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      Fundus autofluorescence features specific for EYS-associated retinitis pigmentosa

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          Abstract

          Purpose

          To assess the utility of fundus autofluorescence (FAF) patterns for predicting the EYS genotype in retinitis pigmentosa (RP) patients.

          Methods

          This retrospective, multi-institutional study analyzed FAF images from 200 RP patients (74 with EYS and 126 without EYS) from Singapore and Japan. Seven FAF patterns including the infinity sign and a broad banded hyper-autofluorescent leading edge were evaluated for their association with the EYS genotype.

          Results

          The infinity sign and broad banded hyperautofluorescent leading edge occurred more frequently in EYS eyes (p = 0.0014 and p = 0.036 respectively). Logistic regression analysis showed that the infinity sign was predictive of EYS (p = 0.003). The combined FAF parameters predicted EYS with a specificity of 95.20%, sensitivity of 25.68% and accuracy of 69.50%, with a cut-off value 0.5 based on the probability of seven FAF parameters.

          Conclusions

          In this multinational cohort study of patients with RP, we demonstrated that specific FAF patterns, particularly the infinity sign, have clinical utility in identifying patients with EYS-associated disease. These findings may be useful for clinicians and geneticists when genotyping patients with RP, and may also enhance our understanding of underlying pathophysiology of EYS-associated RP, which is a prevalent cause of RP in Asia and elsewhere.

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          Most cited references26

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          Retinitis pigmentosa.

          Hereditary degenerations of the human retina are genetically heterogeneous, with well over 100 genes implicated so far. This Seminar focuses on the subset of diseases called retinitis pigmentosa, in which patients typically lose night vision in adolescence, side vision in young adulthood, and central vision in later life because of progressive loss of rod and cone photoreceptor cells. Measures of retinal function, such as the electroretinogram, show that photoreceptor function is diminished generally many years before symptomic night blindness, visual-field scotomas, or decreased visual acuity arise. More than 45 genes for retinitis pigmentosa have been identified. These genes account for only about 60% of all patients; the remainder have defects in as yet unidentified genes. Findings of controlled trials indicate that nutritional interventions, including vitamin A palmitate and omega-3-rich fish, slow progression of disease in many patients. Imminent treatments for retinitis pigmentosa are greatly anticipated, especially for genetically defined subsets of patients, because of newly identified genes, growing knowledge of affected biochemical pathways, and development of animal models.
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            Non-syndromic retinitis pigmentosa

            Retinitis pigmentosa (RP) encompasses a group of inherited retinal dystrophies characterized by the primary degeneration of rod and cone photoreceptors. RP is a leading cause of visual disability, with a worldwide prevalence of 1:4000. Although the majority of RP cases are non-syndromic, 20-30% of patients with RP also have an associated non-ocular condition. RP typically manifests with night blindness in adolescence, followed by concentric visual field loss, reflecting the principal dysfunction of rod photoreceptors; central vision loss occurs later in life due to cone dysfunction. Photoreceptor function measured with an electroretinogram is markedly reduced or even absent. Optical coherence tomography (OCT) and fundus autofluorescence (FAF) imaging show a progressive loss of outer retinal layers and altered lipofuscin distribution in a characteristic pattern. Over the past three decades, a vast number of disease-causing variants in more than 80 genes have been associated with non-syndromic RP. The wide heterogeneity of RP makes it challenging to describe the clinical findings and pathogenesis. In this review, we provide a comprehensive overview of the clinical characteristics of RP specific to genetically defined patient subsets. We supply a unique atlas with color fundus photographs of most RP subtypes, and we discuss the relevant considerations with respect to differential diagnoses. In addition, we discuss the genes involved in the pathogenesis of RP, as well as the retinal processes that are affected by pathogenic mutations in these genes. Finally, we review management strategies for patients with RP, including counseling, visual rehabilitation, and current and emerging therapeutic options.
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              Human photoreceptor topography.

              We have measured the spatial density of cones and rods in eight whole-mounted human retinas, obtained from seven individuals between 27 and 44 years of age, and constructed maps of photoreceptor density and between-individual variability. The average human retina contains 4.6 million cones (4.08-5.29 million). Peak foveal cone density averages 199,000 cones/mm2 and is highly variable between individuals (100,000-324,000 cones/mm2). The point of highest density may be found in an area as large as 0.032 deg2. Cone density falls steeply with increasing eccentricity and is an order of magnitude lower 1 mm away from the foveal center. Superimposed on this gradient is a streak of high cone density along the horizontal meridian. At equivalent eccentricities, cone density is 40-45% higher in nasal compared to temporal retina and slightly higher in midperipheral inferior compared to superior retina. Cone density also increases slightly in far nasal retina. The average human retina contains 92 million rods (77.9-107.3 million). In the fovea, the average horizontal diameter of the rod-free zone is 0.350 mm (1.25 degrees). Foveal rod density increases most rapidly superiorly and least rapidly nasally. The highest rod densities are located along an elliptical ring at the eccentricity of the optic disk and extending into nasal retina with the point of highest density typically in superior retina (5/6 eyes). Rod densities decrease by 15-25% where the ring crosses the horizontal meridian. Rod density declines slowly from the rod ring to the far periphery and is highest in nasal and superior retina. Individual variability in photoreceptor density differs with retinal region and is similar for both cones and rods. Variability is highest near the fovea, reaches a minimum in the midperiphery, and then increases with eccentricity to the ora serrata. The total number of foveal cones is similar for eyes with widely varying peak cone density, consistent with the idea that the variability reflects differences in the lateral migration of photoreceptors during development. Two fellow eyes had cone and rod numbers within 8% and similar but not identical photoreceptor topography.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Investigation
                Role: Data curationRole: InvestigationRole: Methodology
                Role: Data curationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curationRole: InvestigationRole: Methodology
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 February 2025
                2025
                : 20
                : 2
                : e0318857
                Affiliations
                [1 ] Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
                [2 ] Singapore National Eye Centre, Singapore Eye Research Institute, and Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore
                [3 ] Genome Institute of Singapore, Singapore, Singapore
                [4 ] Institute for Precision Medicine, SingHealth Duke-NUS Graduate Medical School, Singapore, Singapore
                [5 ] Division for Advanced Medical Research, Center for Research of Laboratory Animals and Medical Research Engineering, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
                Yokohama City University, JAPAN
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ☯ These authors contributed equally to this work as first authors.

                Author information
                https://orcid.org/0009-0000-0612-2576
                https://orcid.org/0000-0001-7474-9194
                https://orcid.org/0009-0007-7124-7595
                https://orcid.org/0000-0002-5356-7604
                Article
                PONE-D-24-48432
                10.1371/journal.pone.0318857
                11838866
                9f920419-3d87-427e-8aea-9034b5d7e2f1
                © 2025 Kominami et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 21 November 2024
                : 22 January 2025
                Page count
                Figures: 4, Tables: 4, Pages: 12
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100001691, Japan Society for the Promotion of Science;
                Award ID: 23K15929
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100019579, SingHealth;
                Award ID: R1748/71/2020
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100019579, SingHealth;
                Award ID: 05/FY2020/EX/06-A41
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100019579, SingHealth;
                Award ID: 05/FY2022/EX(SLP)/69-A131(b)
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100019579, SingHealth;
                Award ID: 05/FY2022/EX(SLP)/69-A131(b)
                Award Recipient :
                All the funding or resources of support for this study were the Japan Society for the Promotion of Science (JSPS) KAKENHI, grant number 23K15929 to TK; the SingHealth Foundation grant number R1748/71/2020 to BJF; and the SingHealth - Duke-NUS Institute of Precision Medicine grant numbers 05/FY2020/EX/06-A41 and 05/FY2022/EX(SLP)/69-A131(b) to KJ, YMB, and WKL. Funding organizations had no role in the design or conduct of this study. There was no additional external funding received for this study.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Eye Diseases
                Retinal Disorders
                Retinitis
                Retinitis Pigmentosa
                Medicine and Health Sciences
                Ophthalmology
                Eye Diseases
                Retinal Disorders
                Retinitis
                Retinitis Pigmentosa
                Biology and Life Sciences
                Genetics
                Human Genetics
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                Anatomy
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                Anatomy
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                Cell Biology
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                Biology and Life Sciences
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                Cell Biology
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                People and Places
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                Singapore
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                Mathematical and Statistical Techniques
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                Custom metadata
                All relevant data for this study are publicly available from the Nagoya University Institutional Repository ( http://hdl.handle.net/2237/0002011889).

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