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.