Retinitis pigmentosa

Retinitis pigmentosa
Classification and external resources
File:Fundus of patient with retinitis pigmentosa, mid stage.jpg Fundus of patient with retinitis pigmentosa, mid stage (Bone spicule-shaped pigment deposits are present in the mid periphery along with retinal atrophy, while the macula is preserved although with a peripheral ring of depigmentation. Retinal vessels are attenuated.) From a review by Christian Hamel, 2006.
ICD-10	H35.5
ICD-9	362.74
OMIM	268000
MeSH	D012174

File:Human eyesight two children and ball normal vision.jpg

Normal vision. Courtesy NIH National Eye Institute

File:Human eyesight two children and ball with retinitis pigmentosa or tunnel vision.png

The same view with tunnel vision from retinitis pigmentosa. The blackness surrounding the central image does not indicate darkness, but rather a lack of perceived visual information.

Retinitis pigmentosa (RP) is a group of genetic eye conditions that leads to incurable blindness. In the progression of symptoms for RP, night blindness generally precedes tunnel vision by years or even decades. Many people with RP do not become legally blind until their 40s or 50s and retain some sight all their lives. Others go completely blind from RP, in some cases as early as childhood. Progression of RP is different in each case.

RP is a type of progressive retinal dystrophy, a group of inherited disorders in which abnormalities of the photoreceptors (rods and cones) or the retinal pigment epithelium (RPE) of the retina lead to progressive visual loss. Affected individuals first experience defective dark adaptation or nyctalopia (night blindness), followed by reduction of the peripheral visual field (known as tunnel vision) and, sometimes, loss of central vision late in the course of the disease.

Signs

Mottling of the retinal pigment epithelium with black bone-spicule pigmentation is typically indicative (or pathognomonic) of retinitis pigmentosa. Other ocular features include waxy pallor of the optic nerve head, attenuation (thinning) of the retinal vessels, cellophane maculopathy, cystic macular edema and posterior subcapsular cataract.

Diagnosis

The diagnosis of retinitis pigmentosa relies upon documentation of progressive loss in photoreceptor cell function by electroretinography (ERG) and visual field testing.

The mode of inheritance of RP is determined by family history. At least 35 different genes or loci are known to cause "nonsyndromic RP" (RP that is not the result of another disease or part of a wider syndrome).

DNA testing is available on a clinical basis for:

• RLBP1 (autosomal recessive, Bothnia type RP)
• RP1 (autosomal dominant, RP1)
• RHO (autosomal dominant, RP4)
• RDS (autosomal dominant, RP7)
• PRPF8 (autosomal dominant, RP13)
• PRPF3 (autosomal dominant, RP18)
• CRB1 (autosomal recessive, RP12)
• ABCA4 (autosomal recessive, RP19)
• RPE65 (autosomal recessive, RP20)

For all other genes, molecular genetic testing is available on a research basis only.

RP can be inherited in an autosomal dominant, autosomal recessive, or X-linked manner. X-linked RP can be either recessive, affecting primarily only males, or dominant, affecting both males and females, although males are usually more mildly affected. Some digenic (controlled by two genes) and mitochondrial forms have also been described.

Genetic counseling depends on an accurate diagnosis, determination of the mode of inheritance in each family, and results of molecular genetic testing.

Associations

Retinitis pigmentosa is seen in a variety of diseases, so the differential of this sign alone, is broad.

• RP combined with deafness (congenital or progressive) is called Usher syndrome.
• RP combined with opthalmoplegia, dysphagia, ataxia, and cardiac conduction defects is seen in the mitochondrial DNA disorder Kearns-Sayre syndrome (aka Ragged Red Fiber Myopathy)
• RP combined with retardation, peripheral neuropathy, acanthotic (spiked) RBCs, ataxia, steatorrhea, is absence of VLDL is seen in abetalipoproteinemia.

Other conditions include neurosyphilis, toxoplasmosis(Emedicine "Retinitis Pigmentosa"), abetalipoproteinemia, and Refsum's disease.

Genetics

Retinitis pigmentosa (RP) is one of the most common forms of inherited retinal degeneration. This disorder is characterized by the progressive loss of photoreceptor cells and may eventually lead to blindness.

There are multiple genes that, when mutated, can cause the Retinitis pigmentosa phenotype. In 1989, a mutation of the gene for rhodopsin, a pigment that plays an essential part in the visual transduction cascade enabling vision in low-light conditions, was identified. Since then, more than 100 mutations have been found in this gene, accounting for 15% of all types of retinal degeneration. Most of those mutations are missense mutations and inherited mostly in a dominant manner.

The rhodopsin gene encodes a principal protein of photoreceptor outer segments. Studies show that mutations in this gene are responsible for approximately 25% of autosomal dominant forms of RP.

Mutations in four pre-mRNA splicing factors are known to cause autosomal dominant retinitis pigmentosa. These are PRPF3, PRPF8, PRPF31 and PAP1. These factors are ubiquitously expressed and it is still a puzzle as to why defects in a ubiquitous factor should only cause disease in the retina.

Up to 150 mutations have been reported to date in the opsin gene associated with the RP since the Pro23His mutation in the intradiscal domain of the protein was first reported in 1990. These mutations are found throughout the opsin gene and are distributed along the three domains of the protein (the intradiscal, transmembrane, and cytoplasmic domains). One of the main biochemical causes of RP in the case of rhodopsin mutations is protein misfolding, and molecular chaperones have also been involved in RP. It was found that the mutation of codon 23 in the rhodopsin gene, in which proline is changed to histidine, accounts for the largest fraction of rhodopsin mutations in the United States. Several other studies have reported other mutations which also correlate with the disease. These mutations include Thr58Arg, Pro347Leu, Pro347Ser, as well as deletion of Ile-255. In 2000, a rare mutation in codon 23 was reported causing autosomal dominant retinitis pigmentosa, in which proline changed to alanine. However, this study showed that the retinal dystrophy associated with this mutation was characteristically mild in presentation and course. Furthermore, there was greater preservation in electroretinography amplitudes than the more prevalent Pro23His mutation.

Treatment

Although incurable the progression of the disease can be reduced by the daily intake of 15000 IU (equivalent to 4.5 mg) of vitamin A palmitate. Recent studies have shown that proper vitamin A supplementation can postpone blindness by up to 10 years (by reducing the 10% loss pa to 8.3% pa).

September 2010. Other alternative treaments, most are not recognized by Western medicine which include: acupuncture, notalby Per Otte, Freddy Dalghren, Weidong Yu and others have case load after case load of successful treatments to restore the rods and cones within the eye. A high quality vision type vitamin. Other self-treatments would be ways to enhance the nutrition of the eye from a "Whole Food" source. Learn about phytochemicals in foods, and foods rich in lutein and zeaxanthin. These following foods are extremely high with these ingredients and other forms of vitamins/minerials that are excellent for vision problems...In order of their importance: gogi berries (those from higher altitiute, not the vally areas), raw spinach, yellow (esp. red if you can find it) corn, carrots, orange bell peppers, egg yolk, kale. A blend of basil, ginger, cilantro and peppermint mixed into a smoothie-type-drink and include any of the ingredients noted here. Other important foods include; blueberries, almonds (the fat in these helps with the vitamins absorbsion), maca root, camu berry powder, raw chocolate beans, black sesame seeds, ginseng extract, royal jelly freeze dried powder, kang yuan cordyceps, shitake and maitake mushrooms cooked in meals. And a final note, use olive oil or hemp oil on salads, do not cook with the olive oil.

Research on possible treatments

Future treatments may involve retinal transplants, artificial retinal implants, gene therapy, stem cells, nutritional supplements, and/or drug therapies.

2006: Stem cells: UK Researchers working with mice, transplanted mouse stem cells which were at an advanced stage of development, and already programmed to develop into photoreceptor cells, into mice that had been genetically induced to mimic the human conditions of retinitis pigmentosa and age-related macular degeneration. These photoreceptors developed and made the necessary neural connections to the animal's retinal nerve cells, a key step in the restoration of sight. Previously it was believed that the mature retina has no regenerative ability. This research may in the future lead to using transplants in humans to relieve blindness.

2008: Scientists at the Osaka Bioscience Institute have identified a protein, named Pikachurin, which they believe could lead to a treatment for retinitis pigmentosa.

2010: A possible gene therapy seems to work in mice.

2010:R-Tech Ueno(Japanese Medicine manufacture enterprise )Completes Phase II Clinical Study on Ophthalmic Solution UF-021 (Product Name Ocuseva (TM)) on Retinitis Pigmentosa

Notable people with RP

• Willie Brown, former Mayor of San Francisco
• Viviane Forest, Canadian Paralympic alpine skier
• Gordon Gund, U.S. sports team owner
• Leslie Knipfing (sister of Kevin James)
• Jim Knipfel, American novelist, autobiographer, and journalist
• Amar Latif Scottish entrepreneur, television actor, director and motivational speaker
• Isaac Lidsky, former child actor and first blind US Supreme Court clerk
• Woody Shaw, American jazz musician
• Amanda Swafford, American supermodel and television personality
• John Totleben, American illustrator
• Rigo Tovar, Mexican singer, composer, songwriter
• Mildred Weisenfeld, founder of the Fight for Sight eye research foundation in 1946.
• Thomas Wolf, Competitive Snowboarder (Forum Snowboards and Dragon Eyewear), Digital Artist, and Mobility Specialist for blinded veterans.
• Steve Wynn, Las Vegas casino developer
• Ched Towns, Australian triathlete and motivational speaker
• Helgi Hjörvar, member of the Icelandic parliament.
• Sheena Iyengar, Management Guru.
• Tony Sarre, Filmmaker
• Soroor Ahmed, Author of the book "The Jewish Obsession", and a journalist, India.

See also

• Cone dystrophy
• Visual prosthetic
• List of eye diseases and disorders
• Progressive retinal atrophy for the condition in dogs

External links

• 12px Media related to retinitis pigmentosa at Wikimedia Commons

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