Contribution of post-receporal cells to the cone a-wave of the human electroretinogram in congenital stationary night blindness and autoimmune-like retinopathy.

In normal subjects the later part of the cone a-wave to a brief flash increases in amplitude after 50-100 ms darkness due to a contribution from secondary hyperpolarising cells. We recorded these responses along with clinical ON and OFF ERGs in patients with inner retinal dysfunction to see if this part of the a-wave is affected. Patients with autoimmune-like retinopathy and CSNB2 had abnormal ON and OFF responses but the a-wave increased in amplitude in the dark as in normals. Conversely, the OFF-response was normal in CSNB1 but the a-wave did not increase in the dark. Contrary to expectation these results show some hyperpolarising cell function in autoimmune-like disease and CSNB2 and some OFF-pathway abnormality in CSNB1. The a- and d-wave are needed to assess OFF-pathway function.

The PROM1 mutation p.R373C causes an autosomal dominant bull's eye maculopathy associated with rod, rod-cone, and macular dystrophy.

PURPOSE: To characterize in detail the phenotype of five unrelated families with autosomal dominant bull's eye maculopathy (BEM) due to the R373C mutation in the PROM1 gene. METHODS: Forty-one individuals of five families of Caribbean (family A), British (families B, D, E), and Italian (family C) origin, segregating the R373C mutation in PROM1, were ascertained. Electrophysiological assessment, fundus autofluorescence (FAF) imaging, fundus fluorescein angiography (FFA), and optical coherence tomography (OCT) were performed in available subjects. Mutation screening of PROM1 was performed. RESULTS: The R373C mutant was present heterozygously in all affected patients. The age at onset was variable and ranged between 9 and 58 years, with most of the individuals presenting with reading difficulties. Subjects commonly had a mild to moderate reduction in visual acuity except for members of family C who experienced markedly reduced central vision. The retinal phenotype was characterized by macular dystrophy, with retinal pigment epithelial mottling in younger subjects, progressing to typical BEM over time, with the development of macular atrophy in older patients. In addition, all members of family C had typical features of RP. The electrophysiological findings were variable both within and between families. CONCLUSIONS: Mutations in PROM1 have been described to cause a severe form of autosomal recessive RP in two families of Indian and Pakistani descent. The results of this study have demonstrated that a distinct redundant PROM1 mutation (R373C) can also produce an autosomal dominant, fully penetrant retinopathy, characterized by BEM with little inter- and intrafamilial variability, and retinal dystrophy with variable rod or rod-cone dysfunction and marked intra- and interfamilial variability, ranging from isolated maculopathy without generalized photoreceptor dysfunction to maculopathy associated with very severe rod-cone dysfunction.

Contribution of post-receptoral cells to the a-wave of the human photopic electroretinogram.

ERGs were recorded to red flashes (0.01-50 phcdsm(2)) presented against a steady background (2000 sctd) or 0-300 ms after its suppression. The cone a-wave was altered in form and increased in amplitude in the dark. Peak amplitudes were doubled when the dark period was 50-100 ms and also when it was 150-200 ms. Measurement of the a-wave at fixed times showed that amplitude increase occurred at times later than 6-8 ms. The a-wave receives a significant negative-signal contribution from two post-receptoral mechanisms. These are adapted by weak backgrounds and recover their sensitivity extremely rapidly in the dark. The cone photocurrent alone contributes 40-70% of peak amplitude depending on stimulus intensity.

Cone-rod dystrophy, intrafamilial variability, and incomplete penetrance associated with the R172W mutation in the peripherin/RDS gene.

PURPOSE: To determine the underlying molecular genetic basis of a retinal dystrophy identified in a 5-generation family, and to examine the phenotype and degree of intrafamilial variability. DESIGN: Family genetic study. PARTICIPANTS: Nine affected individuals from a nonconsanguineous British family. METHODS: Ophthalmologic examination, color vision testing, fundus photography, autofluorescence imaging, and electrophysiological assessment were performed. The clinical notes of 2 additional deceased affected family members were also reviewed. Blood samples were taken for DNA extraction, with linkage analysis being performed, and subsequent mutation screening of the peripherin/RDS gene. RESULTS: Linkage analysis established a disease interval on chromosome 6p, which harbored the retinal candidate gene, peripherin/RDS. The 3 coding exons of the peripherin/RDS gene were subsequently screened for mutations in affected and unaffected family members. A nonconservative missense substitution, Arg172Trp (R172W), segregated uniquely in all affected subjects. The majority of subjects carrying the R172W peripherin/RDS mutation complained of reduced central vision starting in the second or third decade, with subsequent gradual deterioration of visual acuity and color vision. Three affected individuals complained of nyctalopia. A range of macular appearances were seen, varying from a typical granular appearance to extensive macular atrophy. Autofluorescence imaging in the majority of individuals identified a highly characteristic speckled macular appearance. All affected subjects had abnormal pattern electroretinograms (ERGs) consistent with macular dysfunction and 4 subjects showed additional full-field ERG abnormalities, providing evidence of generalized retinal dysfunction. There was marked variation in the clinical phenotype in those individuals who carried the R172W peripherin/RDS mutation, ranging from severe cone-rod dystrophy to asymptomatic individuals with normal retinal function. CONCLUSIONS: The Arg172Trp (R172W) peripherin/RDS mutation has been previously reported to cause a fully penetrant progressive macular dystrophy with high intrafamilial and interfamilial consistency of phenotype. This is the first report describing marked intrafamilial variation associated with this mutation, including nonpenetrance. These findings are clinically important in relation to advice on prognosis and accurate genetic counseling.

X-linked cone dysfunction syndrome with myopia and protanopia.

PURPOSE: To perform a detailed clinical, psychophysical, and molecular assessment of members of 4 families with an unusual X-linked cone dysfunction syndrome associated with myopia. PARTICIPANTS: Affected and unaffected members of 4 British nonconsanguineous families. METHODS: Subjects underwent both detailed clinical examination and psychophysical testing. After informed consent was obtained, blood samples were taken for DNA extraction, and molecular genetic analysis was performed. The strategy for molecular analysis was to amplify the coding regions of the long and middle wavelength-sensitive cone opsin genes and the upstream locus control region by polymerase chain reaction and to examine these fragments for mutations by sequencing of DNA. RESULTS: The phenotype was almost identical in all 4 families, consisting of moderate to high myopia, astigmatism, moderately reduced acuity, and normal fundi. Electroretinography showed abnormal cone but normal rod responses. Psychophysical testing showed a selective impairment of long cones in combination with well-preserved middle cone and short cone function. There was no evidence to suggest that the phenotype was progressive. Molecular analysis of the X-linked opsin gene array in the 4 families indicated that affected males have inherited the same X-chromosome from their mother. In 2 families, a long/middle hybrid gene was detected. In a third family, the commonly described deleterious Cys203Arg amino acid substitution was identified in both the long and middle opsin genes. In the fourth family, the only abnormality was absence of a middle opsin exon 2; the cause of the protanopia in this family is uncertain. CONCLUSIONS: The X-linked cone dysfunction syndrome associated with myopia and dichromacy described here has many similarities to Bornholm eye disease, a condition previously mapped to Xq28. Except for the Cys203Arg substitution in one family, no alterations in the opsin gene array were identified that could underlie the cone dysfunction. It is therefore possible that the cone dysfunction may have a genetic origin different from that of the dichromacy.

Identification of novel RPGR ORF15 mutations in X-linked progressive cone-rod dystrophy (XLCORD) families.

PURPOSE: To test the incidence of mutations in RPGR ORF15 in six families with X-linked progressive retinal degeneration (cone-rod dystrophy [XLCORD], macular or cone dystrophy) and to undertake a detailed phenotypic assessment of families in whom ORF15 mutations were identified. METHODS: To amplify and sequence ORF15 in its entirety, a cloning strategy was developed. Families with mutations in ORF15 underwent electrophysiological testing, color vision assessment, color fundus photography, and fundus autofluorescence (AF) imaging. RESULTS: Novel protein truncation mutations were identified in two families. In family A, a 2-bp mutation was identified in ORF15+A1094C G1095T, predicted to result in a truncated protein (E364D/E365X). In family B, a G-to-T transversion (ORF15+1176G>T) resulted in a nonsense mutation (G392X). Characteristics of phenotype in both families included progressive deterioration of central vision and subsequently night vision, mild photophobia, and moderate to high myopia. Ophthalmoscopic abnormalities were generally confined to the macula. A parafoveal ring of increased AF was observed, and electrophysiological evidence of a greater generalized abnormality in cone than rod responses were consistent with a cone-rod dystrophy phenotype. CONCLUSIONS: The cloning strategy for ORF15 facilitated comprehensive sequence analysis in patients. Two families were identified with nonsense mutations, and clinical evaluation revealed them both to have a similar phenotype. The presence of a parafoveal ring of increased AF was an early indicator of affected status in these families. No disease-causing mutations in ORF15 were detected in four other families, suggesting that ORF15 mutations may not be the most common cause of XLCORD.

A comparison of ERG abnormalities in XLRS and XLCSNB.

Dark and light adapted ERGs were recorded in 19 patients with XLRS and in 15 patients with CSNB. Patients were assigned to clinical groups after identification of mutations in the RS1 (16 patients), NYX (11 patients) and CACNA1F (4 patients) genes causing XLRS, 'complete' CSNB and 'incomplete' CSNB, respectively. ERG responses were compared with those of 26 healthy volunteers. Rod responses were most severely affected in patients in the NYX group but a rod-generated b-wave could be identified in the majority of patients in this group. Rod responses were less severely affected in the CACNA1F and RS1 groups and ERGs did not differ significantly between these two groups. Cone reponses were largely unaffected in the NYX group but were abnormal in the RS1 and especially CACNA1F groups. The ERG results suggest that the RS1 and CACNA1F gene products have comparable functional consequences and that all three genes may affect multiple retinal sites.

Comparison of ERGs recorded with skin and corneal-contact electrodes in normal children and adults.

PURPOSE: Compare electroretinogram (ERG) responses to full-field stimuli recorded with corneal-contact and skin electrodes in healthy children and adults. METHOD: ERGs were recorded independently in two laboratories in children (aged 4-14 years) and adults (aged 20-62 years). A Burian-Allen (BA) electrode were used to test both children and adults in one laboratory. A Gold Foil (GF) electrode was used to test adults and skin electrodes to test children and adults in the other laboratory. Responses were recorded to full-field stimuli similar to those specified in the ISCEV Standard. Dark-adapted responses were also recorded over a 5 log unit range of stimulus energies. RESULTS: All ISCEV rod and cone responses were recorded in every subject with skin electrodes as well as with eye-contact electrodes. BA and GF amplitudes and latencies were similar for the majority of ISCEV responses. The waveform morphology of rod and cone skin electrode responses was similar to corneal electrode responses in children and adults. GF electrode responses were on average 4 to 5 times larger than skin electrode responses recorded in the same laboratory. After scaling skin electrode responses by 4.5 the distribution of response amplitudes was found to be similar to that for the eye-contact electrodes in both children and adults. Dark-adapted responses were recorded to all stimulus intensities in every subject with each type of electrode. B-wave S-R functions were evaluated by fitting the Naka-Rushton equation. Vmax was similar for BA and GF electrode responses and this was about 4 times greater than for skin electrode responses. Log (sigma) was similar for GF and skin electrodes but these differed significantly from the BA electrode. Vmax and log(sigma) were similar in adults and children for BA and skin electrode responses. CONCLUSION: ERGs to full-field stimuli can be recorded successfully with either eye-contact or skin electrodes.

Abnormalities of the scotopic threshold response correlated with gene mutation in X-linked retinoschisis and congenital stationary night blindness.

STRs and dark-adapted ERGs were recorded in nine normal subjects, nine patients with XLRS, 11 patients with CSNB1 and one patient with CSNB2. In XLRS STR amplitude was significantly lower than normal at every intensity, but the response could be recorded in every patient and the maximum amplitude response was outside the 95% confidence limits in only four of the nine patients. STRs were significantly poorer in patients with CSNB and a responses was not measurable at any intensity in nine of the 11 patients with CSNB1. In both CSNB and XLRS the STR could only be recorded at higher stimulus intensities, suggesting reduced sensitivity of the STR. In XLRS onset and peak latencies were also significantly prolonged and the slope of the intensity-response functions for amplitude and onset latency differed significantly from normal. Maximum STR amplitude did not correlate with the maximum dark-adapted ERG response. The finding of abnormal STRs and dark adapted ERGs in all three dystrophies indicates that the different causative genes must have similar effects on the rod On-bipolar cell pathway. But there were also differences between the three clinical groups, particularly in the greater severity of the abnormality in CSNB1, which suggests that there may be multiple sites of abnormality.

An autosomal dominant bull's-eye macular dystrophy (MCDR2) that maps to the short arm of chromosome 4.

PURPOSE: To describe the phenotype of an autosomal dominant macular dystrophy and identify the chromosomal locus. METHODS: Eleven members of a five-generation, nonconsanguineous British family were examined clinically and also underwent automated perimetry, electrodiagnostic testing, fundus fluorescein angiography, and fundus autofluorescence imaging. Blood samples were taken for DNA extraction and linkage analysis was performed. RESULTS: The phenotype is characterized by bull's-eye macular dystrophy first evident in the first or second decade of life. There is mild visual impairment, central scotomata, and electrophysiological testing indicates that most affected individuals have disease confined to the central retina but older subjects have more widespread rod and cone abnormalities, demonstrated by flash ERG. Genetic linkage analysis established linkage to chromosome 4 at p15.2-16.3 with a maximum lod score of 3.03 at a recombination fraction of 0.00 for marker D4S391. The locus for this autosomal dominant macular dystrophy lies between flanking markers D4S3023 and D4S3022, and overlaps the Stargardt 4 locus. CONCLUSIONS: A new locus was identified for a bull's-eye macular dystrophy on the short arm of chromosome 4.

Mutations in the CACNA1F and NYX genes in British CSNBX families.

X-linked congenital stationary night blindness (CSNBX) is a genetically and phenotypically heterogeneous non-progressive disorder, characterised by impaired night vision but grossly normal retinal appearance. Other more variable features include reduction in visual acuity, myopia, nystagmus and strabismus. Genetic mapping studies by other groups, and our own studies of British patients, identified key recombination events indicating the presence of at least 2 disease genes on Xp11. Two causative genes (CACNA1F and NYX) for CSNBX have now been identified through positional cloning strategies. In this report, we present the results of comprehensive mutation screening in 14 CSNBX families, three with mutations in the CACNA1F gene and 10 with mutations in the NYX gene. In one family we failed to identify the mutation after testing RP2, RPGR, NYX and CACNA1F. NYX gene mutations are a more frequent cause of CSNBX, although there is evidence for founder mutations. Our report of patient population mutation screening for both CSNBX genes, and our exclusion of RP2 and RGPR, indicates that mutations in CACNA1F and NYX are likely to account for all CSNBX.