Mutations in the gene encoding
RPE65 causes LCA2, a major form of Leber's congenital amaurosis,
25–27 which is targeted in current clinical gene therapy trials.
28,29 The protein RPE65 is expressed in the RPE, where it plays a pivotal role in maintaining normal vision by regenerating the visual pigment rhodopsin.
16 In
Rpe65 −/− mice, the blocked visual cycle causes an accumulation of retinyl esters in RPE cells, where they form large lipid droplets (
Fig. 4A). Cone photoreceptors degenerate rapidly, whereas the remaining rods are the exclusive source of electrophysiological response and start to degenerate slowly only after approximately 6 months of age.
30,31 En face imaging at postnatal month (PM) 11 showed a characteristic pattern of hyperfluorescent flecks in the AF mode, which may again indicate metabolic remnants of photoreceptor outer segments (
Fig. 4). Image resolution of SD-OCT in
Rpe65 −/− mice was insufficient to resolve intracellular lipid accumulations in vivo. However, cross-sectional images revealed a reduction of ONL size, resulting in decreased total central retinal thickness of 193 ± 2 μm, which is more than the expected roughly 10% reduction with age and would be consistent with the observed AF.
32 Laminar organization in
Rpe65 −/− mice was not as clearly delineated, perhaps because of a generalized reaction to the ongoing photoreceptor loss. Indeed, it has been shown that the genetic response in
Rpe65 −/− mice includes modified expression of cytoskeletal elements and components of the extracellular matrix.
33 Such a global response might reasonably affect the optical characteristics of the retinal sublayers.