Familial exudative vitreoretinopathy (FEVR) is a hereditary ocular disorder characterized by a failure of peripheral retinal vascularization. Loci associated with FEVR map to 11q13-q23 (EVR1; OMIM 133780, ref. 1), Xp11.4 (EVR2; OMIM 305390, ref. 2) and 11p13-12 (EVR3; OMIM 605750, ref. 3). Here we have confirmed linkage to the 11q13-23 locus for autosomal dominant FEVR in one large multigenerational family and refined the disease locus to a genomic region spanning 1.55 Mb. Mutations in FZD4, encoding the putative Wnt receptor frizzled-4, segregated completely with affected individuals in the family and were detected in affected individuals from an additional unrelated family, but not in normal controls. FZD genes encode Wnt receptors, which are implicated in development and carcinogenesis. Injection of wildtype and mutated FZD4 into Xenopus laevis embryos revealed that wildtype, but not mutant, frizzled-4 activated calcium/calmodulin-dependent protein kinase II (CAMKII) and protein kinase C (PKC), components of the Wnt/Ca(2+) signaling pathway. In one of the mutants, altered subcellular trafficking led to defective signaling. These findings support a function for frizzled-4 in retinal angiogenesis and establish the first association between a Wnt receptor and human disease.

The clinical features in the three children and their relatives with a documented FZD4 mutation support the previous reports of a high degree of intrafamilial and interfamilial variability in FEVR. In extreme cases with very early onset, the development of a retinal fold can mimic PFV, a non-hereditary condition with rare exception.

Background: To develop a consensus strategy for the management of patients at risk for age-related macular degeneration (AMD) for Canadian ophthalmologists, optometrists and physicians. Methods: Development of a consensus strategy began with a review of the literature and existing guidelines. A panel of retina specialists, ophthalmologists, and optometrists from across Canada assessed this evidence to distill what was learned and use this knowledge as the basis for developing a consensus strategy for managing patients at risk of AMD. Results: The expert panel has developed a series of recommendations for Canadian eyecare providers (eg. ophthalmologists, optometrists) and physicians to adopt as a preventive strategy for patients at risk of AMD. Interpretation: This consensus strategy is a practical guideline that can be adopted in the office setting to manage patients at risk of AMD and to advise patients with questions and concerns about AMD.

Contexte : Élaborer une stratégie consensuelle pour la gestion des patients à risque de dégénérescence maculaire liée à l’âge (DMLA) à l’intention des ophtalmologistes, optométristes et médecins du Canada. Méthodes : L’élaboration d’une stratégie consensuelle a débuté avec la recension des textes et un examen des lignes directrices existantes. Un groupe de spécialistes de la rétine, d’ophtalmologistes et d’optométristes provenant d’un bout à l’autre du Canada a évalué cette information probante pour distiller ce qui a été appris et utiliser ces connaissances comme point de départ pour l’élaboration d’une stratégie consensuelle pour la gestion des patients à risque de DMLA. Résultats : Le groupe d’experts a élaboré une série de recommandations à l’intention des fournisseurs de soins oculovisuels (p. ex., ophtalmologistes, optométristes) et médecins du Canada pour l’adoption d’une stratégie préventive dans le cas des patients à risque de DMLA. Interprétation : La présente stratégie consensuelle est une ligne directrice pratique qui peut être adoptée dans un bureau pour gérer les patients à risque de DMLA et pour informer les patients qui ont des questions ou des préoccupations relatives à la DMLA.

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