pathogenesis and the management of this sight-threatening complication. New treatment modalities for these neovascular lesions make early recognition very important for timely management and preservation of vision. This review highlights the causes and current management options available for this condition in children.
    The British journal of ophthalmology 05/2008; 92(4):451-4. DOI:10.1136/bjo.2007.124586 · 2.81 Impact Factor
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    ABSTRACT: To screen for mutations of connexin50 (Cx50)/GJA8 in a panel of patients with inherited cataract and to determine the cellular and functional consequences of the identified mutation. All patients in the study underwent a full clinical examination and leucocyte DNA was extracted from venous blood. The GJA8 gene was sequenced directly. Connexin function and cellular trafficking were examined by expression in Xenopus oocytes and HeLa cells. Screening of the GJA8 gene identified a 139 G to A transition that resulted in the replacement of aspartic acid by asparagine (D47N) in the coding region of Cx50. This change co-segregated with cataract among affected members of a family with autosomal dominant nuclear pulverulent cataracts. While pairs of Xenopus oocytes injected with wild type Cx50 RNA formed functional gap junction channels, pairs of oocytes injected with Cx50D47N showed no detectable intercellular conductance. Co-expression of Cx50D47N did not inhibit gap junctional conductance of wild type Cx50. In transiently transfected HeLa cells, wild type Cx50 localised to appositional membranes and within the perinuclear region, but Cx50D47N showed no immunostaining at appositional membranes with immunoreactivity confined to the cytoplasm. Incubation of HeLa cells transfected with Cx50D47N at 27 degrees C resulted in formation of gap junctional plaques. The pulverulent cataracts present in members of this family are associated with a novel GJA8 mutation, Cx50D47N, that acts as a loss-of-function mutation. The consequent decrease in lens intercellular communication and changes associated with intracellular retention of the mutant connexin may contribute to cataract formation.
    Journal of Medical Genetics 04/2008; 45(3):155-60. DOI:10.1136/jmg.2007.051029 · 5.64 Impact Factor
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    ABSTRACT: The aim of this study was to establish the functional significance of annular macular abnormalities present on fundus autofluorescence imaging (AF) in patients with cone or cone-rod dystrophy. Fundus AF was performed on ten subjects (age range 18-82 years) with cone or cone-rod dystrophy consequent upon RPGR or RIMS1 mutation. International-standard full-field and pattern electroretinograms (ERGs) were performed in all cases. Photopic and scotopic fine matrix mapping (FMM) and multifocal ERG were performed on selected cases. Subjects had annuli of high density AF that bordered central areas of low density in older RPGR cases and most RIMS1 cases. The size of the AF ring correlated with age and enlarged with time in two subjects. High-density rings were associated with a gradient of scotopic and photopic sensitivity loss. Pattern electroretinogram (PERG) P50 amplitude, when detectable, was inversely related to the size of the AF ring. Multifocal ERGs in two subjects showed widespread reduction with relative sparing over the foveal area, in keeping with FMM data. Some patients with cone-rod dystrophy have a parafoveal ring of increased autofluorescence that may enlarge with time. Increased autofluorescence is associated with reduced rod and cone sensitivity, rather than photoreceptor cell death, and AF imaging may help identify viable areas of retina amenable to future therapeutic intervention.
    The British journal of ophthalmology 02/2008; 92(1):95-102. DOI:10.1136/bjo.2007.124008 · 2.81 Impact Factor
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    British Journal of Ophthalmology 06/2006; 90(5):653-4. DOI:10.1136/bjo.2005.086678 · 2.81 Impact Factor
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    ABSTRACT: Without Abstract
    Documenta Ophthalmologica 05/2006; 112(3):219-219. DOI:10.1007/s10633-006-9014-0 · 1.11 Impact Factor
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    ABSTRACT: It has been suggested that sun exposure may be a risk factor for age related macular degeneration (AMD) and that skin sensitivity to sunlight and iris colour could be confounding factors. The aim was to investigate this further in the white population. 446 cases with end stage AMD were compared with 283 spouse controls. Data on sun exposure, places of residence, iris colour, subjective assessment of change in iris colour, hair colour at age 20, and skin sensitivity were obtained using a questionnaire. Iris colour was graded clinically by comparison with standard photographs. AMD was graded using stereoscopic colour fundus photographs as well as clinical examination and was defined as the presence of geographic atrophy or choroidal neovascularisation. All variables were included in a multiple logistic regression model including age, sex, and smoking. There was no association between AMD and sun exposure or related factors except for the suggestion of an association between sunburn prone skin type and geographic atrophy which reached borderline significance. No significant association between AMD and sun exposure, iris colour, change in iris colour, or hair colour was demonstrated.
    British Journal of Ophthalmology 02/2006; 90(1):29-32. DOI:10.1136/bjo.2005.073825 · 2.81 Impact Factor
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    ABSTRACT: There is evidence that smoking is a risk factor for age related macular degeneration (AMD). However, not all studies have demonstrated this association and several key questions about the role of smoking in AMD have still to be determined. The aim of this study was to further investigate this relation for both choroidal neovascularisation (CNV) and geographic atrophy (GA). To investigate the relation between smoking and the risk of developing age related macular degeneration (AMD) in white people, 435 cases with end stage AMD were compared with 280 controls. All subjects had graded stereoscopic colour fundus photography and AMD was defined as the presence of GA or CNV. Smoking history was assessed using multiple parameters in a detailed questionnaire. Comparison of current and former smokers with non-smokers was consistent with smoking being a risk factor for AMD but did not reach statistical significance. There was a strong association between AMD and pack years of cigarette smoking (p = 0.002), the odds ratio increasing with the amount smoked; for subjects with more than 40 pack years of smoking the odds ratio was 2.75 (95% CI 1.22 to 6.20) compared with non-smokers. Both types of AMD showed a similar relation; smoking more than 40 pack years of cigarettes was associated with an odds ratio of 3.43 (95% CI 1.28 to 9.20) for GA and 2.49 (95% CI 1.06 to 5.82) for CNV. Stopping smoking was associated with reduced odds of AMD and the risk in those who had not smoked for over 20 years was comparable to non-smokers. The risk profile was similar for males and females. Passive smoking exposure was associated with an increased risk of AMD (OR 1.87; 95% CI 1.03 to 3.40) in non-smokers. The authors have demonstrated a strong association between the risk of both GA and CNV and pack years of cigarette smoking. This provides support for a causal relation between smoking and AMD. They also show an increased risk for AMD in non-smokers exposed to passive smoking. Stopping smoking appears to reduce the risk of developing AMD.
    British Journal of Ophthalmology 02/2006; 90(1):75-80. DOI:10.1136/bjo.2005.073643 · 2.81 Impact Factor
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    ABSTRACT: To identify the gene responsible for autosomal dominant lamellar pulverulent cataract in a four-generation British family and characterise the functional and cellular consequences of the mutation. Linkage analysis was used to identify the disease locus. The GJA8 gene was sequenced directly. Functional behaviour and cellular trafficking of connexins were examined by expression in Xenopus oocytes and HeLa cells. A 262C>A transition that resulted in the replacement of proline by glutamine (P88Q) in the coding region of connexin50 (Cx50) was identified. hCx50P88Q did not induce intercellular conductance and significantly inhibited gap junctional activity of co-expressed wild type hCx50 RNA in paired Xenopus oocytes. In transfected cells, immunoreactive hCx50P88Q was confined to the cytoplasm but showed a temperature sensitive localisation at gap junctional plaques. The pulverulent cataract described in this family is associated with a novel GJA8 mutation and has a different clinical phenotype from previously described GJA8 mutants. The cataract likely results from lack of gap junction function. The lack of function was associated with improper targeting to the plasma membrane, most probably due to protein misfolding.
    Journal of Medical Genetics 01/2006; 43(1):e2. DOI:10.1136/jmg.2005.034108 · 5.64 Impact Factor
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    ABSTRACT: To determine whether patients with congenital stationary night blindness (CSNB) have electrophysiological evidence of optic nerve fibre mis-routing similar to that found in patients with ocular albinism (OA). We recorded the Pattern Onset VEP using a protocol optimised to detect mis-routing of optic nerve fibres in older children and adults. We tested 20 patients (age 15-69 yrs) with X-linked or autosomal recessive CSNB, 14 patients (age 9-56 yrs) with OA and 13 normally pigmented volunteers (age 21-66 yrs). We measured the amplitude and latency of the CI component at the occipital midline and over left and right occipital hemispheres. We also assessed the computed inter-hemispheric "difference" signal. Subjects with CSNB were classified as having the "complete" or "incomplete" phenotype on the basis of their ERG characteristics. Members of X-linked CSNB pedigrees underwent mutation screening of the NYX and CACNA1F genes. CI was significantly smaller over the ipsilateral hemisphere and more prominent over the contralateral hemisphere in OA patients compared with both controls and CSNB patients. In CSNB patients CI response amplitudes were not significantly different from controls but peak latency was prolonged at all three electrodes compared with controls. The inter-hemispheric "difference" signal was abnormal for the OA group but not for the CSNB group. Contralateral dominance of CI could be identified in the majority of OA patients and the "difference" signal was opposite in polarity for left compared with right eye stimulation in every patient in this group. Only 3 of 20 patients with CSNB showed significant inter-hemispheric asymmetry similar to that seen in the OA patients. All 3 CSNB patients with evidence for optic nerve fibre mis-routing had X-linked pedigrees: 2 had an identified mutation in the NYX gene but no mutation in either the NYX or CACNA1F genes was identified in the third. VEP evidence of optic nerve fibre mis-routing was present in 3 of the 11 subjects with "complete" phenotype and none of the 9 patients with "incomplete" phenotype CSNB. Mis-routing of optic nerve fibres does occur in CSNB but we found evidence of it in only 15% of our patients.
    Documenta Ophthalmologica 12/2005; 111(3):169-78. DOI:10.1007/s10633-005-5503-9 · 1.11 Impact Factor

Publication Stats

3k Citations
452.72 Total Impact Points


  • 1987–2011
    • Moorfields Eye Hospital NHS Foundation Trust
      • Department of Medical Retina
      Londinium, England, United Kingdom
  • 2009
    • UCL Eastman Dental Institute
      Londinium, England, United Kingdom
  • 2008
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      Londinium, England, United Kingdom
  • 1997–2005
    • Institute of Genetics and Molecular Medicine
      Edinburgh, Scotland, United Kingdom
    • University College London
      • Institute of Ophthalmology
      London, ENG, United Kingdom
  • 1992–2005
    • University of Cambridge
      • Department of Pathology
      Cambridge, England, United Kingdom
  • 2004
    • Institut Galli-Valerio
      Lausanne, Vaud, Switzerland
  • 2003
    • George Eliot Hospital NHS Trust
      Nuneaton, England, United Kingdom
  • 1995
    • Cambridge Eco
      Cambridge, England, United Kingdom
  • 1994
    • Manchester Memorial Hospital
      Manchester, Connecticut, United States
    • Clinical Molecular Genetics Society
      Londinium, England, United Kingdom
  • 1993
    • London Research Institute
      Londinium, England, United Kingdom
  • 1990
    • Newcastle University
      • Institute of Cellular Medicine
      Newcastle-on-Tyne, England, United Kingdom