Macular Degeneration: Musch DC

Musch DC, Gillespie BW. · No affiliation provided · Ophthalmology. · Pubmed #16389103 No free full text.

This publication has no abstract.

Leveque TK, Yu L, Musch DC, Chervin RD, Zacks DN. · Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105, USA. · Sleep Breath. · Pubmed #17457629 No free full text.

Abstract: Patients with obstructive sleep apnea (OSA), in comparison to controls, have increased levels of circulating epinephrine and norepinephrine, both of which are risk factors for the development of central serous chorioretinopathy (CSCR). The aim of this pilot study was to investigate the frequency of symptoms that suggest OSA in CSCR patients and normal controls. The Berlin Questionnaire, a validated research tool to assess risk for OSA, was administered to 29 patients who met the criteria for active, acute, non-steroid-induced CSCR and 29 controls matched for age and sex. In this retrospective case-controlled study, the main outcome measure was increased risk for OSA. The mean age of the patients was 47.8 years (range 29-72) and the mean age of controls was 47.3 years (range 25-70). Seventy-six percent (22) of both groups were men. Survey scores showed 58.6% (17) of patients with CSCR to be at an increased risk for OSA compared to 31.0% (nine) of controls. A conditional logistic regression analysis showed that the CSCR group had a higher proportion with an increased risk for OSA compared to the control group (odds ratio=3.67; 95% CI: 1.02, 13.14; P = 0.046). Patients with CSCR may be more likely than other adults to have OSA, and screening for this sleep disorder should be considered in this population. Further research is warranted to determine whether sleep apnea may contribute to the development of CSCR, and to assess whether treatment of sleep apnea might offer a new therapeutic option for some patients with CSCR.

Vasireddy V, Jablonski MM, Mandal MN, Raz-Prag D, Wang XF, Nizol L, Iannaccone A, Musch DC, Bush RA, Salem N, Sieving PA, Ayyagari R. · Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan 48105, USA. · Invest Ophthalmol Vis Sci. · Pubmed #17003453 links to  free full text

Abstract: PURPOSE: To develop and characterize a heterozygous knock-in mouse model carrying the 5-bp deletion in Elovl4 (E_mut+/-) and to study the pathology underlying Stargardt-like macular degeneration (STGD3). METHODS: E_mut+/- mice were generated by targeting a 5-bp deletion (AACTT) in the Elovl4 gene by homologous recombination. E_mut+/- mice of age 2 to 18 months and age-matched wild-type (Wt) littermate control animals were analyzed for the expression of Elovl4 transcript, ELOVL4 protein, photoreceptor-specific genes, and retinal fatty acid composition. Functional retinal changes were evaluated by electroretinography (ERG) and by morphologic and ultrastructural criteria. RESULTS: E_mut+/- mice retinas showed the presence of both Wt and mutant Elovl4 transcripts and proteins. Morphologic evaluation revealed cone photoreceptor ultrastructural abnormalities as early as 2 months of age, accumulation of lipofuscin in retinal pigment epithelium (RPE), and subretinal deposits at later ages. Shortening of rod outer segments (OS) was observed at approximately 10 months of age. Both cone and rod changes progressed with age. Unlike rod-specific genes, expression of selected cone specific genes was significantly reduced by 7 months of age. Mixed rod-cone and light-adapted b-waves were higher than normal at both 8 and 15 months. Levels of the fatty acids 20:5 (P = 0.027), 22:5 (P = 0.040) and 24:6 (P = 0.005) were found to be significantly lower in the retinas of E_mut+/- mice than in retinas of control subjects. CONCLUSIONS: E_mut+/- animals display characteristic features associated with Stargardt-like macular degeneration and serve as a model for the study of the mechanism underlying STGD3.

Haan MN, Klein R, Klein BE, Deng Y, Blythe LK, Seddon JM, Musch DC, Kuller LH, Hyman LG, Wallace RB. · Department of Epidemiology, University of Michigan, 611 Church Street, Ann Arbor, MI 48104, USA. · Arch Ophthalmol. · Pubmed #16832022 links to  free full text

Abstract: OBJECTIVE: To determine the effectiveness of treatment with conjugated equine estrogens (CEE) or with CEE combined with progestin (CEE + P) on age-related macular degeneration (AMD). METHODS: In an ancillary study to the Women's Health Initiative clinical trial of hormone therapy, 4262 women 65 years and older underwent fundus photography for the determination of AMD. Participants were recruited from April 2000 to June 2002 at 21 clinical sites an average of 5 years after randomization. Participants were randomized to treatment with CEE, CEE + P, or placebo. Participants had been treated for an average of 5 years at the ophthalmic evaluation for AMD. RESULTS: The overall prevalence of any AMD was 21.0%. No association was found between CEE + P (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.75-1.11) or CEE alone (OR, 0.98; 95% CI, 0.78-1.25) and early-stage AMD. The CEE + P was associated with a reduced risk of soft drusen (OR, 0.83; 95% CI, 0.68-1.00) after adjustment for covariates and with a reduced risk of neovascular AMD (OR, 0.29; 95% CI, 0.09-0.92). CONCLUSIONS: Treatment with CEE alone or CEE + P does not affect early- or late-stage AMD. Treatment with CEE + P may reduce the risk of soft drusen or neovascular AMD.

Friberg TR, Musch DC, Lim JI, Morse L, Freeman W, Sinclair S, Anonymous00275. · Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. · Ophthalmology. · Pubmed #16581422 No free full text.

Abstract: OBJECTIVE: To determine the effects of subthreshold 810-nm-diode laser treatment on the rate of development of choroidal neovascularization (primary end point) and the effect on visual acuity (VA) in participants with multiple large drusen in one eye and a preexisting neovascular age-related macular degeneration (AMD) lesion in the other. DESIGN: Multicenter, prospective, randomized controlled trial. PARTICIPANTS: Two hundred forty-four patients > or =50 years of age and with a neovascular or advanced AMD lesion in one eye and, in the fellow "study" eye, (1) at least 5 drusen > or = 63 mum in diameter, (2) Early Treatment Diabetic Retinopathy Study best-corrected VA (BCVA) of 20/63 or better, and (3) no evidence of neovascularization at baseline. METHODS: Patients were randomized to treatment or observation of their study eye at each of 22 centers. At each visit, the protocol specified that BCVA, a complete retinal examination, and fluorescein angiography be documented. Treated eyes had a grid of 48 extrafoveal, subthreshold diode (810 nm) laser spots, 125 mum in diameter, placed in an annulus outside of the foveola. Patients were seen at baseline and at 3, 6, 12, 18, 24, 30, and 36 months after randomization. No retreatments were allowed. MAIN OUTCOME MEASURES: Development of choroidal neovascularization (as confirmed by fluorescein angiography) and change in BCVA. RESULTS: Throughout follow-up, the rate of choroidal neovascularization events in treated eyes consistently exceeded that in observed eyes. At 1 year, the difference was 15.8% versus 1.4% (P = 0.05). Most of the intergroup differences in choroidal neovascularization events occurred during the first 2 years of follow-up. Treated eyes showed a higher rate of VA loss (> or =3 lines) at 3- and 6-month follow-ups relative to observed eyes (8.3% vs. 1% and 11.4% vs. 4%, respectively; Ps = 0.02, 0.07). After 6 months, no significant differences were observed in VA loss between groups. CONCLUSION: Prophylactic subthreshold 810-nm-diode laser treatment to an eye with multiple large drusen in a patient whose fellow eye has already suffered a neovascular event places the treated eye at higher risk of developing choroidal neovascularization. We advise against using prophylactic subthreshold diode laser treatment in these eyes.

Vine AK, Stader J, Branham K, Musch DC, Swaroop A. · Department of Ophthalmology, University of Michigan, Kellogg Eye Center, Ann Arbor, Michigan 48105, USA. · Ophthalmology. · Pubmed #16225921 No free full text.

Abstract: PURPOSE: To measure and contrast 2 biomarkers of cardiovascular disease, C-reactive protein (CRP) and plasma homocysteine, in individuals with age-related macular degeneration (AMD) and control individuals without AMD. DESIGN: Case-control study. PARTICIPANTS: Seventy-nine affected individuals and 77 unaffected individuals from the AMD Genetic Study Group returned to obtain CRP and homocysteine levels. METHODS: Both affected and unaffected individuals underwent testing for CRP and homocysteine. A detailed cardiovascular history was taken. MAIN OUTCOME MEASURES: Mean CRP and homocysteine levels in affected and unaffected individuals. RESULTS: Mean CRP levels for affected and unaffected individuals were 3.42 and 2.30 mg/l, respectively (P = 0.03). Mean homocysteine levels for affected and unaffected individuals were 11.72 and 8.88 micromol/l, respectively (P<0.0001). In logistic regression models, older age, higher CRP, and higher homocysteine were risk factors for AMD. There were no significant differences between cases and controls in terms of gender, diabetes, hypertension, use of statin drugs, and smoking. The control group was significantly younger and had a lower rate of vitamin usage than the affected group. CONCLUSIONS: Elevated CRP and homocysteine levels are associated with AMD and implicate the role of chronic inflammation and atherosclerosis.

Luttrull JK, Musch DC, Mainster MA. · Private Practice, 3160 Telegraph Road, Suite 230, Ventura, CA, 93003, USA. · Br J Ophthalmol. · Pubmed #15615751 links to  free full text

Abstract: AIM: To report the visual and clinical outcomes of a pilot study of subthreshold diode micropulse (SDM) laser photocoagulation for clinically significant diabetic macular oedema (CSMO). METHODS: The results of infrared (810 nm) SDM laser photocoagulation for CSMO were retrospectively reviewed in 95 eyes of 69 consecutive patients with mild to moderate non-proliferative diabetic retinopathy. The same laser parameters were used for each patient. Only the number of laser applications varied between patients, depending on their macular findings. Primary outcome measures were Snellen visual acuity, fluorescein angiographic leakage, and CSMO status. RESULTS: Visual acuity was stable or improved in 85% of treated eyes, with a mean follow up of 12.2 months (range 3-29 months). CSMO decreased in 96% and resolved in 79% of treated eyes. No adverse laser events occurred. No laser lesions were detectable ophthalmoscopically or angiographically after treatment, consistent with calculations based on ANSI Z136.1 laser safety standards suggestive of only histologically detectable tissue effects at the laser exposure levels. No laser scarring was observed during the follow up period. CONCLUSION: Subthreshold diode micropulse laser photocoagulation minimises chorioretinal damage in the management of CSMO and demonstrates a beneficial effect on visual acuity and CSMO resolution. Prospective studies are needed to fully evaluate this technique.

Gottfredsdottir MS, Sverrisson T, Musch DC, Stefánsson E. · Department of Ophthalmology, University of Michigan School of Medicine, Kellogg Eye Center, Ann Arbor, USA. · Acta Ophthalmol Scand. · Pubmed #10463414 No free full text.

Abstract: PURPOSE: To examine the importance of genetic factors in age-related macular degeneration by using a twin study to compare the concordance of age-related macular degeneration in monozygotic twin pairs and their spouses. METHODS: This was a prospective study that included 50 twin pairs and 47 spouses. Zygosity was determined by genetic laboratory testing. Macular findings were graded based on the grading system used by the Macular Photocoagulation Study Group and the International ARM Epidemiological Study Group. RESULTS: The concordance of age-related macular degeneration was 90% in monozygotic twin pairs which significantly exceeded that of twin/spouse pairs (70.2%); p=0.0279. In the nine pairs that were concordant, fundus appearance and visual impairment were similar. Environmental factors and medical history were essentially the same in the twin pairs. CONCLUSION: The statistically significant higher concordance of age-related macular degeneration in monozygotic twins compared to their spouses strongly suggests the importance of genetic factors.