The retina of the newborn human infant

An embodied approach to fetal and newborn perceptual and sensorimotor development

The embodied approach argues that interaction with the environment plays a crucial role in brain development and that the presence of sensory effects generated by movements is fundamental. The movement of the fetus is initially random. Then, the repeated execution of the movement creates a link between it and its sensory effects, allowing the selection of movements that produce expected sensations. During fetal life, the brain develops from a transitory fetal circuit to the permanent cortical circuit, which completes development after birth. Accordingly, this process must concern the interaction of the fetus with the intrauterine environment and of the newborn with the new aerial environment, which provides a new sensory stimulation, light. The goal of the present review is to provide suggestions for neuroscientific research capable of shedding light on brain development process by describing from a functional point of view the relationship between the motor and sensory abilities of fetuses and newborns and the increasing complexity of their interaction with objects in the womb and outside of it.

Vitreoretinal biomarkers of retinopathy of prematurity using handheld optical coherence tomography: a review

Retinopathy of prematurity (ROP) is caused by abnormal retinal vascularization in premature infants that has the potential for severe long-term vision impairment. Recent advancements in handheld optical coherence tomography (OCT) have enabled noninvasive, high-resolution, cross-sectional imaging of the infant eye at the bedside. The use of handheld OCT devices in the diagnosis of ROP in premature infants has furthered our understanding of disease state and progression. This review discusses the known and novel biomarkers of ROP severity in premature infants identified through handheld OCT and potential for future directions.

The Newborn's Reaction to Light as the Determinant of the Brain's Activation at Human Birth

Developmental neuroscience research has not yet fully unveiled the dynamics involved in human birth. The trigger of the first breath, often assumed to be the marker of human life, has not been characterized nor has the process entailing brain modification and activation at birth been clarified yet. To date, few researchers only have investigated the impact of the extrauterine environment, with its strong stimuli, on birth. This ‘hypothesis and theory' article assumes the role of a specific stimulus activating the central nervous system (CNS) at human birth. This stimulus must have specific features though, such as novelty, efficacy, ubiquity, and immediacy. We propose light as a robust candidate for the CNS activation via the retina. Available data on fetal and neonatal neurodevelopment, in particular with reference to retinal light-responsive pathways, will be examined together with the GABA functional switch, and the subplate disappearance, which, at an experimental level, differentiate the neonatal brain from the fetal brain. In this study, we assume how a very rapid activation of retinal photoreceptors at birth initiates a sudden brain shift from the prenatal pattern of functions to the neonatal setup. Our assumption implies the presence of a photoreceptor capable of capturing and transducing light/photon stimulus, transforming it into an effective signal for the activation of new brain functions at birth. Opsin photoreception or, more specifically, melanopsin-dependent photoreception, which is provided by intrinsically photosensitive retinal ganglion cells (ipRGCs), is considered as a valid candidate. Although what is assumed herein cannot be verified in humans based on knowledge available so far, proposing an important and novel function can trigger a broad range of diversified research in different domains, from neurophysiology to neurology and psychiatry.

Normal and abnormal foveal development

Normal foveal development begins in utero at midgestation with centrifugal displacement of inner retinal layers (IRLs) from the location of the incipient fovea. The outer retinal changes such as increase in cone cell bodies, cone elongation and packing mainly occur after birth and continue until 13 years of age. The maturity of the fovea can be assessed invivo using optical coherence tomography, which in normal development would show a well-developed foveal pit, extrusion of IRLs, thickened outer nuclear layer and long outer segments. Developmental abnormalities of various degrees can result in foveal hypoplasia (FH). This is a characteristic feature for example in albinism, aniridia, prematurity, foveal hypoplasia with optic nerve decussation defects with or without anterior segment dysgenesis without albinism (FHONDA) and optic nerve hypoplasia. In achromatopsia, there is disruption of the outer retinal layers with atypical FH. Similarly, in retinal dystrophies, there is abnormal lamination of the IRLs sometimes with persistent IRLs. Morphology of FH provides clues to diagnoses, and grading correlates to visual acuity. The outer segment thickness is a surrogate marker for cone density and in foveal hypoplasia this correlates strongly with visual acuity. In preverbal children grading FH can help predict future visual acuity.

Limited time window for retinal gene therapy in a preclinical model of ciliopathy

Retinal degeneration is a common clinical feature of ciliopathies, a group of genetic diseases linked to ciliary dysfunction, and gene therapy is an attractive treatment option to prevent vision loss. Although the efficacy of retinal gene therapy is well established by multiple proof-of-concept preclinical studies, its long-term effect, particularly when treatments are given at advanced disease stages, is controversial. Incomplete treatment and intrinsic variability of gene delivery methods may contribute to the variable outcomes. Here, we used a genetic rescue approach to 'optimally' treat retinal degeneration at various disease stages and examined the long-term efficacy of gene therapy in a mouse model of ciliopathy. We used a Bardet-Biedl syndrome type 17 (BBS17) mouse model, in which the gene-trap that suppresses Bbs17 (also known as Lztfl1) expression can be removed by tamoxifen administration, restoring normal gene expression systemically. Our data indicate that therapeutic effects of retinal gene therapy decrease gradually as treatments are given at later stages. These results suggest the presence of limited time window for successful gene therapy in certain retinal degenerations. Our study also implies that the long-term efficacy of retinal gene therapy may depend on not only the timing of treatment but also other factors such as the function of mutated genes and residual activities of mutant alleles.

Foveal Differentiation and Inner Retinal Displacement Are Arrested in Extremely Premature Infants

Purpose

Children with a history of prematurity often have poorly developed foveae but when during development foveal differences arise. We hypothesize that the course of foveal development is altered from the time of preterm birth.

Methods

Eyes of 102 preterm infants undergoing retinopathy of prematurity screening examinations in the STudy of Eye imaging in Premature infantS (BabySTEPS) (NCT02887157) were serially imaged between 30 and 42 weeks postmenstrual age (PMA) using handheld optical coherence tomography systems. Total retinal thickness, inner retinal layer (IRL) thickness, and outer retinal layer (ORL) thickness were measured at the foveal center and parafovea. Foveal put depth, IRL thickness, and ORL thickness were compared between infants born at different gestational ages using mixed effects models.

Results

Foveal pit depth and IRL thickness were inversely related to gestational age; on average, the most premature infants had the thickest IRL and shallowest pits at all PMAs. Differences were evident by 30 weeks PMA and persisted through 42 weeks PMA. The foveal pits of the most premature infants did not progressively deepen, and the IRLs did not continue to thin with increasing chronological age.

Conclusions

Foveation in extremely preterm infants is arrested from the earliest observed ages and fails to progress through term equivalent age. The developmental displacement of the IRL from the foveal center into the parafovea does not occur normally after preterm birth. These observations suggest that foveal hypoplasia seen in children with history of prematurity is due to disturbances in foveal development that manifest within weeks of birth.

Autofluorescent Granules of the Human Retinal Pigment Epithelium: Phenotypes, Intracellular Distribution, and Age-Related Topography

Purpose

The human retinal pigment epithelium (RPE) accumulates granules significant for autofluorescence imaging. Knowledge of intracellular accumulation and distribution is limited. Using high-resolution microscopy techniques, we determined the total number of granules per cell, intracellular distribution, and changes related to retinal topography and age.

Methods

RPE cells from the fovea, perifovea, and near-periphery of 15 human RPE flat mounts were imaged using structured illumination microscopy (SIM) and confocal fluorescence microscopy in young (≤51 years, n = 8) and older (>80 years, n = 7) donors. Using custom FIJI plugins, granules were marked with computer assistance, classified based on morphological and autofluorescence properties, and analyzed with regard to intracellular distribution, total number per cell, and granule density.

Results

A total of 193,096 granules in 450 RPE cell bodies were analyzed. Based on autofluorescence properties, size, and composition, the RPE granules exhibited nine different phenotypes (lipofuscin, two; melanolipofuscin, five; melanosomes, two), distinguishable by SIM. Overall, lipofuscin (low at the fovea but increases with eccentricity and age) and melanolipofuscin (equally distributed at all three locations with no age-related changes) were the major granule types. Melanosomes were under-represented due to suboptimal visualization of apical processes in flat mounts.

Conclusions

Low lipofuscin and high melanolipofuscin content within foveal RPE cell bodies and abundant lipofuscin at the perifovea suggest a different genesis, plausibly related to the population of overlying photoreceptors (fovea, cones only; perifovea, highest rod density). This systematic analysis provides further insight into RPE cell and granule physiology and links granule load to cell autofluorescence, providing a subcellular basis for the interpretation of clinical fundus autofluorescence.

Limitations and Promise of Retinal Tissue From Human Pluripotent Stem Cells for Developing Therapies of Blindness

The self-formation of retinal tissue from pluripotent stem cells generated a tremendous promise for developing new therapies of retinal degenerative diseases, which previously seemed unattainable. Together with use of induced pluripotent stem cells or/and CRISPR-based recombineering the retinal organoid technology provided an avenue for developing models of human retinal degenerative diseases "in a dish" for studying the pathology, delineating the mechanisms and also establishing a platform for large-scale drug screening. At the same time, retinal organoids, highly resembling developing human fetal retinal tissue, are viewed as source of multipotential retinal progenitors, young photoreceptors and just the whole retinal tissue, which may be transplanted into the subretinal space with a goal of replacing patient's degenerated retina with a new retinal "patch." Both approaches (transplantation and modeling/drug screening) were projected when Yoshiki Sasai demonstrated the feasibility of deriving mammalian retinal tissue from pluripotent stem cells, and generated a lot of excitement. With further work and testing of both approaches in vitro and in vivo, a major implicit limitation has become apparent pretty quickly: the absence of the uniform layer of Retinal Pigment Epithelium (RPE) cells, which is normally present in mammalian retina, surrounds photoreceptor layer and develops and matures first. The RPE layer polarize into apical and basal sides during development and establish microvilli on the apical side, interacting with photoreceptors, nurturing photoreceptor outer segments and participating in the visual cycle by recycling 11-trans retinal (bleached pigment) back to 11-cis retinal. Retinal organoids, however, either do not have RPE layer or carry patches of RPE mostly on one side, thus directly exposing most photoreceptors in the developing organoids to neural medium. Recreation of the critical retinal niche between the apical RPE and photoreceptors, where many retinal disease mechanisms originate, is so far unattainable, imposes clear limitations on both modeling/drug screening and transplantation approaches and is a focus of investigation in many labs. Here we dissect different retinal degenerative diseases and analyze how and where retinal organoid technology can contribute the most to developing therapies even with a current limitation and absence of long and functional outer segments, supported by RPE.

Development of global visual processing: From the retina to the perceptive field

Young children exhibit poorer visual performance than adults due to immaturity of the fovea and of the fundamental processing of visual functions such as masking and crowding. Recent studies suggest that masking and crowding are closely related to the size of the fundamental processing unit-the perceptive field (PF). However, while it is known that the retina and basic visual functions develop throughout childhood, it is not clear whether and how changes in the size of the PF affect masking and crowding. Furthermore, no retinal and perceptual development data have been collected from the same cohort and time. Here we explored the developmental process of the PF and the basic visual functions. Psychophysical and imaging methods were used to test visual functions and foveal changes in participants ranging from 3-17 years old. Lateral masking, crowding and contrast sensitivity were tested using computerized tasks. Foveal measurements were obtained from spectral-domain optical coherence tomography (OCT). The children patterns below 6 years exhibited high crowding, while the expected facilitation was found only at a larger target-flanker distance than required for children above 6 years, who exhibited the typical adult. Foveal thickness and macular volume for the children below 6 years were significantly lower than for the older group. Significant correlation was found for contrast sensitivity, foveal thickness and macular volume with age and between contrast sensitivity and foveal thickness. Our data suggest that the developmental processes at the retina and visual cortex occur in the same age range. Thus, in parallel to maturation of the PF, which enables reduction in crowding, foveal development contributes to increasing contrast sensitivity.

Premises of social cognition: Newborns are sensitive to a direct versus a faraway gaze

Previous studies evidenced that already from birth, newborns can perceive differences between a direct versus an averted gaze in faces both presented in static and interactive situations. It has been hypothesized that this early sensitivity would rely on modifications of the location of the iris (i.e. the darker part of the eye) in the sclera (i.e. the white part), or that it would be an outcome of newborns' preference for configurations of faces with the eye region being more contrasted. One question still remains: What happens when the position of the iris is not modified in the sclera, but the look is 'faraway', that is when the gaze is toward the newborns' face but above his or her own eyes? In the present study, we tested the influence of a direct versus a faraway gaze (i.e., two gazes that only differed slightly in the position of the iris on the vertical axis and not on the horizontal axis) on newborns' face recognition. The procedure was identical to that used in previous studies: using a familiarization-test procedure, we familiarized two groups of newborns (N = 32) with videos of different talking faces that were presented with either a direct or a faraway gaze. Newborns were then tested with photographs of the face seen previously and of a new one. Results evidenced that newborns looked longer at the familiar face, but only in the direct gaze condition. These results suggest that, already from birth, infants can perceive slight differences of gazes when someone is addressing to them.

Retinogenesis of the Human Fetal Retina: An Apical Polarity Perspective

The Crumbs complex has prominent roles in the control of apical cell polarity, in the coupling of cell density sensing to downstream cell signaling pathways, and in regulating junctional structures and cell adhesion. The Crumbs complex acts as a conductor orchestrating multiple downstream signaling pathways in epithelial and neuronal tissue development. These pathways lead to the regulation of cell size, cell fate, cell self-renewal, proliferation, differentiation, migration, mitosis, and apoptosis. In retinogenesis, these are all pivotal processes with important roles for the Crumbs complex to maintain proper spatiotemporal cell processes. Loss of Crumbs function in the retina results in loss of the stratified appearance resulting in retinal degeneration and loss of visual function. In this review, we begin by discussing the physiology of vision. We continue by outlining the processes of retinogenesis and how well this is recapitulated between the human fetal retina and human embryonic stem cell (ESC) or induced pluripotent stem cell (iPSC)-derived retinal organoids. Additionally, we discuss the functionality of in utero and preterm human fetal retina and the current level of functionality as detected in human stem cell-derived organoids. We discuss the roles of apical-basal cell polarity in retinogenesis with a focus on Leber congenital amaurosis which leads to blindness shortly after birth. Finally, we discuss Crumbs homolog (CRB)-based gene augmentation.

Handheld Optical Coherence Tomography Normative Inner Retinal Layer Measurements for Children <5 Years of Age

PURPOSE

Measurements of the ganglion cell complex (GCC), comprising the retinal nerve fiber (RNFL), ganglion cell, and inner plexiform layers, can be correlated with vision loss caused by optic nerve disease. Handheld optical coherence tomography (HH-OCT) can be used with sedation in children who are not amenable to traditional imaging. We report GCC and RNFL measurements in normal children using HH-OCT.

DESIGN

Prospective observational study of normal children ≤5 years of age.

METHODS

Healthy, full-term children ≤5 years of age undergoing sedation or anesthesia were enrolled. Exclusion criteria included prematurity and pre-existing neurologic, genetic, metabolic, or intraocular pathology. Demographic data, axial length (Master-Vu Sonomed Escalon, Lake Success, New York, USA), and HH-OCT macular and optic nerve volume scans at 0° (Bioptigen, Inc., Morrisville, North Carolina, USA) were obtained. Retinal segmentation was completed with DOCTRAP software, creating average volume thickness maps.

RESULTS

Sixty-seven children (67 eyes, 31 males ranging in age from 3.4-70.9 months) were enrolled. Average axial length was 21.2 ± 1.0 mm with mean spherical equivalent +1.49 ± 1.34 diopters (range -2.25 to 4.25). Average GCC volume for the total retina was 0.28 ± 0.04 mm³. Forty-seven of these eyes had RNFL analysis. Average RNFL thickness of the papillomacular bundle was 38.2 ± 9.5 μm. There was no correlation between GCC volume, RNFL thickness, patient age, or axial length.

CONCLUSION

Average GCC volume and RNFL thickness was stable from 6 months to 5 years of age. This study provides normative data for GCC and RNFL obtained by HH-OCT in healthy eyes of young children, to serve in evaluating those with optic neuropathies.

The human newborn's umwelt: Unexplored pathways and perspectives

Historically, newborns, and especially premature newborns, were thought to "feel nothing." However, over the past decades, a growing body of evidence has shown that newborns are aware of their environment, but the extent and the onset of some sensory capacities remain largely unknown. The goal of this review is to update our current knowledge concerning newborns' perceptual world and how ready they are to cope with an entirely different sensory environment following birth. We aim to establish not only how and when each sensory ability arises during the pre-/postbirth period but also discuss how senses are studied. We conclude that although many studies converge to show that newborns are clearly sentient beings, much is still unknown. Further, we identify a series of internal and external factors that could explain discrepancies between studies, and we propose perspectives for future studies. Finally, through examples from animal studies, we illustrate the importance of this detailed knowledge to pursue the enhancement of newborns' daily living conditions. Indeed, this is a prerequisite for assessing the effects of the physical environment and routine procedures on newborns' welfare.

Self-other recognition impairments in individuals with schizophrenia: a new experimental paradigm using a double mirror

Clinical observations suggest early self-consciousness disturbances in schizophrenia. A double mirror combining the images of two individuals sitting on each side of the mirror was used to study self-other differentiation in 12 individuals with early onset schizophrenia (EOS) and 15 individuals with adult onset schizophrenia (AOS) compared to 27 typically developing controls (TDC) matched on age and sex. The effects of intermodal sensory perception (visual-tactile and visual-kinesthetic) on self-other recognition were also studied. The results showed that EOS and AOS individuals, independently of age and schizophrenia severity, were centered on their own image compared to TDC, with both significant earlier self-recognition and delayed other-recognition during the visual recognition task. In addition, there was no significant effect of intermodal sensory stimulation on self-other recognition in EOS and AOS patients, whereas self-centered functioning was significantly increased by visual-tactile stimulation and decreased by visual-kinesthetic stimulation in TDC. The findings suggest that self-other recognition impairments might be a possible endophenotypic trait of schizophrenia.

The primate fovea: Structure, function and development

A fovea is a pitted invagination in the inner retinal tissue (fovea interna) that overlies an area of photoreceptors specialized for high acuity vision (fovea externa). Although the shape of the vertebrate fovea varies considerably among the species, there are two basic types. The retina of many predatory fish, reptilians, and birds possess one (or two) convexiclivate fovea(s), while the retina of higher primates contains a concaviclivate fovea. By refraction of the incoming light, the convexiclivate fovea may function as image enlarger, focus indicator, and movement detector. By centrifugal displacement of the inner retinal layers, which increases the transparency of the central foveal tissue (the foveola), the primate fovea interna improves the quality of the image received by the central photoreceptors. In this review, we summarize ‒ with the focus on Müller cells of the human and macaque fovea ‒ data regarding the structure of the primate fovea, discuss various aspects of the optical function of the fovea, and propose a model of foveal development. The "Müller cell cone" of the foveola comprises specialized Müller cells which do not support neuronal activity but may serve optical and structural functions. In addition to the "Müller cell cone", structural stabilization of the foveal morphology may be provided by the 'z-shaped' Müller cells of the fovea walls, via exerting tractional forces onto Henle fibers. The spatial distribution of glial fibrillary acidic protein may suggest that the foveola and the Henle fiber layer are subjects to mechanical stress. During development, the foveal pit is proposed to be formed by a vertical contraction of the centralmost Müller cells. After widening of the foveal pit likely mediated by retracting astrocytes, Henle fibers are formed by horizontal contraction of Müller cell processes in the outer plexiform layer and the centripetal displacement of photoreceptors. A better understanding of the molecular, cellular, and mechanical factors involved in the developmental morphogenesis and the structural stabilization of the fovea may help to explain the (patho-) genesis of foveal hypoplasia and macular holes.

Developmental visual deprivation: long term effects on human cone driven retinal function

PURPOSE

To assess whether infantile visual deprivation induced by developmental cataract may influence the cone-driven retinal function in humans.

METHODS

A total of 14 patients with history of bilateral developmental cataract (DC), who had undergone uncomplicated cataract extraction surgery and intraocular lens implant, and 14 healthy subjects (HS) were enrolled. All patients underwent complete ophthalmological and orthoptic evaluations and best-corrected visual acuity measurement. Light-adapted full-field electroretinograms (ERG) and photopic negative responses (PhNR) were recorded to obtain a reliable measurement of the outer/inner retinal function and of the retinal ganglion cells' function, respectively.

RESULT

Mean values of light-adapted ERG a- and b-wave implicit times were slightly delayed when compared to HS values. Light-adapted ERG a-wave amplitude mean values showed borderline values (p = 0.001), whereas a-wave amplitude analysis at 5 ms, b-wave and PhNR amplitude mean values showed no significant differences when compared to control values. No significant correlations were found when age at surgery, time elapsed from surgery, duration of the visual deprivation, age at examination, age at first detection of the opacity, BCVA and electrophysiological parameters were plotted together. Coherently with morphological studies, the extremely light bioelectrical impairment of the cone pathway in our cohort of patients describes minimal functional abnormalities of a well-structured retina that is not completely mature.

CONCLUSIONS

Our present results, combined to those of our previous work on congenital cataracts, allow us to enhance the comprehension of functional developmental mechanisms of children's retinas and highlight the relevance of the timely treatment of lens opacities during infancy.

Fgf8 Expression and Degradation of Retinoic Acid Are Required for Patterning a High-Acuity Area in the Retina

Species that are highly reliant on their visual system have a specialized retinal area subserving high-acuity vision, e.g., the fovea in humans. Although of critical importance for our daily activities, little is known about the mechanisms driving the development of retinal high-acuity areas (HAAs). Using the chick as a model, we found a precise and dynamic expression pattern of fibroblast growth factor 8 (Fgf8) in the HAA anlage, which was regulated by enzymes that degrade retinoic acid (RA). Transient manipulation of RA signaling, or reduction of Fgf8 expression, disrupted several features of HAA patterning, including photoreceptor distribution, ganglion cell density, and organization of interneurons. Notably, patterned expression of RA signaling components was also found in humans, suggesting that RA also plays a role in setting up the human fovea.

Overlap of abnormal photoreceptor development and progressive degeneration in Leber congenital amaurosis caused by NPHP5 mutation

Ciliary defects can result in severe disorders called ciliopathies. Mutations in NPHP5 cause a ciliopathy characterized by severe childhood onset retinal blindness, Leber congenital amaurosis (LCA), and renal disease. Using the canine NPHP5-LCA model we compared human and canine retinal phenotypes, and examined the early stages of photoreceptor development and degeneration, the kinetics of photoreceptor loss, the progression of degeneration and the expression profiles of selected genes. NPHP5-mutant dogs recapitulate the human phenotype of very early loss of rods, and relative retention of the central retinal cone photoreceptors that lack function. In mutant dogs, rod and cone photoreceptors have a sensory cilium, but develop and function abnormally and then rapidly degenerate; L/M cones are more severely affected than S-cones. The lack of outer segments in mutant cones indicates a ciliary dysfunction. Genes expressed in mutant rod or both rod and cone photoreceptors show significant downregulation, while those expressed only in cones are unchanged. Many genes in cell-death and -survival pathways also are downregulated. The canine disease is a non-syndromic LCA-ciliopathy, with normal renal structures and no CNS abnormalities. Our results identify the critical time points in the pathogenesis of the photoreceptor disease, and bring us closer to defining a potential time window for testing novel therapies for translation to patients.

Retinal Imaging of Infants on Spectral Domain Optical Coherence Tomography

Spectral domain coherence tomography (SD OCT) has become an important tool in the management of pediatric retinal diseases. It is a noncontact imaging device that provides detailed assessment of the microanatomy and pathology of the infant retina with a short acquisition time allowing office examination without the requirement of anesthesia. Our understanding of the development and maturation of the infant fovea has been enhanced by SD OCT allowing an in vivo assessment that correlates with histopathology. This has helped us understand the critical correlation of foveal development with visual potential in the first year of life and beyond. In this review, we summarize the recent literature on the clinical applications of SD OCT in studying the pathoanatomy of the infant macula, its ability to detect subclinical features, and its correlation with disease and vision. Retinopathy of prematurity and macular edema have been discussed in detail. The review also summarizes the current status of SD OCT in other infant retinal conditions, imaging the optic nerve, the choroid, and the retinal nerve fibre in infants and children, and suggests future areas of research.

Morphological features of retinal development in premature Chinese infants observed by computer-assisted indirect ophthalmoscope imaging

OBJECTIVE

To investigate retinal maturation in premature infants (gestation age <37 weeks). using computer-assisted indirect ophthalmoscope imaging.

METHODS

Premature infants at postmenstrual age 33-46 weeks, who underwent fundus examinations using computer-aided indirect ophthalmoscopy, were stratified into seven postmenstrual-age groups. Images of macular morphology, peripheral retinal vascularization and fundus pigmentation were compared.

RESULTS

The study included 268 infants in the following postmenstrual-age groups: 33-34 weeks (n = 19), 35-36 weeks (n = 37), 37-38 weeks (n = 49), 39-40 weeks (n = 55), 41-42 weeks (n = 49), 43-44 weeks (n = 34), and 45-46 weeks (n = 25). The macula matured with increasing postmenstrual age. A mature macula was observed in 92% of infants at 45-46 weeks. Complete vascularization was achieved at 41-42 weeks in the nasal retina and at 43-44 weeks in the temporal retina. The number of retinas with normal pigmentation increased with postmenstrual age (rising to 84% of infants at postmenstrual age 45-46 weeks).

CONCLUSIONS

Following premature birth, macular morphology, retinal vascularization and retinal pigmentation continue to develop. This study provides reference images of normal retinal development in premature infants.

The contrast sensitivity of the newborn human infant

PURPOSE

To measure the binocular contrast sensitivity (CS) of newborn infants using a fixation-and-following card procedure.

METHODS

The CS of 119 healthy newborn infants was measured using stimuli printed on cards under the descending method of limits (93 infants) and randomized/masked designs (26 infants). One experienced and one novice adult observer tested the infants using vertical square-wave gratings (0.06 and 0.10 cyc/deg; 20/10,000 and 20/6000 nominal Snellen equivalent); the experienced observer also tested using horizontal gratings (0.10 cyc/deg) and using the Method of Constant Stimuli while being kept unaware of the stimulus values.

RESULTS

The CS of the newborn infant was 2.0 (contrast threshold = 0.497; 95% confidence interval: 0.475-0.524) for vertically oriented gratings and 1.74 (threshold = 0.575; 95% confidence interval: 0.523-0.633) for horizontally oriented gratings (P < 0.0006). The standard deviation of infant CS was comparable to that obtained by others on adults using the Pelli-Robson chart. The two observers showed similar practice effects. Randomization of stimulus order and masking of the adult observer had no effect on CS.

CONCLUSIONS

The CS of individual newborn human infants can be measured using a fixation-and-following card procedure.

Is handheld optical coherence tomography reliable in infants and young children with and without nystagmus?

PURPOSE

To evaluate the reliability of the spectral domain handheld OCT (HH-OCT) in assessing foveal morphology in children with and without nystagmus.

METHODS

Forty-nine subjects with nystagmus (mean age 43.83 months; range, 1-82 months) and 48 controls (mean age 43.02 months; range, 0 to 83 months) were recruited and scanned using HH-OCT. A minimum of two separate volumetric scans on the same examination day of the fovea were obtained. The images were imported into ImageJ software where manual retinal layer segmentation of the central foveal B-scan was performed. Agreement between scans was assessed by determining the intraclass correlation coefficients (ICC) and Bland-Altman plots.

RESULTS

Both the nystagmus and control groups showed an excellent degree of reproducibility between two examinations with ICCs greater than 0.96 for central macular thickness (CMT) and greater than 0.8 for the outer nuclear layer and outer segment of the photoreceptors. The nerve fiber layer, ganglion cell layer, outer plexiform layer, inner segment of the photoreceptors, and retinal pigment epithelium were less reliable with ICCs of less than 0.7. There was no difference in the reliability of scans obtained in children with nystagmus as compared with controls and both groups had good intereye agreement with ICCs greater than 0.94 for CMT.

CONCLUSIONS

We have shown for the first time that the HH-OCT provides reliable measurements in children with and without nystagmus. This is important, as the HH-OCT will have a greater diagnostic and prognostic role in young children with nystagmus and other eye diseases in the future.

Racial variation in optic nerve head parameters quantified in healthy newborns by handheld spectral domain optical coherence tomography

PURPOSE

To characterize optic nerve head (ONH) morphology and parameters, including vertical disk diameter, vertical cup diameter, and vertical cup/disk ratio in healthy, full-term newborns using a handheld spectral domain optical coherence tomography (SD-OCT) device.

METHODS

In this prospective observational case series, healthy white, black, and Hispanic full-term newborns delivered at the Duke Birthing Center between August 2010 and May 2011 underwent dilated fundus examination and SD-OCT imaging of the optic nerve in each eye. OCT parameters were calculated and compared for each group of infants.

RESULTS

A total of 58 consecutive newborns of white (n = 22), black (n = 15) and Hispanic (n = 21) ethnicity were included. Mean vertical disk diameter in white, black, and Hispanic newborns was 1.29 ± 0.15 mm (standard deviation), 1.38 ± 0.14 mm, and 1.38 ± 0.14 mm, respectively (white versus Hispanic, P = 0.02; white versus black, P = 0.07). Mean vertical cup diameter in white, black, and Hispanic newborns was 0.44 ± 0.15 mm, 0.56 ± 0.23 mm, and 0.46 ± 0.30 mm, respectively (white versus black, P = 0.03). Mean vertical cup/disk ratio was 0.34 ± 0.10 for white, 0.40 ± 0.17 for black, and 0.33 ± 0.20 for Hispanic newborns (P = 0.07 for white versus black).

CONCLUSIONS

Handheld SD-OCT is an effective means of imaging the ONH in newborns. Racial differences in cup/disk ratio are present at birth. These data may serve as the beginning of a normative dataset for characterizing development of the ONH as well as for comparison to the neonatal ONH in disease states.

Adaptation of the central retina for high acuity vision: cones, the fovea and the avascular zone

Presence of a fovea centralis is directly linked to molecular specification of an avascular area in central retina, before the fovea (or 'pit') begins to form. Modelling suggests that mechanical forces, generated within the eye, initiate formation of a pit within the avascular area, and its later remodelling in the postnatal period. Within the avascular area the retina is dominated by 'midget' circuitry, in which signals are transferred from a single cone to a single bipolar cell, then a single ganglion cell. Thus in inner, central retina there are relatively few lateral connections between neurons. This renders the region adaptable to tangential forces, that translocate of ganglion cells laterally/centrifugally, to form the fovea. Optical coherence tomography enables live imaging of the retina, and shows that there is greater variation in the morphology of foveae in humans than previously thought. This variation is associated with differences in size of the avascular area and appears to be genetically based, but can be modified by environmental factors, including prematurity. Even when the fovea is absent (foveal hypoplasia), cones in central retina adopt an elongated and narrow morphology, enabling them to pack more densely to increase the sampling rate, and to act as more effective waveguides. Given these findings, what then is the adaptive advantage of a fovea? We suggest that the advantages of having a pit in central retina are relatively few, and minor, but together work to enhance acuity.

Evaluation of normal human foveal development using optical coherence tomography and histologic examination

OBJECTIVE

To assess outer retinal layer maturation during late gestation and early postnatal life using optical coherence tomography and histologic examination.

METHODS

Thirty-nine participants 30 weeks' postmenstrual age or older were imaged using a handheld optical coherence tomography system, for a total of 102 imaging sessions. Foveal images from 16 participants (21 imaging sessions) were normal and evaluated for inner retinal excavation and the presence of outer retinal reflective bands. Reflectivity profiles of central, parafoveal, and parafoveal retina were extracted and were compared with age-matched histologic sections.

RESULTS

The foveal pit morphologic structure in infants was generally distinguishable from that in adults. Reflectivity profiles showed a single hyperreflective band at the fovea in all the infants younger than 42 weeks' postmenstrual age. Multiple bands were distinguishable in the outer retina at the peri fovea by 32 weeks' postmenstrual age and at the fovea by 3 months' postterm. By 17 months' postnatal, the characteristic appearance of 4 hyperreflective bands was evident across the foveal region. These features are consistent with previous results from histologic examinations. A "temporal divot" was present in some infants, and the foveal pit morphologic structure and the extent of inner retinal excavation were variable.

CONCLUSIONS

Handheld optical coherence tomography is a viable technique for evaluating neonatal retinas. In premature infants who do not develop retinopathy of prematurity, the foveal region seems to follow a developmental time course similar to that associated with in utero maturation.

CLINICAL RELEVANCE

As pediatric optical coherence tomography becomes more common, a better understanding of normal foveal and macular development is needed. Longitudinal imaging offers the opportunity to track postnatal foveal development among preterm infants in whom poor visual outcomes are anticipated or to follow up treatment outcomes in this population.

Histologic development of the human fovea from midgestation to maturity

PURPOSE

To describe the histologic development of the human central retina from fetal week (Fwk) 22 to 13 years.

DESIGN

Retrospective observational case series.

METHODS

Retinal layers and neuronal substructures were delineated on foveal sections of fixed tissue stained in azure II-methylene blue and on frozen sections immunolabeled for cone, rod, or glial proteins. Postmortem tissue was from 11 eyes at Fwk 20-27; 8 eyes at Fwk 28-37; 6 eyes at postnatal 1 day to 6 weeks; 3 eyes at 9 to 15 months; and 5 eyes at 28 months to 13 years.

RESULTS

At Fwk 20-22 the fovea could be identified by the presence of a single layer of cones in the outer nuclear layer. Immunolabeling detected synaptic proteins, cone and rod opsins, and Müller glial processes separating the photoreceptors. The foveal pit appeared at Fwk 25, involving progressive peripheral displacement of ganglion cell, inner plexiform, and inner nuclear layers. The pit became wider and shallower after birth, and appeared mature by 15 months. Between Fwk 25 and Fwk 38, all photoreceptors developed more distinct inner and outer segments, but these were longer on peripheral than foveal cones. After birth the foveal outer nuclear layer became much thicker as cone packing occurred. Cone packing and neuronal migration during pit formation combined to form long central photoreceptor axons, which changed the outer plexiform layer from a thin sheet of synaptic pedicles into the thickest layer in the central retina by 15 months. Foveal inner and outer segment length matched peripheral cones by 15 months and was 4 times longer by 13 years.

CONCLUSIONS

These data are necessary to understand the marked changes in human retina from late gestation to early adulthood. They provide qualitative and quantitative morphologic information required to interpret the changes in hyper- and hyporeflexive bands in pediatric spectral-domain optical coherence tomography images at the same ages.

Maturation of the human fovea: correlation of spectral-domain optical coherence tomography findings with histology

PURPOSE

To correlate human foveal development visualized by spectral-domain optical coherence tomography (SDOCT) with histologic specimens.

DESIGN

Retrospective, observational case series.

METHODS

Morphology and layer thickness of retinal SDOCT images from 1 eye each of 22 premature infants, 30 term infants, 16 children, and 1 adult without macular disease were compared to light microscopic histology from comparable ages.

RESULTS

SDOCT images correlate with major histologic findings at all time points. With both methods, preterm infants demonstrate a shallow foveal pit indenting inner retinal layers (IRL) and short, undeveloped foveal photoreceptors. At term, further IRL displacement forms the pit and peripheral photoreceptors lengthen; the elongation of inner and outer segments (IS and OS, histology) separates the IS band from retinal pigment epithelium. Foveal IS and OS are shorter than peripheral for weeks after birth (both methods). By 13 months, foveal cone cell bodies stack >6 deep, Henle fiber layer (HFL) thickens, and IS/OS length equals peripheral; on SDOCT, foveal outer nuclear layer (which includes HFL) and IS/OS thickens. At 13 to 16 years, the fovea is fully developed with a full complement of SDOCT bands; cone cell bodies >10 deep have thin, elongated, and tightly packed IS/OS.

CONCLUSIONS

We define anatomic correlates to SDOCT images from normal prenatal and postnatal human fovea. OCT bands typical of photoreceptors of the adult fovea are absent near birth because of the immaturity of foveal cones, develop by 24 months, and mature into childhood. This validates the source of SDOCT signal and provides a framework to assess foveal development and disease.

Genetic and phenotypic variations of inherited retinal diseases in dogs: the power of within- and across-breed studies

Considerable clinical and molecular variations have been known in retinal blinding diseases in man and also in dogs. Different forms of retinal diseases occur in specific breed(s) caused by mutations segregating within each isolated breeding population. While molecular studies to find genes and mutations underlying retinal diseases in dogs have benefited largely from the phenotypic and genetic uniformity within a breed, within- and across-breed variations have often played a key role in elucidating the molecular basis. The increasing knowledge of phenotypic, allelic, and genetic heterogeneities in canine retinal degeneration has shown that the overall picture is rather more complicated than initially thought. Over the past 20 years, various approaches have been developed and tested to search for genes and mutations underlying genetic traits in dogs, depending on the availability of genetic tools and sample resources. Candidate gene, linkage analysis, and genome-wide association studies have so far identified 24 mutations in 18 genes underlying retinal diseases in at least 58 dog breeds. Many of these genes have been associated with retinal diseases in humans, thus providing opportunities to study the role in pathogenesis and in normal vision. Application in therapeutic interventions such as gene therapy has proven successful initially in a naturally occurring dog model followed by trials in human patients. Other genes whose human homologs have not been associated with retinal diseases are potential candidates to explain equivalent human diseases and contribute to the understanding of their function in vision.

With or without a Hole: Young Infants' Sensitivity for Topological versus Geometric Property

Evidence from adult psychophysics, brain imaging, and honeybee's behaviour has been reported to support the notion that topological properties are the primitives of visual representation (Chen, 1982 Science218 699–700). Here, we ask how the sensitivity to topological property might originate during development. Specifically, we tested 1.5- to 6-month-old infants' visual sensitivity for topological versus geometric properties with the forced-choice novelty preference technique. A disk and a ring were used in the topologically different condition (experiment 1), while a disk and a triangle were used in the geometrically different condition (experiment 2). Spontaneous preferences for the disk, the ring, and the triangle were measured pairwise using the preferential looking-time technique (experiment 3). The results showed that infants could reliably discriminate stimuli based on topological differences, but failed to do so with geometric differences. Moreover, in the generalisation task, infants showed higher novelty preference for the topologically different figure (the ring). In addition, the results of both experiments cannot be attributed to a spontaneous preference for the ring or for the disk. Further analysis on individual infants' age and performance revealed two distinct developmental trends. Infants seem to be sensitive to topological differences as young as 1.5 months, while their ability to discriminate geometric differences was at chance before 3 months and gradually improved with age. Taken together, our findings suggested an early sensitivity for topological property, at least for the detection of stimuli with or without a hole.

Nitisinone improves eye and skin pigmentation defects in a mouse model of oculocutaneous albinism

Mutation of the tyrosinase gene (TYR) causes oculocutaneous albinism, type 1 (OCA1), a condition characterized by reduced skin and eye melanin pigmentation and by vision loss. The retinal pigment epithelium influences postnatal visual development. Therefore, increasing ocular pigmentation in patients with OCA1 might enhance visual function. There are 2 forms of OCA1, OCA-1A and OCA-1B. Individuals with the former lack functional tyrosinase and therefore lack melanin, while individuals with the latter produce some melanin. We hypothesized that increasing plasma tyrosine concentrations using nitisinone, an FDA-approved inhibitor of tyrosine degradation, could stabilize tyrosinase and improve pigmentation in individuals with OCA1. Here, we tested this hypothesis in mice homozygous for either the Tyrc-2J null allele or the Tyrc-h allele, which model OCA-1A and OCA-1B, respectively. Only nitisinone-treated Tyrc-h/c-h mice manifested increased pigmentation in their fur and irides and had more pigmented melanosomes. High levels of tyrosine improved the stability and enzymatic function of the Tyrc-h protein and also increased overall melanin levels in melanocytes from a human with OCA-1B. These results suggest that the use of nitisinone in OCA-1B patients could improve their pigmentation and potentially ameliorate vision loss.

Dynamics of human foveal development after premature birth

PURPOSE

To determine the dynamic morphologic development of the human fovea in vivo using portable spectral domain-optical coherence tomography (SD-OCT).

DESIGN

Prospective, observational case series.

PARTICIPANTS

Thirty-one prematurely born neonates, 9 children, and 9 adults.

METHODS

Sixty-two neonates were enrolled in this study. After examination for retinopathy of prematurity (ROP), SD-OCT imaging was performed at the bedside in nonsedated infants aged 31 to 41 weeks postmenstrual age (PMA) (= gestational age in weeks + chronologic age) and at outpatient follow-up ophthalmic examinations. Thirty-one neonates met eligibility criteria. Nine children and nine adults without ocular pathology served as control groups. Semiautomatic retinal layer segmentation was performed. Central foveal thickness, foveal to parafoveal (FP) ratio (central foveal thickness divided by thickness 1000 μm from the foveal center), and 3-dimensional thickness maps were analyzed.

MAIN OUTCOME MEASURES

In vivo determination of foveal morphology, layer segmentation, analysis of subcellular changes, and spatiotemporal layer shifting.

RESULTS

In contrast with the adult fovea, several signs of immaturity were observed in the neonates: a shallow foveal pit, persistence of inner retinal layers (IRLs), and a thin photoreceptor layer (PRL) that was thinnest at the foveal center. Three-dimensional mapping showed displacement of retinal layers out of the foveal center as the fovea matured and the progressive formation of the inner/outer segment band in the opposite direction. The FP-IRL ratios decreased as IRL migrated before term and minimally after that, whereas FP-PRL ratios increased as PRL subcellular elements formed closer to term and into childhood. A surprising finding was the presence of cystoid macular edema in 58% of premature neonates that appeared to affect inner foveal maturation.

CONCLUSIONS

This study provides the first view into the development of living cellular layers of the human retina and of subcellular specialization at the fovea in premature infant eyes using portable SD-OCT. Our work establishes a framework of the timeline of human foveal development, allowing us to identify unexpected retinal abnormalities that may provide new keys to disease activity and a method for mapping foveal structures from infancy to adulthood that may be integral in future studies of vision and visual cortex development.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Visual advantage in deaf adults linked to retinal changes

The altered sensory experience of profound early onset deafness provokes sometimes large scale neural reorganisations. In particular, auditory-visual cross-modal plasticity occurs, wherein redundant auditory cortex becomes recruited to vision. However, the effect of human deafness on neural structures involved in visual processing prior to the visual cortex has never been investigated, either in humans or animals. We investigated neural changes at the retina and optic nerve head in profoundly deaf (N = 14) and hearing (N = 15) adults using Optical Coherence Tomography (OCT), an in-vivo light interference method of quantifying retinal micro-structure. We compared retinal changes with behavioural results from the same deaf and hearing adults, measuring sensitivity in the peripheral visual field using Goldmann perimetry. Deaf adults had significantly larger neural rim areas, within the optic nerve head in comparison to hearing controls suggesting greater retinal ganglion cell number. Deaf adults also demonstrated significantly larger visual field areas (indicating greater peripheral sensitivity) than controls. Furthermore, neural rim area was significantly correlated with visual field area in both deaf and hearing adults. Deaf adults also showed a significantly different pattern of retinal nerve fibre layer (RNFL) distribution compared to controls. Significant correlations between the depth of the RNFL at the inferior-nasal peripapillary retina and the corresponding far temporal and superior temporal visual field areas (sensitivity) were found. Our results show that cross-modal plasticity after early onset deafness may not be limited to the sensory cortices, noting specific retinal adaptations in early onset deaf adults which are significantly correlated with peripheral vision sensitivity.

Holistic face processing in newborns, 3-month-old infants, and adults: evidence from the composite face effect

Holistic face processing was investigated in newborns, 3-month-old infants, and adults through a modified version of the composite face paradigm and the recording of eye movements. After familiarization to the top portion of a face, participants (N = 70) were shown 2 aligned or misaligned faces, 1 of which comprised the familiar top part. In the aligned condition, no visual preference was found at any group age. In the misaligned condition, 3-month-olds preferred the face stimulus with the familiar top part, adults preferred the face stimulus with the novel one, and newborns did not manifest any visual preference. Results revealed that both infants' and adults' eye movements may be affected by holistic face information and demonstrated holistic face processing in 3-month-olds.

Development of visual perception

Processes of visual development that yield a view of the world as coherent and stable begin well before birth and extend over the first several years after the onset of visual experience. Infants are born capable of seeing and with specific preferences that guide the point of gaze to relevant portions of the visual scene to support learning about objects and faces. Visual development after birth is characterized by critical periods in many notable visual functions, and by extensive learning from experience and increasing control over eye movement systems. WIREs Cogni Sci 2011 2 515-528 DOI: 10.1002/wcs.128 For further resources related to this article, please visit the WIREs website.

Deaf and hearing children: a comparison of peripheral vision development

This study investigated peripheral vision (at least 30° eccentric to fixation) development in profoundly deaf children without cochlear implantation, and compared this to age-matched hearing controls as well as to deaf and hearing adult data. Deaf and hearing children between the ages of 5 and 15 years were assessed using a new, specifically paediatric designed method of static perimetry. The deaf group (N = 25) were 14 females and 11 males, mean age 9.92 years (range 5-15 years). The hearing group (N = 64) were 34 females, 30 males, mean age 9.13 years (range 5-15 years). All participants had good visual acuity in both eyes (< 0.200 LogMAR). Accuracy of detection and reaction time to briefly presented LED stimuli of three light intensities, at eccentricities between 30° and 85° were measured while fixation was maintained to a central target. The study found reduced peripheral vision in deaf children between 5 and 10 years of age. Deaf children (aged 5-10 years) showed slower reaction times to all stimuli and reduced ability to detect and accurately report dim stimuli in the far periphery. Deaf children performed equally to hearing children aged 11-12 years. Deaf adolescents aged 13-15 years demonstrated faster reaction times to all peripheral stimuli in comparison to hearing controls. Adolescent results were consistent with deaf and hearing adult performances wherein deaf adults also showed significantly faster reaction times than hearing controls. Peripheral vision performance on this task was found to reach adult-like levels of maturity in deaf and hearing children, both in reaction time and accuracy of detection at the age of 11-12 years.

Development of contrast mechanisms in humans: a VEP study

PURPOSE

The visual system undergoes major developmental changes in infancy and continues to mature throughout childhood. This study was designed to investigate the developmental change in the contrast response function and the neural mechanisms that contribute to this change.

METHODS

Participants were 29 infants from 15 to 28 weeks of age, two children, one adolescent, and nine adults. Visual evoked potentials were elicited by horizontal square-wave gratings contrast-reversed at 7.5 Hz. Spatial frequencies of 0.75 and 1.5 cpd were used, and contrast was swept in seven octave steps from 1 to 64% with an initial step at 0%. There were 10 runs of each condition (8.5 s each). Fourier analysis was used to derive amplitude and phase of the dominant (second harmonic) frequency component in the response, which were then plotted vs. contrast. The empirical contrast response functions were fitted using a nonlinear model, which generates estimates of shunting inhibition, conductance, and the integrative time constant in the system.

RESULTS

Typically, in comparison to older observers, contrast response functions in infants are relatively linear with increases in contrast, and they exhibit little if any contrast gain control (amplitude compression and phase advance with increasing contrast). Time constants in infants are longer than in adults, and infants demonstrate less decrease in time constant values with increasing contrast than do adults.

CONCLUSIONS

These results are consistent with greater shunting inhibition in the visual cortex of older observers.

Contrast insensitivity: the critical immaturity in infant visual performance

This is a targeted review of the critical immaturities limiting psychophysical luminance contrast detection in human infants. Three-month-old infants are 50 times less sensitive to contrast than adults are. Rod experiments suggest that early-stage immaturities, like the short length of infant rod outer segments, have only a modest direct effect on infant visual performance. Infant contrast sensitivity may resemble adult extrafoveal sensitivity, because the foveal cones of the neonate are immature and may not generate strong enough responses to mediate visual performance. This use of the extrafoveal retina reduces the high-spatial frequency end of the infant contrast sensitivity function (CSF), contributing to poor infant resolution acuity. The remaining difference between infant and adult CSFs may be a simple overall reduction in infant sensitivity. The maximum of the infant CSF increases proportionately with age, and may be numerically near the infant's age in weeks. Contrast discrimination experiments indicate that the critical immaturity that limits infant contrast sensitivity is a mid-level phenomenon, occurring before the site of the contrast gain control. For example, the infant ascending visual pathway might be limited by large amounts of intrinsic noise. These results suggest that there is little effect of inattentiveness to the psychophysical task by ostensibly alert infant patients or subjects. The clinician or researcher can interpret behavioral measurements of infant visual performance with confidence.

Reduced grating acuity associated with retinal toxicity in children with infantile spasms on vigabatrin therapy

PURPOSE

To determine whether visual functions are decreased in children with infantile spasms and vigabatrin-attributed retinal toxicity.

METHODS

Contrast sensitivity and grating acuity were measured by using sweep visual evoked potential (VEP) testing in 42 children with infantile spasms (mean age, 29.23 +/- 18.31 months). All children had been exposed to vigabatrin (VGB) for a minimum of 1 month. These children were divided into retinal toxicity and no toxicity groupings based on 30-Hz flicker amplitude reductions on the full-field electroretinogram. A multivariate analysis of variance (MANOVA) compared visual functions between children with and without retinal toxicity.

RESULTS

The MANOVA showed that visual function was significantly affected by VGB retinal toxicity. Further univariate analysis revealed that grating acuity was significantly reduced in children with toxicity. No differences in contrast sensitivity were found between children with toxicity and those without.

CONCLUSIONS

Reduced visual functions from VGB-attributed retinal toxicity can be detected in children with infantile spasms with the sweep VEP.

Rod photoreceptor differentiation in fetal and infant human retina

Human rods and cones are arranged in a precise spatial mosaic that is critical for optimal functioning of the visual system. However, the molecular processes that underpin specification of cell types within the mosaic are poorly understood. The progressive differentiation of human rods was tracked from fetal week (Fwk) 9 to postnatal (P) 8 months using immunocytochemical markers of key molecules that represent rod progression from post-mitotic precursors to outer segment-bearing functional photoreceptors. We find two phases associated with rod differentiation. The early phase begins in rods on the foveal edge at Fwk 10.5 when rods are first identified, and the rod-specific proteins NRL and NR2e3 are detected. By Fwk 11-12, these rods label for interphotoreceptor retinoid binding protein, recoverin, and aryl hydrocarbon receptor interacting protein-like 1. The second phase occurs over the next month with the appearance of rod opsin at Fwk 15, closely followed by the outer segment proteins rod GTP-gated sodium channel, rod arrestin, and peripherin. TULP is expressed relatively late at Fwk 18-20 in rods. Each phase proceeds across the retina in a central-peripheral order, such that rods in far peripheral retina are only entering the early phase at the same time that cells in central retina are entering their late phase. During the second half of gestation rods undergo an intracellular reorganization of these proteins, and cellular and OS elongation which continues into infancy. The progression of rod development shown here provides insight into the possible mechanisms underlying human retinal visual dysfunction when there are mutations affecting key rod-related molecules.

Perceptual Completion in Newborn Human Infants

Despite decades of studies of human infants, a still open question concerns the role of visual experience in the development of the ability to perceive complete shapes over partial occlusion. Previous studies show that newborns fail to manifest this ability, either because they lack the visual experience required for perceptual completion or because they fail to detect the pattern of motion. To distinguish these possibilities, newborns' perception of a center-occluded object was tested, using stroboscopic motion. Infants (mean age of 72 hr) perceived the object as a connected unit, providing the first evidence that the newborn is capable of filling in gaps in the visible surface layout when the relevant visual information can be detected by his or her immature visual system.

Development of the human retina in the absence of ganglion cells

Retinal development was studied in eyes from fetal and neonatal human anencephalic (AnC) and normal age-matched infants to determine the time of retinal ganglion cell (GC) loss and its effect on the development of other retinal neurons. At fetal week (Fwk) 14, GC loss was evident in central retina and by Fwk 19-20 almost all GC were absent, although immunocytochemical labeling for GC markers brain 3, neurofilament M and parvalbumin detected a few GC in the AnC far periphery at older ages. The inner nuclear and inner plexiform (IPL) layers showed variable amounts of thinning but all normal bipolar (BP) and horizontal cell markers were still present. The amacrine (AM) labels calbindin and calretinin were markedly reduced. Lamination for these markers in the IPL was less organized than in normal retinas, with BP and AM markers extending into the degenerated GC layer. Cone and rod photoreceptors had normal morphology and topography in AnC retina and each expressed normal phototransduction and synaptic markers. The prospective fovea was identified in AnC neonatal retina by cone packing and the absence of immunolabeled rod photoreceptors. In one AnC neonatal retina, blood vessels and astrocytes extended across the inner retina in the putative fovea and there was no evidence of a pit. In another AnC neonatal retina, blood vessels and astrocytes formed a foveal avascular zone in the inner retina and a shallow pit was present within this zone. However, both foveas showed evidence for the onset of cone elongation and packing. These findings support the model of Springer and Hendrickson [2005; Vis. Neurosci. 22, 171] in which the foveal avascular zone is critical for pit formation, but suggest that mechanisms inherent to the outer retina may be involved in early stages of foveal cone packing.

Gradients of cone differentiation and FGF expression during development of the foveal depression in macaque retina

Cones in the foveola of adult primate retina are narrower and more elongated than cones on the foveal rim, which in turn, are narrower and more elongated than those located more eccentric. This gradient of cone morphology is directly correlated with cone density and acuity. Here we investigate the hypothesis that fibroblast growth factor (FGF) signaling mediates the morphological differentiation of foveal cones--in particular, the mechanism regulating the elongation of foveal cones. We used immunoreactivity to FGF receptor (R) 4, and quantitative analysis to study cone elongation on the horizontal meridian of macaque retinae, aged between foetal day (Fd) 95 and 2.5 years postnatal (P 2.5 y). We also used in situ hybridization and immunohistochemistry to investigate the expression patterns of FGF2 and FGFR1-4 at the developing fovea, and three other sample locations on the horizontal meridian. Labeled RNA was detected using the fluorescent marker "Fast Red" (Roche) and levels of expression in cone inner segments and in the ganglion cell layer (GCL) were compared using confocal microscopy, optical densitometry, and tested for statistical significance. Our results show that morphological differentiation of cones begins near the optic disc around Fd 95, progressing toward the developing fovea up until birth, approximately. Levels of FGF2 and FGFR4 mRNAs expression are low in foveal cones, compared with cones closer to the optic disc, during this period. There is no similar gradient of FGF2 mRNA expression in the ganglion cell layer of the same sections. Maturation of foveal cones is delayed until the postnatal period. The results suggest that a wave of cone differentiation spreads from the disc region toward the developing fovea during the second half of gestation in the macaque. A gradient of expression of FGFR4 and FGF2 associated with the wave of differentiation suggests that FGF signalling mediates cone narrowing and elongation.

Development of the neural retina and its vasculature in the marmosetCallithrix jacchus

The morphological sequence of retinal development in the New World marmoset monkey Callithrix jacchus is similar to previous reports in Macaca and humans. The incipient fovea is present at fetal day (Fd) 100 as the only part of the retina that contains five distinct layers, including a single layer of cone photoreceptors. A foveal pit begins to form at Fd 135 in the center of the foveal avascular zone which is surrounded by a ring of blood vessels (BV) and astrocytes. At birth (Fd 144) the fovea has a single layer of cones over the pit center where the inner retinal layers are thinned but still separated. After birth the fovea rapidly matures so that foveal cone and pit morphology are similar to adult by 4 months. Five distinct layers and the BV plexus in the nerve fiber layer are present to the retinal edge in neonatal marmosets. Near the optic disc BV are sprouting into outer retinal layers at birth and vascularization of the outer retina is completed by 2 to 3 months. Retinal length increases sharply up to Fd 135, but undergoes a quiescent period around birth during which pit formation begins. Length then increases again up to 4mo, followed by a slow increase into adulthood. The postnatal increase is accompanied by a marked thinning of the peripheral retina. The pars plana appears after birth and its length increases at least until 2 years of age. The major difference between marmoset and Macaca is the relative immaturity of the marmoset fovea at birth, and its rapid development after birth. This makes the marmoset a good candidate for neonatal experimental manipulation of retinal and eye development.