lecture # 18
DESCRIPTION
Lecture # 18. Retinal disease 4 / 4/13. QUIZ on Tuesday. 20 minutes at end of class 10 points added to midterm grade (up to total of 100) Bring your calculators. Animal Wiki due midnight tonight. Keep it simple - PowerPoint PPT PresentationTRANSCRIPT
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Lecture #18
Retinal disease4/4/13
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QUIZ on Tuesday
• 20 minutes at end of class• 10 points added to midterm grade (up to total
of 100)• Bring your calculators
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Animal Wiki due midnight tonight
• Keep it simple• If you can’t find out any color vision info make
your best guess based on similar organisms• Be sure to try some wiki formatting (bullets or
colors, adding links)
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Final wiki project
• Topic of interest to you• Introduction page
State topicWhy is it interesting / important?Give brief introduction or background
• 3 topic pagesDraw on primary literatureEach 500-1000 wordsMake interesting to reader so they will learn
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For next week
• Identify a topic• With one sentence for each, tell me:
What is your topic?Why is it important for vision?Why is it interesting?
• Based on this I will suggest some references
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Wiki project timeline
• Description of each week’s wiki project assignment is on the web4/11 - Identify topic4/18 - Make intro page and find references4/25 – 1st main page5/11 - Final project finished
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Wiki project ideas
• In depth study of an animal visual system (mantis shrimp, humans, comparison of primates)
• Tetrachromatic females • Instrumentation used by optometrist to check
your vision• Characteristics of light environment
Color and polarization in the sky
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More ideas• Flicker fusion frequency - temporal
perception• Depth perception• Fluorescence in the ocean• Animal coloration and camouflage• Eye research of UMd faculty
Bill Jeffery, Betsy Quinlan, Dan Butts, Hey-Kyoung Lee, Richard Payne (not KLC)
• Robotic vision
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Some topics done previously
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Todays topics
• Why the retina is susceptible to disease• Major retinal diseases
Diabetic retinopathyAge related macular degenerationOther genetic diseases
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Structure of the retina
Pigment epithelium
Photoreceptors
Outer nuclear layer
Outer plexiform layer
Inner nuclear layer
Inner plexiform layer
Ganglion cell layer
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Retina formation
• Cells form once early in developmentPrior to birth
• In mammals, if cells are damaged, they do not regenerateLost foreverThis is not true of fish where retina grows their entire life
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Retina under high stress #1• High metabolism of
photoreceptorsIn dark, ion channels are open and current is constantly flowing In the dark, normal state of synapse is to release glutamate
Glutamate release
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Retina under high stress #2
High energy needs are met by the choroid (blood circulation behind RPE) and retinal vasculature (above ganglion cell layer)
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Retinal vasculature has hole around fovea
Few blood vessels above retina but none above macula
Most energy demanding tissue in nervous system has to get O2 and energy in and waste out by diffusion
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Retina under stress #3
• Photoreceptors are exposed to high light levelsThis includes damaging UVLight sensitivity is reason for their existenceStill susceptible to light damage
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Structure of the retina
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mRNA goes from nucleus (n) to inner segment (m, e) where protein is made and sent to outer segment (o)
Photoreceptors
Rat rod Frog rodsGreen Red
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New membrane (proteins) added at boundary of inner and outer segments
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New outer segments are built up at same time
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Retina does turn over outer segments (OS)
• Label photoreceptors with H3-methionine
• Used to make proteins : follow these after they are added to OS
• Outer segment turns over in 10 days (rat)
2 days
3 days 4 days
7 days 9 days
Young 1967
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Tip of outer segment is removed by phagocytosis into RPE
RPE
Outer segment
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Phagosomes are present in rods and cones each day
Rods shed at beginning of dayCones shed at beginning of night
Rod shedding Cone shedding
Young 1978
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Retinal disease
• How is retinal health / disease diagnosed?Examine fundusPsychophysical testingElectrophysiology
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Diagnosis #1
• Fundus imaging
• OphthalmoscopeInvented by Helmholtz
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Ophthalmascope
• Illuminate the eye nearly on axis
• View retina on axis
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Two vascular systems for retina
Choroid is behind RPE - hidden from viewRetinal vasculature - this is what see in fundus - no blood vessels on top of fovea / macula
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#2 Fluoroscein angiography• Inject fluorescent dye
• Provides finer resolution of retinal vasculature
• Look for fluid loss through capillaries
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#3 Higher resolution imaging : OCT
• Optical coherence tomography
• Essentially ultrasound with light
• Get microscope like resolution of the retina
Optical - uses light Coherence - interference from retinal layers compared to mirror Tomography - profile in sections
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Invention and development of OCT
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Optical coherence tomography
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OCT normal 3D view
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Blood build up on /in retina
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Age related macular degeneration
Pigment epithelial detachment and drusen or deposits
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#4 Psychophysics
• Behavioral response to stimulusVisual acuityIntensityTemporal responsePeripheral visionColor visionDark adapted (rod) vision
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#5 Electrophysiology
• Record electrical response of the eye
• Apply electrode (as a contact lens)• Measure potential in response to light pulse
Electroretinogram
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Electrical set up
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Neurons of retina
Photoreceptors
Horizontal cells
Bipolar cellsAmacrine cells
Ganglion cells
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Normal ERG in response to flash of light
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Irregular ERG responses as a result of retinal disease
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Types of retinal disease
• Most common (few % of population)Glaucoma - next classDiabetic retinopathyAge related macular degenerationAll three have both genetic and non-genetic causes
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Health related information at National Eye Institute
Info on many diseases
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Diabetic retinopathy
• Diabetic eye diseaseDamage to retina as result of having diabetes
• Diabetic retinopathyDamage to blood vessels of retina
May swell (aneurisms) and eventually block blood flow
As some are blocked, new vessels try to grow on surface of retina
• Leading cause of blindness in adults
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Vision with proliferative retinopathy
Blood leaks from vessels growing on surface of retina
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Prevention• Get eye exam
40-50% of people with diabetes have some form of retinopathy
• Keep blood sugar and blood pressure in check
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Treatment
• Retinopathy can be treated with laser surgeryUse laser to shrink and seal leaking blood vessels
• May also need vitrectomy - remove blood stained vitreous
• 95% chance can prevent blindness over 5 yrs
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Age related macular degeneration (AMD)
• Disease associated with aging of the eyeDestroys sharp central vision
• Leading loss of vision in people > 60 yrsAffects >1.7 M people
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Two kinds of AMD
• Wet AMDBlood vessels grow under retina and lift maculaMay leak fluid which raises macula up from back of eye
Lose contact with RPE and blood supplyRapid loss of vision
SymptomStraight lines appear wavy
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Two kinds of AMD
• Dry AMDPhotoreceptors degenerateResults in blurry central vision and then vision lossSymptom - blurred vision
Can’t recognize facesNeed more light for reading
May coincide with growth of drusenYellow deposits under retina
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Example of vision with AMD
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Prevalence
• Wet AMD - 15%• Dry AMD - 85%• But most of severe vision loss is from wet
AMDWet form always arises from first having dry form
• Risk factorsSmoking, obesity, Caucasian, female, family history
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Treatment• Dry AMD
Take high doses of antioxidants and zincSlows progression
Eat vegetables
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Treatment
• Wet AMDDestroy blood vessels by
Laser surgeryPhotodynamic therapy
Inject drug which is light activated to destroy blood vesselsInject anti growth factors to slow blood vessel growth
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Phenotypes of AMD
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Identify regions of genome which linked to susceptibility
CFH gene
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Some genes found
• CFH - Complement factor H Y402H allele2.5x higher risk for heterozygote carrier and 6x for homozygoteOther alleles show association with AMD
Some causativeOthers protective
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March 2013
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Now many loci for AMD
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Rattner et al 1999
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Mendelian retinal diseases
• Single gene mutationsMendelian inheritanceEarly onsetMore severe clinical courseUntreatable
• All together infect 1:2000 people
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Hereditary diseases
• Age of onsetLeber congenical amaurosis - retinal dystrophies diagnosed shortly after birth or in infancy
Dystrophy - abnormal development
Degeneration - loss after previous function
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Hereditary diseases
• Pattern of visual lossLoss in periphery first - retinitis pigmentosaLoss in center first - macular degeneration
• Rod vs cone involvementRods firstCones first
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Hereditary diseases
• Inheritance patternDominant -
Recessive -
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Hereditary diseases
• Inheritance patternDominant - get disease if just one copy of mutant geneRecessive - need two copies of mutant gene
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Example: Retinitis pigmentosa has many forms
• Result of impaired rod function• Progressive degeneration of retina beginning
in midperipherySpares central retina until late in disease
• Characteristic retinal depositCalled bone spicule pigmentary deposit
• Eventually lose rod and cone functionIf lose cones early called cone-rod dystrophy
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Inheritance
• X linked• Autosomal recessive• Autosomal dominant
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Genetic causes of retinal disease
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Retnet Diseases
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Retnet Genes
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Progress in retinal disease identification
Nearly 200 known genes
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Many genes are from phototransduction pathway
• Screen families of affected and unaffected individualsSequence 15 rod phototransduction genesSequence all of them since <1999 didn’t have them all mapped in humans
30% of autosomal dominant RP is caused by rhodopsin mutations
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Phototransduction
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Summary
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Retinitis pigmentosa - causal genes2013 (36 genes)
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Still more work to do
• Well studied diseases still have unknown causes40% of retinitis pigmentosa cases are unexplained
• Genetic susceptibility for degenerative diseases just beginning