Presentation
Individuals typically present with bilateral and slow vision loss starting in the first or second decade of life. [eyewiki.aao.org]
BACKGROUND OF THE PRESENT INVENTION Optic neuropathy or, often called, optic atrophy describes the loss of some or most of the fibers of the optic nerve. [google.sr]
However, pendular and triangular waveforms may also be present. The nystagmus may rarely be vertical. [diseaseinfosearch.org]
The work presented in this thesis provides further insight into the molecular and genetic basis of two classical forms of inherited optic neuropathy, namely autosomal dominant optic atrophy (DOA) and Wolfram syndrome. [ethos.bl.uk]
Besides the common symptoms described above for Leigh syndrome, retinitis pigmentosa is often present and an important diagnostic clue. [rarediseasesnetwork.org]
Entire Body System
- Pallor
(A) Bilateral temporal disc pallor; 26. Fig. (B) bilateral diffuse pallor 27. Thank You All [slideshare.net]
Temporal pallor is seen in about half of patients, and the other half have total disc pallor. Pallor of the neuroretinal rim is seen universally, in contrast to glaucoma where pallor of the rim is not usually seen until late stages. [healio.com]
DOA101 23 0.4/0.3 -6.5/-7.0 Dyschromatopsia, tritan axis Normal outer boundaries, relative central scotoma Temporal pallor Borderline subnormal DOA102 52 0.7/0.9 -3.5/-4.25 Temporal pallor Pathological DOA103 12 1.0/1.0 (0.2/0.2 at age 37 y) -4.25/-3.5 [bmcmedgenet.biomedcentral.com]
ANATOMY OF THE OPTIC NERVE Intraocular course Intraorbital course Intracanalicular course Intracranial course CLINICAL EXPRESSION OF DISEASE Pallor and cupping Optic disc swelling (edema) Accompanying signs ISCHEMIC OPTIC NEUROPATHIES Nonarteritic anterior [neurology.mhmedical.com]
Both optic nerve heads present temporal pallor as seen on fundus photography and those are often more prominent at red-free fundus photo. Humphrey visual field test shows cecocentral scotoma in right eye and central scotoma in left eye. [eyewiki.aao.org]
- Malnutrition
Nutrition in CKD : 5th edition [PDF] Malnutrition in chronic kidney disease (CKD) is common but is often undiagnosed. This evidence-based clinical practice guideline summarises the main interventions that may be recommended in the... [evidence.nhs.uk]
Associated with this are malnutrition, failure to gain weight, frequent chest infections, and exhaustion. In the presence of a complete cleft, the tongue may cause respiratory problems by going through the cleft and into the nose. [emedicine.medscape.com]
- Malaise
Clinical features may be non-specific and include lethargy and malaise, or reflect target organ damage and present with abnormal liver tests, cirrhosis, diabetes mellitus, arthropathy, cardiomyopathy, skin pigmentation and gonadal failure. [aetna.com]
- Plethora
Both the retinal veins and the arteries are dilated, creating the impression of a plethora of vascular trunks on the disc. In the peripapillary zone, moderate vascular tortuosity is present. [atlasophthalmology.net]
Eyes
- Central Scotoma
METHOD: Three patients with bilateral optic atrophy and central scotomas of their visual fields were clinically diagnosed with ADOA. [ncbi.nlm.nih.gov]
Few errors on saturated, more on unsaturated, tritan axis Centrocoecal scotoma OU, age 37 y Small, evenly shaped disks N/A DOA104 28 0.4/0.2 +0.75/+1.0 No significant abnormality Outer borders normal, mild relative central scotoma Small, evenly shaped [bmcmedgenet.biomedcentral.com]
Humphrey visual field test shows cecocentral scotoma in right eye and central scotoma in left eye. [eyewiki.aao.org]
Visual field testing reveals a central scotoma, a cecocentral scotoma or an enlarged blind spot. There may be extension of the scotoma to the superior temporal field in late stages. OCT shows thinning of the nerve fiber layer. [healio.com]
- Visual Impairment
The visual impairment is usually moderate, but ranges from severe (legal blindness with acuity OPA1, which encodes a mitochondrial inner membrane protein. Optic atrophy can also be syndromic. [blueprintgenetics.com]
Persons with OPA1 have scotomas (areas of impaired visual acuity) in the central visual fields and sparing of the peripheral visual fields. [ncbi.nlm.nih.gov]
The degree of visual impairment is quite variable and the phenotype of aniridia can include cases of autosomal dominant keratitis. This is an autosomal dominant disorder inherited directly from a parent who has aniridia. [djo.org.in]
Psychiatrical
- Suggestibility
Cell biological findings suggest that OPA1 is regulated by post-translational mechanisms and we would like to hypothesize that loss of OPA1 function might lead to impaired mitochondrial quality control. [publikationen.ub.uni-frankfurt.de]
Other optic nerve findings suggestive of ADOA include an increased cup-to-disc ratio (48%), temporal gray crescent (31%) and peripapillary atrophy (69%). [healio.com]
The strong association of OPA1 with membranes suggests its anchoring to the inner membrane [21]. [wikigenes.org]
Our findings suggest that an analysis of genomic rearrangements is mandatory in the investigation and diagnosis of ADOA. [bmcmedgenet.biomedcentral.com]
Despite recent data suggesting that the condition is more common than previously thought (the estimated minimum prevalence in a population in northern England is 4.07/100.000, or about 1 in 25.000), ADOA is more rarely reported in Asia. [iovs.arvojournals.org]
Neurologic
- Gait Ataxia
Systemic abnormalities include spastic gait, ataxia and mental handicap. 23. Wolfram syndrome Wolfram syndrome is also referred to as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). Inheritance. [slideshare.net]
[…] are met: Individual to be tested exhibits signs and symptoms of SCA such as progressive gait and limb incoordination, imbalance, dysarthria and disturbances of eye movements; and Non-genetic causes of ataxia have been excluded (eg, alcoholism, multiple [aetna.com]
- Abnormal Gait
Gait 3 Mental Retardation-Hypotonic Facies Syndrome X-Linked, 1 4 Merosin Deficient Congenital Muscular Dystrophy 5 Metachondromatosis 1 Metachromatic Leukodystrophy 2 Metaphyseal Anadysplasia 2 1 Metaphyseal Chondrodysplasia, Jansen Type 1 Metaphyseal [preventiongenetics.com]
- Spastic Gait
Systemic abnormalities include spastic gait, ataxia and mental handicap. 23. Wolfram syndrome Wolfram syndrome is also referred to as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). Inheritance. [slideshare.net]
Workup
Visual Field Test
- Central Scotoma
METHOD: Three patients with bilateral optic atrophy and central scotomas of their visual fields were clinically diagnosed with ADOA. [ncbi.nlm.nih.gov]
Few errors on saturated, more on unsaturated, tritan axis Centrocoecal scotoma OU, age 37 y Small, evenly shaped disks N/A DOA104 28 0.4/0.2 +0.75/+1.0 No significant abnormality Outer borders normal, mild relative central scotoma Small, evenly shaped [bmcmedgenet.biomedcentral.com]
Humphrey visual field test shows cecocentral scotoma in right eye and central scotoma in left eye. [eyewiki.aao.org]
Visual field testing reveals a central scotoma, a cecocentral scotoma or an enlarged blind spot. There may be extension of the scotoma to the superior temporal field in late stages. OCT shows thinning of the nerve fiber layer. [healio.com]
Other Pathologies
- Gliosis
Slightly or moderately raised dirty white or greyish disc with poorly delineated margins due to gliosis. Optic disc is full of connective tissues. Obscuration of the lamina cribrosa. [slideshare.net]
Treatment
Food and Drug Administration has chosen Wave Life Sciences’ planned phase 2/3 study of suvodirsen, its lead experimental therapy for the treatment of Duchenne muscular dystrophy, to break new ground. [globalgenes.org]
FIG. 6 is a fluoangiography of SR prior to treatment. FIG. 7 is an optical coherence tomography scan of SR before treatment. [google.sr]
Most exciting of all, more sophisticated treatment methods have evolved over the past 20 years. The age at presentation determines the treatment. If possible, provide early treatment and direct it at the cranial vault. [emedicine.medscape.com]
Acetazolamide in the treatment of X-linked retinoschisis maculopathy. Arch Ophthalmol. 2007;125:571-573. Grover S, Apushkin MA, Fishman GA. Topical dorzolamide for the treatment of cystoid macular edema in patients with retinitis pigmentosa. [rarediseases.org]
State-of-the-art coverage of key areas such as OCT and all of the newest imaging techniques for the eye, orbit and visual pathways; anti-VEGF treatment for retinopathy of prematurity; and minimally invasive strabismus surgery. [books.google.com]
Prognosis
Prognosis is variable, with moderate to severe visual loss and nystagmus. Systemic abnormalities include spastic gait, ataxia and mental handicap. 23. [slideshare.net]
The prognosis for Leigh syndrome is poor. Depending on the defect, individuals typically live a few years. [rarediseasesnetwork.org]
The presence of syndactyly seems to represent a different genetic variant of LQTS also associated with a poor prognosis. [aetna.com]
Patients with type I have the best long-term prognosis, whereas those with types II and III have neurologic compromise and die young. [12] Saethre-Chotzen Syndrome This is an autosomal dominant condition with full penetrance. [emedicine.medscape.com]
Etiology
Lyons, both globally recognized leaders, provide authoritative coverage of all the pediatric ophthalmic conditions you’re likely to encounter in practice, including the latest clinical advances in etiology, diagnosis, and medical and surgical management [books.google.com]
[…] parasellar region. [7] Family history Autosomal dominant optic atrophy is a genetically heterogeneous condition, associated with a genetic mutation in the OPA1 on 3q28. [1] Leber’s hereditary optic neuropathy and dominant optic atrophy have mitochondrial etiology [explainmedicine.com]
Tobacco use increases oxidative DNA damage in sperm-possible etiology of childhood cancer. Asian Pac J Cancer Prev 2015; 16: 6967-6972. F rancis PJ. Genetics of inherited retinal disease. JRSM 2006; 99:189-191. [djo.org.in]
Candidates for diagnostic testing include infants, children, and adults with generalized hypotonia and proximal muscle weakness of unknown etiology. [aetna.com]
[…] mercaptopurine 6-MP 6MP toxicity 6-thioguanine 6-TG 6TG AZA toxicity Azathioprine S-adenosyl-L-methionine genotype Thioguanine Thiopurine S-Methyltransferase genotype Thiopurine TPMT mutation TPMT gene TPMT genetics 0030133 Thrombotic Risk, Inherited Etiologies [aruplab.com]
Epidemiology
DOA+ - Optic atrophy - deafness- polyneuropathy - myopathy Classification (Orphanet): - Inborn errors of metabolism - Rare eye disease - Rare genetic disease - Rare neurologic disease Classification (ICD10): - Diseases of the ear and mastoid process - Epidemiological [csbg.cnb.csic.es]
Further epidemiological studies are needed in order to determine the prevalence of ADOA in Singapore. [iovs.arvojournals.org]
Clinical and epidemiological aspects. Acta Ophthalmol Scand. 1996;74(1):3-7. ↑ Votruba M, Fitzke FW, Holder CE, Carter A, Bhattacharya SS, Moore AT. Clinical features in affected individuals from 21 pedigrees with dominant optic atrophy. [eyewiki.aao.org]
Epidemiology and penetrance of Leber hereditary optic neuropathy in Finland. Eur J Hum Genet 2007; 15:1079-89. S acai PY, Salomão SR, Carelli V, Pereira JM, Belfort R, Sadun AA, et al. [djo.org.in]
Clinical and epidemiological aspects. Acta Ophthalmol Scand. 1996, 74: 3-7. 10.1111/j.1600-0420.1996.tb00672.x. [bmcmedgenet.biomedcentral.com]
Pathophysiology
This syndrome has a discrete pathophysiology and differs genetically and clinically from recessive Wolfram syndrome. Received October 25, 2016. Accepted April 21, 2017. © 2017 by the American Diabetes Association. [diabetes.diabetesjournals.org]
The unifying pathophysiological theme is mitochondrial dysfunction, but the specific disease mechanisms that ultimately precipitate neuronal loss, particularly retinal ganglion cell (RGC) degeneration, still remain unclear. [ethos.bl.uk]
Hereditary optic neuropathies and a proposed common pathophysiology through mitochondrial dysfunction. [eyewiki.aao.org]
Clinical features, molecular genetics, and pathophysiology of dominant optic atrophy. J Med Genet. 1998;35(10):793-800. Vortruba M, Thiselton D, Bhattacharya SS. Optic disc morphology of patients with OPA1 autosomal dominant optic atrophy. [healio.com]
We found four different OPA1 mutations, including frameshift and missense mutations, to segregate with the disease, demonstrating a role for mitochondria in retinal ganglion cell pathophysiology [1]. [wikigenes.org]
Prevention
Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.com]
Early diagnosis and prevention of complications are the two branches of its treatment, because even though an important progression in the treatment has been done, with substances such as 4-phenylbutyric acid, there is still no curative treatment. [medigraphic.com]
It must be performed with care to prevent any neurologic problems. Spinal fusion should be performed, and cord pressure should be decompressed. [emedicine.medscape.com]
Mohr-Tranebjaerg syndrome XLR 3 TMEM126A 612988 Optic Atrophy 7 AR 0 WFS1 606201 noninsulin-dependent diabetes mellitus / Diabetes mellitus type II; Wolfram syndrome; Deafness, autosomal dominant 6/14/38; Wolfram-like syndrome AD, AR 17 To date, there is no preventative [centogene.com]
DESCRIPTION OF THE PREFERRED EMBODIMENTS As used herein, the term “ophthalmic neuroprotector” means a ophthalmic composition that can be used in therapy that prevents, retards or reverses apoptosis associated neuronal death resulting from primary neuronal [google.sr]