Relationships between mesopic visual sensitivity and macular inner and outer retinal layer thickness in healthy younger, middle-aged and older adults

PURPOSE

To examine relationships between mesopic visual sensitivity measurements on microperimetry and macular inner and outer retinal layer (IRL and ORL) thicknesses in healthy younger, middle-aged and older subjects.

METHODS

In total, 154 healthy adults were divided into three age groups each with similar mean sensitivity. Regional retinal sensitivity (determined by mesopic fundus-controlled microperimetry) and IRL (ganglion cell-related layer) and ORL thicknesses were measured in the five subfields: central fovea (1 mm diameter) and the quadrants temporal, nasal, superior and inferior of a parafoveal ring of outer diameter 3 mm and inner diameter 1 mm. Relationships between regional sensitivity and corresponding IRL and ORL thicknesses were assessed through a univariate and multivariate linear regression model.

RESULTS

Visual sensitivity means for each subfield differed across age groups (all p < 0.001). In each parafoveal ring quadrant, mean IRL thickness was reduced in the older eyes compared to the other groups (all p < 0.0001). In the inferior region, worse sensitivity was correlated with greater IRL thickness (p = 0.0207) in the middle-aged group and with a thicker ORL (p < 0.0001) and thinner IRL (p = 0.0003) in the older eyes (R2  = 0.51). The slopes of regression lines relating sensitivity to IRL thickness and age group (p = 0.0027) or to ORL thickness and age group (p = 0.0020) differed significantly.

CONCLUSIONS

The relationship observed between mesopic visual sensitivity and retinal layer thickness varied with age. A worse sensitivity was related to a thicker macular IRL layer in middle-aged eyes and to a thicker ORL and thinner IRL in older eyes.

Effects of D-serine treatment on outer retinal function

The role of the N-Methyl-D-Aspartate Receptor (NMDAR) in the outer retina is unclear despite expression of the NMDAR-complex and its subunits in the outer retina. The flash-electroretinogram (fERG) offers a non-invasive measurement of the retinal field potentials of the outer retina that can serve to clarify NMDAR contribution to early retinal processing. The role of the NMDAR in retinal function was assessed using a genetic mouse model for NMDAR hypofunction (SR^-/-), where the absence of the enzyme serine racemase (SR) results in an 85% reduction of retinal D-serine. NMDAR hypo- and hyperfunction in the retina results in alterations in the components of the fERG. The fERG was examined after application of exogenous D-serine to the eye in order to determine whether pre- and post-topical delivery of D-serine would alter the fERG in SR^-/- mice and their littermate WT controls. Amplitude and implicit time of the low-frequency components, the a- and b-wave, were conducted. Reduced NMDAR function resulted in a statistically significantly delayed a-wave and reduced b-wave in SR^-/- animals. The effect of NMDAR deprivation was more prominent in male SR^-/- mice. A hyperfunction of the NMDAR, through exogenous topical delivery of 5 mM D-serine, in WT mice caused a significantly delayed a-wave implicit time and reduced b-wave amplitude. These changes were not observed in female WT mice. There were temporal delays in the a-wave and amplitude and a decrease in the b-wave amplitude and implicit time in both hypo- and NMDAR hyperfunctional male mice. These results suggest that NMDAR and D-serine are involved in the retinal field potentials of the outer retina that interact based on the animal's sex. This implicates the involvement of gonadal hormones and D-serine in retinal functional integrity.

Intrasession repeatability of pupil size measurements under different light levels provided by a multidiagnostic device in healthy eyes

BACKGROUND

The measurement of the pupillary function is an indispensable test in some eye examinations, being necessary the evaluation of the precision of instruments performing such measures. The aim of this study was to evaluate the intrasession repeatability of pupil size measurements provided by a multidiagnostic platform in a large sample of healthy eyes.

METHODS

This prospective study enrolled 100 healthy eyes of 100 patients, with ages ranging from 23 to 65 years old. Repeated pupil size measures under photopic (P, 220 lx), mesopic (M, 160 lx), low mesopic (L, 70 lx), and scotopic conditions (S, 1 lx) were obtained with the VX120 system (Visionix-Luneau Technologies, Chartres, France) after a complete eye exam. Likewise, pupil size was also measured once in the fellow eye in a total of 75 eyes. The level of intrasession variability as well as differences between fellow eyes were evaluated.

RESULTS

Most of differences between repeated measures did not exceed 0.5 mm (82% of S and 100% of P below this value). No significant differences between these repeated measures were found for S (p = 0.099) and L (p = 0.751). However, statistically significant differences were found between repeated measures for M (p = 0.002) and P (p = 0.003). The analysis of clinical relevance of differences between pairs (Passing-Bablok) only confirmed the clinical relevance of differences between the first and second repeated measurement of M. Concerning the comparative analysis between fellow eyes, no statistically significant differences in pupil size were found between right and left eyes in any light condition evaluated (p ≥ 0.227).

CONCLUSIONS

The VX120 system can provide consistent measurements of pupil size under scotopic, low mesopic and photopic conditions, with a relative limitation under mesopic conditions.

Spatial contrast sensitivity from star- to sunlight in healthy subjects and patients with glaucoma

Glaucoma is traditionally considered an asymptomatic disease until later stages. However, questionnaire studies revealed visual complaints related to various tasks, especially under extreme luminance conditions (such as outdoor at night on an unlit road or outside in the sun). We measured contrast sensitivity (CS) over a luminance range of 6 log units spanning the scotopic to photopic range and we aimed (1) to determine whether Weber's law also holds under extremely high luminance conditions and (2) to compare CS as a function of spatial frequency and luminance between glaucoma patients and healthy subjects. We included 22 glaucoma patients and 51 controls, all with normal visual acuity. For the second aim, we used a subgroup of 22 age-similar controls. Vertically oriented sine-wave gratings were generated with a projector-based setup (stimulus size 8x5 degrees). CS was measured monocularly at 1, 3, and 10 cycles per degree (cpd); mean luminance ranged from 0.0085 to 8500 cd/m². ANOVA was used to analyze the effect of glaucoma, luminance, and spatial frequency on logCS. In controls, Weber's law held for 3 and 10 cpd; for 1 cpd, CS dropped above 1000 cd/m² (P = 0.003). The logCS versus log luminance curves did not differ grossly between patients and controls (P = 0.14; typically 0-0.2 log units); the difference became larger with decreasing luminance (P = 0.003) but did not depend clearly on spatial frequency (P = 0.27). We conclude that differences between glaucoma and healthy were relatively modest for the spatially redundant, static stimulus as used in the current study.

Effects of absolute luminance and luminance contrast on visual discrimination in low mesopic environments

Recent research revealed considerable decline in visual perception under low luminance conditions. However, systematic studies on how visual performance is affected by absolute luminance and luminance contrast under low mesopic conditions (<0.5 cd/m²) is lacking. We examined performance in a simple visual discrimination task under low mesopic luminance conditions in three experiments in which we systematically varied base luminance and luminance contrast between stimulus and background. We further manipulated eccentricity of the stimuli because of known rods and cones gradients along the retina. We identified a "deficiency window" for performance as measured by d' when luminance was < 0.06 cd/m² and luminance contrast as measured by the luminance ratio between stimulus and background was below < 1.7. We further calculated performance-based luminance as well as contrast efficiency functions for reaction times (RTs). These power functions demonstrate the contrast asymptote needed to decrease RTs and how such a decrease can be achieved given various combinations of absolute luminance and luminance contrast manipulations. Increased eccentricity resulted in slower RTs indicative of longer scan distances. Our data provide initial insights to performance-based efficiency functions in low mesopic environments that are currently lacking and to the physical mechanisms being utilized for visual perception in these extreme environments.

Photopic and Mesopic Performance of 2 Different Trifocal Diffractive Intraocular Lenses

Purpose To assess photopic and mesopic vision in patients implanted with 2 different trifocal intraocular lenses (IOLs). Methods Fifty patients with cataract in both eyes had surgery with bilateral implantation of a trifocal FineVision (FV, n = 25) or AT LISA tri 839MP (LisaTri, n = 25) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity and corrected distance visual acuity (CDVA) were determined using the Early Treatment Diabetic Retinopathy Study test. Intermediate (65 cm) and near (40 cm) visual acuity were also measured, both with best distance correction (DCIVA and DCNVA, respectively). The CSV1000 test chart was used for binocular and monocular contrast sensitivity. Defocus curves were constructed under photopic and mesopic conditions. Results Mean patient age was 68.4 ± 5.5 years (FV) and 67.3 ± 5.6 years (LisaTri) (p = 0.540). No differences were found in terms of visual acuity between the groups. The CDVA, DCIVA, and DCNVA were 0.05 ± 0.06, 0.25 ± 0.10, and 0.13 ± 0.10 logMAR for FV and -0.04 ± 0.11, 0.32 ± 0.09, and 0.12 ± 0.11 logMAR for LisaTri, respectively (p = 0.09, p = 0.08, and p = 0.12). Photopic and mesopic defocus curves were comparable between the 2 IOL groups (p>0.05). Mesopic values were significantly worse than photopic in both groups for all the measured values (p<0.001). No differences in contrast sensitivity were observed between the 2 IOL groups (p>0.05). Conclusions Both trifocal diffractive IOLs provided good visual quality with a statistically significant decrease in mesopic conditions.

The science behind codes and standards for safe pedestrian walkways: lighting and visual cues

BACKGROUND

Walkway codes and standards are created through consensus by committees based on a number of factors, including historical precedence, common practice, cost, and, sometimes, empirical data. The authors maintain that codes and standards that can have an impact on human safety and welfare should give consideration in their formulation to the results of pertinent scientific research.

PURPOSE

This article extends a companion one in examining many elements of common walkway codes and standards related specifically to lighting, warnings and markings. It indicates which elements are based on or supported by empirical data; and which elements could benefit from additional scientific research.

PRACTICAL APPLICATIONS

This article identifies areas in which additional research leading toward scientific based codes and standards may be beneficial in enhancing the safety of pedestrian walkway surfaces.