Longitudinal analysis of retinal hemangioblastomatosis and visual function in ocular von Hippel-Lindau disease.
OBJECTIVE
Characterization of the structural and functional progression of ocular von Hippel-Lindau (VHL) disease and analysis of patient factors influencing disease progression.


METHODS
Retrospective analysis of a case series from a longitudinal, observational study.


METHODS
Two hundred forty-nine participants with clinically defined systemic VHL disease and more than 2 years of ophthalmic follow-up.


METHODS
Standardized scoring of ocular phenotype and systemic characteristics was performed at each study visit and was analyzed longitudinally to determine progression of ocular VHL disease.


METHODS
Measures evaluated include: visual acuity, features of ocular VHL disease (presence, location, number, and extent of retinal capillary hemangioblastomas [RCHs]), germline mutation in the VHL gene, demographics (age, gender, age at onset of ocular disease), and patient characteristics (smoking status, body mass index).


RESULTS
Most participants demonstrated relative anatomic and functional stability in ocular VHL disease status over a mean follow-up of 8.2 ± 4.0 years. Approximately three quarters (73%) of participants without ocular VHL disease at baseline remained disease free at the end of follow-up. Among eyes with ocular VHL disease at baseline, 88% did not demonstrate RCHs in a new retinal location, 70% remained stable in RCH number, and 79% remained stable in the extent of RCH involvement. Mean visual acuity for all study eyes (n = 498) decreased by 5.1 ± 0.6 letters across follow-up, with 16.1% of study eyes decreasing by more than 10 letters in visual acuity. Among eyes affected at baseline, greater vision loss was associated with the presence of juxtapapillary RCHs, development of RCH in a new location, and increase in peripheral RCH number and extent. Younger baseline age, younger age at onset of ocular VHL disease, involvement of the fellow eye with ocular VHL disease, and missense or protein-truncating germline mutations were associated significantly with increased anatomic involvement and functional deterioration.


CONCLUSIONS
Patients with ocular VHL disease maintain relative anatomic and functional stability, with only a minority demonstrating marked anatomic progression and vision loss. Systemic and ocular risk factors for anatomic progression and vision loss can help practitioners identify patients with a higher risk profile for counseling, closer follow-up, and proactive treatment.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Brian C
BC
Toy
Elvira
E
Agrón
Divya
D
Nigam
Emily Y
EY
Chew
Wai T
WT
Wong
D000328:Adult; D018450:Disease Progression; D005260:Female; D018095:Germ-Line Mutation; D018325:Hemangioblastoma / Q000235:genetics / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009154:Mutation; D019572:Retinal Neoplasms / Q000235:genetics / Q000503:physiopathology*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology*; D051794:Von Hippel-Lindau Tumor Suppressor Protein / Q000235:genetics; D006623:von Hippel-Lindau Disease / Q000235:genetics / Q000503:physiopathology*
D051794:Von Hippel-Lindau Tumor Suppressor Protein; C497446:VHL protein, human