Delayed on- and off-retinal responses of cones pathways in regular cannabis users: An On-Off flash electroretinogram case-control study

Exploring the ElectroRetinoGraphy as a biomarker for predicting and monitoring therapeutic response to antidepressants in major depressive disorder: study protocol for the MESANTIDEP trial

Background

Major depressive disorder (MDD) is a frequent and highly debilitating condition for which current antidepressant treatments show limited effectiveness. In addition, their implementation requires one or more trial-and-error processes, which involves months of untreated illness. Achieving faster efficacy by identifying the most adapted treatment for each patient as the first line treatment could significantly reduce MDD-related morbidity and mortality while enhancing patients' quality of life. To achieve this goal, there is a need to identify markers for predicting and monitoring therapeutic response to antidepressants.

Methods

The MESANTIDEP study is designed to identify electroretinographic (ERG) biomarkers that can predict the therapeutic response at 12 weeks to the two main classes of antidepressants prescribed as first-line treatments for MDD: Selective Serotonin Reuptake Inhibitors (SSRIs) and alpha-2 adrenergic receptor antagonists (α2-antagonists). Secondly, the study aims to explore the relationship between ERG measurements and therapeutic response at 6 and 12 weeks in MDD patients treated with SSRIs or α2-antagonists. To this end, patients diagnosed with MDD and needing to start an antidepressant from the SSRI or α2-antagonist classes will be enrolled. At the inclusion visit, prior to starting their antidepressant treatment, patients will undergo various assessments, including clinical and sleep questionnaires, as well as ERG tests. Patients will initiate their antidepressant treatment the day after the inclusion visit. Subsequent evaluations, identical to those at baseline, will be conducted 6 and 12 weeks afterwards to monitor therapeutic response to antidepressants.

Discussion

The MESANTIDEP study will contribute to identify ERG markers predicting and monitoring the therapeutic response to antidepressants. If such markers are highlighted, it is intended to help clinicians in the treatment management of MDD patients. ERG measurements being easy to perform and accessible to all, they could be integrated into a multimodal treatment approach in routine clinical practice. It would enable more rapid therapeutic intervention tailored to each patient could reduce the functional impact of the disease, improve patients' quality of life, and decrease MDD-associated morbidity and mortality.

Clinical Trial Registration

Clinicaltrials.gov, identifier NCT06532604.

Adverse Ocular Impact and Emerging Therapeutic Potential of Cannabis and Cannabinoids: A Narrative Review

Cannabis is the most used drug worldwide with an estimated 219 million users. This narrative review aims to explore the adverse effects and therapeutic applications of cannabis and cannabinoids on the eye, given its growing clinical and non-clinical uses. The current literature reports several adverse ocular effects of cannabis and cannabinoids, including eyelid tremor, ptosis, reduced corneal endothelial cell density, dry eyes, red eyes, and neuro-retinal dysfunction. Cannabinoids may transiently impair night vision, depth perception, binocular and monocular contrast sensitivity, and dynamic visual acuity. Cannabinoids are not currently considered a first-line treatment option for any ocular conditions. Δ-9-tetrahydrocannabinol been shown to result in short-term intraocular pressure reduction, but insufficient evidence to support its use in treating glaucoma exists. Potential therapeutic applications of cannabinoids include their use as a second-line agent for treatment-refractory blepharospasm, for dry eye disease given corneal anti-inflammatory properties, and for suppression of pendular nystagmus in individuals with multiple sclerosis, which all necessitate further research for informed clinical practices.

Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies

The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.

Retinal electroretinogram features can detect depression state and treatment response in adults: A machine learning approach

BACKGROUND

Major depressive disorder (MDD) is a major public health problem. The retina is a relevant site to indirectly study brain functioning. Alterations in retinal processing were demonstrated in MDD with the pattern electroretinogram (PERG). Here, the relevance of signal processing and machine learning tools applied on PERG was studied.

METHODS

PERG - whose stimulation is reversible checkerboards - was performed according to the International Society for Clinical Electrophysiology of Vision (ISCEV) standards in 24 MDD patients and 29 controls at the inclusion. PERG was recorded every 4 weeks for 3 months in patients. Amplitude and implicit time of P50 and N95 were evaluated. Then, time/frequency features were extracted from the PERG time series based on wavelet analysis. A statistical model has been learned in this feature space and a metric aiming at quantifying the state of the MDD patient has been derived, based on minimum covariance determinant (MCD) mahalanobis distance.

RESULTS

MDD patients showed significant increase in P50 and N95 implicit time (p = 0,006 and p = 0,0004, respectively, Mann-Whitney U test) at the inclusion. The proposed metric extracted from the raw PERG provided discrimination between patients and controls at the inclusion (p = 0,0001). At the end of the follow-up at week 12, the difference between the metrics extracted on controls and patients was not significant (p = 0,07), reflecting the efficacy of the treatment.

CONCLUSIONS

Signal processing and machine learning tools applied on PERG could help clinical decision in the diagnosis and the follow-up of MDD in measuring treatment response.

Variations of retinal dysfunctions with the level of cannabis use in regular users: Toward a better understanding of cannabis use pathophysiology

The impact of regular cannabis use on retinal function has already been studied using flash (fERG) and pattern (PERG) electroretinogram. Delayed ganglion and bipolar cells responses were observed as showed by increased peak time of PERG N95 and fERG b-wave recorded in photopic condition. Hypoactivity of amacrine cells was also showed by decreased amplitudes of oscillatory potentials (OPs). However, it is unknown how these retinal anomalies evolve according to the level of cannabis use in cannabis users. The aim of this study was to longitudinally assess the retinal function during a treatment aiming to reduce cannabis use. We recorded PERG and fERG in 40 regular cannabis users receiving either an 8 weeks mindfulness-based relapse prevention program or an 8 weeks treatment-as-usual therapy. ERGs were recorded before treatment, at the end of it, and 4 weeks afterward. We found reduced peak times in PERG N95 and fERG b-wave (p = 0.032 and p = 0.024: Dunn's post-hoc test) recorded at week 8 and increased amplitudes in OP2 and OP3 (p = 0.012 and p = 0.030: Dunn's post-hoc test) recorded at week 12 in users with decreased cannabis use. These results support variations of retinal anomalies with the level of cannabis use, implying that reduction of cannabis use could restore retinal function in regular users.