Mechanisms of cone sensitivity loss in retinitis pigmentosa

PURPOSE

To explore the mechanisms of cone sensitivity loss in retinitis pigmentosa by combining two-colour perimetry with threshold versus intensity (tvi) testing.

METHODS

Seven subjects with autosomal recessive retinitis pigmentosa and 10 normal subjects were recruited and underwent perimetric testing of one eye using 480- and 640-nm Goldman size V targets presented under scotopic conditions (no background illumination) and against a white background ranging in luminance from -1.5 to 2 log cd m-2 in 0.5 log cd m-2 steps. Data were fitted with tvi functions of the form logT = logT0 + log ((A + A0)/A0)n, where T is the threshold, T0 is the absolute threshold, A is the background intensity, A0 is the 'dark-light' constant and n is a gain constant.

RESULTS

Reliable tvi functions could not be obtained within the region of the visual field corresponding to loss of the ellipsoid zone on optical coherence tomography. At fixation, changes in both T0 and A0 were observed, consistent with a d1 mechanism loss, which resulted in an upwards and rightwards shift of the tvi function. Losses at [±3°, ±3°] demonstrated changes in T0, consistent with a d3 mechanism loss, resulting in an upwards translation of the tvi curve.

CONCLUSIONS

Although the absolute cone threshold was elevated at each location, shifts in the tvi function (so-called d1 mechanism loss) at fixation minimise threshold elevation in the presence of white adapting backgrounds, such as those typically employed in standard two-colour perimetry. At more peripheral testing locations, changes in threshold occurred independent of background luminance (so-called d3 mechanism loss). These findings suggest that backgrounds which selectively adapt rods while maintaining cones at, or near, absolute threshold may be preferable to conventional two-colour perimetry for assessing loss of cone sensitivity, especially at the point of fixation.

Predicted effectiveness of EnChroma multi-notch filters for enhancing color perception in anomalous trichromats

EnChroma filters are aids designed to improve color vision for anomalous trichromats. Their use is controversial because the results of lab-based assessments of their effectiveness have so far largely failed to agree with positive anecdotal reports. However, the effectiveness of EnChroma filters will vary depending on the conditions of viewing, including whether the stimuli are broadband reflective surfaces or colors presented on RGB displays, whether illumination spectra are broadband or narrowband, the transmission spectra of particular filters, and the cone spectral sensitivity functions of the observer. We created a model of anomalous trichromatic color vision to predict the effects of EnChroma filters on the color signals impaired in anomalous trichromacy. Using the model we varied illumination, filter type and observer cone sensitivity functions, and tested the effect of presenting colors as broadband reflective surfaces or on RGB displays. We also used hyperspectral images to assess the impact of the filters on anomalous trichromats' color vision for natural scenes. Model results predicted that the filters should be broadly effective at enhancing anomalous trichromats' equivalent to L/(L + M) chromatic contrasts under a range of viewing conditions, but are substantially more effective for deuteranomals than for protanomals. The filters are predicted to be more effective for broadband reflective surfaces presented under broadband illuminants than for surfaces presented under narrowband illuminants or for colors presented on RGB displays. Since the potential impacts of contrast adaptation and perceptual learning are not considered in the model, it needs to be empirically validated. Results of empirical tests of the effects of EnChroma filters on deuteranomalous color vision in comparison with model predictions are presented in an accompanying paper (Somers et al., in prep.).

Retinal response to light exposure in BEST1-mutant dogs evaluated with ultra-high resolution OCT

Mutations in BEST1 cause an autosomal recessive disease in dogs where the earliest changes localize to the photoreceptor-RPE interface and show a retina-wide micro-detachment that is modulated by light exposure. The purpose of this study was to define the spatial and temporal details of the outer retina and its response to light with ultra-high resolution OCT across a range of ages and with different BEST1 mutations. Three retinal regions were selected in each eye: near the fovea-like area, near the optic nerve, both in the tapetal area, and inferior to the optic nerve in the non-tapetal area. The OS+ slab thickness was defined between the peak near the junction of inner and outer segments (IS/OS) and the transition between basal RPE, Bruch membrane, choriocapillaris and proximal tapetum (RPE/T). In wildtype (WT) dogs, two tapetal regions showed additional hyperscattering OCT peaks within the OS+ slab likely representing cone and rod outer segment tips (COST and ROST). The inferior non-tapetal region of WT dogs had only one of these peaks, likely ROST. In dogs with BEST1 mutations, all three locations showed a single peak, likely suggesting optical silence of COST. Light-dependent expansion of the micro-detachment by about 10 um was detectable in both tapetal and non-tapetal retina across all ages and BEST1 mutations.

Evolutionary and developmental specialization of foveal cell types in the marmoset

In primates, high-acuity vision is mediated by the fovea, a small specialized central region of the retina. The fovea, unique to the anthropoid lineage among mammals, undergoes notable neuronal morphological changes during postnatal maturation. However, the extent of cellular similarity across anthropoid foveas and the molecular underpinnings of foveal maturation remain unclear. Here, we used high-throughput single-cell RNA sequencing to profile retinal cells of the common marmoset (Callithrix jacchus), an early divergent in anthropoid evolution from humans, apes, and macaques. We generated atlases of the marmoset fovea and peripheral retina for both neonates and adults. Our comparative analysis revealed that marmosets share almost all their foveal types with both humans and macaques, highlighting a conserved cellular structure among primate foveas. Furthermore, by tracing the developmental trajectory of cell types in the foveal and peripheral retina, we found distinct maturation paths for each. In-depth analysis of gene expression differences demonstrated that cone photoreceptors and Müller glia (MG), among others, show the greatest molecular divergence between these two regions. Utilizing single-cell ATAC-seq and gene-regulatory network inference, we uncovered distinct transcriptional regulations differentiating foveal cones from their peripheral counterparts. Further analysis of predicted ligand-receptor interactions suggested a potential role for MG in supporting the maturation of foveal cones. Together, these results provide valuable insights into foveal development, structure, and evolution.

Parafoveal cone function in choroideremia assessed with adaptive optics optoretinography

Choroideremia (CHM) is an X-linked retinal degeneration leading to loss of the photoreceptors, retinal pigment epithelium (RPE), and choroid. Adaptive optics optoretinography is an emerging technique for noninvasive, objective assessment of photoreceptor function. Here, we investigate parafoveal cone function in CHM using adaptive optics optoretinography and compare with cone structure and clinical assessments of vision. Parafoveal cone mosaics of 10 CHM and four normal-sighted participants were imaged with an adaptive optics scanning light ophthalmoscope. While acquiring video sequences, a 2 s 550Δ10 nm, 450 nW/deg2 stimulus was presented. Videos were registered and the intensity of each cone in each frame was extracted, normalized, standardized, and aggregated to generate the population optoretinogram (ORG) over time. A gamma-pdf was fit to the ORG and the peak was extracted as ORG amplitude. CHM ORG amplitudes were compared to normal and were correlated with bound cone density, ellipsoid zone to RPE/Bruch's membrane (EZ-to-RPE/BrM) distance, and foveal sensitivity using Pearson correlation analysis. ORG amplitude was significantly reduced in CHM compared to normal (0.22 ± 0.15 vs. 1.34 ± 0.31). In addition, CHM ORG amplitude was positively correlated with cone density, EZ-to-RPE/BrM distance, and foveal sensitivity. Our results demonstrate promise for using ORG as a biomarker of photoreceptor function.

A modified motor-clutch model reveals that neuronal growth cones respond faster to soft substrates

Neuronal growth cones sense a variety of cues including chemical and mechanical ones to establish functional connections during nervous system development. Substrate-cytoskeletal coupling is an established model for adhesion-mediated growth cone advance; however, the detailed molecular and biophysical mechanisms underlying the mechanosensing and mechanotransduction process remain unclear. Here, we adapted a motor-clutch model to better understand the changes in clutch and cytoskeletal dynamics, traction forces, and substrate deformation when a growth cone interacts with adhesive substrates of different stiffnesses. Model parameters were optimized using experimental data from Aplysia growth cones probed with force-calibrated glass microneedles. We included a reinforcement mechanism at both motor and clutch level. Furthermore, we added a threshold for retrograde F-actin flow that indicates when the growth cone is strongly coupled to the substrate. Our modeling results are in strong agreement with experimental data with respect to the substrate deformation and the latency time after which substrate-cytoskeletal coupling is strong enough for the growth cone to advance. Our simulations show that it takes the shortest time to achieve strong coupling when substrate stiffness was low at 4 pN/nm. Taken together, these results suggest that Aplysia growth cones respond faster and more efficiently to soft than stiff substrates.

Hyperglycemia and circadian disruption lead to retinal dysfunction in a stabilized colony of the fat sand rat Psammomys obesus

PURPOSE

The Fat Sand Rat (Psammomys obesus) recapitulates several features of human pre-proliferative diabetic retinopathy, but data are restricted to wild animals, incompatible with stringent biomedical research criteria. To overcome this barrier, we characterized retinal changes in a colony of P. obsesus maintained under strictly controlled housing conditions.

METHODS

Animals were maintained on low or high caloric energy diets, and raised under either standard (12 h light/12 h dark) or shortened (5 h light/5 h dark) photoperiods. Visual responses were tested by electroretinography, while structural/molecular changes were assayed by immunochemistry and molecular biology (RNAseq and qPCR).

RESULTS

Whereas high calorie diet alone did not induce hyperglycemia, coupled with short photoperiod >80 % animals developed severe hyper-insulinemia by 15 weeks, and 16 % animals further developed hyperglycemia. In these groups, electroretinography showed significant declines in visual responses in both hyper-insulinemic and hyperglycemic animals, especially in photopic (cone) responses. Transcriptomics analysis of hyperglycemic compared to low caloric controls revealed major upregulation in pathways involved in glial activation, extracellular matrix remodeling, inflammation, cytokine production, partial ischemic responses and angiogenesis. Western blotting against rhodopsin and cone opsin also showed decreased levels in both groups, overall decreases being greater for cones than rods in hyperglycemic animals.

CONCLUSIONS

P. obesus maintained in rigorously monitored captive conditions, albeit showing attenuated responses to dietary overload compared to wild counterparts, nevertheless do develop some retinal features of diabetic retinopathy-like degeneration. Such a colony with known sanitary status opens their broader use for biomedical research.

ASSOCIATION OF INTRAVENOUS FLUORESCEIN ANGIOGRAPHY AND ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Case Series

PURPOSE

To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy.

METHODS

Consecutive patients with diabetic retinopathy older than age 18 years presenting to a single center in Toronto, Canada, from 2020 to 2021 were recruited. Adaptive optics was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. Intravenous fluorescein angiography was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal-barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson's correlation coefficient.

RESULTS

Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r = 0.303, P = 0.027), as well as perfusion (r = 0.272, P = 0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r = 0.770, P = 0.043; r = 0.846, P = 0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r = -0.819, P = 0.046).

CONCLUSION

Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with diabetic retinopathy. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.

FOVEAL PHENOTYPES IN CHOROIDEREMIA ON ADAPTIVE OPTICS SCANNING LIGHT OPHTHALMOSCOPY

PURPOSE

Choroideremia is an X-linked inherited retinal degeneration involving the choriocapillaris, retinal pigment epithelium, and photoreceptors. Adaptive optics scanning light ophthalmoscopy allows visualization of retinal structure at the level of individual cells and is well poised to provide insight into the pathophysiologic mechanisms underpinning the retinal degeneration in choroideremia.

METHODS

Foveal adaptive optics scanning light ophthalmoscopy images of 102 eyes of 54 individuals with choroideremia were analyzed. Measures were compared with those from standard clinical imaging. Visual acuity was also measured and compared with quantitative foveal metrics.

RESULTS

The 3 distinct phenotypes observed were: relatively normal (5 eyes, 4 individuals), spiderweb (9 eyes, 7 individuals), and salt and pepper (87 eyes, 47 individuals). Peak cone density (86 eyes of 51 individuals) was significantly lower in choroideremia than in healthy retinas (P < 0.0001, range: 29,382-157,717 cones/mm2). Peak cone density was significantly related to extent of retained ellipsoid zone on en face optical coherence tomography (r2 = 0.47, P = 0.0009) and inversely related to visual acuity (r2 = 0.20, P = 0.001).

CONCLUSION

Distinct phenotypes can be observed on adaptive optics scanning light ophthalmoscopy imaging in choroideremia that cannot always be discerned on standard clinical imaging. Quantitative measures on adaptive optics imaging are related to the structural and functional severity of disease.

Longitudinal Assessment of OCT-Based Measures of Foveal Cone Structure in Achromatopsia

Purpose

Achromatopsia (ACHM) is an autosomal recessive retinal disease associated with reduced or absent cone function. There is debate regarding the extent to which cone structure shows progressive degeneration in patients with ACHM. Here, we used optical coherence tomography (OCT) images to evaluate outer nuclear layer (ONL) thickness and ellipsoid zone (EZ) integrity over time in individuals with ACHM.

Methods

Sixty-three individuals with genetically confirmed ACHM with follow-up ranging from about 6 months to 10 years were imaged using either Bioptigen or Cirrus OCT. Foveal cone structure was evaluated by assessing EZ integrity and ONL thickness.

Results

A total of 470 OCT images were graded, 243 OD and 227 OS. The baseline distribution of EZ grades was highly symmetrical between eyes (P = 0.99) and there was no significant interocular difference in baseline ONL thickness (P = 0.12). The EZ grade remained unchanged over the follow-up period for 60 of 63 individuals. Foveal ONL thickness showed a clinically significant change in only 1 of the 61 individuals analyzed, although detailed adaptive optics imaging revealed no changes in cone density in this individual.

Conclusions

ACHM appears to be a generally stable condition, at least over the follow-up period assessed here. As cones are the cellular targets for emerging gene therapies, stable EZ and ONL thickness demonstrate therapeutic potential for ACHM, although other aspects of the visual system need to be considered when determining the best timing for therapeutic intervention.

Cone-isolation contrast sensitivity - do pupil and stimulus sizes matter?

CLINICAL RELEVANCE

Computer-based colour perception tests permit clinical assessment of cone-specific pathways, proving valuable for both identifying type and severity of hereditary colour vision deficiency and enhanced detection and monitoring of acquired colour deficiency from disease. Understanding the parameters that affect computer-based colour perception tests may enhance their veracity and clinical utility.

BACKGROUND

Testing contrast sensitivity separately for the three cone systems enables a quantification of colour perception that can be clinically useful. This study evaluated the effects of pupil diameter and stimulus size on cone contrast sensitivity (CCS) assessed with the ColorDx (Konan Medical, Incorporated).

METHODS

Forty subjects, aged 21-31 years, who met the inclusion criteria participated. The tested eye was randomised. Two Landolt C sizes (2.68 degrees, 6/194, "small"; 8.58 degrees, 6/619, "large") were used, with one size and three chromaticities presented per block of trials. Stimulus presentation used the adaptive screening mode, sequentially determining contrast sensitivity for long-, medium-, and short-wavelength stimuli. Subjects were tested with their natural pupil size (range 4-5 mm diameter), then while viewing through a 2.5-mm artificial pupil. Parametric statistical tests were used for comparisons of performance across pupil size and stimulus size.

RESULTS

Two-way within-subjects ANOVA indicates no interaction between pupil size and stimulus size for any of the three stimulus chromaticities. The main effect of stimulus size was significant for M-cone (F = 6.506, 2-tailed P = .015) and S-cone (F = 67.728, 2-tailed P < .001) stimuli. The main effect of pupil size was significant for all three stimulus chromaticities (L-cone: F = 227.161, M-cone: F = 249.979, S-cone: F = 89.371, 2-tailed P < .001 for all).

CONCLUSION

Although CCS was reduced for all three chromaticities and both stimulus sizes with lower retinal illuminance, only S-wavelength cone contrast sensitivity was significantly different for the small versus large stimuli under the 2.5-mm pupil condition in this cohort. Whether CCS in older patients with naturally small pupils changes with an enlarged stimulus or dilated pupils remains to be explored.

Temporospatial dynamics of the morphogenesis of the rabbit retina from prenatal to postnatal life: Light and electron microscopic study

The retina consists of various cell types arranged in eight cell layers and two membranes that originate from the neuroectodermal cells. In this study, the timing of differentiation and distribution of the cellular components and the layers of the rabbit retina are investigated using light and electron microscopy and immunohistochemical techniques. There were 32 rabbit embryos and 12 rabbits used. The rabbit retina begins its prenatal development on the 10th day of gestation in the form of optic cup. The process of neuro- and gliogenesis occurs in several stages: In the first stage, the ganglionic cells are differentiated at the 15th day. The second stage includes the differentiation of Muller, amacrine, and cone cells on the 23rd day. The differentiation of bipolar, horizontal, and rod cells and formation of the inner segments of the photoreceptors consider the late stage that occurs by the 27th and 30th day of gestation. On the first week of age postnatally, the outer segments of the photoreceptors are developed. S100 protein is expressed by the Muller cells and its processes that traverse the retina from the outer to the inner limiting membranes. Calretinin is intensely labeled within the amacrine and displaced amacrine cells. Ganglionic cells exhibited moderate immunoreactivity for calretinin confined to their cytoplasm and dendrites. In conclusion, all stages of neuro- and gliogenesis of the rabbit retina occur during the embryonic period. Then, the retina continues its development postnatally by formation of the photoreceptor outer segments and all layers of the retina become established. RESEARCH HIGHLIGHTS: The aim of this study is to investigate the morphogenesis of the rabbit retina during pre- and postnatal life. The primordia of the retina could be observed in the form of the optic cup. The ganglionic cells are the first cells to differentiate, while the photoreceptor cells are the last. S100 protein is expressed by the Muller cells and its processes. Calretinin is intensely labeled in the amacrine and displaced amacrine cells and moderately expressed in the cytoplasm and dendrites of ganglionic cells.

Germline knockout of Nr2e3 protects photoreceptors in three distinct mouse models of retinal degeneration

Retinitis pigmentosa (RP) is a common form of retinal dystrophy that can be caused by mutations in any one of dozens of rod photoreceptor genes. The genetic heterogeneity of RP represents a significant challenge for the development of effective therapies. Here, we present evidence for a potential gene-independent therapeutic strategy based on targeting Nr2e3, a transcription factor required for the normal differentiation of rod photoreceptors. Nr2e3 knockout results in hybrid rod photoreceptors that express the full complement of rod genes, but also a subset of cone genes. We show that germline deletion of Nr2e3 potently protects rods in three mechanistically diverse mouse models of retinal degeneration caused by bright-light exposure (light damage), structural deficiency (rhodopsin-deficient Rho-/- mice), or abnormal phototransduction (phosphodiesterase-deficient rd10 mice). Nr2e3 knockout confers strong neuroprotective effects on rods without adverse effects on their gene expression, structure, or function. Furthermore, in all three degeneration models, prolongation of rod survival by Nr2e3 knockout leads to lasting preservation of cone morphology and function. These findings raise the possibility that upregulation of one or more cone genes in Nr2e3-deficient rods may be responsible for the neuroprotective effects we observe.

Age-Related Macular Degeneration, a Mathematically Tractable Disease

A progression sequence for age-related macular degeneration onset may be determinable with consensus neuroanatomical nomenclature augmented by drusen biology and eye-tracked clinical imaging. This narrative review proposes to supplement the Early Treatment of Diabetic Retinopathy Study (sETDRS) grid with a ring to capture high rod densities. Published photoreceptor and retinal pigment epithelium (RPE) densities in flat mounted aged-normal donor eyes were recomputed for sETDRS rings including near-periphery rich in rods and cumulatively for circular fovea-centered regions. Literature was reviewed for tissue-level studies of aging outer retina, population-level epidemiology studies regionally assessing risk, vision studies regionally assessing rod-mediated dark adaptation (RMDA), and impact of atrophy on photopic visual acuity. The 3 mm-diameter xanthophyll-rich macula lutea is rod-dominant and loses rods in aging whereas cone and RPE numbers are relatively stable. Across layers, the largest aging effects are accumulation of lipids prominent in drusen, loss of choriocapillary coverage of Bruch's membrane, and loss of rods. Epidemiology shows maximal risk for drusen-related progression in the central subfield with only one third of this risk level in the inner ring. RMDA studies report greatest slowing at the perimeter of this high-risk area. Vision declines precipitously when the cone-rich central subfield is invaded by geographic atrophy. Lifelong sustenance of foveal cone vision within the macula lutea leads to vulnerability in late adulthood that especially impacts rods at its perimeter. Adherence to an sETDRS grid and outer retinal cell populations within it will help dissect mechanisms, prioritize research, and assist in selecting patients for emerging treatments.

Peak Cone Density Predicted from Outer Segment Length Measured on Optical Coherence Tomography

PURPOSE

To compare peak cone density predicted from outer segment length measured on optical coherence tomography with direct measures of peak cone density from adaptive optics scanning light ophthalmoscopy.

METHODS

Data from 42 healthy participants with direct peak cone density measures and optical coherence tomography line scans available were used in this study. Longitudinal reflectivity profiles were analyzed using two methods of identifying the boundaries of the ellipsoid and interdigitation zones to estimate maximum outer segment length: peak-to-peak and the slope method. These maximum outer segment length values were then used to predict peak cone density using a previously described geometrical model. A comparison between predicted and direct peak cone density measures was then performed.

RESULTS

The mean bias between observers for estimating maximum outer segment length across methods was less than 2 µm. Cone density predicted from the peak-to-peak method against direct cone density measures showed a mean bias of 6,812 cones/mm2 with 50% of participants displaying a 10% difference or less between predicted and direct cone density values. Cone density derived from the slope method showed a mean bias of -17,929 cones/mm2 relative to direct cone density measures, with only 41% of participants demonstrating less than a 10% difference between direct and predicted cone density values.

CONCLUSION

Predicted foveal cone density derived from peak-to-peak outer segment length measurements using commercial optical coherence tomography show modest agreement with direct measures of peak cone density from adaptive optics scanning light ophthalmoscopy. The methods used here are imperfect predictors of cone density, however, further exploration of this relationship could reveal a clinically relevant marker of cone structure.

Cone cell dysfunction attenuates retinal neovascularization in oxygen-induced retinopathy mouse model

Aberrant neovascularization is the most common feature in retinopathy of prematurity (ROP), which leads to the retinal detachment and visual defects in neonates with a low gestational age eventually. Understanding the regulation of inappropriate angiogenic signaling benefits individuals at-risk. Recently, neural activity originating from the specific neural activity has been considered to contribute to retinal angiogenesis. Here, we explored the impact of cone cell dysfunction on oxygen-induced retinopathy (OIR), a mouse model commonly employed to understand retinal diseases associated with abnormal blood vessel growth, using the Gnat2cpfl3 (cone photoreceptor function loss-3) strain of mice (regardless of the sex), which is known for its inherent cone cell dysfunction. We found that the retinal avascular area, hypoxic area, and neovascular area were significantly attenuated in Gnat2cpfl3 OIR mice compared to those in C57BL/6 OIR mice. Moreover, the HIF-1α/VEGF axis was also reduced in Gnat2cpfl3 OIR mice. Collectively, our results indicated that cone cell dysfunction, as observed in Gnat2cpfl3 OIR mice, leads to attenuated retinal neovascularization. This finding suggests that retinal neural activity may precede and potentially influence the onset of pathological neovascularization.

Long-Term Porcine Retina Explants as an Alternative to In Vivo Experimentation

Purpose

The porcine retina represents an optimal model system to study treatment approaches for inherited retinal dystrophies owing to close anatomical similarities to the human retina, including a cone enriched visual streak. The aim of this work was to establish a protocol to keep explants in culture for up to 28 days with good morphological preservation.

Methods

Two to four retina explants per eye were obtained from the central part of the retina and transferred onto a membrane insert with the photoreceptors facing down. Different medium compositions using Neurobasal-A medium containing 100 or 450 mg/dL glucose and combinations of fetal calf serum, B-27 with or without insulin and N-2 were tested. We developed a tissue quality score with robust markers for different retinal cell types (protein kinase C alpha, peanut agglutinin and 4',6-diamidino-2-phenylindol).

Results

Retinae were kept until 28 days with only little degradation. The best results were attained using Neurobasal-A medium containing 100 mg/dL glucose supplemented with B-27 containing insulin and N-2. For an easy preparation process, it is necessary to minimize transport time and keep the eyes on ice until dissected. Heat-mediated decontamination by the butcher has to be avoided.

Conclusions

Using a standardized protocol, porcine retina explants represent an easy to handle intermediate model between in vitro and in vivo experimentation. This model system is robustly reproducible and contributes to the implementation of the 3R principle to minimize animal experimentation.

Translational Relevance

This model can be used to test future therapeutic approaches for inherited retinal dystrophies.

In vivo cone-photoreceptor density comparison between eyes with subretinal drusenoid deposits and healthy eyes using high magnification imaging

PURPOSE

To compare photoreceptor density automated quantification in eyes with subretinal drusenoid deposits (SDD) and healthy controls using Heidelberg Spectralis High Magnification Module (HMM) imaging.

METHODS

Twelve eyes of 6 patients with intermediate AMD, presenting with SDD were included, as well as twelve eyes of healthy controls. Individual dot SDD within the central 30° retina were examined with infrared confocal laser ophthalmoscopy, HMM, and spectral-domain optical coherence tomography (SD-OCT). Photoreceptor density analysis was performed on the best-quality image using the ImageJ Foci Picker plugin, after the removal of SDD from the HMM image. Correlations were made between the HMM quantified photoreceptor density, SD-OCT characteristics, stage, and number of SDD.

RESULTS

Mean age was 75.17 ± 2.51 years in the SDD group (3 males, 3 females) versus 73.17 ± 3.15 years in the healthy control group (p = 0.2). Defects in the overlying ellipsoid zone were present on SD-OCT in 8/12 (66.66%) eyes. The mean ± standard deviation foci detected (i.e., cone photoreceptors) was 7123.75 ± 3683.32 foci/mm2 in the SDD group versus 13,253 ± 3331.00 foci/mm2 in the healthy control group (p = 0.0003). The number of SDD was associated with a reduction in foci density, p = 0.0055, r = - 0.7622.

CONCLUSION

The decreased cone density in eyes with SDD may correlate with a decrease in retinal function in intermediate AMD eyes independent of neovascular complications or outer retinal pigment epithelial atrophy.

Optimal Control with RdCVFL for Degenerating Photoreceptors

Both the rod and cone photoreceptors, along with the retinal pigment epithelium have been experimentally and mathematically shown to work interdependently to maintain vision. Further, the theoredoxin-like rod-derived cone viability factor (RdCVF) and its long form (RdCVFL) have proven to increase photoreceptor survival in experimental results. Aerobic glycolysis is the primary source of energy production for photoreceptors and RdCVF accelerates the intake of glucose into the cones. RdCVFL helps mitigate the negative effects of reactive oxidative species and has shown promise in slowing the death of cones in mouse studies. However, this potential treatment and its effects have never been studied in mathematical models. In this work, we examine an optimal control with the treatment of RdCVFL. We mathematically illustrate the potential this treatment might have for treating degenerative retinal diseases such as retinitis pigmentosa, as well as compare this to the results of an updated control model with RdCVF.

Vision: A prolonged and colorless experience

The discovery of melanopsin cells in the retina might render the standard model of human color perception incomplete. Measurements made with a technically advanced visual display address this question and point to a new role for the melanopsin system.

Determining Photoreceptor Cell Identity: Rod Versus Cone Fate Governed by tbx2b Opposing nrl

Purpose

NRL is an influential transcription factor and central to animal modeling in ophthalmology. Disrupting NRL abrogates rod development and produces an excess of S-cones (also known as "UV cones" or "short-wavelength-sensitive1 [SWS1] cones"). Strikingly, mutations in zebrafish tbx2b produce the exact opposite phenotypes (excess rods and loss of SWS1 cones). We sought to define what genetic relationship exists, if any, between these transcription factors. We also infer whether these two phenotypes (altered rod abundance and altered SWS1 cone abundance) are independent versus inter-related.

Methods

Zebrafish mutants were bred to disrupt nrl and tbx2b in concert. Rods and SWS1 cones were quantified and characterized at ultrastructural and transcriptional levels.

Results

Considering single mutant zebrafish, we confirmed previously established phenotypes and noted that the number of rods lost in nrl-/- mutants is reflected by a concomitant increase in SWS1 cone abundance. The tbx2b-/- mutants present the opposite phenotype(s) but exhibit a similar trade-off in cell abundances, with lots of rods and a concomitant decrease in SWS1 cones. Double mutant nrl-/-;tbx2b-/- zebrafish recapitulate the nrl-/- mutant phenotype(s).

Conclusions

The tbx2b is thought to be required for producing SWS1 cones in zebrafish, but this can be over-ridden when nrl is absent. Regarding the altered cell abundances observed in either tbx2b-/- or nrl-/- mutants, the alterations in rod and SWS1 cones appear to not be two separate phenotypes but are instead a single intertwined outcome. The tbx2b and nrl are in an epistatic relationship, with nrl phenotypes dominating, implying that tbx2b is upstream of nrl in photoreceptor cell fate determination.

Expression patterns of CYP26A1, FGF8, CDKN1A, and NPVF in the developing rhesus monkey retina

The fovea centralis (fovea) is a specialized region of the primate retina that plays crucial roles in high-resolution visual acuity and color perception. The fovea is characterized by a high density of cone photoreceptors and no rods, and unique anatomical properties that contribute to its remarkable visual capabilities. Early histological analyses identified some of the key events that contribute to foveal development, but the mechanisms that direct the specification of this area are not understood. Recently, the expression of the retinoic acid-metabolizing enzyme CYP26A1 has become a hallmark of some of the retinal specializations found in vertebrates, including the primate fovea and the high-acuity area in avian species. In chickens, the retinoic acid pathway regulates the expression of FGF8 to then direct the development of a rod-free area. Similarly, high levels of CYP26A1, CDKN1A, and NPVF expression have been observed in the primate macula using transcriptomic approaches. However, which retinal cells express these genes and their expression dynamics in the developing primate eye remain unknown. Here, we systematically characterize the expression patterns of CYP26A1, FGF8, CDKN1A, and NPVF during the development of the rhesus monkey retina, from early stages of development in the first trimester until the third trimester (near term). Our data suggest that some of the markers previously proposed to be fovea-specific are not enriched in the progenitors of the rhesus monkey fovea. In contrast, CYP26A1 is expressed at high levels in the progenitors of the fovea, while it localizes in a subpopulation of macular Müller glia cells later in development. Together these data provide invaluable insights into the expression dynamics of several molecules in the nonhuman primate retina and highlight the developmental advancement of the foveal region.

From water to land: Evolution of photoreceptor circuits for vision in air

When vertebrates first conquered the land, they encountered a visual world that was radically distinct from that of their aquatic ancestors. Fish exploit the strong wavelength-dependent interactions of light with water by differentially feeding the signals from up to 5 spectral photoreceptor types into distinct behavioural programmes. However, above the water the same spectral rules do not apply, and this called for an update to visual circuit strategies. Early tetrapods soon evolved the double cone, a still poorly understood pair of new photoreceptors that brought the "ancestral terrestrial" complement from 5 to 7. Subsequent nonmammalian lineages differentially adapted this highly parallelised retinal input strategy for their diverse visual ecologies. By contrast, mammals shed most ancestral photoreceptors and converged on an input strategy that is exceptionally general. In eutherian mammals including in humans, parallelisation emerges gradually as the visual signal traverses the layers of the retina and into the brain.

Adaptive optics imaging in inherited retinal diseases: A scoping review of the clinical literature

Adaptive optics (AO) imaging enables direct, objective assessments of retinal cells. Applications of AO show great promise in advancing our understanding of the etiology of inherited retinal disease (IRDs) and discovering new imaging biomarkers. This scoping review systematically identifies and summarizes clinical studies evaluating AO imaging in IRDs. Ovid MEDLINE and EMBASE were searched on February 6, 2023. Studies describing AO imaging in monogenic IRDs were included. Study screening and data extraction were performed by 2 reviewers independently. This review presents (1) a broad overview of the dominant areas of research; (2) a summary of IRD characteristics revealed by AO imaging; and (3) a discussion of methodological considerations relating to AO imaging in IRDs. From 140 studies with AO outcomes, including 2 following subretinal gene therapy treatments, 75% included fewer than 10 participants with AO imaging data. Of 100 studies that included participants' genetic diagnoses, the most common IRD genes with AO outcomes are CNGA3, CNGB3, CHM, USH2A, and ABCA4. Confocal reflectance AO scanning laser ophthalmoscopy was the most reported imaging modality, followed by flood-illuminated AO and split-detector AO. The most common outcome was cone density, reported quantitatively in 56% of studies. Future research areas include guidelines to reduce variability in the reporting of AO methodology and a focus on functional AO techniques to guide the development of therapeutic interventions.

Melatonin suppression by light involves different retinal photoreceptors in young and older adults

Age-related sleep and circadian rhythm disturbances may be due to altered nonvisual photoreception. Here, we investigated the temporal dynamics of light-induced melatonin suppression in young and older individuals. In a within-subject design study, young and older participants were exposed for 60 min (0030-0130 at night) to nine narrow-band lights (range: 420-620 nm). Plasma melatonin suppression was calculated at 15, 30, 45, and 60 min time intervals. Individual spectral sensitivity of melatonin suppression and photoreceptor contribution were predicted for each interval and age group. In young participants, melanopsin solely drove melatonin suppression at all time intervals, with a peak sensitivity at 485.3 nm established only after 15 min of light exposure. Conversely, in older participants, spectral light-driven melatonin suppression was best explained by a more complex model combining melanopsin, S-cone, and M-cone functions, with a stable peak (~500 nm) at 30, 45, and 60 min of light exposure. Aging is associated with a distinct photoreceptor contribution to melatonin suppression by light. While in young adults melanopsin-only photoreception is a reliable predictor of melatonin suppression, in older individuals this process is jointly driven by melanopsin, S-cone, and M-cone functions. These findings offer new prospects for customizing light therapy for older individuals.

Novel pathogenic variants in Tubulin Tyrosine Like 5 (TTLL5) associated with cone-dominant retinal dystrophies and an abnormal optical coherence tomography phenotype

Purpose

Autosomal recessive cone and cone-rod dystrophies (CD/CRD) are inherited forms of vison loss. Here, we report on and correlate the clinical phenotypes with the underlying genetic mutations.

Methods

Clinical information was collected from subjects, including a family history with a chart review. They underwent a full ophthalmic examination, including best-corrected visual acuity, direct and indirect ophthalmoscopy, color vision testing, color fundus photography, contrast sensitivity, autofluorescence, and spectral domain-optical coherence tomography (SD-OCT), and full-field electroretinography. Next-generation panel-based genetic testing was used to identify DNA variants in subject buccal swab samples.

Results

Genetic testing in two patients revealed three novel variants in the TTLL5 gene associated with CD/CRD: two missense variants (c.1433G>A;p.(Arg478Gln), c.241C>G;p.(Leu81Val), and one loss-of-function variant (c.2384_2387del;p.(Ala795Valfs*9). Based on in-silico analysis, structural modeling, and comparison to previously reported mutations, these novel variants are very likely to be disease-causing mutations. Combining retinal imaging with SD-OCT analysis, we observed an unusual sheen in the CD/CRD phenotypes.

Conclusion

Based on the protein domain location of novel TTLL5 variants and the localization of TTLL5 to the connecting cilium, we conclude that the CD/CRD disease phenotype is characterized as a ciliopathy caused by protein tracking dysfunction. This initially affects cone photoreceptors, where photoreceptor cilia express a high level of TTLL5, but extends to rod photoreceptors over time. Fundus photography correlated with SD-OCT imaging suggests that the macular sheen characteristically seen with TTLL5 mutations derives from the photoreceptor's outer segments at the posterior pole.

Late gene therapy limits the restoration of retinal function in a mouse model of retinitis pigmentosa

Retinitis pigmentosa is an inherited photoreceptor degeneration that begins with rod loss followed by cone loss. This cell loss greatly diminishes vision, with most patients becoming legally blind. Gene therapies are being developed, but it is unknown how retinal function depends on the time of intervention. To uncover this dependence, we utilize a mouse model of retinitis pigmentosa capable of artificial genetic rescue. This model enables a benchmark of best-case gene therapy by removing variables that complicate answering this question. Complete genetic rescue was performed at 25%, 50%, and 70% rod loss (early, mid and late, respectively). Early and mid treatment restore retinal output to near wild-type levels. Late treatment retinas exhibit continued, albeit slowed, loss of sensitivity and signal fidelity among retinal ganglion cells, as well as persistent gliosis. We conclude that gene replacement therapies delivered after 50% rod loss are unlikely to restore visual function to normal. This is critical information for administering gene therapies to rescue vision.

Poster Session I: Vernier thresholds of a Poisson-noise-limited computational observer with and without fixational eye movements

Vernier acuity is a fundamental measure of spatial vision. We modeled how stimulus encoding by the cones limits Vernier acuity. We determined Vernier thresholds for a computational observer that had access to the Poisson-distributed cone photopigment excitations. The observer also had access to the cone mosaic layout and the stimulus possibilities on each trial. We varied stimulus contrast (100%, 50%, 22%, 11% Michelson contrast) and duration (2, 4, 9, 18 stimulus frames; frame duration 8.33 ms) while fixing other stimulus properties (foveal viewing; two achromatic vertical bars; length 6.2 arcmin; width 1 arcmin; vertical gap 0.1 arcmin). When the retinal image is stationary, Vernier thresholds depend jointly on contrast and duration through contrast energy: squared contrast times duration. Introducing fixational drift eye movements impairs performance, when the information about eye path is not accounted for by the computational observer. When the path of fixational drift is made available and used ideally, there is no noticeable difference with the stationary case. The lack of improvement when the path of fixational drift is known exactly may reflect the high-density of foveal cones relative to the optical point spread function and the fact that we did not introduce temporal filtering by the visual system. Our results suggest the possibility of a rich interaction between optics, cone sampling, fixational eye movements, post-receptoral filtering and visual performance.

Poster Session II: XR-based personalized active aid for color deficient observers

In a previous study, Xu et al. (Optics Express, 2022) investigated the efficacy of active aid in the form of personalized image enhancement to increase color discrimination ability in color-deficient observers (CDO). The study parameterized severity of color deficiency, the wavelength shift of cone spectral fundamentals, and the spectral distribution of display primaries. The first parameter was derived by computing the confusion index of the CDO, employing a modified version of the FM-100 test (ZJU50Hue). The second parameter was determined via evaluation of a wavelength-shifted ZJU50Hue test on color-normal observers (CNO). The three parameters were used to model the gamut mapping between CNO and CDO. In this study, extended reality (XR) based modules were developed to acquire these parameters and consequently tailor the headset display to assist CDOs. We chose to implement the Cambridge color test over the ZJU50Hue test as threshold results along the protan, deutan, and tritan lines are more informative than a single confusion index. Preliminary results on a calibrated Varjo XR-3 headset suggest a high correlation between the standard CCT and our XR-based trivector test. As the calibration, simulation and modeling processes all take place in the same HMD, we intend to model the CNO-CDO gamut mapping into a post-process graphics shader to enhance the camera input of the XR-3 and perform a paper-based Ishihara test for evaluation of real-world color discrimination efficacy.

Poster Session II: Cone spacing and S-cone proportion is sufficient to describe varying S-cone regularity across the human central retina

The topography of S-cones in the human retina is vital to understand short-wavelength sampling of visual space. In humans S-cones have been reported as randomly arranged within 2° eccentricity and semi-regular more peripherally. A model describing how S-cone regularity varies across the retina is yet to be formulated. Here we describe such a model, dependent on 2 parameters - the average distance between neighboring cones and the proportion of S-cones - that is sufficient to explain S-cone regularity across the central retina. Cones were classified using AO-OCT optoretinography in ROIs distributed across the 4 cardinal meridians in 2 subjects (12 ROIs each) between 1.3 - 12.9°eccentricity. The radius of the S-exclusion zone, the area surrounding S-cones where other S-cones are significantly unlikely to appear, was found to be about twice the average distance between neighboring cones in 19/24 mosaics. We found that the measured regularity of S-cone mosaics increases linearly with the increasing proportion of S cones with eccentricity. Using the average distance between neighboring cones and proportion of S-cones per ROI as variables, we created a model to simulate S-cone mosaics that agree well with the observed topography. These results benefit our understanding of the foundational patterns underpinning spectral topography, and the ability to accurately simulate S-cone topography in computational models of early vision.

Cone Density Is Correlated to Outer Segment Length and Retinal Thickness in the Human Foveola

Purpose

Assessment of the relationship between in vivo foveolar cone density, cone outer segment length (OSL), and foveal retinal thickness (RT).

Methods

Foveolar cone density maps covering the central ±300 µm of the retina were derived from adaptive optics scanning laser ophthalmoscopy images. The corresponding maps of foveal cone OSL and RT were derived from high-resolution optical coherence tomography volume scans. Alignment of the two-dimensional maps containing OSL and RT with the cone density map was achieved by placing the location of maximum OSL on the cone density centroid (CDC).

Results

Across 10 participants (27 ± 9 years; 6 female), cone density at the CDC was found to be between 147,038 and 215,681 cones/mm². The maximum OSL and minimum RT were found to lie between 31 and 40, and 193 and 226 µm, respectively. A significant correlation was observed between cone density at the CDC and maximum OSL (P = 0.001), as well as the minimal RT (P < 0.05). Across all participants, the best fit for the relationship between normalized cone density and normalized OSL within the central 300 µm was given by a quadratic function.

Conclusions

Using optical coherence tomography-derived measurements of OSL enables to estimate CDC cone density and two-dimensional foveal cone density maps for example in patient eyes unsuitable for adaptive optics imaging. Furthermore, the observation of a fixed relationship between the normalized OSL and cone density points to a conserved mechanism shaping the foveal pit.

Poster Session II: SSVEP measurements of color and spatial frequency response in V1

INTRO

Recent work from our group (Segala et al, eLife, 2023) shows that the rules for binocular luminance signal combination depend on spatial frequency (SF). Structured patterns show strong interocular suppression while unstructured inputs (mean field disks) do not. Here, we used SSVEPs to ask if SF dependence is also found in chromatic pathways.

METHODS

SSVEPs were recorded from 12 subjects using a canonical V1 template (Poncet & Ales, 2023). Eyes were targeted using shutter goggles and stimuli were contrast-reversing gratings or disks at 5Hz (left eye) and 7Hz (right eye). Experimental factors were stimulus SF (disk, grating 1cpd), chromaticity (LMS, L-M or S-cone isolating) and ocularity (left, right or both).

RESULTS

Monocular conditions generated large responses at 2F. In binocular conditions, all 2F responses showed suppression, and significant intermodulation (IM) terms (sums and differences of the inputs - e.g., 2Hz) were present. The magnitude of both suppression and IM in the binocular condition depended on SF and chromaticity; IM amplitudes were higher for gratings compared to disks in the luminance condition, but higher for disks compared to gratings in the chromatic conditions. Overall we found significant differences in the spectral response signatures across all stimulus combinations.

CONCLUSION

All inputs undergo binocular combination in V1 but the rules governing the combination appear to depend on both chromaticity and SF.

Poster Session II: Intravitreal gene therapy in primate reaches extrafoveal cones

Intravitreal delivery of gene therapy vectors to the retina carries lower risk of adverse events versus subretinal injections, but efficiently targeting cones is a challenge. We used a new adeno-associated vector (AAV) to deliver genes to primate cone photoreceptors. The vector carries a cassette directing expression of an engineered 493 nm opsin to long- and middle-wavelength (L/M) cones, and was injected into the vitreous of the left eye of an adult macaque. An identical AAV carrying a fusion of the engineered opsin to green fluorescent protein (GFP) was injected into the right eye. Electroretinograms were performed on the left eye before and after injection to measure isolated 493 nm light responses; 5 weeks post-injection, response increased modestly. A central strip of the right eye was prepared for histology with cryosections; we found ~30% of cones in the fovea had been transduced, with a preference toward L/M cones (see https://iovs.arvojournals.org/article.aspx?articleid=2782955). Upon close examination of GFP in the peripheral retina, we were surprised to find extensive expression in cones across the retina. Here, we report patches of expression from the perifovea to the retinal margin which reaches ~10% of cones. Expression patches appeared stochastically, or in regions containing blood vessels or disrupted Muller cells. This demonstrates that extrafoveal expression is attainable using intravitreal injection of gene therapy vectors in an adult primate.

Contributed Session III: AAV-mediated gene therapy for PDE6C achromatopsia: Progress and challenges

PURPOSE

To determine the clinical circumstances under which viral mediated gene therapy can rescue cone function in a nonhuman primate model of PDE6C achromatopsia.

METHODS

Infant rhesus macaques homozygous for the PDE6C R565Q mutation were generated through a breeding program at the California National Primate Research Center. Homozygotes were treated in the right eye with adeno-associated virus (AAV5) carrying rhesus PDE6C under the control of the PR1.7 cone-specific promoter. The left eye was used as a control. Animals were tested by full-field and multifocal electroretinography. A total of 7 animals have been treated.

RESULTS

The virus was found to be safe, but with variable inflammatory response. There were no obvious alterations in retinal lamination in treated eyes. The virus was expressed specifically in cone photoreceptors. Pre- and post-treatment systemic steroids led to minimal to moderate inflammatory response. In general, the gene therapy partially restored the cone responses on ERG within one month of injection in infants, but not in the older animals. If restored, the rescued cone responses were sustained and durable for over a year. Chromatic ERG testing showed restoration of amplitudes in all three cone subtypes.

CONCLUSIONS

AAV-mediated gene therapy partially restored cone function and was relatively durable. Inflammation and age of administration may be important to outcomes. Similar approaches in human patients may warrant investigation.

Poster Session II: Non-degenerating double cone opsin knockout mouse model of blue cone monochromacy

Ma et al. (2022) performed opsin gene therapy in a mouse model of blue cone monochromacy (BCM). Treatment was only effective for young animals because the retina degenerated, with a significant reduction in the number viable cones by 3 months. Their mouse was created by mating an Opn1mw knockout with a gene trap inserted in intron 2 of the Opn1mw gene, to an Opn1sw knockout with the neomycin resistance gene inserted in intron 3 of the Opn1sw gene. The Opn1mw knockout was reported as having "greatly reduced" M opsin expression, while the Opn1sw knockout was a severely hypomorphic allele. Their double opsin gene knockout (DKO) mouse is not a good model of BCM, which is typically a stationary disorder with no cone degeneration. We evaluated Opn1mw Opn1sw DKO mice for cone degeneration; these mice were created by Regeneron by deleting both genes using genome editing. Eyes of 1 year old DKO animals were processed for cryosections. Sections were immunostained using antibodies against a variety of cone proteins (S and M opsins, arrestin) and markers for retinal degeneration, then confocal imaged. Despite the absence of both cone opsins, cones remain viable and morphologically normal, and the retina shows no signs of degeneration at 1 year. This DKO mouse model will be a valuable tool for developing gene therapies targeting cone opsins, and also for understanding color vision circuitry in the retina.

Contributed Session II: High-resolution assessment of saccadic landing positions for S-cone-isolating targets

The role of S-cone signals in guiding visuomotor behavior is not fully understood. Previously, we used high-resolution retinal tracking during a visual search-and-identification task to show that the preferred retinal locus (PRL) of fixation for S-cone-isolated targets was larger than and offset from the PRL measured with L/M-isolating optotypes (Wang et al, ARVO 2023). Here, we present an analysis of saccadic landing behavior under these conditions. We used an adaptive optics ophthalmoscope to record retinal videos while subjects (N = 6) made small saccades to a tumbling-E stimulus that appeared at random loci within a 3x3 square grid with 0.5° spacing. Subjects reported stimulus orientation via keypress, after which the target moved to a new location. Retinal videos recorded during each experiment were used to extract eye position traces and localize stimuli in retinal coordinates. Saccade PRLs were computed from the post-saccadic retinal landing positions using the ISOA method. The mean (± SEM) saccade PRL areas were 122 ± 8.1 arcmin2 and 525 ± 133 arcmin2 for the L/M- and S-cone conditions, respectively (p<0.01; Wilcoxon rank-sum test). For both conditions, the post-saccadic ISOA size reduced over the course of ~300 ms. The average displacement between the L/M- and S-cone saccade PRL was 7.72 ± 1.24 arcmin, similar to that reported previously for fixation, suggesting the retinal locus directed to a target of interest depends on the visual pathway mediating its detection.

Contributed Session III: The limits of resolution in the S-cone pathway

The resolution of the S-cone pathway is first constrained by the density and arrangement of S-cones in the photoreceptor mosaic. Prior work comparing S-cone isolating visual acuity (sVA) to histological estimates of S-cone density has led to mixed conclusions, likely due to inter-individual differences in the S-cone sub-mosaic. We examined sVA in subjects with spectrally classified cone mosaics to test how the grain of the S-cone sub-mosaic limits resolution. Three observers whose cones were previously classified via adaptive optics (AO)-OCT based optoretinography participated in an sVA task at eccentricities ranging from 1.3° to 12.9° spread along all four cardinal meridians. Observers adapted to yellow light [CIE (0.45, 0.51); 200 cd/m2] for two minutes.Then, acuity was measured using a Tumbling 'E' task that showed blue [CIE (0.16, 0.044); 0.66 cd/m2) letters on the same yellow background, with an S-cone contrast of 0.93 (L/M-cone contrasts <0.01). Simultaneously recorded high-resolution AOSLO videos helped guide stimulus delivery to the spectrally classified retinal area. Measured sVAs were worse than predicted by the calculated S-cone Nyquist limit at all eccentricities, suggesting pooling of information from S-cones. Moreover, this pooling increased with eccentricity. While sVA does not follow the S-cone Nyquist limit, it is in good concordance with the Nyquist limit corresponding to known estimates of the sampling density of small bistratified retinal ganglion cells.

Contributed Session II: The relationship between temporal summation at detection threshold and fixational eye movements

We studied the relationship between the threshold temporal summation of increment pulses and fixational eye-movements. Six participants completed a 2AFC increment detection task. Stimuli were 0.16 x 2.2 arcmin increments of 543 nm light presented via an AOSLO with a 60 Hz frame rate. Stimuli for temporal integration were two single frame presentations with a 16 ms (consecutive frames), 33 ms, 100 ms, or 300 ms inter-stimulus interval (ISI). Data were also collected for increments presented on a single frame. Stimuli were presented in either world-fixed coordinates (natural retinal image motion) or were stabilised on the retina. There were large differences in overall sensitivity across individuals, but the time-course of performance change with ISI was similar across participants. Thresholds for ISI=33 ms were close to performance with two consecutive frames, suggesting complete summation of light energy; whereas thresholds for ISI=300 ms were closer to the single-frame case, suggesting limited summation; and thresholds for ISI=100 ms were intermediate, suggesting residual summation. The effect of ISI on threshold was similar for stabilised stimuli and natural viewing, but there was a small trend towards lower thresholds for stabilised stimuli at short ISI and vice-versa at long ISI. We plan to present our results in the context of an ideal observer calculation that may clarify how the initial visual encoding, including temporal summation within cones, shapes performance.

Establishing Fully-Automated Fundus-Controlled Dark Adaptometry: A Validation and Retest-Reliability Study

Purpose

The purpose of this study was to establish and validate a novel fundus-controlled dark-adaptometry method.

Methods

We developed a custom dark-adaptometry software for the S-MAIA device using the open-perimetry-interface. In the validation-substudy, participants underwent dark-adaptometry testing with a comparator device (MonCvONE, 59% rhodopsin bleach, cyan and red stimuli centered at 2 degrees, 4 degrees, and 6 degrees eccentricity). Following a brief break (approximately 5 minutes), the participants were bleached again and underwent dark-adaptometry testing with the S-MAIA device (same loci). In the retest reliability-substudy, participants were tested twice with the S-MAIA device (same loci as above). Nonlinear curve fitting was applied to extract dark-adaptation curve parameters. Validity and repeatability were summarized in terms of the mean bias and 95% limits of agreement (LoAs).

Results

In the validation-substudy (N = 20 participants, median age interquartile range [IQR] 31.5 years [IQR = 25.8, 62.0]), measures of rod-mediated dark-adaptation showed little to no between method differences for the cone-rod-break-time (bias 95% confidence interval [95% CI] of +0.1 minutes [95% CI = -0.6 to 0.8]), rod-intercept-time (-0.23 minutes [95% CI = -1.38 to 0.93]), and S2 slope (-0.01 LogUnits/minutes [95% CI = -0.02 to -0.01]). In the retest reliability-substudy (N = 10 participants, 32.0 years [95% CI = 27.0, 57.5]), the corresponding LoAs were (cone-rod-break-time) -3.94 to 2.78 minutes, (rod-intercept-time) -4.55 to 3.11 minutes, and (S2 slope [rate-limited component of rod recovery]) -0.03 to 0.03 LogUnits/minutes. The LoAs for the steady-state cone and rod thresholds were -0.28 to 0.33 LogUnits and -0.34 to 0.28 LogUnits.

Conclusions

The devised fundus-controlled dark-adaptometry method yields valid and reliable results.

Translational Relevance

Fundus-controlled dark-adaptometry solves the critical need for localized testing of the visual cycle and retinoid transfer in eyes with unstable fixation.

Pediatric presentation of enhanced S-cone syndrome associated with two heterozygous NR2E3 mutations

We report the case of an otherwise healthy 10-year-old girl referred to our institution for gradually decreasing vision and nyctalopia. Based on clinical examination, she was diagnosed with inherited retinal dystrophy, presumably due to enhanced S-cone syndrome (ESCS). Subsequent genetic testing confirmed a rare combination of NR2E3 heterozygous mutations: c.119-2A>C and c.932G>A p.(Arg311Gln).

MNREAD Reading Vision in Adults With Glaucoma Under Mesopic and Photopic Conditions

Purpose

Despite good photopic visual acuity, glaucoma patients report difficulty performing daily activities under dim light such as reading. Here we investigated the impact of mesopic lighting conditions on reading vision of glaucoma patients.

Methods

The study design included 39 patients with glaucoma and 40 healthy controls. Reading vision was assessed with MNREAD charts under mesopic (2 cd/m2) and photopic (220 cd/m2) conditions. Four reading indexes: maximum reading speed (MRS), critical print size (CPS), reading acuity (RA), and reading accessibility index (ACC) were obtained from the MNREAD test yielding a plot of reading speed versus print size.

Results

Compared to photopic conditions, reading vision of both healthy controls and glaucoma patients significantly decreased under mesopic conditions (P < 0.05). For glaucoma patients (85% with mild or moderate glaucoma), MRS and ACC decreased by six words per minute and 0.1, respectively under mesopic conditions; CPS and RA increased by 0.25 and 0.18 logMAR, respectively. Moreover, under both photopic and mesopic conditions, reading vision of glaucoma patients was significantly worse than that of healthy controls, but the difference was greater under mesopic conditions (P < 0.05) even after controlling for age and visual acuity.

Conclusions

Mesopic conditions make reading more challenging for both healthy controls and glaucoma patients. However, reading in dim light appears to be more burdensome for glaucoma patients. Mesopic reading tests mediated by both cone and rod photoreceptor systems likely provide a more sensitive and comprehensive assessment of a patient's reading impairment than testing under photopic conditions.

Contributed Session II: Computational modeling of shift in unique yellow for small stimuli

Unique yellow (UY) is largely invariant to L:M cone proportion for spatially-extended stimuli in healthy trichromats. However, a recent adaptive-optics-based study by Boehm et al. reveals that when stimulus size is reduced to a few arcmin, color appearance depends on the local L:M proportion in the patch of the retina on which the stimulus was imaged. We aimed to determine if such findings are consistent with a normative account of visual processing. A series of 3.5 and 10 arcmin stimuli were simulated as isoluminant mixtures of 540 and 680 nm primaries. We modeled sensory encoding under adaptive-optics conditions using the open-source software ISETBio, for simulated retinal cone mosaics with varying local L:M proportions. The resultant cone excitations were decoded using a Bayesian image reconstruction algorithm (Zhang et al., 2022). For the 3.5 arcmin stimuli, as local L:M proportion decreased, the 540 nm component of the reconstructions increased relative to the 680 nm component. This is qualitatively consistent with the experimental observations of Boehm et al. For 10 arcmin stimuli, in contrast, reconstructions were stable across variation in local L:M cone proportion. Notably, reconstructions depend not only on the local L:M cone proportion, but also on the proportion in the immediately surrounding retina, leading to a testable prediction. The computational observations frame the experimental results as a normative consequence of visual processing.

Poster Session II: Investigating photoreceptor function in disease-affected retinas using optoretinography

Assessing the functional response of photoreceptors is vital in understanding retinal disease progression. Traditional subjective methods like visual acuity and visual fields, and objective ones like electroretinography, have limitations. An ideal complement to these techniques is optoretinography (ORG), which images the retina and tests its function at once. ORG utilizes the phase of the optical coherence tomography (OCT) signal to quantify nanometer-scale changes, measuring subtle photoreceptor responses to stimuli. Efforts to observe stimulus-evoked responses in human cone photoreceptors began with adaptive optics (AO) and common path interferometry, enabling the resolution and tracking of individual cells. Advances in OCT systems with cellular resolution through AO or digital aberration correction successfully measured ORG responses from single cones and rods. This method tracks phase differences between outer segment tips (COST or ROST) and the inner-outer segment junction (IS/OS) to assess individual cell responses. A novel velocity-based method recently demonstrated the feasibility of measuring ORG signals with clinical-grade OCT systems. In the present work, we implemented this technique on disease-affected human retinas, revealing lower magnitudes of response compared to healthy retinas, and highlighting its potential clinical applications.

Misidentifying illuminant changes in natural scenes due to failures in relational colour constancy

The colours of surfaces in a scene may not appear constant with a change in the colour of the illumination. Yet even when colour constancy fails, human observers can usually discriminate changes in lighting from changes in surface reflecting properties. This operational ability has been attributed to the constancy of perceived colour relations between surfaces under illuminant changes, in turn based on approximately invariant spatial ratios of cone photoreceptor excitations. Natural deviations in these ratios may, however, lead to illuminant changes being misidentified. The aim of this work was to test whether such misidentifications occur with natural scenes and whether they are due to failures in relational colour constancy. Pairs of scene images from hyperspectral data were presented side-by-side on a computer-controlled display. On one side, the scene underwent illuminant changes and on the other side, it underwent the same changes but with images corrected for any residual deviations in spatial ratios. Observers systematically misidentified the corrected images as being due to illuminant changes. The frequency of errors increased with the size of the deviations, which were closely correlated with the estimated failures in relational colour constancy.

Layers of inhibitory networks shape receptive field properties of AII amacrine cells

In the retina, rod and cone pathways mediate visual signals over a billion-fold range in luminance. AII ("A-two") amacrine cells (ACs) receive signals from both pathways via different bipolar cells, enabling AIIs to operate at night and during the day. Previous work has examined luminance-dependent changes in AII gap junction connectivity, but less is known about how surrounding circuitry shapes AII receptive fields across light levels. Here, we report that moderate contrast stimuli elicit surround inhibition in AIIs under all but the dimmest visual conditions, due to actions of horizontal cells and at least two ACs that inhibit presynaptic bipolar cells. Under photopic (daylight) conditions, surround inhibition transforms AII response kinetics, which are inherited by downstream ganglion cells. Ablating neuronal nitric oxide synthase type-1 (nNOS-1) ACs removes AII surround inhibition under mesopic (dusk/dawn), but not photopic, conditions. Our findings demonstrate how multiple layers of neural circuitry interact to encode signals across a wide physiological range.

Electroretinographic findings in retinal vasculitis

AIM

To describe and correlate electroretinographic responses with clinical and angiographic findings in retinal vasculitis (RV).

METHODS

Medical records of patients with diagnosis of RV at a tertiary eye centre from December 2017 to May 2021 were reviewed. Cases in which fluorescein angiography (FFA) and full field electroretinography (ffERG) were done within 1 month were included. FFAs were graded according to the Angiography Scoring for Uveitis Working Group from 0 to 40, where 0 is normal. A novel ffERG grading system was implemented where individual waves were graded for timing and amplitude and general ffERG score was determined with 6 being a perfect score.

RESULTS

20 patients (34 eyes) were included. Mean age was 43.9±19.8 years; 70% were female. Median best-corrected visual acuity was 0.8 (0.08-1). Mean FFA score was 12.6±6.5. Median general ffERG score was 5 (0-6). 68% and 91% of eyes had responses with general ffERG scores ≥5 and 4, respectively. Flicker timing was most commonly affected.FFA scores weakly correlated with delayed photopic cone b-wave and flicker timing (p=0.03 and 0.016, respectively). Vitreous haze moderately correlated with delayed cone b-wave timing (p<0.001), delayed flicker timing (p=0.002) and weakly correlated with lower flicker amplitude (p=0.03). Underlying systemic disease was associated with poor ffERG responses.

CONCLUSION

In this study, RV was not frequently associated with severe global retinal dysfunction Higher FFA scores, and vitreous haze grading were weakly, but significantly, correlated with cone-generated ffERG responses.

Foveal cone loss in tamoxifen maculopathy: a case report

BACKGROUND

Tamoxifen is used in low dose concentrations (20-40 mg per day) as a therapy for breast cancer but is known to have ocular side effects. In this case report, the foveal cone integrity in a tamoxifen-treated patient who complained of a small central scotoma in the left eye while reading was examined using high resolution adaptive optics imaging.

CASE PRESENTATION

Both eyes of a 54-year-old Caucasian, non-hispanic female who had been treated with tamoxifen for 1.5 years were examined using various imaging modalities including fundus photography, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography, and adaptive optics scanning laser ophthalmoscopy. Clinical spectral-domain optical coherence tomography showed a very small disruption to the photoreceptor layer at the fovea in the left eye only. However, adaptive optics scanning laser ophthalmoscopy imaging revealed foveal cone loss in both eyes, but to a lesser extent in the right eye. Inner retinal changes were not observed in either eye.

CONCLUSION

The area of cone loss was similar in size to a single newsprint letter when projected onto the retina, matching the patient's description of a scotoma in the left eye. Given the isolated loss of foveal cone photoreceptors with the absence of previously reported inner retinal and vascular changes, our results may indicate the earliest retinal changes associated with tamoxifen retinopathy.

Clinical Characteristics and Genetic Variants in Taiwanese Patients With PROM1-Related Inherited Retinal Disorders

Purpose

This study investigated the clinical characteristics of patients with PROM1-related inherited retinal diseases (IRDs).

Methods

Patients diagnosed with IRDs who had mutations in PROM1 were identified at Linkou Chang Gung Memorial Hospital and Kaohsiung Medical University Hospital in Taiwan. Information on clinical characteristics and best-corrected visual acuity was recorded. Color fundus (CF) images, fundus autofluorescence photography (FAF), spectral-domain optical coherence tomography (SD-OCT), and electroretinograms (ERGs) were analyzed to examine patient phenotypes. PROM1 variants were detected using whole exome sequencing and verified by Sanger sequencing.

Results

Fourteen patients from nine families with PROM1-related IRDs were analyzed. Most patients exhibited chorioretinal atrophy in the macular area, with or without extramacular involvement on CF. Similarly, hypo-autofluorescence confined to the macular area, with or without extramacular involvement, was present for most patients on FAF. Furthermore, SD-OCT revealed outer retinal tubulations and focal or diffuse retinal thinning. ERGs showed variable findings, including maculopathy with normal ERG, subnormal cone response, and extinguished rod and cone responses. We detected five variants of the PROM1 gene, including c.139del, c.794del, c.1238T>A, c.2110C>T, and c.1117C>T.

Conclusions

In this study, we evaluated 14 Taiwanese patients with five PROM1 variants. Additionally, incomplete penetrance of heterozygous PROM1 variants was observed. Furthermore, patients with autosomal dominant PROM1 variants had lesions in the macular area and the peripheral region of the retina. SD-OCT serves as a useful tool for early detection of PROM1-related IRDs, as it captures certain signs of such diseases.