Focal cone electroretinograms: aging and macular disease

Focal cone electroretinograms were obtained with a 3-degree flickering stimulus from 100 normal eyes and 134 eyes with known macular disease. Responses were obtained during direct visualization of the fundus with a hand-held stimulator-ophthalmoscope. Mean foveal cone amplitude for 100 normal eyes was 0.31 microV, with 95% of all amplitudes greater than 0.18 microV. There was a significant inverse correlation between amplitude and age for responses obtained from the fovea (r = -0.91; p less than 0.001) but not for responses obtained from the parafovea (midway between fovea and disk, r = -0.53; not significant). In eyes with known maculopathy, mean foveal cone amplitude was correlated with Snellen acuity. Even after correcting for normal decreases in amplitude with age, responses were significantly reduced in 88/94 (94%) of all eyes with 20/40 or poorer acuity, suggesting that the focal electroretinogram is a sensitive test for detecting macular disease.

Detection of the carrier state of X-linked retinoschisis

We determined the extent of suppressive rod-cone interaction in 11 obligate carriers and eight potential carriers of X-linked retinoschisis from eight families. Despite otherwise normal ophthalmoscopic and functional testing, all of the obligate heterozygous carriers demonstrated a complete absence of normal rod-cone interaction. Of the potential heterozygous carriers, three had normal rod-cone interactions, two had no detectable interaction, and two yielded technically unsatisfactory results. This lack of rod-cone interactions allows heterozygous individuals to be identified clinically and has implications concerning the origin of this inherited disorder.

Rod and cone psychophysics and electroretinography: methods for comparison in retinal degenerations

Methods have been developed to compare full field rod and cone electroretinograms with results of rod and cone static perimetric measurements across the visual field. In a limited number of patients with retinal degeneration, including two subtypes of retinitis pigmentosa, there were close relationships between electroretinographic and psychophysical parameters. Maximum b-wave amplitude and visual field area were highly correlated, as were electroretinographic and perimetric measures of sensitivity loss. Future application of the methods to large numbers of patients with typical retinitis pigmentosa may help elucidate different mechanisms of retinal degeneration.

The directional sensitivity of the photoreceptors in the human achromat

1. The anatomical nature of the retinal photoreceptors in a typical, complete achromat was investigated by measuring their directional sensitivity. 2. A small (0.5 deg), brief (94 ms) test flash was placed at threshold by varying either its intensity (indirect method) or the intensity of a large (5 deg) adapting field (direct method). The dependent variable was the intensity of light required for the detection threshold as a function of the position of entry in the pupil. An infra-red viewing system was used to monitor the achromat's pupil and eye position. 3. At both scotopic and mesopic adapting field luminances, the complete achromat's receptors displayed only a small directional sensitivity effect. The effect was not wavelength dependent and could be attributed solely to the rods. 4. The results are consistent with other psychophysical evidence indicating that the complete achromat's retinae lack the post-receptoral function of the cone photoreceptors. Therefore they do not confirm previous reports that complete achromats have a second, high-intensity type of photoreceptor.

Rod and cone dysfunction in carriers of X-linked retinitis pigmentosa

Carriers of X-linked retinitis pigmentosa were studied using electroretinographic and psychophysical procedures. Under both dark- and light-adapted (cone-isolated) conditions, electroretinogram (ERG) a-waves of carriers were reduced in amplitude but normal in implicit time, whereas b-waves were reduced in amplitude and delayed in implicit time. Reductions in b-wave amplitudes of the carriers as a group were equivalent for the rod and cone systems. Luminance-response functions for both dark-adapted and cone-isolated b-waves were fit by the Naka-Rushton equation and demonstrated a selective reduction of Rmax; the semi-saturation constant (K) and the slope parameter (n) were normal. Electroretinograms recorded using the brightest stimulus flashes were most effective at distinguishing carriers from normals. Absolute thresholds of the carriers were elevated significantly across the central 40 degrees of the visual field. As a group, the threshold elevations of the carriers were approximately equal for the rod and cone systems.

Rod ERG diurnal rhythm in some patients with dominant retinitis pigmentosa

Five patients with dominant retinitis pigmentosa who were monocularly entrained to a 14 hr light: 10 hr dark cycle showed an abnormal diurnal rhythm in the rod electroretinogram of the entrained eye. These patients as a group showed larger-than-normal reductions in b-wave sensitivity 1.5 hr and 8 hr after light onset relative to other times of day. The findings raise the possibility that these patients have an abnormality in rod photoreceptor function associated with the process of outer segment renewal.

The relation of rhodopsin and scotopic retinal sensitivity in sector retinitis pigmentosa

We used reflection retinal densitometric, psychophysical, and electroretinographic techniques to study the scotopic retinal function of a mother and her three daughters who had clinical evidence of a sectoral type of retinitis pigmentosa. Retinal regions with, and those without, ophthalmoscopic signs of degeneration were investigated. During dark adaptation, the time courses of rhodopsin regeneration and recovery of scotopic sensitivity were similar to normal as was the relation of rhodopsin to scotopic threshold. In dark-adapted eyes, threshold increases were not proportional to rhodopsin loss. The results of psychophysical tests of background adaptation and temporal summation, and analysis of the relation of electroretinographic a- to b-wave amplitudes, led to the conclusion that abnormalities of photoreceptor cell function central to the rhodopsin-bearing outer segments accounted for the increased thresholds.

Galactosylceramide-beta-galactosidase deficiency in association with cherry red spot

A 13-month-old white girl was the product of a normal pregnancy and delivered by caesarean section for breech presentation. Regression of motor milestones started by 11 months, when delayed language development was also noted. She was normocephalic without major dysmorphic features or organomegaly. Fundus examination disclosed a subtle cherry red spot bilaterally. No startle response was elicited. By 17 months she was extremely irritable and unable to tolerate liquids; there was symmetrical spasticity and florid cherry red spots. She died at 18 months of age. A systematic search for conditions associated with a cherry red spot was unrevealing. The absence of galactosylceramide galactosidase activity was unexpected and was confirmed on three occasions in two laboratories. Lactosylceramide I content, an enzyme thought to be identical to galactosylceramide-beta-galactosidase, was significantly decreased. The presence of a cherry red spot in Krabbe's disease, indicative of neuronal storage, has not been previously recognized. The existence of this variant has implications for genetic and biochemical studies.

Visual function and rhodopsin levels in humans with vitamin A deficiency

Details of rod and cone dysfunction in vitamin A deficiency have been studied in two subjects with primary biliary cirrhosis and one with Crohn's disease, all of whom presented with symptoms of night blindness. Visual function in the mid-peripheral retina was monitored with two-color adaptometry and rhodopsin levels were measured by fundus reflectometry. Initially all three subjects had no measurable rod function and delayed cone adaptation. In one case the dark-adapted cone threshold was also elevated. Oral supplementation with vitamin A restored visual function to normal within 8 days in all subjects. During supplementation, cone function was restored more rapidly than that of rods, though the pattern of recovery was similar for each receptor type. Final thresholds improved first, though the rates at which they were reached were abnormally slow. As recovery continued, adaptation kinetics returned to normal. When rod adaptation was delayed, the regeneration of rhodopsin was also abnormally slow. When rod final threshold was 2 log units higher than normal, rhodopsin regeneration was incomplete, reaching about 70% of the normal level. The initial stages of visual dysfunction during onset of vitamin A deficiency were studied in one subject, and were found to mirror the pattern seen during recovery: rod adaptation was initially slower than normal, but reached completion. Cone adaptation remained normal until rod function was almost absent.

Central visual fields for short wavelength sensitive pathways in glaucoma and ocular hypertension

While conventional clinical visual acuity and kinetic visual fields may be essentially normal in ocular hypertension and early stages of glaucoma, other foveal aspects of vision (eg color, spatial and temporal contrast sensitivity) may be quite abnormal. Specifically, a selective vulnerability of the short wavelength sensitive (SWS) visual pathways in these conditions has previously been noted. Here we studied the central visual fields of 33 primary open angle glaucoma (POAG) patients, 32 ocular hypertensives (OHT), and 24 age-matched normal controls using blue and yellow test flashes on bright yellow backgrounds. SWS cone and MWS and/or LWS cone pathway sensitivities were measured at the fovea and at 2.5 degrees, 5 degrees, 10 degrees and 15 degrees eccentricities, in either the inferior temporal (for OHT) or horizontal nasal retina (for POAG). As expected, all groups had normal sensitivity to yellow flashes--detected by LWS and/or MWS cones--in these meridians. By comparison, for the blue flashes--detected by the SWS cones--the POAG and OHT groups had sensitivity deficits, uniformly across the central visual field, of about 6X and 1.8X, respectively, compared to normals. While six of 31 (19%) OHT subjects had localized glaucomatous field defects (greater than 0.4 log units) in the non-foveal inferior temporal retina, none of the 12 OHT subjects who were also tested in the horizontal nasal retina showed loss in this meridian. Finally, while no POAG subjects had localized sensitivity loss for yellow flashes in the horizontal nasal retina, four did show local field defects with blue test flashes.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanisms of rod-cone interaction: evidence from congenital stationary nightblindness

The dark-adapted rod system can elevate cone-mediated thresholds for flicker detection as well as thresholds for the detection of hue. We examined these two types of rod-cone interactions in two individuals with congenital stationary nightblindness (CSNB), a retinal disorder in which rod outer segment function is intact, but in which a defect occurs in the transmission of rod signals within the retina. The two types of rod-cone interaction were differentially affected by the retinal pathology; the rod-cone flicker interaction was normal, but the rod-cone hue interaction was absent. These results provide evidence that, despite similarities in the adaptational properties of these two types of rod-cone interaction, they are mediated by different visual mechanisms.

Temporal summation in the achromat

We investigated temporal summation of the rods in a complete achromat, who lacks cone vision. Critical duration (tc) was estimated both at the achromat's preferred area of fixation and at an area 12 deg laterally in the nasal visual field. Comparable tc determinations were made in a normal trichromat. At background luminances of 0.0 and 0.6 scot. td, where the rods mediate detection, the values of tc were similar for the achromat and the normal. At a luminance of 813 scot. tds, however, where the middle-wavelength sensitive cones mediate detection in the trichromat, the tc for the achromat was much longer than that for the trichromat.

Morphological findings in retinitis pigmentosa with early diffuse rod dysfunction

The retina from the postmortem donor eye of a 64-year-old man with advanced autosomal dominant retinitis pigmentosa (RP) was studied with light and electron microscopy. Two children of the donor were tested with two-color, dark-adapted static perimetry and found to have Type 1 or D-type RP, the psychophysical subtype with early onset of severe rod dysfunction diffusely affecting the entire retina. In the macula of the donor retina, rods and cones were clustered in irregularly shaped patches, in association with pigmented retinal pigmented epithelial cells. Only cones in the middle of these patches possessed outer segments, and these were poorly organized. Of the few photoreceptors remaining outside of the macula, those in the superior retina had well-formed terminals and appeared to be rods. Rods were also observed superior to the disk and in the temporal mid-periphery. The few photoreceptors remaining in the inferior retina were also rod-like, but had less well-formed terminals. The retinal pigmented epithelium was relatively normal near surviving photoreceptors, but was depigmented, had thinned, or was absent in regions of photoreceptor dropout. These findings represent the first reported morphology of the retina from an eye donor with known psychophysical subtype of RP.

Diurnal rhythm in the human rod ERG: retinitis pigmentosa

Rod ERGs were measured at three times of day over an extensive range of retinal illuminances in six light-entrained patients with autosomal recessive or isolate forms of retinitis pigmentosa and at five times of day in six light-entrained normal volunteers. B-wave amplitude versus retinal illuminance functions from each time of day were described by determining the parameters of the best-fit Naka-Rushton function. Results from normal subjects showed that rod ERG threshold (defined as the log retinal illuminance necessary to elicit a 2.0 microV response) was elevated 1 1/2 hr after daily light-onset due to both an increase in log k (semi-saturation constant) and a decrease in log Vmax (maximum rod amplitude). The magnitude of the threshold elevation 1 1/2 hr after light-onset was comparable in patients with retinitis pigmentosa and normal subjects. Whereas thresholds returned to pre-light exposure levels rapidly during the light-phase of the daily cycle in normal subjects, thresholds continued to rise in patients with retinitis pigmentosa due primarily to a further increase in log k. These findings are consistent with abnormal rod photoreceptor disc renewal mechanisms in retinitis pigmentosa.

Functional and morphological variations of fundus flavimaculatus

In order to investigate functional differences between fundus flavimaculatus and ophthalmoscopically similar diseases, we performed testing of spectral sensitivity, transient tritanopia, visual fields, fluorescein angiography, color vision, electrophysiological parameters, dark adaptation, cone flicker threshold during dark adaptation, and a thorough clinical investigation in five patients. Four had characteristic fundus flavimaculatus, while one patient turned out to have an atypical form. All five patients showed similar results in clinical investigations, electrophysiological data, and visual field tests. However psychophysical tests showed a number of differences in the single atypical patient. Although his ophthalmoscopic picture was not entirely typical of fundus flavimaculatus, only his psychophysical data could identify the patient as functionally distinct from the other four.

Progressive cone dystrophy

Psychophysical, reflectometric, and electrophysiologic studies were done on four members of a dominant pedigree with progressive cone dystrophy. The two youngest individuals were asymptomatic at the initial examination, and none of the subjects complained of problems associated with night vision. Nevertheless, absent or grossly reduced cone-mediated electroretinographic (ERG) responses showed the widespread loss of cone function, and moderate elevations (less than 1 log unit) in absolute threshold together with reductions in rhodopsin levels in the mid-peripheral retina provided evidence of impairment of the rod system. The progressive nature of the disease was apparent from the case histories and the changes in visual performance that occurred on re-test after a 5-year interval. Moreover, the results of increment threshold measurements at several retinal loci suggested that peripheral cones may be affected earlier and more severely than those in the central retina.

Sensitivities in older eyes with good acuity: eyes whose fellow eye has exudative AMD

We compared several indices of foveal visual function between two groups of people aged 60 and older. One group was comprised of individuals who had good acuity in one eye, but had a history of exudative aging macular degeneration (AMD) in the other eye. We measured visual function in these individuals' good eyes only. The second group was a normative group; it was comprised of individuals who had good acuity in each eye. None of the eyes which we tested from either group had funduscopic evidence of macular pathology other than macular drusen and/or hypopigmentation. We found that eyes whose fellow eye had suffered from exudative AMD themselves suffered compromised foveal function, even when they retained 20/20 or better acuity. Losses of sensitivity mediated by blue-sensitive cones tended to be greater for 1 degree than for 3 degrees diameter test stimuli. Absolute sensitivity losses at long test wavelengths were probably due to several factors, including decreased effective cone photopigment density. Slow rates of recovery during dark adaptation were associated with the presence of many macular drusen and/or macular hypopigmentation. Eyes whose fellow eye had suffered from exudative AMD had more macular drusen and hypopigmentation than eyes whose fellow eye had not suffered from exudative AMD.

Rod-cone interaction in patients with fundus flavimaculatus

Dark adaptation and the rise of cone flicker threshold (25 Hz) during dark adaptation were measured psychophysically in three patients with fundus flavimaculatus. The dark adaptation curve showed a delayed rod-cone break but a normal final rod threshold in all these patients. However, the rise of cone flicker threshold during dark adaptation was not delayed and also reached a normal final value. This indicates that the delay in rod dark adaptation does not influence the rise of cone flicker threshold during dark adaptation. This finding contrasts with current concepts that the rise of the cone flicker threshold reflects an increasing inhibitory influence of dark adapting rods.

Rhodopsin topography and rod-mediated function in cats with the retinal degeneration of taurine deficiency

Cats on a taurine-deficient diet were studied with imaging fundus reflectometry and full-field electroretinography. The pattern of rhodopsin loss and the natural history of the disease were determined from maps of the rhodopsin distribution in the central and nasal retina of cats with different degrees of severity of the retinopathy. Rhodopsin loss is first detectable in a focal region of the central retina. Subsequently, there are decreases in rhodopsin in the paracentral and nasal midperipheral retina. The horizontal streak of high rhodopsin levels is preferentially reduced in this retinopathy. The b-wave amplitude of the rod-dominated ERG is markedly reduced in cats with only mildly decreased levels of rhodopsin in the peripheral retina. In an affected cat with moderate rhodopsin loss in the central retina but minimal loss nasally, a light-microscopic study of the retina showed that there was disorganization and shortening of rod outer segments and loss of rod photoreceptor cells in the areas of reduced rhodopsin levels.

Regional variation of contrast sensitivity across the retina of the achromat: sensitivity of human rod vision

1. Detection thresholds for two-dimensional Gabor functions of varying spatial and temporal frequency were used to investigate the post-receptoral sensitivity across the retina of the typical and complete achromat. 2. Under photopic conditions there is no evidence for post-receptoral cone function at any retinal eccentricity investigated. Sensitivity saturates in a way consistent with known psychophysical and electrophysiological measures of rod saturation. This occurs in a unitary fashion across the retina. 3. Under scotopic conditions the regional fall-off in spatio-temporal sensitivity is similar for the achromat and duplex retina. This suggests that the rods in the achromat make normal neural connections. 4. Taken together this supports the contention that the typical and complete achromat is a functional rod monochromat and hence can be used to explore the sensitivity of the isolated rod post-receptoral mechanism under mesopic conditions where its sensitivity is optimal. This is where its contribution is most difficult to isolate in the duplex retina. 5. For the human rod mechanism, mesopic post-receptoral sensitivity for all spatio-temporal stimuli is optimal in the central region of the retina and falls off as a function of eccentricity. 6. For localized stimuli, peripheral spatial sensitivity is reduced evenly at all spatial frequencies compared with that of the central retina. A similar displacement of the spatial sensitivity function of the rod mechanism occurs as illuminance is reduced. 7. For localized stimuli, temporal acuity of the rod mechanism is around 20-25 Hz irrespective of retinal position. As the illuminance is further lowered dynamics of the rod pathway are reduced irrespective of retinal position and the sensitivity function maintains a bandpass shape. 8. The regional distribution sensitivity of the rod mechanism changes as illuminance is reduced from mesopic to scotopic levels.

The relationship between rod perimetric thresholds and full-field rod ERGs in retinitis pigmentosa

Dark-adapted static perimetric fields and rod full-field electroretinograms (ERGs) were measured in normal subjects and 15 patients with retinitis pigmentosa. Psychophysical thresholds for short-wavelength stimuli were obtained from 76 locations across the retina on a modified Octopus 201 perimeter; threshold differences to short- and long-wavelength stimuli were used to determine whether rods were mediating threshold at each retinal location. Full-field rod ERG peak-to-peak amplitude as a function of retinal illuminance was analyzed by determining the parameters of the best-fit Naka-Rushton equation. Rod ERG thresholds and mean rod perimetric thresholds were significantly correlated with a slope of approximately 1.0. Log k was positively correlated with threshold elevation in the region of peak field sensitivity and log Vmax was positively correlated with log rod visual field area. These results demonstrate correspondence between parameters derived from rod visual fields and parameters derived from the Naka-Rushton analysis of the full-field rod ERG.

Chronic eyelid closure and its effect upon the human cone and rod electroretinogram

The human rod and cone systems have different spectral and adaptive sensitivities. Ganzfeld electroretinogram responses show that chronic eyelid closure, such as extensive symblepharon, can lead to dark-adaptation of the rods but simultaneously permit light-adaptation of the cones of the same eye. This effect is due to the red-filtering properties of the closed eyelid and the differential sensitivity of the two photoreceptor systems to the long wavelengths.