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Purpose To determine the frequency and severity of visual function loss in female carriers of X-linked retinitis pigmentosa (XLRP). Design Case series. Participants XLRP carriers with cross-sectional data (n = 242) and longitudinal data (n = 34, median follow-up: 16 years, follow-up range: 3–37 years). Half of the carriers were from RPGR- or RP2-genotyped families. Methods Retrospective medical records review. Main Outcome Measures Visual acuities, visual field areas, final dark adaptation thresholds, and full-field ERGs to 0.5 Hz and 30 Hz flashes. Results In genotyped families, 40% of carriers showed a baseline abnormality on at least one of the three psychophysical tests. There was a wide range of function among carriers; for example 3 of 121 (2%) of genotyped carriers were legally blind due to poor visual acuity, some as young as 35 years of age. Visual fields were less affected than visual acuity. In all carriers, the average ERG amplitude to 30 Hz flashes was about 50% of normal, and the average exponential rate of amplitude loss over time was half that of XLRP males (3.7%/year vs 7.4%/year, respectively). Among obligate carriers with affected fathers and/or sons, 53 of 55 (96%) had abnormal baseline ERGs. Some carriers who initially had completely normal fundi in both eyes went on to develop moderately decreased vision, though not legal blindness. Among carriers with RPGR mutations, those with mutations in ORF15, compared to those in exons 1–14, had worse final dark adaptation thresholds and lower 0.5 Hz and 30 Hz ERG amplitudes. Conclusions Most carriers of XLRP had mildly or moderately reduced visual function but rarely became legally blind. In most cases, obligate carriers could be identified by ERG testing. Carriers of RPGR ORF15 mutations tended to have worse visual function than carriers of RPGR exon 1–14 mutations. Since XLRP carrier ERG amplitudes and decay rates over time were on average half of those of affected males, these observations were consistent with the Lyon hypothesis of random X-inactivation.
Purpose To determine the frequency and severity of visual function loss in female carriers of X-linked retinitis pigmentosa (XLRP). Design Case series. Participants XLRP carriers with cross-sectional data (n = 242) and longitudinal data (n = 34, median follow-up: 16 years, follow-up range: 3–37 years). Half of the carriers were from RPGR- or RP2-genotyped families. Methods Retrospective medical records review. Main Outcome Measures Visual acuities, visual field areas, final dark adaptation thresholds, and full-field ERGs to 0.5 Hz and 30 Hz flashes. Results In genotyped families, 40% of carriers showed a baseline abnormality on at least one of the three psychophysical tests. There was a wide range of function among carriers; for example 3 of 121 (2%) of genotyped carriers were legally blind due to poor visual acuity, some as young as 35 years of age. Visual fields were less affected than visual acuity. In all carriers, the average ERG amplitude to 30 Hz flashes was about 50% of normal, and the average exponential rate of amplitude loss over time was half that of XLRP males (3.7%/year vs 7.4%/year, respectively). Among obligate carriers with affected fathers and/or sons, 53 of 55 (96%) had abnormal baseline ERGs. Some carriers who initially had completely normal fundi in both eyes went on to develop moderately decreased vision, though not legal blindness. Among carriers with RPGR mutations, those with mutations in ORF15, compared to those in exons 1–14, had worse final dark adaptation thresholds and lower 0.5 Hz and 30 Hz ERG amplitudes. Conclusions Most carriers of XLRP had mildly or moderately reduced visual function but rarely became legally blind. In most cases, obligate carriers could be identified by ERG testing. Carriers of RPGR ORF15 mutations tended to have worse visual function than carriers of RPGR exon 1–14 mutations. Since XLRP carrier ERG amplitudes and decay rates over time were on average half of those of affected males, these observations were consistent with the Lyon hypothesis of random X-inactivation.
A study of 707 cases of retinitis pigmentosa and choroideraemia presenting over 12 years were classified according to their modes of inheritance -439 autosomal recessive (62%), 193 autosomal dominant (27O/o), 75 X-linked (10.7%). The patients with autosomal recessive transmission included 58 Usher syndrome, 12 Laurence-Moon-Bardet-Biedl syndrome and 33 Leber's congenital amaurosis. Another 37 had an early onset with macular degeneration and 31 were of late onset with pericentral dystrophy. Forty two were offspring of consanguineous parents. Of 193 individuals (78 families) with autosomal dominant inheritance, 20% had night blindness from early childhood. With Xlinked transmission, 33 males and 31 female carriers comprised the retinitis pigmentosa group and eight males and three carrier females, choroideraemia. Almost all this X-linked group were of British ancestry. Of patients originating from the Mediterranean area, 94% had autosomal recessive disease.
X-linked retinitis pigmentosa (XLRP) is manifested in affected males in their first decade and results in blindness by the third or fourth decade. Carrier detection is difficult since most carrier females show no or only equivocal signs well into or beyond their reproductive years. The genes, or the mutations causing RP have not been identified but at least two have been localised to the short arm of the X chromosome provisionally named RP2 and RP3. Identifying inheritance of one or other of these genes must be done by linkage in families using close, informative DNA markers. Here we report the localisation of a highly informative polymerase chain reaction (PCR) detectable microsatellite marker DXS538 using a previously studied family with X-linked RP3 in which recombination had occurred in the region of importance. The DXS538 dinucleotide repeat locus was previously localised to Xp21 .l-pl1.21 to study RP3 in one XLRP family. Using published RFLP data we narrowed the localisation of DXS538 to the region Xp21 .1-pl1.23. Thus DXS538 is now a convenient diagnostic tool, aiding carrier detection of XLRP in females, as shown in the family presented here.Key words: (CA), dinucleotide repeat microsatellite, polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), X-linked retinitis pigmentosa (XLRP).X-linked retinitis pigmentosa (XLRP; also X-linked pigmentary retinal dystrophy) is characterised by progressive contraction of the visual fields, night blindness, widespread pigmentary changes in the retina and an absence of electroretinal responses. Manifestation in affected males begins in the first decade and results in blindness by the third or fourth decade.' Most carrier females show no or only equivocal signs of the defect well into or beyond their reproductive years, making early carrier detection by electrophysiological and psychophysical testsThe localisation of two separate loci for retinitis pigmentosa RP2 and RP3 and a possible third RP6 on the x chromosome makes carrier detection possible by DNA technique^.^.^ Using closely linked restriction fragment length polymorphisms (RFLPs), the segregation of XLRP can be followed for carrier detection. Traditionally this involved Southern blotting using RFLPs which often lacked information because only few variants were possible to distinguish between chromosomes and women were seen as homozygous such that a definite answer is only possible in a few families. In the family studied here the XLRP locus has been previously shown using linkage analysis to be in the distal location (RP3).' However, the RFLPs used in the region of RP3 were not informative since the haplotypes of the family members were almost always identical. Therefore, in the absence of appropriate RFLPs centromeric to the ornithine trans carbamylase (OTC) locus, polymerase chain reaction (PCR) was used to amplify a (CA), repeat microsatellite marker DXS538 to provide information enabling distinction between the normal and disease carrying chromosome. DXS538 (previously lo...
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