Models of the normal and abnormal rod system

Characteristics of Eyes With CRB1-Associated EOSRD/LCA: Age-Related Changes

PURPOSE

To evaluate ocular and retinal features of CRB1-associated early onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA) for age-related changes.

DESIGN

Retrospective cohort study.

METHODS

Sixteen pediatric patients with biallelic CRB1 EOSRD/LCA who had been followed for up to 18 years were reviewed. Results of comprehensive ophthalmic examinations-including visual acuity, refractive error, dark-adapted visual threshold, Goldmann perimetry, and macular optical coherence tomography (OCT)-were analyzed for significant age-related changes using mixed-effects models.

RESULTS

Visual acuity dark-adapted visual sensitivity, and area of seeing visual field (all subnormal from the earliest ages recorded) declined with increasing age. Hyperopia was stable through childhood and adolescence. In CRB1 EOSRD/LCA, OCT extrafoveal inner and outer laminar thicknesses exceeded those in controls but varied little with age, and foveal metrics (depth, breadth, thickness at rim) differed significantly from those in controls, but variations in foveal metrics were not associated with declines in acuity.

CONCLUSIONS

From the youngest ages, retinal and visual function is significantly subnormal and becomes progressively compromized. A goal of future therapies should be intervention at young ages, when there is more function to be rescued.

Mechanisms of cone sensitivity loss in retinitis pigmentosa

PURPOSE

To explore the mechanisms of cone sensitivity loss in retinitis pigmentosa by combining two-colour perimetry with threshold versus intensity (tvi) testing.

METHODS

Seven subjects with autosomal recessive retinitis pigmentosa and 10 normal subjects were recruited and underwent perimetric testing of one eye using 480- and 640-nm Goldman size V targets presented under scotopic conditions (no background illumination) and against a white background ranging in luminance from -1.5 to 2 log cd m-2 in 0.5 log cd m-2 steps. Data were fitted with tvi functions of the form logT = logT0 + log ((A + A0)/A0)n, where T is the threshold, T0 is the absolute threshold, A is the background intensity, A0 is the 'dark-light' constant and n is a gain constant.

RESULTS

Reliable tvi functions could not be obtained within the region of the visual field corresponding to loss of the ellipsoid zone on optical coherence tomography. At fixation, changes in both T0 and A0 were observed, consistent with a d1 mechanism loss, which resulted in an upwards and rightwards shift of the tvi function. Losses at [±3°, ±3°] demonstrated changes in T0, consistent with a d3 mechanism loss, resulting in an upwards translation of the tvi curve.

CONCLUSIONS

Although the absolute cone threshold was elevated at each location, shifts in the tvi function (so-called d1 mechanism loss) at fixation minimise threshold elevation in the presence of white adapting backgrounds, such as those typically employed in standard two-colour perimetry. At more peripheral testing locations, changes in threshold occurred independent of background luminance (so-called d3 mechanism loss). These findings suggest that backgrounds which selectively adapt rods while maintaining cones at, or near, absolute threshold may be preferable to conventional two-colour perimetry for assessing loss of cone sensitivity, especially at the point of fixation.

Retinal sensitivity changes in early/intermediate AMD: a systematic review and meta-analysis of visual field testing under mesopic and scotopic lighting

Visual fields under mesopic and scotopic lighting are increasingly being used for macular functional assessment. This review evaluates its statistical significance and clinical relevance, and the optimal testing protocol for early/intermediate age-related macular degeneration (AMD). PubMed and Embase were searched from inception to 14/05/2022. All quality assessments were performed according to GRADE guidelines. The primary outcome was global mean sensitivity (MS), further meta-analysed by: AMD classification scheme, device, test pattern, mesopic/scotopic lighting, stimuli size/chromaticity, pupil dilation, testing radius (area), background luminance, adaptation time, AMD severity, reticular pseudodrusen presence, and follow-up visit. From 1489 studies screened, 42 observational study results contributed to the primary meta-analysis. Supported by moderate GRADE certainty of the evidence, global MS was significantly reduced across all devices under mesopic and scotopic lighting with large effect size (-0.9 [-1.04, -0.75] Hedge's g, P < 0.0001). The device (P < 0.01) and lighting (P < 0.05) used were the only modifiable factors affecting global MS, whereby the mesopic MP-1 and MAIA produced the largest effect sizes and exceeded test-retest variabilities. Global MS was significantly affected by AMD severity (intermediate versus early AMD; -0.58 [-0.88, -0.29] Hedge's g or -2.55 [3.62, -1.47] MAIA-dB) and at follow-up visit (versus baseline; -0.62 [-0.84, -0.41] Hedge's g or -1.61[-2.69, -0.54] MAIA-dB). Magnitudes of retinal sensitivity changes in early/intermediate AMD are clinically relevant for the MP-1 and MAIA devices under mesopic lighting within the central 10° radius. Other factors including pupil dilation and dark adaptation did not significantly affect global MS in early/intermediate AMD.

Investigating the linkage between mesopic spatial summation and variations in retinal ganglion cell density across the central visual field

PURPOSE

The relationship between perimetric stimulus area and Ricco's area (RA) determines measured thresholds and the sensitivity of perimetry to retinal disease. The nature of this relationship, in addition to effect of retinal ganglion cell (RGC) number on this, is currently unknown for the adaptation conditions of mesopic microperimetry. In this study, achromatic mesopic spatial summation was measured across the central visual field to estimate RA with the number of RGCs underlying RA also being established.

METHODS

Achromatic luminance thresholds were measured for six incremental spot stimuli (0.009-2.07 deg2 ) and 190.4 ms duration, at four locations, each at 2.5°, 5° and 10° eccentricity in five healthy observers (mean age 61.4 years) under mesopic conditions (background 1.58 cd/m2 ). RA was estimated using two-phase regression analysis with the number of RGCs underlying RA being calculated using normative histological RGC counts.

RESULTS

Ricco's area exhibited a small but statistically insignificant increase between 2.5° and 10° eccentricity. Compared with photopic conditions, RA was larger, with the difference between RA and the Goldmann III stimulus (0.43°) being minimised. RGC number underlying RA was also higher than reported for photopic conditions (median 70 cells, IQR 36-93), with no significant difference being observed across test locations.

CONCLUSIONS

Ricco's area and the number of RGCs underlying RA do not vary significantly across the central visual field in mesopic conditions. However, RA is larger and more similar to the standard perimetric Goldmann III stimulus under mesopic compared with photopic adaptation conditions. Further work is required to determine if compensatory enlargements in RA occur in age-related macular degeneration, to establish the optimal stimulus parameters for AMD-specific microperimetry.

IMPAIRMENTS IN CONE PIGMENT REGENERATION AND ABSOLUTE THRESHOLD IN MACULAR TELANGIECTASIA TYPE 2

Macular telangiectasia—which is associated with loss of the Müller cells, which in turn have a crucial role in the cone visual cycle—results in impaired cone photopigment regeneration kinetics and significantly elevated cone and rod thresholds.

To test the hypothesis that Müller cell dysfunction in macular telangiectasia type 2 (MacTel) results in delayed cone adaptation kinetics and to assess absolute cone and rod thresholds in this condition.

Scotopic microperimetry: evolution, applications and future directions

For many inherited and acquired retinal diseases, reduced night vision is a primary symptom. Despite this, the clinical testing options for spatially resolved scotopic vision have until recently been limited. Scotopic microperimetry is a relatively new visual function test that combines two-colour perimetry with fundus-controlled perimetry performed in scotopic luminance conditions. The technique enables spatially resolved mapping of central retinal sensitivity alongside the ability to distinguish between rod and cone photoreceptor sensitivities. Two companies produce commercially available scotopic microperimeters - Nidek (Nidek Technologies Srl, Padova, Italy) and CenterVue (CenterVue S.p.A., Padova, Italy). Scotopic microperimetry is a promising technology capable of detecting changes in retinal sensitivity before changes in other measures of visual function. Scotopic microperimetry is a promising functional biomarker that has the potential as a useful clinical trial outcome measure. This review summarises the evolution and applications of scotopic microperimetry, and discusses testing options, including testing grid selection, dark-adaptation time and threshold sensitivity analyses.

Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature

Purpose

There is growing interest in functional testing for early/intermediate age‐related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD.

Recent findings

PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real‐world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non‐modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real‐world patient outcome including quality of life and/or activities of daily living indices. Twenty‐six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low‐photopic and scotopic conditions. Meta‐analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (−1.52dB [−2.27, −0.78 dB]) and MS (−1.47dB [−2, −0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non‐clinically meaningful reductions. There was insufficient data for meta‐analyses regarding other clinical automated perimetry protocols. Only one study assessed a real‐world patient outcome (on‐road driving performance), with no significant link to visual field outcomes in early/iAMD.

Summary

Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.

Luminance Thresholds and Their Correlation With Retinal Structure in X-Linked Retinoschisis

Purpose

To provide a comprehensive analysis of light- and dark-adapted luminance thresholds and their associations with retinal structure in X-linked retinoschisis (XLRS).

Methods

Nine subjects with XLRS and 10 visually-normal individuals participated. Threshold was measured at 15 locations along the horizontal meridian of the visual field at several adaptation levels (5 × 10⁻⁵ to 50 cd/m²) after dark-adaptation. The relationship between threshold and adaptation level across the field was described using a standard “threshold-versus-illuminance” model. Optical coherence tomography images were obtained and segmented to quantify outer nuclear layer (ONL⁺) and outer segment (OS⁺) thickness. A linear structure-function model was used to describe the relationship between threshold and the product of ONL⁺ and OS⁺ thickness.

Results

For peripheral field measurements, thresholds were generally normal for most subjects with XLRS. All subjects had perifoveal and parafoveal threshold elevations under dark-adapted and high illuminance conditions, with thresholds at moderate illuminances being closer to normal. For foveal measurements, seven of nine subjects with XLRS had normal dark-adapted thresholds, and all had abnormally elevated high illuminance thresholds. Threshold-versus-illuminance curves in the fovea, parafovea, and perifovea were abnormally steep for subjects with XLRS, appearing similar to the normal peripheral field shape. Under both dark- and light-adapted conditions, threshold was predicted by ONL⁺ × OS⁺ thickness at nearly all field locations.

Conclusions

Threshold elevation in XLRS is complex, depending on both the adaptation level and the visual field location. The pattern of threshold-versus-illuminance suggests that macular function in XLRS is similar to the periphery of controls.

Threshold versus intensity functions in two-colour automated perimetry

PURPOSE

Two-colour computerised perimetry is a technique developed for assessing cone- and rod-function at fixed background luminances in retinal disease. However, the state of adaptation during testing is unknown but crucial in the interpretation of results. We therefore aimed to determine the adaptational state of rod- and cone-mechanisms in two-colour perimetry.

METHODS

Sensitivity to 480 nm (blue) and 640 nm (red) Goldmann size V targets was determined for 10 normal subjects aged 16 to 46 years at 17 locations in the central 60 degrees of the visual field under scotopic conditions and then from -1.5 log cd m^-2 to 2 log cd m^-2 (white background) in 0.5 log unit steps. Data were fitted with threshold versus intensity (tvi) functions of the form logT = logT₀ + log ((A + A₀ )/A₀ )ⁿ .

RESULTS

No clear rod-cone break was observed for 640 nm stimuli. For 480 nm stimuli, transition from rod-detection to cone-detection occurred at mesopic illumination levels, where rod adaptation approached Weber behaviour. Cone detection mechanisms did not display Weber-like adaptation until the background luminance approached 1 log cd.m^-2 . Diseases resulting in a "filter effect" - including disorders of the photoreceptors - are therefore predicted to affect sensitivity when rod function is probed with short-wavelength targets under scotopic conditions, but less so under mesopic conditions. Filter effects are similarly anticipated to affect cone function measured using long-wavelength targets under mesopic conditions (e.g., during microperimetry), but less so under photopic conditions.

CONCLUSIONS

Asymmetries in adaptation in automated two-colour perimetry are predicted to artefactually favour the detection of losses in rod sensitivity under scotopic conditions and cones under mesopic conditions.

Increment Threshold Functions in Retinopathy of Prematurity

PURPOSE

To assess scotopic background adaptation in subjects with a history of preterm birth and retinopathy of prematurity (ROP). Retinopathy of prematurity is known to have long-term effects on rod photoreceptor and rod mediated postreceptor retinal function.

METHODS

Rod-mediated thresholds for detection of 3° diameter, 50 ms stimuli presented 20° from fixation were measured using a spatial forced choice method in 36 subjects (aged 9-17 years) with a history of preterm birth and 11 age similar term-born subjects. Thresholds were measured first in the dark-adapted condition and then in the presence of 6 steady background lights (-2.8 to +2.0 log scot td). A model of the increment threshold function was fit to each subject's thresholds to estimate the dark-adapted threshold (TDA) and the Eigengrau (A0, the background that elevates threshold 0.3 log unit above TDA).

RESULTS

In subjects with a history of severe ROP, both TDA and A0 were significantly elevated relative to those in former preterms who never had ROP and term-born control subjects. Subjects who had mild ROP had normal TDA but elevated A0. Neither TDA nor A0 differed significantly between former preterms who never had ROP and term-born controls.

CONCLUSIONS

The results suggest that in severe ROP, threshold is affected at a preadaptation site, possibly the rod outer segment. In mild ROP, changes in the Eigengrau may reflect increased intrinsic noise in the photoreceptor or postreceptor circuitry or both.

The neural retina in retinopathy of prematurity

Retinopathy of prematurity (ROP) is a neurovascular disease that affects prematurely born infants and is known to have significant long term effects on vision. We conducted the studies described herein not only to learn more about vision but also about the pathogenesis of ROP. The coincidence of ROP onset and rapid developmental elongation of the rod photoreceptor outer segments motivated us to consider the role of the rods in this disease. We used noninvasive electroretinographic (ERG), psychophysical, and retinal imaging procedures to study the function and structure of the neurosensory retina. Rod photoreceptor and post-receptor responses are significantly altered years after the preterm days during which ROP is an active disease. The alterations include persistent rod dysfunction, and evidence of compensatory remodeling of the post-receptor retina is found in ERG responses to full-field stimuli and in psychophysical thresholds that probe small retinal regions. In the central retina, both Mild and Severe ROP delay maturation of parafoveal scotopic thresholds and are associated with attenuation of cone mediated multifocal ERG responses, significant thickening of post-receptor retinal laminae, and dysmorphic cone photoreceptors. These results have implications for vision and control of eye growth and refractive development and suggest future research directions. These results also lead to a proposal for noninvasive management using light that may add to the currently invasive therapeutic armamentarium against ROP.

Fundus-driven perimetry (microperimetry) compared to conventional static automated perimetry: similarities, differences, and clinical applications

Fundus-driven perimetry, commonly known as microperimetry, is a technique for measuring visual field sensitivity, whilst simultaneously viewing the fundus. In this article, we review the technique, focusing on the MP-1 microperimeter (Nidek Instruments, Inc, Padua, Italy); we compare it with conventional static automated perimetry, emphasizing the importance of understanding the effects of the different stimulus conditions and data analyses on the interpretation of microperimetry data. The clinical applications of the technique, in the evaluation of functional and structural changes that accompany retinal diseases, are illustrated by its use in patients with age-related macular degeneration, Stargardt disease, and retinitis pigmentosa. In addition, the advantages and limitations of the technique are summarized.

Comparison between MP-1 and Humphrey visual field defects in glaucoma and retinitis pigmentosa

PURPOSE

To compare MP-1 microperimeter and Humphrey Field Analyzer (HFA) defects, in patients with retinitis pigmentosa (RP), a disease primarily affecting the photoreceptors, and in patients with glaucoma, a disease primarily affecting postreceptoral ganglion cells, and to analyze the similarities and differences between the results.

METHODS

Eleven patients (11 eyes) with RP and 10 patients (10 eyes) with primary open-angle glaucoma (OAG) underwent MP-1 and HFA visual field testing (10-2 pattern). All tested eyes had defects encroaching within 10° of fixation. MP-1 total deviation (TD) probability defects, derived from a previously collected normative database of 50 subjects, were compared to HFA TD defects and to the local defect map of the MP-1. Test duration was compared between instruments.

RESULTS

In RP patients, MP-1 scotomata were deeper and wider than HFA defects; however in OAG, the opposite was observed. Examination duration in both patient groups was 12 to 14 min for the MP-1 and 6 min for the HFA. The MP-1 local defect map tended to overestimate defects compared to the MP-1 TD analysis.

CONCLUSIONS

The differences in results between the MP-1 and HFA for the two groups of patients with RP and OAG can be attributed to the different adaptation levels and to the dynamic range of test lights available for the two instruments. The clinician should also be aware of the possible consequences of the differences in the method of derivation of normative data for the two instruments, as this may affect the interpretation of visual field results.

Effects of ageing on postreceptoral short-wavelength gain control: transient tritanopia increases with age

We investigated the effect of ageing on the neural gain control in the short-wavelength opponent channel. In order to tackle specifically postreceptoral changes, we determined the effect of ageing on transient tritanopia, a paradoxical and transient reduction of short-wavelength sensitivity after the presentation of a long-wavelength adapting light. The results demonstrate an unexpected and significant increase of transient tritanopia with age, which cannot be explained by a general decline of short-wave sensitivity or the selective reduction of retinal illumination. Instead, our data imply that ageing affects also short-wavelength gain control at the site of chromatic opponency or beyond. Age-related changes of adaptation processes should therefore be considered an important factor influencing the visual performances of the elderly.

The neurovascular retina in retinopathy of prematurity

The continuing worldwide epidemic of retinopathy of prematurity (ROP), a leading cause of childhood visual impairment, strongly motivates further research into mechanisms of the disease. Although the hallmark of ROP is abnormal retinal vasculature, a growing body of evidence supports a critical role for the neural retina in the ROP disease process. The age of onset of ROP coincides with the rapid developmental increase in rod photoreceptor outer segment length and rhodopsin content of the retina with escalation of energy demands. Using a combination of non-invasive electroretinographic (ERG), psychophysical, and image analysis procedures, the neural retina and its vasculature have been studied in prematurely born human subjects, both with and without ROP, and in rats that model the key vascular and neural parameters found in human ROP subjects. These data are compared to comprehensive numeric summaries of the neural and vascular features in normally developing human and rat retina. In rats, biochemical, anatomical, and molecular biological investigations are paired with the non-invasive assessments. ROP, even if mild, primarily and persistently alters the structure and function of photoreceptors. Post-receptor neurons and retinal vasculature, which are intimately related, are also affected by ROP; conspicuous neurovascular abnormalities disappear, but subtle structural anomalies and functional deficits may persist years after clinical ROP resolves. The data from human subjects and rat models identify photoreceptor and post-receptor targets for interventions that promise improved outcomes for children at risk for ROP.

Retinal degeneration in children: dark adapted visual threshold and arteriolar diameter

To assess the condition of the retina in children with retinal degeneration due to Bardet-Biedl syndrome (BBS, n=41), Leber congenital amaurosis (LCA, n=31), or Usher syndrome (USH, n=13), the dark adapted visual threshold (DAT) and arteriolar diameters were measured. Compared to controls, the initial DATs of nearly all (83/85) were significantly elevated, and in 26/62 with serial DATs, significant progressive elevation occurred. Arteriolar diameters were significantly attenuated and narrowed with age in BBS and USH, but not LCA. Higher DATs were associated with narrower arterioles. Such non-invasive procedures can document the natural history of these retinal diseases and have the potential to assess response to future treatment.

Photoreceptor calcium channels: Insight from night blindness

The genetic locus for incomplete congenital stationary night blindness (CSNB2) has been identified as the CACNA1f gene, encoding the α1F calcium channel subunit, a member of the L-type family of calcium channels. The electroretinogram associated with CSNB2 implicates α1F in synaptic transmission between retinal photoreceptors and bipolar cells. Using a recently developed monoclonal antibody to α1F, we localize the channel to ribbon active zones in rod photoreceptor terminals of the mouse retina, supporting a role for α1F in mediating glutamate release from rods. Detergent extraction experiments indicate that α1F is part of a detergent-resistant active zone complex, which also includes the synaptic ribbons. Comparison of native mouse rod calcium currents with recombinant α1F currents reveals that the current–voltage relationship for the native current is shifted approximately 30 mV to more hyperpolarized potentials than for the recombinant α1F current, suggesting modulation of the native channel by intracellular factors. Lastly, we present evidence for L-type α1D calcium channel subunits in cone terminals of the mouse retina. The presence of α1D channels in cones may explain the residual visual abilities of individuals with CSNB2.

Time course of adaptation to stimuli presented along cardinal lines in color space

Visual sensitivity is a process that allows the visual system to maintain optimal response over a wide range of ambient light levels and chromaticities. Several studies have used variants of the probe-flash paradigm to show that the time course of adaptation to abrupt changes in ambient luminance depends on both receptoral and postreceptoral mechanisms. Though a few studies have explored how these processes govern adaptation to color changes, most of this effort has targeted the L-M-cone pathway. The purpose of our work was to use the probe-flash paradigm to more fully explore light adaptation in both the L-M- and the S-cone pathways. We measured sensitivity to chromatic probes presented after the onset of a 2-s chromatic flash. Test and flash stimuli were spatially coextensive 2 degrees fields presented in Maxwellian view. Flash stimuli were presented as excursions from white and could extended in one of two directions along an equiluminant L-M-cone or S-cone line. Probes were presented as excursions from the adapting flash chromaticity and could extend either toward the spectrum locus or toward white. For both color lines, the data show a fast and slow adaptation component, although this was less evident in the S-cone data. The fast and slow components were modeled as first- and second-site adaptive processes, respectively. We find that the time course of adaptation is different for the two cardinal pathways. In addition, the time course for S-cone stimulation is polarity dependent. Our results characterize the rapid time course of adaptation in the chromatic pathways and reveal that the mechanics of adaptation within the S-cone pathway are distinct from those in the L-M-cone pathways.

Abnormalities of the long flash ERG in congenital stationary night blindness of the Schubert-Bornschein type

We investigated abnormalities of the retinal cone ON- and OFF-pathways in 24 males with Schubert-Bornschein congenital stationary night blindness (CSNB). Substantial differences were found between both CSNB types. In incomplete type, a-, b- and d-waves were reduced and delayed, whereas in complete type only the b-wave showed significant changes. Oscillatory potentials (OPs) were not discernible from noise in incomplete CSNB and showed significant peak alterations of the ON-OPs only in complete CSNB. In the complete CSNB type, the ON pathway appeared to be mainly affected. In the incomplete CSNB form marked involvement of both the ON and the OFF pathways was noted.

A method for comparing psychophysical and multifocal electroretinographic increment thresholds

The multifocal electroretinogram (mfERG) has been commonly used as a method for obtaining objective visual fields. Although qualitative comparisons have been good, quantitative comparisons between the results from mfERG and the results from Humphrey Visual Field Analyser (HVFA) have found variable degrees of agreement depending upon the mfERG response parameter examined and/or the disease studied. Lack of agreement may be due to differences in methodology, differences in the sites of response generation, and/or differences derived from comparing suprathreshold versus threshold responses. In addition, the two procedures are performed at different levels of adaptation. We developed an approach for matching stimulus parameters and compared mfERG and psychophysical thresholds to assess the effects of technique and level of adaptation on the two responses. Psychophysical and mfERG thresholds were obtained as a function of the adaptation level (1.5-4.0 log td) and retinal location. The derived increment threshold-versus-intensity functions for both measures were fitted using the equation logT=logT(0)+log((A+A(0))/A(0))(n). We found that the values of A(0) for the mfERG data were one log unit higher than those for the psychophysical data. In addition, the value of the slope (n) for the mfERG data was shallower (0.8) than that of the psychophysical data (1.0). Predictions were made about comparisons of HVFA threshold and mfERG amplitude data in patients with retinal disease based upon a two-site model of adaptation. The data for some groups of patients could be best-fitted with a model of a disease acting at a site distal to all gain changes, whereas data from other patients were best fitted with a model of a disease acting at a site proximal to all retinal gain. The relationship between the Humphrey visual field threshold losses and mfERG amplitude reductions depends upon the site and mechanism of a particular disease process and the model of retinal gain assumed. In no case is a one-to-one relationship between the losses in the two measures predicted.

Background adaptation in a rat model of retinopathy of prematurity

Low dark-adapted, scotopic retinal and visual sensitivity in retinopathy of prematurity (ROP) could be due to disease of the inner retina, or the recently described rod photoreceptor abnormalities. Receptoral disease decreases catch of quanta from both test flashes and steady background lights; increment threshold functions are shifted up and right. In diseases with normal receptors but low retinal sensitivity due to abnormal post receptoral processing, the increment threshold functions are shifted up with no horizontal translation. Herein we test the hypothesis that the rod photoreceptors are the site of ROP disease which causes low dark adapted b-wave sensitivity. The effect of steady background light on the ERG b-wave in a rat model of ROP is studied. ERG stimulus/response functions were obtained using full-field stimuli in the dark-adapted state, and in the presence of a steady background light. In each adaptation condition, log sigma, the test flash intensity that produced a half-maximum b-wave amplitude, was calculated. In pilot experiments, the background light selected had raised log sigma about a log unit in controls. In dark-adapted ROP rats log sigma was significantly higher, 0.35 log unit, than in controls. In the presence of the background light, log sigma in ROP and control rats did not differ significantly indicating a relative shift, up and right, of the increment sensitivity function for the less sensitive ROP rats. The effect of the background light is consistent with receptoral disease causing low dark adapted b-wave sensitivity in ROP rats.

Augmented rod bipolar cell function in partial receptor loss: an ERG study in P23H rhodopsin transgenic and aging normal rats

Physiological consequences of early stages of photoreceptor degeneration were examined in heterozygous P23H rhodopsin transgenic (Tg) and in aging normal Sprague-Dawley rats. Rod photoreceptor and rod bipolar (RB) cell function were estimated with maximum value and sensitivity parameters of P3 and P2 components of the electroretinogram. In both Tg and aging normal rats, the age-related rate of decline of P3 amplitude was steeper than that of the P2 amplitude. Tg rats showed greater than normal sensitivity of the rods. A new model of distal RB pathway connectivity suggested photoreceptor loss could not be the sole cause of physiological abnormalities; there was an additional increase of post-receptoral sensitivity. We propose that changes at rod-RB synapses compensate for the partial loss of rod photoreceptors in senescence and in early stages of retinal degeneration.

Assessing retinal function with the multifocal technique

With the multifocal technique, as developed by Erich Sutter and colleagues, scores of focal electroretinogram (ERG) responses can be obtained in a matter of minutes. Although this technique is relatively new, it has already provided insights into the mechanisms of retinal disease. However, because it is new, there also remain questions about how it works and what it measures. This chapter considers some of these insights and some of these questions. The first part (Section 2) describes how the multifocal ERG (mERG) is recorded and considers its relationship to the full-field ERG. The mERG responses are shown to be from relatively local regions of the retina and are comprised of the same components as the full-field ERG. The diagnostic advantage of the mERG as compared to the full-field ERG is also illustrated. In Section 3, the effects of damage to different cell layers of the retina are shown to affect the mERG differently, and these changes are summarized within a conceptual framework. It is argued, for example, that when diseases of the receptor outer segment, like retinitis pigmentosa, result in small, depressed mERG responses, then the damage is, as expected, at the outer segment. However, when these diseases result in mERG responses that are reasonably large but very delayed, then the damage is beyond the outer segment, probably in the outer plexiform layer. The implicit time of the mERG, not amplitude, is the more sensitive measure of damage in degenerative diseases of the receptors. On the other hand, diseases, like glaucoma, which act on the ganglion axon, do not result in easily identified changes to the mERG unless inner retinal damage is involved as well. Inner retinal damage changes the waveform of the mERG and decreases the naso-temporal variation normally observed. Finally, diseases, like diabetes, that act on more than one layer of the retina can have a range of effects. In Section 4, recent work with the monkey mERG is reviewed, with emphasis on the relevance to human diseases. For example, blocking the sodium-based action potentials produced by ganglion and amacrine cells eliminates the naso-temporal variation in the monkey mERG and these altered mERG responses resemble those from some patients with diabetes or glaucoma. Finally, in Section 5 the second-order kernel is described. The presence of a second-order kernel has important implications for understanding the shape of the mERG response (first-order kernel). Full-field simulations of the mERG paradigm illustrate that the first-order kernel is comprised of responses with different waveforms. Further, it is argued that the nonlinear, adaptive mechanisms that produce the second-order kernel are involved in shaping the time course of the response. Patients with large, but abnormally delayed mERG responses (first-order kernel), do not have a detectable second-order kernel. It is speculated that a markedly diminished second-order kernel is diagnostic of outer plexiform layer damage, not inner plexiform layer damage as is commonly assumed.

Chromatic contrast sensitivity: the role of absolute threshold and gain constant in differences between the fovea and the periphery

A model of foveal achromatic and chromatic sensitivity [Vision Res. 36, 1597 (1996)] was extended to the peripheral visual field. Threshold-versus-illuminance functions were analyzed to determine effects of eccentricity on absolute thresholds and gain constants of chromatic and luminance mechanisms. The resulting peripheral model successfully predicted peripheral contrast sensitivity as a function of wavelength, for both white and 500-nm backgrounds. We conclude that the short-wavelength-sensitive cone opponent mechanism may mediate thresholds in Sloan's notch in the normal periphery and that interpretation of reduced chromatic sensitivity in the periphery requires an explicit model of how eccentricity affects both the gain constant and the absolute threshold.

Autosomal dominant cone-rod retinal dystrophy (CORD6) from heterozygous mutation of GUCY2D, which encodes retinal guanylate cyclase

OBJECTIVE

To describe the clinical features of autosomal dominant cone-rod retinal dystrophy (CRD) in a British family mapping to chromosome 17p12-p13 (CORD6), with a heterozygous mutation (Glu837Asp/ Arg838Ser) of GUCY2D.

DESIGN

A prospective, clinical family survey.

PATIENTS

Ten affected members of a family with autosomal dominant CRD.

METHODS

Full clinical examinations were undertaken. Selected affected family members underwent electrophysiologic evaluation, scotopic static perimetry, dark adaptometry, and color vision assessment.

MAIN OUTCOME MEASURES

Clinical appearance and electroretinographic responses.

RESULTS

Typical clinical and electroretinographic features of childhood-onset CRD were recorded. In addition, moderate myopia and pendular nystagmus were seen in affected individuals. Color vision assessment in the youngest affected individual showed no color discrimination on a tritan axis, but retention of significant red-green discrimination. Electronegative electroretinogram responses were seen on electrophysiology in the only young family member examined.

CONCLUSIONS

The phenotype associated with GUCY2D CRD is clinically distinct from that associated with other dominant CRD loci. Unusual electroretinographic responses may indicate that this mutation of GUCY2D is associated with early defects in photoreceptor synaptic transmission to second-order neurons.

Rod and cone visual cycle consequences of a null mutation in the 11-cis-retinol dehydrogenase gene in man

Vertebrate vision starts with photoisomerization of the 11-cis-retinal chromophore to all-trans-retinal. Biosynthesis of 11-cis-retinal is required to maintain vision. A key enzyme catalyzing the oxidation of 11-cis-retinol is 11-cis-retinol dehydrogenase (11-cis-RDH), which is encoded by the RDH5 gene. 11-cis-RDH is expressed in the RPE and not in the neural retina. The consequences of a lack of 11-cis-RDH were studied in a family with fundus albipunctatus. We identified the causative novel RDH5 mutation, Arg157Trp, that replaces an amino acid residue conserved among short-chain alcohol dehydrogenases. Three-dimensional structure modeling and in vitro experiments suggested that this mutation destabilizes proper folding and inactivates the enzyme. Studies using RPE membranes indicated the existence of an alternative oxidizing system for the production of 11-cis-retinal. In vivo visual consequences of this null mutation showed complex kinetics of dark adaptation. Rod and cone resensitization was extremely delayed following full bleaches; unexpectedly, the rate of cone recovery was slower than rods. Cones showed a biphasic recovery with an initial rapid component and an elevated final threshold. Other unanticipated results included normal rod recovery following 0.5% bleach and abnormal recovery following bleaches in the 2-12% range. These intermediate bleaches showed rapid partial recovery of rods with transitory plateaux. Pathways in addition to 11-cis-RDH likely provide 11-cis-retinal for rods and cones and can maintain normal kinetics of visual recovery but only under certain constraints and less efficiently for cone than rod function.

Retinal rod photoreceptor-specific gene mutation perturbs cone pathway development

Rod-specific photoreceptor dystrophies are complicated by the delayed death of genetically normal neighboring cones. In transgenic (Tg) swine with a rod-specific (rhodopsin) gene mutation, cone photoreceptor physiology was normal for months but later declined, consistent with delayed cone cell death. Surprisingly, cone postreceptoral function was markedly abnormal when cone photoreceptor physiology was still normal. The defect was localized to hyperpolarizing cells postsynaptic to the middle wavelength-sensitive cones. Recordings throughout postnatal development indicated a failure of cone circuitry maturation, a novel mechanism of secondary cone abnormality in rod dystrophy. The results have implications for therapy for human retinal dystrophies and raise the possibility that rod afferent activity plays a role in the postnatal maturation of cone retinal circuitry.

An L-type calcium-channel gene mutated in incomplete X-linked congenital stationary night blindness

The locus for the incomplete form of X-linked congenital stationary night blindness (CSNB2) maps to a 1.1-Mb region in Xp11.23 between markers DXS722 and DXS255. We identified a retina-specific calcium channel alpha1-subunit gene (CACNA1F) in this region, consisting of 48 exons encoding 1966 amino acids and showing high homology to L-type calcium channel alpha1-subunits. Mutation analysis in 13 families with CSNB2 revealed nine different mutations in 10 families, including three nonsense and one frameshift mutation. These data indicate that aberrations in a voltage-gated calcium channel, presumably causing a decrease in neurotransmitter release from photoreceptor presynaptic terminals, are a frequent cause of CSNB2.

Psychophysical evidence for losses in rod sensitivity in the aging visual system

Rod sensitivity was measured with a criterion-free psychophysical method at 10 deg in the horizontal meridian of the nasal field of the left eye on 26 young (mean age, 24.1 yr) and 14 older (mean age 72.6 yr) observers in good ocular health. A 1 deg, 90 msec stimulus was delivered by means of a free-viewing optical system under computer control. Stimulus wavelengths were chosen to have either significant (406 nm) or minimal (560 nm) absorption by the older lens. After correction for senile miosis and lens density, 0.39 log unit higher thresholds for the older observers remained and are interpreted as being due to neural factors.

S-cone spatial contrast sensitivity can be independent of pre-receptoral factors

Short-wavelength-sensitive (S-) cone-mediated thresholds have been used to study the early stages of visual loss, but due to the effects of non-neural factors (pupil size, lenticular density, macular pigment density) S-cone thresholds are often of limited clinical utility. The current study evaluates four possible effects of non-neural factors on S-cone contrast sensitivity, and shows how these can be minimized by measuring sensitivity for 1-5 c/deg with a range of retinal illuminances for blue test gratings on yellow backgrounds. The data are fit well with a simple four-parameter model which indicates that S-cone contrast sensitivity can be relatively independent on non-neural factors. A simple control experiment is described for evaluating the independence in individual patients.

Increment threshold and purity discrimination spectral sensitivities of X-chromosome-linked color-defective observers

The goal of the study was to evaluate spectral opponency in nine X-chromosome-linked color-defective observers. The tasks included increment threshold spectral sensitivity on an achromatic background, heterochromatic flicker photometry, and colorimetric purity discrimination. With a task of heterochromatic flicker photometry, the anomalous trichromatic observers showed spectral sensitivity of the corresponding dichromat. The increment threshold spectral sensitivity and colorimetric purity discrimination data were analyzed using the concept of standard cone photopigment spectral sensitivities for normal and defective vision, and a model that postulates one cone-additive and two cone-antagonistic systems. The model incorporated a shift of the peak spectral sensitivity of the long-wavelength-sensitive (LWS) pigment (for protan observers) or of the middle-wavelength-sensitive (MWS) pigment (for deutan observers). Two dichromats and two anomalous trichromats did not show clear evidence of LWS vs MWS cone antagonism. Five anomalous trichromats showed such cone antagonism. Molecular genetic analysis of the opsin genes is presented for eight of the observers.

Chromatic discrimination with variation in chromaticity and luminance: data and theory

Boynton and Kambe developed a model of chromatic discrimination in which thresholds are mediated by two independent mechanisms: the short-wavelength sensitive (S-) cones (S-cone axis), and the middle-wavelength sensitive (M-) and long-wavelength sensitive (L-) cones (M/L-cone axis). In this study, we used a Maxwellian view optical system to investigate fundamental properties of the model as a function of chromaticity and luminance. We confirmed that discriminations along the S-cone axis were dependent on S-cone excitation level. However, changes in chromaticity and changes in mean luminance were not described by a single threshold-vs-radiance (TVR) template. We developed a model to account for the different effects of changing S-cone excitation by varying mean chromaticity and by varying mean luminance. M/L-cone discriminations showed a minimum at the L-cone excitation to white, indicating strong opponency. The thresholds increased with luminance approaching a Weber region and showing parallel functions for differing chromaticities. These data are fit by a model allowing retinal gain controls and spectral opponency.

Light adaptation of human rod receptors: the leading edge of the human a-wave and models of rod receptor activity

The human rod receptors can be studied by measuring the leading edge of the rod a-wave of the ERG. Computational models, previously shown to fit the recordings from single rods, are fitted to dark-adapted a-wave responses. A model proposed by Lamb and Pugh [(1992) Journal of Physiology, 499, 719-758] fits slightly better than the traditional models based upon n-stage exponential filters. To test alternative models of rod light adaptation, a-waves were recorded to flashes presented upon steady adapting lights. Steady adapting lights decrease the rods' sensitivity. Human rods must adapt as response compression alone predicts far greater decreases in sensitivity. The evidence suggests that the mechanism(s) of adaptation include a change in the time-course of the rod's response. Human rods appear to adapt in much the same manner as do the rods of other vertebrates.

Pigment tests evaluated by a model of chromatic discrimination

Clinical color-vision tests are evaluated within the framework of a model of chromatic discrimination in terms of cone excitation. The motivation for this study was to derive a method for evaluation of test design, test sensitivity, and observer performance. The discrimination model is based on the assumption that chromatic discrimination is mediated in two independent channels, one for short-wavelength cones and one for long- and middle-wavelength cones. Luminance-dependent templates are derived for each channel, and they describe chromatic-discrimination behavior of the young color-normal observer. The templates incorporate receptor- and opponent-level gain controls. We show how the chromaticities of clinical tests can be calculated in cone-excitation units and how discrimination behavior on the tests can be plotted on the templates. The tests include the Farnsworth-Munsell 100-hue, the Farnsworth Panel D-15, the Farnsworth Panel D-15 desaturated, the American Optical Hardy-Rand-Rittler, the Farnsworth F2 plate, the Standard Pseudoisochromatic Plates, Part II, the Ishihara, and the Minimalist tests. Clinical-test data collected on young color-normal observers at different illumination levels show the validity of the techniques.

Modeling the dynamics of light adaptation: the merging of two traditions

Light adaptation has been studied using both aperiodic and periodic stimuli. Two well-documented phenomena are described: the background-onset effect (from an aperiodic-stimulus tradition) and high-temporal-frequency linearity (from the periodic-stimulus tradition). These phenomena have been explained within two different theoretical frameworks. Here we briefly review those frameworks. We then show that the models developed to predict the phenomenon from one tradition cannot predict the phenomenon from the other tradition, but that the models from the two traditions can be merged into a class of models that predicts both phenomena.

Quantal noise and decision rules in dynamic models of light adaptation

To evaluate some of the consequences of including probabilistic processes (e.g. quantal noise) in a computable model of light-adaptation dynamics, we considered the behavior of a general class of models. These models contain four stages: (1) early noise; (2) a deterministic filtering and gain-changing stage; (3) late noise; (4) a decision rule that is either an ideal (signal-known-exactly) detector or a peak-trough detector. With the ideal detector and without late noise, the observer's sensitivity as a function of mean luminance and temporal frequency is not affected by the filtering and gain-changing stage. Consequently, if the early noise is entirely quantal fluctuations, sensitivity will always be a square-root function of mean luminance and a uniform (flat) function of temporal frequency. This latter prediction is contradicted by all known data; either the ideal-detector is the wrong decision rule or sensitivity is almost always limited by sources of noise other than quantal fluctuations. With the peak-trough detector, however, with or without late noise, the observer's sensitivity as a function of temporal frequency does reflect the sensitivity of the low-level filtering and gain-changing stage. Late noise is needed, however, if the observer's sensitivity as a function of mean luminance is to go through both a square-root and a Weber region. Comparing these conclusions to similar work on the spatial frequency dimension highlights differences between the spatial and temporal frequency domains. Finally, on the basis of these analyses and evidence from the literature, we question whether quantal fluctuations limit visual sensitivity under any condition.

A computational model of the amplitude and implicit time of the b-wave of the human ERG

To improve the usefulness of the ERG in identifying the sites and mechanisms of adaptation, development, and disease processes, a theoretical framework based upon Granit's analysis of the ERG was evaluated. The framework assumes that the ERG is the sum of two potentials, one, P3, generated by the receptors and the other, P2, generated by the cells of the INL. Hood and Birch (1990a, b) demonstrated that the leading edge of the a-wave can be quantitatively described by a model used to describe the response from single rod receptors. This model provides P3(t), a theoretical receptor response as a function of time, for any given flash intensity. The ERGs from normal observers and patients with retinal diseases were analyzed in this framework, first by deriving P2 by computer subtracting the predicted P3(t) responses. This analysis was successful and a computational model of the ERG was then derived. The model of P2(t) was constructed with linear filters and a static nonlinearity and using P3(t) as the input. The ERG for any given flash intensity is then P3(t) + P2(t). The model describes (1) the change both in implicit times and in trough-to-peak b-wave amplitudes with flash intensity for the normal, dark-adapted observers; and (2) the changes in b-wave implicit times and amplitudes for three patients with retinal diseases. Among the implications drawn from these analyses were as follows: (1) The fits of the Naka-Rushton equation to trough-to-peak b-wave amplitudes must be interpreted with great care. (2) When the INL is affected by retinal disease, the b-wave may be a very poor reflection of INL activity. (3) The implicit time of the b-wave can provide a measure of receptor sensitivity.

Electroretinographic assessment of background adaptation in 10-week-old human infants

Full field, scotopic b-wave stimulus/response functions of 10-week-old infants and adults were measured in the dark-adapted condition, and in the presence of steady backgrounds. Dark adapted b-wave sensitivity (log sigma) differed significantly between infants and adults; the median dark adapted sensitivity of infants was 0.50 log unit less than that of adults. The median eigengraus of infants (-1.32 log scot. td) and adults (-1.55 log scot. td) did not differ significantly. The median slope of the linear portion of the background adaptation function was about 0.9 for infants and adults. These results argue for post-receptoral immaturities, but do not rule out receptoral immaturities.