Hyperosmolarity response of ocular standing potential as a clinical test for retinal pigment epithelium activity normative data

Diabetes-Induced Changes of the Rat ERG in Relation to Hyperglycemia and Acidosis

PURPOSE

To understand the mechanism of changes in the c-wave of the electroretinogram (ERG) in diabetic rats, and to explore how glucose manipulations affect the c-wave.

METHODS

Vitreal ERGs were recorded in control and diabetic Long-Evans rats, 3-60 weeks after IP vehicle or streptozotocin. A few experiments were performed on Brown Norway rats. Voltage responses to current pulses were used to measure the transepithelial resistance of the retinal pigment epithelium (RPE).

RESULTS

During development of diabetes the b-wave amplitude progressively decreased to about half of the initial amplitude after a year. In contrast, the c-wave was strongly affected from the very beginning (3 weeks) of diabetes. In control rats, the c-wave was cornea-positive at lower illuminations but was cornea-negative at higher (photopic) illumination. In diabetics, the whole amplitude-intensity curve was shifted toward negativity. The magnitude of this shift was markedly affected by acute glucose manipulations in diabetics but not in controls. Increased blood glucose made the c-wave more negative, and decreased blood glucose with insulin had the opposite effect. Experimentally induced acidification of the retina had a small effect that was different from diabetes, shifting the c-wave toward positivity, slightly in controls and more noticeably in diabetics. One reason for the significant negativity of the diabetic ERG was a decrease of the cornea-positive response of the RPE due to a decrease of the transepithelial resistance.

CONCLUSIONS

The ERG c-wave is more negative in diabetics than in control animals, and is far more sensitive to changes in blood glucose. The increased negativity is largely if not entirely due to changes in the transepithelial resistance of the RPE, an electrical analog of the breakdown of the blood-retinal barrier observed in other studies. The sensitivity of the c-wave to glucose in diabetics may also be due to changes in transepithelial resistance.

The electro-oculogram

The retinal pigment epithelium (RPE) lying distal to the retina regulates the extracellular environment and provides metabolic support to the outer retina. RPE abnormalities are closely associated with retinal death and it has been claimed several of the most important diseases causing blindness are degenerations of the RPE. Therefore, the study of the RPE is important in Ophthalmology. Although visualisation of the RPE is part of clinical investigations, there are a limited number of methods which have been used to investigate RPE function. One of the most important is a study of the current generated by the RPE. In this it is similar to other secretory epithelia. The RPE current is large and varies as retinal activity alters. It is also affected by drugs and disease. The RPE currents can be studied in cell culture, in animal experimentation but also in clinical situations. The object of this review is to summarise this work, to relate it to the molecular membrane mechanisms of the RPE and to possible mechanisms of disease states.

Electrical responses from diabetic retina

Diabetic retinopathy has long been considered to be a retinal manifestation of systemic diabetic angiopathy. Indeed, it is therapeutically true. However, the prolongation of OP peak latency in diabetic eyes without any angiographic evidence of angiopathy leads us to presume that certain neuronal disorders occur early in diabetic eyes. Even though we cannot neglect the possibility that the prolongation of the OP peak latency may derive from undetectable retinal hypoperfusion, it is still far from conventional diabetic angiopathy. Rather, the status should be properly termed "intraretinal diabetic neuropathy" in that the neurones are the disturbed cells to cause visual dysfunction. Thereafter, the OP amplitude diminishes as retinopathy advances, probably depending on the degree of retinal circulatory disturbance. Marked diminution of the OP amplitude predicts rapid progression and poor prognosis of retinopathy. Diabetic retinal pigment epitheliopathy as manifested by one of our non-photic EOG responses is another kind of early ocular involvement of diabetes. Because its mechanisms are not yet known, so far we have not succeeded in correlating it to any kind of subjective visual index. Routine fundus inspection or fluorescent fundus angiography is incapable of detecting the compromised neural retina and/or retinal pigment epithelial integrity and thus the electrophysiology of vision has the edge in ophthalmology.

Corneal D.C. recordings of slow ocular potential changes such as the ERG c-wave and the light peak in clinical work. Equipment and examples of results

A set-up for D.C. recordings of slow ocular potentials such as the c-wave of the electroretinogram (ERG) as well as the fast oscillation (FO), the light peak (LP) and the dark trough (DT) in both clinical and experimental work is described. It includes matched calomel half-cells connected by saline-agar bridges to a corneal contact lens on the eye and a reference chamber on the forehead, a low-drift differential-input D.C. amplifier, an A/D converter, a computer, a thermoprinter, a flexible disc memory, a plotter, and a device for light stimulation controlled by the computer. Examples of the usefulness of the set-up in clinical work are shown in the form of D.C. c-wave ERGs of normal subjects as well as of patients with vitelliform macular degeneration, choriocapillaris atrophy, and retinitis pigmentosa. The direct corneal recording of the FO and LP is demonstrated as well. The different origins of the standing potential (SP) of the eye, the ERG c-wave, the FO and the LP are reviewed briefly.

Hyperosmolarity-induced hyperpolarization of the membrane potential of the retinal pigment epithelium

The hyperosmolarity-induced changes of the apical (Vap) and basal (Vba) membrane potentials of the retinal pigment epithelium (RPE) were studied in an in-vitro RPE-choroid preparation of the frog. Both Vap and Vba were simultaneously hyperpolarized by hyperosmolarity at either the apical or basal side of the RPE. Hyperosmolarity at the apical side hyperpolarized Vap greater than Vba, and increased the trans-epithelial potential (TEP) across the RPE. Hyperosmolarity at the basal side hyperpolarized Vba, simultaneously hyperpolarized Vap by a smaller amount, and reduced the TEP. The hyperosmolarity response (a decrease of the ocular standing potential induced by an intravenous hypertonicity) is due mainly to a hyperpolarization of Vba.

Hyperosmolarity response of ocular standing potential as a clinical test for retinal pigment epithelium activity diabetic retinopathy

The hyperosmolarity response, a drug-induced response from the retinal pigment epithelium, was recorded in diabetic retinopathy. The hyperosmolarity response was occasionally abnormal at the pre-retinopathic stage and at the first stage of retinopathy by Scott classification. The response was frequently abnormal at the second and third stages of retinopathy. The hyperosmolarity response is useful for early diagnosis of pigment epitheliopathy in diabetes.

Hyperosmolarity response of ocular standing potential as a clinical test for retinal pigment epithelium activity rhegmatogenous retinal detachment

The hyperosmolarity response of the ocular standing potential was recorded in unilateral rhegmatogenous retinal detachment (8 eyes) and in the fellow 'healthy' eye (8 eyes). The hyperosmolarity response was greatly suppressed (M-4 SD: M and SD indicate respectively the mean and the standard deviation in normal subjects) in all affected eyes (p < 0.005), and slightly abnormal in 2 fellow eyes. The L/D ratio was normal in 2 affected eyes and in all fellow eyes. The hyperosmolarity response in the affected eyes was still greatly suppressed 14 months after successful surgical treatment.