Peripheral cone contrast sensitivity in glaucoma

Ganglion cell loss and age-related visual loss: a cortical pooling analysis

PURPOSE

To evaluate the ability of the cortical pooling model to predict the effects of random, mild ganglion cell loss, we compared the predictions of the model with the age-related loss and variability in achromatic and chromatic contrast sensitivity.

METHODS

The relative sensitivity to small (0.5 degrees ) and large (3.0 degrees ) stimuli was compared in older (mean = 67 years, n = 27) and younger (mean = 23 years, n = 32) adults. Contrast sensitivity for modulations along the luminance, equiluminant L-cone, and equiluminant S-cone axes was assessed at the fovea and at four peripheral locations (12 degrees ).

RESULTS

When the stimuli were large, threshold measurements obtained from all participants were reliable and well within the range of modulations along the chromatic axes that could be produced by the phosphors of the CRT. For the large stimuli, neither long- nor short-term variability increased as a function of age. Increasing the size of the stimulus did not decrease the magnitude of the age-related losses when the stimulus was chromatic, and visual losses observed with large chromatic stimuli were not different from those obtained with small achromatic stimuli. Moreover, chromatic contrast sensitivity assessments identified significant visual losses in four individuals who were not identified by achromatic contrast sensitivity assessments and only missed identifying one individual with significant losses in achromatic contrast sensitivity.

CONCLUSIONS

The declines in achromatic and chromatic sensitivity as a function of age (0.4-0.7 dB per decade) were similar to those obtained in previous studies of achromatic and chromatic perimetry and are consistent with the loss of retinal ganglion cells reported in histologic studies. The results of this study are consistent with the predictions the cortical pooling model makes for both variability and contrast sensitivity. These findings emphasize that selective visual impairments do not necessarily reflect preferential damage to a single ganglion cell class and that it is important to include the influence of higher cortical processing when quantifying the relation between ganglion cells and visual function.

The effect of simulated lens yellowing and opacification on blue-on-yellow acuity and contrast sensitivity

Short-wavelength-sensitive (SWS) resolution acuity has been reported to be limited by the density of the responding ganglion cells for people without appreciable age-related lenticular change. This study measured the robustness of SWS-cone acuity and contrast sensitivity (CS) to simulated lens yellowing and opacification. Resolution acuity at 8 deg eccentricity proved robust to significant amounts of yellowing and remained lower than detection acuity, indicating that the resolution continued to be limited by ganglion cell density. Both the detection and resolution CS functions were affected by simulated lens yellowing, except for resolution close to the CS cut-off. For simulated opacification, only dense opacity significantly affected performance. SWS resolution acuity and CS close to the resolution limit are resistant to moderate simulated age-related lens changes and continue to be mediated by the density of the responding ganglion cells, indicating important clinical potential to measure SWS neural losses of vision in older subjects.

Chromatic and achromatic defects in patients with progressing glaucoma

To evaluate the pattern of losses associated with glaucomatous injury in patients with progressing glaucoma, functional losses were examined in 14 patients with progressing glaucoma using tests for which detection should be selectively mediated by one of three psychophysical mechanisms. Red-on-white increments, blue-on-white increments and critical flicker frequency were used to isolate the responses of the red-green chromatic mechanism, the blue-on chromatic mechanism, and the high-frequency flicker achromatic mechanism. For our 3.1 degrees circular stimuli, chromatic defects were found in a greater number of the patients with glaucoma than were achromatic defects. We evaluated these defects in terms of two existing hypotheses: preferential loss and reduced redundancy. The greater sensitivity to glaucomatous injury of chromatic tests, compared to achromatic tests, found in this and other studies and the apparent discrepancy between anatomical and psychophysical studies can be parsimoniously explained by differences in cortical summation of ganglion cell responses for the chromatic and achromatic pathways.

Visual evoked potential assessment of the effects of glaucoma on visual subsystems

The purpose of this study is to test the hypothesis that glaucoma leads to selective deficits in parallel pathways or channels. Sweep VEPs were obtained to isolated-check stimuli that were modulated sinusoidally in either isoluminant chromatic contrast or in positive and negative luminance contrast. Response functions were obtained from 14 control subjects, 15 patients with open-angle glaucoma, and seven glaucoma suspects. For all three groups of subjects we found characteristic differences between the VEP response functions to isoluminant chromatic contrast stimuli and to luminance contrast stimuli. The isoluminant chromatic stimulus conditions appeared to favor activity of the P-pathway, whereas the luminance contrast stimuli at low depths of modulation favored M-pathway activity. VEP responses for patients with OAG were significantly reduced for chromatic contrast and luminance contrast conditions, whereas VEP responses for glaucoma suspects were significantly reduced only for the 15-Hz positive luminance contrast condition. Our results suggest that both M- and P-pathways are affected by glaucoma.

Comparison of red-green, blue-yellow and achromatic losses in glaucoma

Achromatic losses in glaucoma would be expected to be greater than, or equal to, red-green chromatic losses if the following assumptions are made: (1) the function of the remaining axons is either unchanged or non-selectively reduced; (2) red-green chromatic information is signaled by the midget ganglion cell system; and (3) the function of the magnocellular system is reduced at least as much as that of the midget ganglion cells. This prediction was tested by measuring red-green (along with blue-yellow) mixture thresholds for 1 deg, 0.2 sec test spots presented on a color monitor on a white background of 50 cd/m2. Ellipses were fitted to plots of green contrast as a function of red contrast (or yellow as a function of blue), and major and minor axes of these ellipses were taken as measures of chromatic and achromatic thresholds, respectively. The study population consisted of 29 eyes in 29 patients with early glaucoma; control data were derived from a data bank of 83 normal eyes. Red-green losses were significantly (P < 0.05) greater than achromatic losses in 6 out of the 11 eyes which showed significant losses of either chromatic or achromatic sensitivity (or both). It is concluded that, for these eyes, at least one of the above three assumptions is incorrect.

Chromatic and luminance systems deficits in glaucoma

The purpose of this study was to compare the effects of glaucoma, at different stages of the disease process, on the two color-opponent system and on the luminance system. Discrimination thresholds were measured along the two equiluminant cardinal color axes (RG and YV) and along an achromatic luminance axis (LD) in 27 patients with open-angle glaucoma (OAG) and in 13 glaucoma suspects. Patients with OAG showed increased thresholds along all three axes. The threshold increases correlated significantly with the level of visual field loss. For glaucoma suspects, thresholds were also increased along all three axes. A subgroup of patients with OAG, those with pigmentary glaucoma, showed minimal increases in threshold along the RG axis. To further investigate this finding an additional 15 patients, seven with primary OAG and eight with pigmentary glaucoma were run in a two-alternative forced-choice experiment. For patients with pigmentary glaucoma, thresholds were increased less along the RG axis. The results of the study for OAG patients and glaucoma suspects are consistent with deficits in the two color-opponent systems, and in the luminance system.