PubMed · 7767138
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G Woodruff. 1995-05-06. Amblyopia: could we do better?. https://doi.org/10.1136/bmj.310.6988.1153
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OBJECTIVE: To identify genetic variants associated with amblyopia in African (AFR) and Admixed American (AMR) ancestry groups, expanding on previous studies conducted in European ancestry. DESIGN: Retrospective ancestry-stratified genome-wide association study (GWAS) and gene-level rare variant association study (RVAS). PARTICIPANTS: Participants in the All of Us Research Program from AFR and AMR ancestry groups who had whole-genome sequencing available. Cases and controls were distinguished based on the presence of International Classification of Diseases 9/10/SNOMED diagnosis codes for amblyopia in electronic health records. This yielded ancestry-stratified subsets of 269 cases and 71 585 controls of AMR ancestry and 366 cases and 79 460 controls of AFR ancestry. METHODS: Stratified logistic regression models were adjusted for age, biological sex, and the top 10 principal components of genomic ancestry. GWAS was limited to common variants (minor allele frequency ≥1%), and RVAS was limited to rare variants with coding sequence-altering effects (minor allele frequency >1%, exonic only, excluding synonymous variants) aggregated at the gene level using the SKAT algorithm. Downstream analyses of the significant variants were performed using KEGG and GO pathway analysis and STRING database queries for protein-protein interactions and gene-gene interactions. MAIN OUTCOME MEASURES: Single-nucleotide polymorphisms were determined to have genome-wide significance if P < 5e-8 in the GWAS, and genes were determined to have significant association with amblyopia in the RVAS if P < 8.0 × 10-4. RESULTS: In the AMR GWAS, 245 unique single-nucleotide polymorphisms mapping to 97 distinct loci were identified, notably within neurodevelopmental and axonal guidance genes, including ROBO1, SEMA4B, PTPRD, NRXN1, and CAMK2D. The AFR GWAS identified 11 significant variants corresponding to 6 loci mapping primarily to long noncoding RNAs and pseudogenes. The AMR RVAS identified 15 genes, including axonal transport genes (KIF1B and KIF7) and growth factor signaling genes (EGF, ERBIN, and AKAP17A). The AFR RVAS identified a single gene, DLG2, which encodes the postsynaptic protein PSD-93, which promotes the closure of the sensitive period of neuroplasticity for vision in early childhood. CONCLUSIONS: Genetic risk architectures for amblyopia differ across ancestries but fundamentally converge on neurodevelopmental signaling, cortical synapse assembly, and sensitive period plasticity rather than ocular structural dynamics. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
PURPOSE: This study estimates the prevalence of common visual disorders (amblyopia, strabismus, refractive errors) in a group of inner-city school children. In addition, the study addresses the issue of access to care for vision-screening programs, specifically for children with recognized difficulties in obtaining routine medical care. METHODS: School children from an inner-city elementary school were enrolled into a prospective vision-screening program combining the identification arm (screening) and diagnostic/treatment arm (ophthalmic examination). The screening consisted of Snellen E optotypes presented at a 10-foot test distance. Each child failing the vision screening was examined by an ophthalmologist at the school using standard protocol. This allowed the authors to examine all children identified through the vision-screening program. RESULTS: Six-hundred eighty children were screened during the 1993 to 1994 school year. Eleven percent (76) failed the vision screening and were examined, 68 of whom failed the ophthalmic examination. The estimated prevalence of visual morbidity was as follows: amblyopia, 3.9%; strabismus, 3.1%, and refractive errors, 8.2%. CONCLUSION: Amblyopia, strasbismus, and refractive errors were found in relatively high frequencies for this population sample of inner city children. These findings underscore the necessity of comprehensive vision-screening programs that integrate follow-up care. Children with limited access to specialized eye care must be provided with a mechanism for obtaining these services.