8 research outputs found
Ocular Signs Correlate Well with Disease Severity and Genotype in Fabry Disease
<div><p>Ocular signs in Fabry disease have generally been regarded to be primarily of diagnostic value. We explored whether ocular findings, alone or in particular in combination with the α-galactosidase A gene mutation, have predictive value for disease severity. Data from the Fabry Outcome Survey (FOS), a large, global database sponsored by Shire, were selected for adult patients who had undergone ophthalmological examination. Three ocular signs were assessed: cornea verticillata, tortuous conjunctival and/or retinal vessels, and cataract. Fabry disease severity was measured using FOS Mainz Severity Score Index and modifications thereof. Ophthalmological data were available for 1203 (699 female, 504 male) adult patients with eye findings characteristic of Fabry disease in 55.1%. Cornea verticillata had a similar distribution in women (51.1%) and men (50.8%), whereas tortuous vessels and Fabry cataract were somewhat more frequent in men than in women. Patients with cornea verticillata, selected as the principal ocular sign for this study, had more severe disease (median score, 20.0) versus those without ocular signs (11.0; <i>P</i><0.001). This finding could be confirmed by applying age adjusted severity scores. Moreover, the prevalence of cornea verticillata was significantly higher in patients with null (male, 76.9%; female, 64.5%) and missense (male, 79.2%; female, 67.4%) mutations versus mild missense (male, 17.1%; female, 23.1%) and the p.N215S (male, 15.0%; female, 15.6%) mutations (<i>P</i><0.01). Our analyses show a correlation between the prevalence of ocular changes in Fabry disease and disease severity. Consequently, information on ocular findings and α-galactosidase A gene mutation may help assess the risk for more severe Fabry disease. These observed findings are of notable clinical importance, as Fabry disease is characterized by high clinical course variability and only weak genotype-phenotype correlation at the individual patient level. Further confirmatory studies are needed.</p></div
Representative ocular changes seen in patients with Fabry disease.
<p>Representative ocular changes include (A) cornea verticillata, (B) increased tortuosity of conjunctival vessels, and (C) increased tortuosity of retinal vessels.</p
Disease severity score by type of mutation and presence of cornea verticillata.
<p>Median ariFOS-MSSI score by type of mutation and presence of cornea verticillata in adult (A) male and (B) female patients. ariFOS-MSSI = age-related individual Fabry Outcome Survey Mainz severity score index.</p
FOS-MSSI and ariFOS-MSSI score, and eye changes.
<p>Median (A) FOS-MSSI and (B) ariFOS-MSSI scores in male and female adult patients with and without eye findings. ariFOS-MSSI = age-related individual Fabry Outcome Survey Mainz severity score index; FOS-MSSI = Fabry Outcome Survey Mainz severity score index. The median FOS-MSSI and ariFOS-MSSI scores represent the medians after removing cornea verticillata from the calculation of the FOS-MSSI score.</p
Prevalence of eye findings by type of mutation.
<p>Prevalence of eye findings overall (among those patients with mutation information available) and by type of mutation in adult (A) male and (B) female patients.</p
The graphs show the CT values across different subgroups of age (A), disease duration (B), visual acuity (C), as well as with Fishman phenotype (D), visual field severity stage (E) and ERG alteration grade (F).
<p>The graphs show the CT values across different subgroups of age (A), disease duration (B), visual acuity (C), as well as with Fishman phenotype (D), visual field severity stage (E) and ERG alteration grade (F).</p
The pictures outline the variability of choroidal thickness in STGD.
<p>A) In this patient a thin choroid was associated with a Fishman phenotype 2, a relatively early onset (15 years) and a longer duration (11 years) of the disease. Visual acuity was 20/400, visual field loss consisted of paracentral scotomas and ERG photopic response was severely abnormal. B) In this patient a thick choroid was associated with a Fishman phenotype 1, a relatively late onset (25 years) and short duration (5 years) of the disease. Visual acuity was 20/200, visual field loss was limited to a central scotoma while ERG shows abnormal photopic response.</p
The pictures compare an EDI-OCT scan where choroidal borders could be reliably identified (A) with another scan with ill-defined choroidal borders (B).
<p>The pictures compare an EDI-OCT scan where choroidal borders could be reliably identified (A) with another scan with ill-defined choroidal borders (B).</p