Gene panels and genomic testing for childhood cataract and lens dislocation disorders

Congenital cataract (CC) affects 3–5 individuals per 10,000 and is a significant cause of lifelong visual disability worldwide. Highly heterogeneous, CC may be isolated or may form one manifestation of a multisystemic condition. It is estimated that around 50% of bilateral CC cases have a genetic basis, with well over 100 genes implicated in their underlying etiology. Consequently, the identification and characterisation of CC is not equivalent to making a clinical diagnosis on which is based care planning, genetic counselling and non-ocular management. Until recently, clinical investigation of patients with CC has been based upon an iterative, clinically-driven process that is expensive, time-consuming and inefficient. The advent of Next Generation Sequencing promises to provide a platform upon which can be built a unified approach to diagnosis. We, and others, have shown that such an approach can identify the molecular basis of CC and other lens-related disorders such as lens subluxation in the majority (over 70% in our series) of cases. When applied early in the diagnostic pathway this can direct ongoing management, improve outcomes for pathents, and direct genetic counselling for families with CC.