Temperature-Mediated Neural Interventions in Knee Osteoarthritis: a Review of Cryoneurolysis and Cooled Radiofrequency Ablation with Ultrasound Guidance

PURPOSE OF REVIEW

Knee osteoarthritis is a debilitating chronic disease affecting nearly half of the world's population at some point in their lives. Treatment of pain and loss of function associated with this disease has been limited. In this review, we seek to explore how neural interventions with ultrasound guidance may be an emerging option for non-pharmacologic pain relief in patients with knee osteoarthritis.

RECENT FINDINGS

Cryoneurolysis techniques have been demonstrated to provide pain relief out to 150 days post-treatment in knee osteoarthritis in select individuals. There have also been studies of cryoneurolysis pre-operatively to total knee replacement providing reduced pain, reduced opioid use post-operatively, and shorter hospital length of stay. Cooled radiofrequency ablation (CRFA) has been demonstrated to significantly reduce pain, improve functionality, and reduce pharmacologic needs in knee osteoarthritis out to 2 years. Both interventions appear to have increased accuracy with ultrasound, and CRFA appears to be associated with improved patient outcomes. The research demonstrates the efficacy of both cryoneurolysis and cooled radiofrequency ablation in the treatment of knee osteoarthritis. Ultrasound guidance in neurolysis provides an additional tool with real-time, high-accuracy nerve localization. These therapies should be considered for certain patients to assist in pain management in the non-operative and post-operative phase of knee osteoarthritis management. Further research is needed to further define the long-term effects and the long-term utility of the techniques in knee pain.

Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis

OBJECTIVE

To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility.

METHODS

Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC.

RESULTS

We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 10⁹/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 10⁹/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 10⁹/L.

CONCLUSIONS

A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.

Progression of Pro23His Retinopathy in a Miniature Swine Model of Retinitis Pigmentosa

Purpose

We characterize the progression of retinopathy in Filial 1 (F1) progeny of a transgenic (Tg) founder miniswine exhibiting severe Pro23His (P23H) retinopathy.

Methods

The F1 TgP23H miniswine progeny were created by crossing TgP23H founder miniswine 53-1 with wild type (WT) inbred miniature swine. Scotopic (rod-driven) and photopic (cone-driven) retinal functions were evaluated in F1 TgP23H and WT littermates using full field electroretinograms (ffERGs) at 1, 2, 3, 6, 9, 12, and 18 months of age, as well as the Tg founder miniswine at 6 years of age. Miniswine were euthanized and their retinas processed for morphologic evaluation at the light and electron microscopic level. Retinal morphology of a 36-month-old Tg miniswine also was examined.

Results

Wild type littermates reached mature scotopic and photopic retinal function by 3 months, while TgP23H miniswine showed abnormal scotopic ffERGs at the earliest time point, 1 month, and depressed photopic ffERGs after 2 months. Rod and cone photoreceptors (PR) exhibited morphologic abnormalities and dropout from the outer nuclear layer at 1 month, with only a monolayer of cone PR somata remaining after 2 months. The retinas showed progressive neural remodeling of the outer retina that included dendritic retraction of rod bipolar cells and glial seal formation by Müller cells. The TgP23H founder miniswine showed cone PR with relatively intact morphology exclusive to the area centralis.

Conclusions

The F1 Tg miniswine and the TgP23H founder miniswine exhibit similar retinopathy.

Translational Relevance

TgP23H miniswine are a useful large-eye model to study pathogenesis and preservation cone PRs in humans with retinitis pigmentosa.

Cone photoreceptors develop normally in the absence of functional rod photoreceptors in a transgenic swine model of retinitis pigmentosa

PURPOSE

Human and swine retinas have morphological and functional similarities. In the absence of primate models, the swine is an attractive model to study retinal function and disease, with its cone-rich visual streak, our ability to manipulate their genome, and the differences in susceptibility of rod and cone photoreceptors to disease. We characterized the normal development of cone function and its subsequent decline in a P23H rhodopsin transgenic (TgP23H) miniswine model of autosomal dominant RP.

METHODS

Semen from TgP23H miniswine 53-1 inseminated domestic swine and produced TgP23H and Wt hybrid littermates. Retinal function was evaluated using ERGs between postnatal days (P) 14 and 120. Retinal ganglion cell (RGC) responses were recorded to full-field stimuli at several intensities. Retinal morphology was assessed using light and electron microscopy.

RESULTS

Scotopic retinal function matures in Wt pigs up to P60, but never develops in TgP23H pigs. Wt and TgP23H photopic vision matures similarly up to P30 and diverges at P60 where TgP23H cone vision declines. There are fewer TgP23H RGCs with visually evoked responses at all ages and their response to light is compromised. Photoreceptor morphological changes mirror these functional changes.

CONCLUSIONS

Lack of early scotopic function in TgP23H swine suggests it as a model of an aggressive form of RP. In this mammalian model of RP, normal cone function develops independent of rod function. Therefore, its retina represents a system in which therapies to rescue cones can be developed to prolong photopic visual function in RP patients.

Iodoacetic acid, but not sodium iodate, creates an inducible swine model of photoreceptor damage

Our purpose was to find a method to create a large animal model of inducible photoreceptor damage. To this end, we tested in domestic swine the efficacy of two chemical toxins, known to create photoreceptor damage in other species: Iodoacetic Acid (IAA) and Sodium Iodate (NaIO(3)). Intravenous (IV) administration of NaIO(3) up to 90 mg/kg had no effect on retinal function and 110 mg/kg was lethal. IV administration of IAA (5-20 mg/kg) produced concentration-dependent changes in visual function as measured by full-field and multi-focal electroretinograms (ffERG and mfERG), and 30 mg/kg IAA was lethal. The IAA-induced effects measured at two weeks were stable through eight weeks post-injection, the last time point investigated. IAA at 7.5, 10, and 12 mg/kg produce a concentration-dependent reduction in both ffERG b-wave and mfERG N1-P1 amplitudes compared to baseline at all post-injection times. Comparisons of dark- and light-adapted ffERG b-wave amplitudes show a more significant loss of rod relative to cone function. The fundus of swine treated with ≥10 mg/kg IAA was abnormal with thinner retinal vessels and pale optic discs, and we found no evidence of bone spicule formation. Histological evaluations show concentration-dependent outer retinal damage that correlates with functional changes. We conclude that NaIO(3,) is not an effective toxin in swine. In contrast, IAA can be used to create a rapidly inducible, selective, stable and concentration-dependent model of photoreceptor damage in swine retina. Because of these attributes this large animal model of controlled photoreceptor damage should be useful in the investigation of treatments to replace damaged photoreceptors.

Generation of an inbred miniature pig model of retinitis pigmentosa

PURPOSE

The Pro23His (P23H) rhodopsin (RHO) mutation underlies the most common form of human autosomal dominant retinitis pigmentosa (adRP). The objective of this investigation was to establish a transgenic miniature swine model of RP using the human P23H RHO gene.

METHODS

Somatic cell nuclear transfer (SCNT) was used to create transgenic miniature pigs that expressed the human P23H RHO mutation. From these experiments, six transgenic founders were identified whose retinal function was studied with full-field electroretinography (ffERG) from 3 months through 2 years. Progeny from one founder were generated and genotyped to determine transgene inheritance pattern. Retinal mRNA was isolated, and the ratio of P23H to wild-type pig RHO was measured.

RESULTS

A single transgene integration site was observed for five of the six founders. All founders had abnormal scotopic and photopic ffERGs after 3 months. The severity of the ffERG phenotype was grouped into moderately and severely affected groups. Offspring of one founder inherited the transgene as an autosomal dominant mutation. mRNA analyses demonstrated that approximately 80% of total RHO was mutant P23H.

CONCLUSIONS

Expression of the human RHO P23H transgene in the retina creates a miniature swine model with an inheritance pattern and retinal function that mimics adRP. This large-animal model can serve as a novel tool for the study of the pathogenesis and therapeutic intervention in the most common form of adRP.

An adaptive ERG technique to measure normal and altered dark adaptation in the mouse

The time-course of dark adaptation provides valuable insights into the function and interactions between the rod and cone pathways in the retina. Here we describe a technique that uses the flash electroretinogram (ERG) response to probe the functional integrity of the cone and rod pathways during the dynamic process of dark adaptation in the mouse. Retinal sensitivity was estimated from the stimulus intensity required to maintain a 30 microV criterion b-wave response during a 40 min period of dark adaptation. When tracked in this manner, dark adaptation functions in WT mice depended upon the bleaching effects of initial background adaptation conditions. Altered dark adaptation functions, commensurate with the functional deficit were recorded in pigmented mice that lacked cone function (Gnat2 ( cplf3 )) and in WT mice injected with a toxin, sodium iodate (NaIO(3)), which targets the retinal pigment epithelium and also has downstream effects on photoreceptors. These data demonstrate that this adaptive tracking procedure measures retinal sensitivity and the contributions of the rod and/or cone pathways during dark adaptation in both WT control and mutant mice.

Stimulation via a subretinally placed prosthetic elicits central activity and induces a trophic effect on visual responses

PURPOSE

Subretinal prosthetics are designed to electrically stimulate second-order cells, replacing dysfunctional photoreceptors in diseases such as retinitis pigmentosa (RP). For functional vision to occur, this signal must also reach central visual structures. In the current study, a subretinally implanted prosthetic was evaluated in the Royal College of Surgeons (RCS) rat model of RP, to determine its capacity to activate the retinotectal pathway.

METHODS

Prosthetic implants were placed in RCS and wild-type (WT) rats at 4 weeks of age and evaluated 3 months later. Control rats underwent sham surgery, implantation with inactive prosthetics, or no treatment. Implant- and visible-evoked responses were isolated and evaluated in the superior colliculus (SC).

RESULTS

In WT and RCS rats with active prosthetics, implant-driven responses were found in 100% of WT and 64% of RCS rats and were confined to a small SC region that corresponded to the retinal sector containing the implant and differed from visible-evoked responses. In addition, visible-evoked responses were more robust at sites that received implant input compared to sites that did not. These effects were not seen in WT rats or RCS control animals; although a general trophic effect on the number of responsive sites was observed in all RCS rats with surgery compared to untreated RCS rats.

CONCLUSIONS

Direct activation of the retina by a subretinal implant induces activity in the SC of RCS rats, suggesting that these implants have some capacity to replace dysfunctional photoreceptors. The data also provide evidence for implant-induced neurotrophic effects as a consequence of both its presence and its activity in the retina.

Improved contact lens electrode for corneal ERG recordings in mice

The electroretinogram (ERG) is routinely used to study retinal physiology in the clinic and in research. Due to their outstanding properties, contact lens electrodes (CLEs) are widely used for ERG recordings. Though the procedures for ERG recordings in mice are similar to those used in humans and larger vertebrates, use of CLEs in the mouse has been limited because of difficulties involved with the manufacturing of small contact lenses. We describe a simple instrument and method for manufacturing contact lenses and CLEs for stable ERG recordings in mice. The instrument operates like a hole-punch and is based on slip joint pliers incorporating a ball bearing on one jaw and forming plate on the other. These CLEs are simple to manufacture, inexpensive and provide stable, long-term recordings of corneal ERGs in mice. With minor modifications, these CLEs could be made for other small animals such as rats or fish.

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.

Predictors and outcomes of scleroderma renal crisis: the high-dose versus low-dose D-penicillamine in early diffuse systemic sclerosis trial

OBJECTIVE

The reported frequency of scleroderma M01-R renal crisis (SRC) in diffuse systemic sclerosis (SSc; scleroderma) is 15-20%. Early use of angiotensin-converting enzyme (ACE) inhibitors has markedly improved outcome. The present analysis reexamines the prognostic factors for and outcome of SRC in a prospective cohort of patients with early diffuse SSc.

METHODS

We retrospectively evaluated the cohort of SSc patients who participated in the High-Dose Versus Low-Dose D-Penicillamine in Early Diffuse SSc trial. Patients with diffuse cutaneous scleroderma were enrolled if their disease duration was <18 months. Because the trial failed to show a difference between treatment groups, the data were pooled.

RESULTS

One hundred thirty-four SSc patients entered the observation period a mean +/- SD of 0.8 +/- 0.3 years after onset of SSc. SRC occurred in 18 patients a mean +/- SD of 0.9 +/- 1.1 years after entry. During a mean +/- SD 4.0 +/- 1.1 years of followup after entry, 9 of the 18 patients died (mean +/- SD 0.6 +/- 0.9 years after SRC onset). Baseline characteristics that predicted SRC included a modified Rodnan skin thickness score of >or=20 (P < 0.01), enlarged cardiac silhouette on radiograph (P = 0.04), large joint contractures (wrist, elbow, knee) (P = 0.008), and prednisone use at entry (P = 0.01). Baseline characteristics that did not predict SRC included age, sex, race, Health Assessment Questionnaire score, fist closure, handspread, lung involvement, muscle weakness, erythrocyte sedimentation rate, and platelet count. In 5 of 10 subjects for whom at least 2 sequential skin scores were available, skin scores increased significantly (P = 0.012) in the 6 months before onset of SRC.

CONCLUSION

SRC occurred in 13% of patients soon (mean 11 months) after entry into the cohort. Predictors of SRC identified in this study included higher than average skin score, prednisone use at study entry, large joint contractures, and heart enlargement. Our data suggest, however, that low-dose prednisone alone was not associated with the onset of SRC, except in the appropriate clinical setting. Although ACE inhibitors and dialysis are now readily available, SRC continues to be associated with poor survival (in this study, 50% of patients with SRC died).

Adaptation of spatiotemporal mechanisms by increment and decrement stimuli

Sawtooth modulation has been used in the past to examine visual sensitivity to luminance increments and decrements. The threshold elevation caused by adaptation depends on the spatial profile of the stimulus field and the polarities of the adaptation and test stimuli. We hypothesized that the adaptation effects reflect a change in the sensitivity of the spatiotemporal channels that detect the stimuli. We used a 2-deg disk centered in a larger surround field. Five levels of contrast between the test field and surround were investigated: equiluminant, three intermediate levels, and dark. At each contrast, observers adapted for 5 s to 2-Hz sawtooth modulation (rapid-on or rapid-off). Immediately after adaptation, thresholds were measured for detection of a single cycle of either a rapid-on or a rapid-off waveform. Varying the contrast of the surround affected observers' sensitivity to the polarity of the sawtooth stimulus to the extent that the pattern of sensitivity with the equiluminant surround was the opposite of that with the dark surround. To examine temporal factors, we measured thresholds for slow (500-ms ramps) and fast (8.3-ms pulses) test stimuli. The adaptation effect was preserved with the ramp stimuli but not with the pulse stimuli. Blurring the edge between the test and surround fields in the equiluminant surround condition raised thresholds for all sawtooth test stimuli, suggesting that spatiotemporal channels sensitive to high spatial frequencies and low temporal frequencies facilitate detection in that condition. These findings suggest that adaptation to sawtooth modulation can differentially effect the sensitivity of ON and OFF pathways, but the relative desensitization of each pathway depends on an interaction with the adaptation state of spatiotemporal channels that are involved in detection.

Processing of scotopic increments and decrements

Rod and cone photoreceptors send their signals to ON- and OFF-retinal ganglion cells through different pathways in the primate retina. We hypothesized that increments and decrements of light may be processed differently by the rod-bipolar pathway because of the funneling of the rod signal through the rod bipolar cell. We tested this hypothesis using a psychophysical adaptation paradigm, which has provided evidence that photopic increments and decrements of light are processed by ON- and OFF-pathways in the human visual system. We had observers adapt to either a rapid-on or rapid-off sawtooth waveform, under both photopic and scotopic conditions. We then measured detection thresholds for one cycle of a rapid-on or rapid-off sawtooth stimulus. For photopic stimuli, sawtooth adaptation asymmetrically raised thresholds for test stimuli in a manner that depended on the polarity of the adaptation stimulus. For scotopic stimuli, thresholds were raised, but no significant selective adaptation effect was found. By repeating the photopic condition with sawtooth stimuli which had been filtered using an impulse response function derived for the rod system, we demonstrated that the lack of selective adaptation was not a consequence of the sluggish temporal response of the rod-bipolar pathway. We conclude instead that the reduced effectiveness of sawtooth adaptation is due to channeling of rod photoreceptor signals through the rod bipolar cell before reaching ON- and OFF-ganglion cells.

Increment and decrement detection on temporally modulated fields

Increment and decrement probe thresholds were measured during the presentation of two types of temporal masking stimuli. In Experiment 1, we measured thresholds for increment or decrement rectangular probes presented during the presentation of an increment or decrement Gaussian masking stimulus. We find that thresholds are higher when the probe and the Gaussian mask are of the same sign (e. g. both increments). However, both types of Gaussian mask raised increment and decrement probe thresholds above steady state conditions. In Experiment 2, we presented increment or decrement probes at one of eight possible phases of a 1 Hz luminance-modulated sine wave. For both increment and decrement probes, threshold variation with phase is non-sinusoidal in shape, but increment and decrement probe thresholds vary as a function of the sinusoid phase. These experiments show that increment and decrement thresholds vary as a function of the adaptation state of the visual system, and as a function of the direction of change in the adaptation state. Data from both experiments are discussed in terms of a recent neurophysiological model [Hood & Graham (1998). Threshold fluctuations on temporally modulated backgrounds: a possible physiological explanation based upon a recent computational model. Visual Neuroscience, 15 (5), 957-967]. We find that the predicted ON- and OFF-pathway responses do not correlate in a straightforward manner with the psychophysical thresholds, suggesting that detection of increment and decrement probes may not be performed exclusively by one pathway. Our data have implications for modeling visual performance under conditions where visual adaptation is dynamic, such as when scanning complex images or natural scenes.

The peripheral flicker effect: desensitization of the luminance pathway by static and modulated light

Previous studies have shown that luminance flicker, presented peripheral to a foveal test target, increases thresholds for target detection: the peripheral flicker (PF) effect. These studies have also shown that thresholds are elevated more for luminance targets, relative to chromatic targets. In the present study we examined the specificity of the PF effect on the luminance mechanism and assessed the contribution of modulated stray-light to the test field, as well as longer range spatial interactions. We found that the presence of a foveal luminance pedestal, as well as PF, caused a notch to appear in the spectral sensitivity function around 570 nm. This result confirms the hypothesis that the PF effect decreases the sensitivity of the luminance pathway. To assess the contribution of stray-light to the PF effect, we modulated a luminance pedestal without the presence of PF in order to simulate the stray-light effect in isolation. A decrease in sensitivity for wavelengths around 570 nm occurred with modulated stray-light, suggesting that modulated stray-light contributes substantially to this effect. We then minimized the modulated stray-light by phase-reversing a checkerboard pattern in the periphery. A significant, though smaller, threshold elevation to mid-spectrum stimuli was obtained, suggesting that long range spatial effects are also active in the PF effect. We conclude that the PF effect causes a desensitization of foveal luminance pathways via local and more long range spatial interactions. Our results are consistent with previous data which suggest that the PF effect is due to selective adaptation of cells in the magnocellular pathway (M-cells). Our data imply that local network adaptation may be a property of the magnocellular pathway.

The effects of luminance and chromatic background flicker on the human visual evoked potential

Previous studies report that background luminance flicker, which is asynchronous with signal averaging, reduces the amplitude and increases the latency of the pattern-onset visual evoked potential (VEP). This effect has been attributed to saturation of the magnocellular (m-) pathway by the flicker stimulus. In the current study, we evaluate this hypothesis and further characterize this effect. We found that flicker had similar effects on the pattern-onset and pattern-reversal VEP, suggesting that the reversal and onset responses have similar generators. Chromatic flicker decreased latency of the chromatic VEP whereas luminance flicker increased peak latency to luminance targets. This result indicates that luminance flicker saturates a rapidly conducting m-pathway whereas chromatic flicker saturates a more slowly conducting parvocellular (p-) pathway. Finally, evoked potentials to chromatic and luminance stimuli were recorded from 34 electrodes over the scalp in the presence of static and asynchronously modulated backgrounds. An equivalent dipole model was used to assess occipital, parietal, and temporal lobe components of the surface response topography. Results showed that chromatic flicker reduced activity to a greater extent in the ventral visual pathway whereas luminance flicker reduced activity to a greater extent in the dorsal visual pathway to parietal lobe. We conclude that the VEP to isoluminant color and luminance stimuli contains both m- and p-pathway components. Asynchronous flicker can be used to selectively reduce the contribution of these pathways to the surface recorded VEP. Our results provide evidence of parallel pathways in the human visual system, with a dorsal luminance channel projecting predominantly to the posterior parietal lobe and a ventral color channel projecting predominantly to inferior temporal lobe.

Short-term changes in the response characteristics of the human visual evoked potential

The present study examined how the response characteristics of the visual evoked potential (VEP) varied during the course of trials using a sinusoidal grating stimulus that reversed contrast in a square-wave manner. To accomplish this, amplitude and phase values were derived in short segments during the course of continuous stimulation for three subjects. When stimulus spatial frequencies of 0.77 or 1.55 c/deg were used, VEP amplitude remained at a stable value throughout the trial. At 3.1 c/deg, 6-12 sec were required for VEP amplitude to increase to a stable value, which was on average 204% greater than the value noted during the first few seconds of the trial. At 6.2 and 12.4 c/deg, VEP amplitude changes were more complex, first increasing and then decreasing substantially, to levels that were on average 63.8% and 38% of the peak reached earlier in the trial. In all cases, VEP phase decreased during the trial. The magnitude of this decrease ranged up to 50 deg, corresponding to an approx. 10.5 msec delay for the 6.65 Hz stimulation rate used. Prior exposure to an adapting grating diminished the changes in VEP amplitude and advanced the phase changes. Therefore, these changes appear to represent a form of contrast adaptation that is restricted to responses to high spatial frequencies. In addition, the present results provide evidence against a fundamental assumption of signal averaging--that an invariant stimulus will evoke an invariant response.

Anatomy and physiology of the visual system

This article reviews the anatomy and physiology of the visual system. The physical stimulus is coded by several separate and parallel pathways at multiple sites in the nervous system. We outline the major parallel pathways of the system, from their beginning in the retina, to the multiple cortical areas that receive visual input. Emphasis has been placed on the functional properties of the neurons of these pathways and the various cortical processing areas as they are currently known. Clinical syndromes as a result of damage to specific visual cortical areas are also described.

Effect of sawtooth polarity on chromatic and luminance detection

Psychophysical studies have documented that many observers show lower thresholds for rapid-off than for rapid-on sawtooth luminance modulation. This finding, together with physiological findings from chromatically opponent ganglion cells of the macaque monkey, prompted a search for a similar bias in psychophysical detection of chromatic increments and decrements of light. Using a luminance pedestal in conjunction with a luminance background to favor detection by chromatic mechanisms, we measured spectral sensitivity for rapid-on and rapid-off sawtooth stimuli presented spatially coextensive with the pedestal. There were two different pedestal chromaticities: one broadband, and the second composed only of long-wavelength light to enhance short-wavelength-sensitive, cone-mediated detection. Spectral-sensitivity measurements for different wavelength stimuli revealed no systematic differences across the visible spectrum as a function of sawtooth waveform polarity or pedestal chromaticity. Similarly, temporal contrast-sensitivity functions for hetero-chromatically modulated red-green sawtooth stimuli did not reveal an asymmetry in sensitivity for rapid-red and rapid-green chromatic change. Some of the observers showed a higher sensitivity for luminance modulated rapid-off sawtooth stimuli, as also noted in previous studies. This asymmetry was not found when a white luminance pedestal and background was used. These results suggest that the cone inputs to chromatically opponent ON- and OFF-center cells are sufficiently balanced to provide equivalent psychophysical thresholds for chromatic increments and decrements of light.

DL-2-amino-4-phosphonobutyric acid does not eliminate "ON" responses in the visual system of goldfish

DL-2-Amino-4-phosphonobutyric acid (APB) suppresses activity in retinal ON pathways. It is generally assumed that loss of the ON pathway would result in loss of ON responses in the visual system. We tested this assumption by recording activity from the optic nerves of intact goldfish (Carassius auratus) before and after intraocular injection of APB. Whole-nerve responses to increments and decrements of light were compared to electroretinogram responses and to tectal evoked potentials. APB severely reduced the amplitude of the electroretinogram b-wave but left ON and OFF responses from the optic nerve and tectum intact, although decreased in sensitivity. We conclude that APB does not completely eliminate ON responses in the visual system, at least in goldfish. The selectivity and effectiveness of APB must be evaluated in other species before this agent can be relied upon as a useful tool in understanding the roles of ON and OFF pathways in visual function.

Spectral sensitivity of ON and OFF responses from the optic nerve of goldfish

The vertebrate retina processes visual information in parallel neural pathways known as the ON and OFF pathways. These pathways encode increments and decrements of light independently as excitatory responses. We examined the photopic spectral response of ON and OFF mechanisms in goldfish by measuring the sensitivity of optic nerve responses to the onset and termination of stimuli of various wavelengths. Using various adapting backgrounds, we found that the ON and OFF responses have different spectral sensitivities. The weighting of the cone inputs to the responses was estimated by an algebraic summation model. This model suggests that for the ON response, input from S-cones is stronger and more independent than for the OFF response, and M- and L-cones show stronger antagonism in the ON response than in the OFF response. The OFF response probably receives input from all cone types, but spectral antagonism is weak and its dominant input is from L-cones.

Sensitivity of ERG components from dark-adapted goldfish retinas treated with APB

The electroretinogram (ERG) of the dark-adapted goldfish was examined before and after intravitreal injection of DL-2-amino-4-phosphonobutyric acid (APB). APB abolished the b-wave and decreased absolute sensitivity of the remaining waveform, which was composed of a vitreal-negative component followed by a vitreal-positive component. The sensitivity, time course and amplitude of these components differed from ERGs obtained from animals treated with sodium aspartate. Spectral sensitivity of both post-APB components closely resembled that of the normal dark-adapted b-wave. The results suggest that APB does not act selectively on any particular class of photoreceptors or photoreceptor pathways in the dark-adapted goldfish retina.

APB selectively reduces visual responses in goldfish to high spatiotemporal frequencies

Visual responses of goldfish to rotating square-wave gratings were recorded before and after intraocular injection of 2-amino-4-phosphonobutyric acid (APB). High doses of APB reduced the rate of optokinetic nystagmus (OKN) to a relatively high spatial frequency grating moving at a high temporal frequency. Responses to a low spatial frequency grating were not altered, nor were responses to the higher spatial frequency when it rotated slowly. The effects of APB were transient and lasted no longer than 3 d. We conclude that APB reduces OKN to high spatiotemporal frequencies in goldfish.