U-M team: Genetic testing sheds light on degenerative eye disease

February 14, 2007

Genetic testing for eye disease is providing vital information about complex retinal diseases, especially when used to confirm a clinician’s diagnosis.

In a newly published review of such tests that were conducted over a five-year period at the University of Michigan Kellogg Eye Center, scientists were able to confirm a clinician’s diagnosis in half of the cases. The testing took place in the laboratory of Radha Ayyagari, Ph.D., director of Kellogg’s Ophthalmic Molecular Diagnostic Laboratory.

In the February issue of Archives of Ophthalmology, Ayyagari and her colleagues report on 350 genetic tests conducted since 1999, when the U-M Ophthalmic Molecular Diagnostic Laboratory became one of the first laboratories in the nation to receive government approval for ophthalmic testing under the Clinical Laboratory Improvement Amendment (CLIA). For each test described in the current study, scientists analyzed one or more of eight genes known to cause diseases of the retina.

Of the 350 tests, 266 were performed to confirm a clinician’s diagnosis, by far the most common use of genetic testing for eye disease. Another 75 tests sought to determine whether an individual was a “carrier” of a disease, and nine tests were used to predict the likelihood that an individual with a family history of a given eye disease would go on to develop it.

Ayyagari’s team was able to determine the molecular basis of the disease in half of 266 tests conducted to confirm a diagnosis. These results are significant because many retinal diseases present similar symptoms, and it is sometimes difficult for even the most skilled specialist to distinguish one from the other. By comparing a patient’s DNA to known disease-causing genes, scientists deliver information needed to confirm or rule out a diagnosis. To date, scientists have identified over 130 genes associated with retinal disease, such as retinitis pigmentosa and macular degeneration.

The authors observe that genetic testing for eye disease is a relatively new and evolving practice. Says Ayyagari, “Molecular diagnostics does not replace the necessary expertise of the ophthalmologist; rather, it adds a new tool to the ophthalmologist’s diagnostic arsenal.”

The report describes one case in which parents with no family history of retinal degeneration requested genetic testing in hopes of revealing the specific nature of their son’s eye disease. They also wanted to know whether the younger son, who was experiencing more subtle symptoms, had the same disease or a milder vision problem due to a different disease. Testing revealed that both boys had two gene mutations linked to Stargardt’s macular degeneration, a blinding disease that begins in childhood.

Genetic counseling is a crucial part of the genetic testing process, particularly when the patient may face the possibility of blindness, says Ayyagari. The family needs to prepare for all possible test results, understand the implications of test results for the patient and other family members, and be aware of the limitations of genetic testing. If physicians do not have the time or skills to provide this background, Ayyagari urges them to refer their patients to genetic counselors.

The study also reported that a diagnosis could not be confirmed in 133 cases, or half the tests conducted to confirm a diagnosis. “It is very difficult for patients to understand that the test may not be definitive,” says Ayyagari. “Genetic testing may not always yield the firm facts we receive in other kinds of testing, such as blood tests for cholesterol levels.”

A related point of confusion is that an inconclusive result does not necessarily rule out a diagnosis for a given disease. Limitations still exist in technologies for genetic testing, explains Ayyagari. In addition, very slight genetic variations believed to be benign may have either a cumulative effect or may alter the way another gene functions. Finally, while there has been great progress, scientists have yet to identify all the genes that contribute to disease of the retina.

“Tomorrow we may discover a new gene that explains many of the previously inconclusive test reports,” says Ayyagari.

In a related paper in the same issue of Archives of Ophthalmology, Stephen Daiger, Ph.D., University of Texas Health Science Center, writes on the promise of genetic testing for eye disease. He says, “Across all of the categories of inherited retinopathy, careful screening of known disease genes leads to detection of pathogenic mutations in 25% to 90% of patients, an extraordinary accomplishment.”

It is to the patient’s advantage to have a molecular diagnosis on file, observes Ayyagari. “When treatments begin to emerge for these complex genetic diseases,” she says, “the individual’s genotype may determine whether a new treatment will be the one that works for that patient.”

Source: University of Michigan Health System

Explore further: Genetic mutation in extended Amish family in Indiana protects against aging and increases longevity (Update)

Related Stories

Genetic mutation in extended Amish family in Indiana protects against aging and increases longevity (Update)

November 15, 2017
The first genetic mutation that appears to protect against multiple aspects of biological aging in humans has been discovered in an extended family of Old Order Amish living in the vicinity of Berne, Indiana, report Northwestern ...

Research exploring common biology of cancer, infection and psychiatric disease

November 16, 2017
Nevan Krogan, PhD, is a mapmaker, but the object of his exploration is not any newfound continent or alien world. Instead, he and his colleagues map cells. Rather than cities, towns and interstates, these maps show proteins, ...

Age and gut bacteria contribute to multiple sclerosis disease progression

November 17, 2017
Researchers at Rutgers Robert Wood Johnson Medical School published a study suggesting that gut bacteria at young age can contribute to multiple sclerosis (MS) disease onset and progression.

New player in Alzheimer's disease pathogenesis identified

November 14, 2017
Scientists at Sanford Burnham Prebys Medical Discovery Institute (SBP) have shown that a protein called membralin is critical for keeping Alzheimer's disease pathology in check. The study, published in Nature Communications, ...

New cancer cell screening is improving childhood leukaemia treatment

November 14, 2017
A study has shown that current methods used to determine the correct level of chemotherapy required for each young patient may be improved by looking at the genetic make-up of the child's cancer cells.

Wider sampling of tumor tissues may guide drug choice, improve outcomes

November 15, 2017
A new study focused on describing genetic variations within a primary tumor, differences between the primary and a metastatic branch of that tumor, and additional diversity found in tumor DNA in the blood stream could help ...

Recommended for you

Hibernating ground squirrels provide clues to new stroke treatments

November 17, 2017
In the fight against brain damage caused by stroke, researchers have turned to an unlikely source of inspiration: hibernating ground squirrels.

Molecular guardian defends cells, organs against excess cholesterol

November 16, 2017
A team of researchers at the Harvard T. H. Chan School of Public Health has illuminated a critical player in cholesterol metabolism that acts as a molecular guardian in cells to help maintain cholesterol levels within a safe, ...

Prototype ear plug sensor could improve monitoring of vital signs

November 16, 2017
Scientists have developed a sensor that fits in the ear, with the aim of monitoring the heart, brain and lungs functions for health and fitness.

Ancient enzyme could boost power of liquid biopsies to detect and profile cancers

November 16, 2017
Scientists are developing a set of medical tests called liquid biopsies that can rapidly detect the presence of cancers, infectious diseases and other conditions from only a small blood sample. Researchers at The University ...

FDA to crack down on risky stem cell offerings

November 16, 2017
U.S. health authorities announced plans Thursday to crack down on doctors pushing stem cell procedures that pose the gravest risks to patients amid an effort to police a burgeoning medical field that previously has received ...

Engineering the gut microbiome with 'good' bacteria may help treat Crohn's disease

November 15, 2017
Penn Medicine researchers have singled out a bacterial enzyme behind an imbalance in the gut microbiome linked to Crohn's disease. The new study, published online this week in Science Translational Medicine, suggests that ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.