Etienne M Schönbach1, Rupert W Strauss2, Xiangrong Kong3, Beatriz Muñoz4, Mohamed A Ibrahim4, Janet S Sunness5, David G Birch6, Gesa-Astrid Hahn7, Fadi Nasser7, Eberhart Zrenner7, SriniVas R Sadda8, Sheila K West4, Hendrik P N Scholl9. 1. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio, USA. 2. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Department of Ophthalmology, Medical University, Graz, Austria; Moorfields Eye Hospital, London, UK; Department of Ophthalmology, Johannes Kepler University, Linz, Austria. 3. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Department of Biostatistics and Epidemiology, University of Massachusetts-Amherst, Amherst, Massachusetts, USA. 4. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA. 5. Hoover Low Vision Rehabilitation Services, Greater Baltimore Medical Center, Baltimore, Maryland, USA. 6. Retina Foundation of the Southwest, Dallas, Texas, USA. 7. Center for Ophthalmology, Eberhard Karls Universität, Tübingen, Germany. 8. Doheny Eye Institute, UCLA David Geffen School of Medicine, Los Angeles, California, USA. 9. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA; Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland. Electronic address: Hendrik.Scholl@usb.ch.
Abstract
PURPOSE: To investigate the natural history of Stargardt disease (STGD1) using fixation location and fixation stability. DESIGN: Multicenter, international, prospective cohort study. METHODS: Fixation testing was performed using the Nidek MP-1 microperimeter as part of the prospective, multicenter, natural history study on the Progression of Stargardt disease (ProgStar). A total of 238 patients with ABCA4-related STGD1 were enrolled at baseline (bilateral enrollment in 86.6%) and underwent repeat testing at months 6 and 12. RESULTS: Outcome measures included the distance of the preferred retinal locus from the fovea (PRL) and the bivariate contour ellipse area (BCEA). After 12 months of follow-up, the change in the eccentricity of the PRL from the anatomic fovea was -0.0014 degrees (95% confidence interval [CI], -0.27 degrees, 0.27 degrees; P = .99). The deterioration in the stability of fixation as expressed by a larger BCEA encompassing 1 standard deviation of all fixation points was 1.21 degrees squared (deg2) (95% CI, -1.23 deg2, 3.65 deg2; P = .33). Eyes with increases and decreases in PRL eccentricity and/or BCEA values were observed. CONCLUSIONS: Our observations point to the complexity of fixation parameters. The association of increasingly eccentric and unstable fixation with longer disease duration that is typically found in cross-sectional studies may be countered within individual patients by poorly understood processes like neuronal adaptation. Nevertheless, fixation parameters may serve as useful secondary outcome parameters in selected cases and for counseling patients to explain changes to their visual functionality.
PURPOSE: To investigate the natural history of Stargardt disease (STGD1) using fixation location and fixation stability. DESIGN: Multicenter, international, prospective cohort study. METHODS: Fixation testing was performed using the Nidek MP-1 microperimeter as part of the prospective, multicenter, natural history study on the Progression of Stargardt disease (ProgStar). A total of 238 patients with ABCA4-related STGD1 were enrolled at baseline (bilateral enrollment in 86.6%) and underwent repeat testing at months 6 and 12. RESULTS: Outcome measures included the distance of the preferred retinal locus from the fovea (PRL) and the bivariate contour ellipse area (BCEA). After 12 months of follow-up, the change in the eccentricity of the PRL from the anatomic fovea was -0.0014 degrees (95% confidence interval [CI], -0.27 degrees, 0.27 degrees; P = .99). The deterioration in the stability of fixation as expressed by a larger BCEA encompassing 1 standard deviation of all fixation points was 1.21 degrees squared (deg2) (95% CI, -1.23 deg2, 3.65 deg2; P = .33). Eyes with increases and decreases in PRL eccentricity and/or BCEA values were observed. CONCLUSIONS: Our observations point to the complexity of fixation parameters. The association of increasingly eccentric and unstable fixation with longer disease duration that is typically found in cross-sectional studies may be countered within individual patients by poorly understood processes like neuronal adaptation. Nevertheless, fixation parameters may serve as useful secondary outcome parameters in selected cases and for counseling patients to explain changes to their visual functionality.
Authors: Etienne M Schönbach; Rupert W Strauss; Beatriz Muñoz; Yulia Wolfson; Mohamed A Ibrahim; David G Birch; Eberhart Zrenner; Janet S Sunness; Michael S Ip; SriniVas R Sadda; Sheila K West; Hendrik P N Scholl Journal: JAMA Ophthalmol Date: 2020-07-01 Impact factor: 7.389
Authors: Husam Alghanem; Tapas R Padhi; Adrienne Chen; Leslie M Niziol; Maria Fernanda Abalem; Natalie Dakki; Timothy Steffens; Chris Andrews; David C Musch; K Thiran Jayasundera; Naheed W Khan Journal: Transl Vis Sci Technol Date: 2019-09-27 Impact factor: 3.283
Authors: Luminita Tarita-Nistor; Mark S Mandelcorn; Efrem D Mandelcorn; Samuel N Markowitz Journal: Transl Vis Sci Technol Date: 2020-07-30 Impact factor: 3.283
Authors: S Scott Whitmore; Christopher R Fortenbach; Justine L Cheng; Adam P DeLuca; D Brice Critser; Elizabeth L Geary; Jeremy M Hoffmann; Edwin M Stone; Ian C Han Journal: Sci Rep Date: 2020-10-06 Impact factor: 4.379