Marques João Pedro, Soares Célia Azevedo, Carvalho Ana Luísa, Estrela-Silva Sérgio, Santos Luísa Coutinho, Ramos Lina, Silva Eduardo
Departament of Ophthalmology, Hospitais da Universidade de Coimbra (HUC), Unidade Local de Saúde (ULS) Coimbra, E.P.E., Coimbra, Portugal.
Clinical and Academic Centre of Coimbra (CACC), Coimbra, Portugal.
Clin Genet. 2025 Jun;107(6):600-611. doi: 10.1111/cge.14691. Epub 2025 Jan 2.
The Portuguese Society of Ophthalmology and the Portuguese Society of Human Genetics developed clinical practice guidelines to streamline genetic testing for inherited retinal dystrophies (IRDs), underlining the critical role of molecular diagnosis in enhancing patient care. Genetic testing is pivotal in diagnosis, genetic counselling, prognosis and access to clinical trials, and new gene-specific therapies. These guidelines recommend genetic testing in all IRD patients and provide a detailed assessment of available testing methods, ensuring that genetic counselling is integrated into ophthalmic care. Essential to this process is the inclusion of at least one genetic counselling session to effectively communicate and discuss implications of test results with patients and families/carers. Key recommendations include cascade testing to identify at-risk family members and standardisation of variant classification according to international criteria to ensure consistency in diagnosis and care. Ophthalmological follow-up is generally prescribed at intervals of 1-2 years for adults and 6 months for paediatric patients, to monitor disease progression and complications. Paediatric considerations are addressed, reflecting the complexities and ethical concerns associated with testing minors. These guidelines aim to elevate diagnostic accuracy, guide therapeutic decisions and ultimately improve patient outcomes, marking a significant advance in the genetic management of IRDs.
葡萄牙眼科学会和葡萄牙人类遗传学会制定了临床实践指南,以简化遗传性视网膜营养不良(IRD)的基因检测流程,强调分子诊断在改善患者护理方面的关键作用。基因检测在诊断、遗传咨询、预后以及参与临床试验和新型基因特异性治疗中都起着关键作用。这些指南建议对所有IRD患者进行基因检测,并对现有检测方法进行详细评估,确保将遗传咨询纳入眼科护理中。这一过程的关键是至少安排一次遗传咨询会议,以便与患者及其家属/护理人员有效沟通并讨论检测结果的影响。主要建议包括进行级联检测以识别高危家庭成员,以及根据国际标准对变异分类进行标准化,以确保诊断和护理的一致性。对于成年人,眼科随访通常规定间隔1至2年进行一次,对于儿科患者则为6个月一次,以监测疾病进展和并发症。指南还考虑到了儿科方面的因素,反映了与检测未成年人相关的复杂性和伦理问题。这些指南旨在提高诊断准确性,指导治疗决策并最终改善患者预后,标志着IRD基因管理方面的重大进展。