Overview
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
Two clinical ophthalmic geneticists, who also have extensive laboratory experience, have provided opinions on the problems of predictive DNA testing in an ophthalmic setting of ADRP. The rapid progress of genetic research associated with the human genome project has raised many new ethical issues and made clinicians reconsider conventional treatment issues. Many ethical guidelines are being imposed on researchers and clinicians that will need to be modified in the future to reflect the changing perspective of the current clinical practice and in accordance with patient’s wishes.
How will it change management? Predictive DNA testing for an untreatable disease
A well informed adult can consent to a predictive DNA test. However, predictive DNA testing in children raises issues of what the child (as the person now and the adult he/she will become) would want. To only order an investigation that will change management is an important axiom of clinical care, not just for hospital financial administrators. Some would argue that there is no value in early diagnosis of RP as it will not change management. This applies to the electrophysiology testing as much as the DNA testing. It is also important to consider the specificity and sensitivity of the ERG and the DNA test. The arguments for DNA testing if there was no other treatment and no risk of using a night light would be poor. However, there is a slight chance that treatment for nyctalopia with a night light may not be totally safe. This is a controversial area. Most studies conducted since the original paper proposing that night lights cause myopia have failed to support this finding.1 If the parents were insistent despite counselling, then the night light argument could be used to …
