Incidence of Age-Related Macular Degeneration in the Central Region of Portugal: The Coimbra Eye Study - Report 5.

PURPOSE: To describe the 6.5-year incidence and progression of age-related macular degeneration (AMD) in a coastal town of central Portugal. METHODS: Population-based cohort study. Participants underwent standardized interviews and ophthalmological examination. Color fundus photographs were graded according to the International Classification and Grading System for AMD and ARM. The crude and age-standardized incidence of early and late AMD was calculated, and progression was analyzed. RESULTS: The 6.5-year cumulative incidence of early AMD was 10.7%, and of late AMD it was 0.8%. The incidence of early AMD was 7.2, 13.1 and 17.7% for participants aged 55-64, 65-74 and 75-84 years (p < 0.001). The late AMD incidence was 0.3, 0.9 and 2.8% for the corresponding age groups (p = 0.003). The age-standardized incidence was 10.8% (95% CI, 10.74-10.80%) for early and 1.0% (95% CI, 1.00-1.02%) for late AMD. The incidence of both neovascular AMD and geographic atrophy was 0.4%. Progression occurred in 17.2% of patients. CONCLUSION: The early AMD incidence in a coastal town of central Portugal was found to be similar to that of major epidemiological studies of European-descent populations; however, the incidence of late AMD was lower, and further analysis on risk factors will be conducted.

MYOC Gene Sequencing Analysis in Primary Open-Angle Glaucoma Patients from the Centre Region of Portugal.

INTRODUCTION: Primary open-angle glaucoma is the most frequent subtype of glaucoma. Relatives of primary open-angle glaucoma patients have an increased risk of developing the disease, suggesting a genetic predisposition to the disease. MYOC was the first primary open-angle glaucoma-causing gene identified. This study aimed to identify sequence variations in the MYOC gene that may be responsible for the phenotype in a group of primary open-angle glaucoma patients from the Centre Region of Portugal. MATERIAL AND METHODS: The three coding exons and the proximal splicing junctions of the MYOC gene were studied using a PCR sequencing approach in a group of 99 primary open-angle glaucoma patients. RESULTS: The sequencing analysis enabled the identification of 20 variants, including four in the promoter region, seven in the introns and nine in exons one and three, of which four were missense variants. DISCUSSION: Initially, all four missense sequence variations identified were considered candidates to glaucoma causing disease mutations. However, after literature review, only variant c.1334C>T (Ala445Val) remained as likely responsible for mild late-onset normal tension glaucoma. CONCLUSION: This is the first study performed in a group of primary open-angle glaucoma patients from the Centre Region of Portugal, contributing to the identification of one genetic variant in the MYOC gene and reinforcing the hypothesis that normal tension glaucoma could be also due to MYOC gene mutations.

Introdução: O glaucoma primário de ângulo-aberto é o subtipo mais frequente de glaucoma. Os familiares de doentes com glaucoma primário de ângulo-aberto têm um risco maior de desenvolverem a doença, o que sugere uma predisposição genética para a doença. MYOC foi o primeiro gene causador de glaucoma primário de ângulo-aberto a ser identificado. Este estudo pretendeu identificar variações de sequência no gene MYOC que possam ser responsáveis pelo fenótipo num grupo de doentes com glaucoma primário de ângulo-aberto da Região Centro de Portugal. Material e Métodos: Os três exões codificantes e as regiões adjacentes do gene MYOC foram estudados utilizando o método de PCR-sequenciação num grupo de 99 doentes com glaucoma primário de ângulo aberto. Resultados: A análise de sequenciação permitiu identificar 20 variantes, incluindo quatro na região promotora, sete nos intrões e nove nos exões um e três, das quais quatro eram variantes missense. Discussão: Inicialmente, todas as quatro variações de sequência missense identificadas foram consideradas candidatas a mutações causadoras de glaucoma. No entanto, após análise da literatura, somente a variante c.1334C>T (Ala445Val) permaneceu como provável responsável pelo glaucoma de pressão normal de início tardio. Conclusão: Este é o primeiro estudo realizado num grupo de doentes com glaucoma primário de ângulo aberto da Região Centro de Portugal, contribuindo para a identificação de uma variante genética no gene MYOC e reforçando a hipótese de que o glaucoma de pressão normal também poderá ser causado por mutações no gene MYOC.

Age-Related Macular Degeneration Staging by Color Fundus Photography vs. Multimodal Imaging-Epidemiological Implications (The Coimbra Eye Study-Report 6).

Epidemiology of age-related macular degeneration (AMD) is based on staging systems relying on color fundus photography (CFP). We aim to compare AMD staging using CFP to multimodal imaging with optical coherence tomography (OCT), infra-red (IR), and fundus autofluorescence (FAF), in a large cohort from the Epidemiologic AMD Coimbra Eye Study. All imaging exams from the participants of this population-based study were classified by a central reading center. CFP images were graded according to the International Classification and Grading System for AMD and staged with Rotterdam classification. Afterward, CFP images were reviewed with OCT, IR, and FAF and stage update was performed if necessary. Early and late AMD prevalence was compared in a total of 1616 included subjects. In CFP-based grading, the prevalence was 14.11% for early AMD (n = 228) and 1.05% (n = 17) for late AMD, nine cases (0.56%) had neovascular AMD (nAMD) and eight (0.50%) geographic atrophy (GA). Using multimodal grading, the prevalence increased to 14.60% for early AMD (n = 236) and 1.61% (n = 26) for late AMD, with 14 cases (0.87%) of nAMD and 12 (0.74%) of GA. AMD staging was more accurate with the multimodal approach and this was especially relevant for late AMD. We propose that multimodal imaging should be adopted in the future to better estimate and compare epidemiological data in different populations.

OCT angiography findings in children with amblyopia.

PURPOSE: To compare the microstructure and vascularity of amblyopic eyes in children with their contralateral eye and with eyes from control children using optical coherence tomography angiography (OCT-A). METHODS: We conducted a prospective, cross-sectional evaluation of macular and optic disk vascular density and flow area using OCT-A (Avanti RTVue XR, Optovue Inc, Fremont, CA). Parameters were calculated using automated software. RESULTS: A total of 52 children were included: 26 subjects with amblyopia and 26 nonamblyopic controls. The amblyopic eye of subjects showed a statistically significant decrease in macular vascular density (P = 0.0171) of the superficial capillary plexus (SCP), in the optic disk flow area (P = 0.0195) and in the average retinal nerve fiber layer thickness (P = 0.0194) as well as a marginally statistically significant decrease in the macular flow area of the SCP (P = 0.0305) and in the optic density (P = 0.0279). Compared with randomly selected eyes of controls, amblyopic eyes showed a statistically significant decrease in the macular flow area of the SCP (P = 0.005) and of the deep capillary plexus (DCP; P = 0.002), in the macula vascular density of the SCP (P = 0.022), in the optic disk flow area (P = 0.004), and a marginally statistical significant increase in the area of foveal avascular zone of the DCP (P = 0.038). CONCLUSIONS: In our study cohort amblyopic eyes manifested significant differences in macular and optic disk vascularization. The clinical significance of these findings warrants further research.

Sialidosis type I: ophthalmological findings.

Sialidosis is a lysosomal storage disease caused by deficit of neuraminidase. It is an autosomal recessive disease, heterogeneous in its onset, presentation and prognosis. We report a case of a male patient with molecular and enzymatic confirmation of the diagnosis. Symptoms began at age 26 with reduced visual acuity, bilateral cherry-red spots and later myoclonus. A brother, now deceased, had the same confirmed disease. We describe the symptoms and clinical findings of the patient, as well review the current knowledge on the topic. With this report, we highlight the importance of a clinical history integrating all the patient's symptoms in order to achieve the diagnosis. In the presence of a cherry-red spot, a comprehensive study is mandatory. Despite being a rare disease, sialidosis carries a significant burden for its patients and its diagnosis should always be considered in the appropriate setting.