Electro-oculogram in vitamin A deficiency associated with cystic fibrosis. Short communication

Electro-oculograms (EOGs) were recorded in a patient with cystic fibrosis and vitamin A deficiency before and during vitamin A supplementation (25,000 IU/day). Before vitamin A supplementation the EOG Arden light/dark ratio was 1.27. After seven months of vitamin A supplementation the Arden ratio increased to 3.0. These results reveal that vitamin A deficiency can cause an abnormal EOG.

Psychophysical evidence for post-receptoral sensitivity loss in diabetics

Although numerous reports show that the sensitivity of the S cone system is decreased in diabetic patients, few studies have been directed toward identifying the possible sites of the sensitivity loss. In this study, a psychophysical technique was used to test hypotheses about sites of S cone system sensitivity loss in a group of patients with early diabetic retinopathy. A model of the S cone system was assumed and the experimental conditions were chosen to distinguish between explanations for S cone sensitivity loss at the receptor level from explanations for loss at a post-receptoral level. Within the context of the model, the data were consistent with S cone system sensitivity loss occurring at a post-receptoral level.

Reply to Stuart and Lovegrove's question, "visual processing deficits in dyslexia: receptors or neural mechanisms?"

Recently Stuart and Lovegrove questioned the receptor hypothesis of Grosser and Spafford which these authors used to account for the findings that dyslexic individuals have superior peripheral color discrimination to normal readers but also have poorer peripheral brightness discrimination than normal readers. Stuart and Lovegrove hypothesized that dyslexics instead have an impaired transient visual system. The receptor hypothesis is an attempt by Grosser and Spafford to link the functioning of the rods and cones to transient and sustained visual system functioning in a more specific manner than has been tried heretofore by suggesting that, while the parvocellular system is almost entirely fed by cones, both kinds of receptors drive magnocellular cells (but with the rapid onset of early transient system responding being due to the highly light sensitive rods). The rods are proposed to be the receptors initiating the rapid onset of responding in the magnocellular, transient pathway. In dyslexic individuals, they maintain, there are relatively fewer rods to provide for the rapid onset of transient system responses, resulting in a diminished capacity of the transient system to inhibit sustained system activity (as occurs with normal readers). Their receptor hypothesis supplements the concept of transient-vs-sustained system differences.

Spectral response curves of congenital dichromats

In a previous paper I have derived spectral response curves for the foveal cones of the CIE normal observer. These are based on the 1931 mixture data, the Judd 1951 V (lambda) curve, and the absorbance data of the pigments in the human cones. In the present paper I have found that the spectral response curves of congenital dichromats may be assumed to be similar to those of the CIE normal observer.

[Colored light stimuli in ERG for differential diagnosis of cone dystrophies]

We recorded electroretinograms (ERG) with white and color stimuli in normal persons and four patients with cone dystrophies. Kodak Wratten-filters in blue, blue-green, green, yellow and red were used for the color flashes. ERGs to all color stimuli were recorded at dark and light adapted conditions with different stimulus intensities, to 30 Hz flicker stimulation and with special filtering for oscillatory potentials. Selective blue cone-responses were obtained using strong blue flashes at a yellow background. Patients with cone dystrophies showed slightly to moderately reduced responses at dark adaptation to blue, blue-green, green and yellow stimuli. Red stimuli elicited only small responses with a markedly delayed b-wave implicit time. The light adapted recordings, flicker responses and oscillatory potentials were reduced to all color stimuli. However, differences between patients with cone dystrophies could be detected concerning the responses to red and green. In two patients the responses were reduced to the same degree to all color stimuli. Another patient had very small responses and no oscillatory potentials to red, but his responses were only moderately reduced to green. A patient with combined red-green cone and rod dystrophy had a blue cone hypersensitivity. Responses to blue and blue-green were large at all stimulus conditions, but responses to all other stimuli were much smaller. The blue cone ERG showed a prominent blue cone response. ERG recording to colored stimuli allows a separation of retinal dysfunction in patients with cone dystrophies.

Abnormal dark adaptation kinetics in autosomal dominant sector retinitis pigmentosa due to rod opsin mutation

The time course of dark adaptation was measured in 10 subjects from three families with autosomal dominant sector retinitis pigmentosa (RP) due to mutations in the first exon of the rod opsin gene. In each subject cone adaptation and the early part of the recovery of rod sensitivity followed the normal time course, but the later phase of rod adaptation was markedly prolonged. The recovery of rod sensitivity is much slower than that reported in any other outer retinal dystrophy. Using a model based upon primate data of rod outer segment length and turnover, we have calculated that the delayed phase of the recovery of rod sensitivity in the RP patients tested following strong light adaptation could be due in part to formation of new disc membrane with its normal concentration of rhodopsin rather than in situ regeneration of photopigment.

Motion thresholds in retinitis pigmentosa

Minimum displacement thresholds, or dmin, were measured in 29 subjects with retinitis pigmentosa (RP) and 10 subjects with normal vision. The results showed that RP can affect an observer's ability to judge the correct direction of motion in a random-dot pattern. The majority of RP subjects had elevated dmin. They required a larger displacement to perceive the correct direction of motion. Only 5 of the 29 RP subjects had thresholds within two standard deviations of the mean of the normal-observer distribution. Moreover, three RP subjects were unable to detect the correct direction of motion regardless of the displacement magnitude, and four RP subjects consistently reported motion in the opposite direction at small displacements. The results cannot be explained by abnormal temporal processing or a reduction in the effective luminance. There was a statistically significant correlation (r = 0.72, P less than 0.001) between log threshold and log MAR, consistent with the hypothesis that a reduction in the spatial density of the photoreceptors contributes to the motion-threshold elevation. Motion thresholds also were measured in subjects with normal vision under conditions of simulated "photoreceptor" dropout. The results showed that a random elimination of information from over 25% of the image positions significantly elevates motion thresholds. These results also support the spatial-density reduction hypothesis.

The electroretinogram in infants and young children

Electroretinography (ERG), especially when combined with visual evoked potential recording, can provide valuable information to the pediatric clinician assessing a young child with nystagmus who appears not to see. ERG changes are described in clinical conditions affecting rod and/or cone function, vitreoretinal disease, maculopathies, and disorders involving the retina and central nervous system. The role of ERG in monitoring treatment, and in excluding retinal disease prior to eye surgery, is also covered.

A null mutation in the rhodopsin gene causes rod photoreceptor dysfunction and autosomal recessive retinitis pigmentosa

Mutations within the rhodopsin gene are known to give rise to autosomal dominant retinitis pigmentosa (RP), a common hereditary form of retinal degeneration. We now describe a patient with autosomal recessive RP who is homozygous for a nonsense mutation at codon 249 within exon 4 of the rhodopsin gene. This null mutation, the first gene defect identified in autosomal recessive retinitis pigmentosa, should result in a functionally inactive rhodopsin protein that is missing the sixth and seventh transmembrane domains including the 11-cis-retinal attachment site. We also found a different null mutation carried heterozygously by an unrelated unaffected individual. Heterozygous carriers of either mutation had normal ophthalmologic examinations but their electroretinograms revealed an abnormality in rod photoreceptor function.

Nondetectable electroretinogram in combined methylmalonic aciduria and homocystinuria

We present the case of a patient with congenital methylmalonic aciduria with homocystinuria and a nondetectable electroretinogram. To our knowledge, this is a new entity to be considered in the differential diagnosis of nondetectable electroretinography in infancy.

Prediction of visual acuity recovery in cystoid macular edema

Three consecutive patients participated in a prospective evaluation of pseudophakic cystoid macular edema. The duration of the macular edema ranged from 6 to 8 months. On the initial visit, the best corrected acuity with spectacles was determined and a potential acuity meter reading was obtained; this test suggested potential for visual recovery in two of the three patients. Sub-tenon's injections of methylprednisolone acetate (20 mg) were administered along with topical 1% prednisolone acetate and 1% atropine. One month later, visual acuity was improved by more than 2 Snellen lines in all three of the patients. A visual acuity measurement with the potential acuity meter that is better than the best corrected acuity with spectacles may reflect the presence of intact, but dysfunctional photoreceptors that are capable of restoring visual acuity upon resolution of the edema.

Photopic ERG components in retinitis pigmentosa

The persistence of a residual flicker electroretinogram 20 Hz response in many cases of retinitis pigmentosa, when the Oscillatory Potentials (OPs) were no longer recordable, led the authors to an investigation by Fourier analysis. The study was carried out in 33 patients affected by different hereditary forms of retinitis pigmentosa revealing recordable 20 Hz flash ERG responses. We applied the Fourier analysis to this ERG response and compared the weight percentage of the first two components to the OP added amplitude. The analysis showed that the 20 Hz flash ERG response contains only the first harmonic in patients with no recordable OPs and both harmonics in patients with recordable OPs. This relationship between OPs and 20 Hz second component, that is possibly related to the activity of inner retina as well as the OPs, can demonstrate an alteration of the inner retina which evolves with distinct electrophysiological features from the ERG photoreceptor impairment.

[The properties of visual functions and familial analysis in blue cone monochromatism]

The diagnosis of blue cone monochromatism (BCM) is based on severely affected color vision with preserved blue function, nearly absent photopic ERG, and a family pedigree compatible with X-linked inheritance. In the past, there has been no familial report of BCM in Japan. We found a Japanese family with BCM and studied the ocular findings of three affected members and a female carrier. Two of three affected members showed unique properties of BCM in their visual functions, including color vision and ERG. One affected member, a brother of their mother (43 years old), showed achromatic color vision. He had diabetic retinopathy and moderate cataract, which, might have disturbed his preserved blue cone function, resulting in the achromatic vision. A female carrier showed normal visual function, except that her photopic ERG was slightly reduced in amplitude.

Supernormal cone electroretinograms in central retinal vein occlusion

In 12 successive cases of unilateral central retinal vein occlusion (CRVO), the strongly light-adapted cone electroretinogram (both a- and b-wave) was always slower and larger (supernormal) to long-wave stimuli compared with that of the unaffected eye. This supernormality became less as the level of light adaptation decreased; in the dark-adapted state, long-wave stimuli produced subnormal responses from the affected eye in all but two subjects. This supernormality was not caused by ineffectiveness of the adapting light related to a reduced cone quantal catch because it occurred in the dark. At any one state of adaptation, the supernormality increased with the wavelength of stimulation, paralleling the relative absorption ratio of long-middle wavelength-sensitive cones. This suggests that cones, especially long wavelength-sensitive cones, are less able to reduce their responsiveness to light with increasing levels of light adaptation in a retina affected by CRVO.

Study of retinal dystrophy in RCS rats: a comparison of Mg-ATP dependent light scattering activity and ERG b-wave

A comparative study using the techniques of ERG to measure the b-wave and light scattering relaxation spectrophotometry (LSRS) to determine the dynamic behavior Mg-ATP dependent processes in the rod photoreceptors of pigmented control and dystrophic RCS rats has been carried out. LSRS results, based exclusively on photoreceptor rod outer segment dynamics, suggest a progressive failure in the dark and light-induced Mg-ATP dependent processes as a function of age. The dark signal amplitude in the dystrophic rats decreases to about 50% of the control by 5 weeks post-natal; the light-induced signal has decreased by 30% in the same period. The ERG b-wave results indicate that the differences in the amplitude and the time required to attain the peak amplitude become increasingly pronounced between the control and dystrophic groups of rats again as a function of age. By 10 weeks of age, the intensity of light required to obtain a b-wave with a amplitude of 100 microM is 10(3) greater in the dystrophic RCS rats. Similarly, the time to achieve this peak increases in the dystrophs with age. These results indicate that the retinal dystrophy in the RCS rat affects the activity of the rod photoreceptor cells.

'On' response defect in paraneoplastic night blindness with cutaneous malignant melanoma

Response properties of rod and cone systems were assessed in a patient with an acquired form of night blindness associated with a metastatic cutaneous malignant melanoma. The night blindness, a sensation of shimmering lights, and selective reductions in the amplitudes of both rod and cone electroretinographic (ERG) b-waves were present before and after chemotherapy, confirming that this disorder was a paraneoplastic consequence of the melanoma rather than a response to chemotherapy. During ERG testing with flashes of extended duration, the cone b-wave abnormality was found to be a predominant loss of the cone ERG "on" response with relative preservation of the "off" response, similar to that observed in patients with congenital stationary night blindness. An impairment in signal transmission specific for retinal "on" pathways may be a primary defect in both of these forms of night blindness.

Abnormal rod dark adaptation in autosomal dominant retinitis pigmentosa with proline-23-histidine rhodopsin mutation

We studied rod and cone function in 13 patients from four families with autosomal dominant retinitis pigmentosa and the proline-23-histidine rhodopsin mutation. In patients with early stages of this disease, rod sensitivity was mildly abnormal throughout the retina and cone sensitivity was normal. In more severely affected patients, sensitivity loss varied with retinal region, some regions showing mild rod loss only and other regions having pronounced rod and cone dysfunction. Rhodopsin levels were decreased below normal by amounts that indicated the rod sensitivity loss was determined by the reduced ability to absorb light. The most characteristic abnormality of this genotype was a slowed rod branch of dark adaptation, which was present regardless of the extent or severity of disease. The time required for recovery of rod sensitivity was more than twice the normal time. These findings with dark-adapted perimetry, fundus reflectometry, and dark adaptometry showed intrafamilial and interfamilial consistency.

A computational model of the amplitude and implicit time of the b-wave of the human ERG

To improve the usefulness of the ERG in identifying the sites and mechanisms of adaptation, development, and disease processes, a theoretical framework based upon Granit's analysis of the ERG was evaluated. The framework assumes that the ERG is the sum of two potentials, one, P3, generated by the receptors and the other, P2, generated by the cells of the INL. Hood and Birch (1990a, b) demonstrated that the leading edge of the a-wave can be quantitatively described by a model used to describe the response from single rod receptors. This model provides P3(t), a theoretical receptor response as a function of time, for any given flash intensity. The ERGs from normal observers and patients with retinal diseases were analyzed in this framework, first by deriving P2 by computer subtracting the predicted P3(t) responses. This analysis was successful and a computational model of the ERG was then derived. The model of P2(t) was constructed with linear filters and a static nonlinearity and using P3(t) as the input. The ERG for any given flash intensity is then P3(t) + P2(t). The model describes (1) the change both in implicit times and in trough-to-peak b-wave amplitudes with flash intensity for the normal, dark-adapted observers; and (2) the changes in b-wave implicit times and amplitudes for three patients with retinal diseases. Among the implications drawn from these analyses were as follows: (1) The fits of the Naka-Rushton equation to trough-to-peak b-wave amplitudes must be interpreted with great care. (2) When the INL is affected by retinal disease, the b-wave may be a very poor reflection of INL activity. (3) The implicit time of the b-wave can provide a measure of receptor sensitivity.

Visual processing deficits in dyslexia: receptors or neural mechanisms?

In 1989 and 1990 Grosser and Spafford attributed abnormalities in the peripheral vision of dyslexic subjects to an anomalous distribution of rods and cones. We argue that at the light levels used in these experiments cone responses should dominate both central and peripheral vision. A more likely explanation of their findings is that there is a postreceptoral deficit in the transient visual channel. This hypothesis is supported by independent anatomical, physiological, and psychophysical evidence.

Influence of rod adaptation upon cone responses to light offset in humans: II. Results in an observer with exaggerated suppressive rod-cone interaction

In normal observers, sensitivity of cones to rapid sinusoidal flicker decreases by about 0.7 log units as rods progressively dark adapt. However, Arden and Hogg (1985) described a night-vision disorder characterized by normal rod sensitivity but exaggerated suppressive rod-cone interaction (SRCI). We refer to this condition as the exaggerated SRCI syndrome (ESS). The present paper examines the influence of rod-adaptation upon cone-mediated responses to light onset and offset in an observer with ESS. Under all conditions of adaptation examined, sensitivity of cones to rapid-on waveforms is indistinguishable to that of a normal observer tested under identical circumstances; rod sensitivity is also normal. However, the sensitivity of cones to transient decreases in illumination is clearly subnormal under light-adapted conditions. This deficit in cone responsiveness to light offset becomes increasingly subnormal as rods dark adapt and, when completely dark adapted, the ESS observer is nearly blind to 1 Hz rapid-off sawtooth waveforms. These results strongly bolster previous results that suggest that suppressive rod-cone interaction is restricted to the response to transient decreases in illumination.

Early receptor potentials recorded in humans via dermal electrodes. Normative data and prognostic value in retinal detachment

Early receptor potentials were recorded by skin electrodes positioned at the inferior orbital margin in 32 patients with recent bullous retinal detachments and in nine patients with old, total retinal detachments. Results were compared to those obtained in a normative study performed on 200 healthy subjects. In patients with recent retinal detachments, no significant variations were found with respect to normal subjects. In patients with old retinal detachments, an early receptor potential of decreased amplitude was recorded in only five subjects, while in the other four the trace could not be separated from the noise.

Color electroretinography. A method for separation of dysfunctions of cones

Electroretinograms to white and color stimuli were recorded in four normal subjects and nine subjects with different cone dysfunctions, including protanopia, cone dystrophy, cone dystrophy with supernormal b-waves at dark adaptation, cone dystrophy with missing b-waves during light adaptation and rod-cone dystrophy with blue cone hypersensitivity. Color stimuli were obtained with Kodak Wratten filters in blue, blue-green, green, yellow and red. Electroretinograms to all stimuli were recorded during dark and light adaptation with different stimulus intensities and to 30-Hz flicker stimulation. In protanopia, responses to red during light adaptation and flicker stimulation were reduced. All cone dystrophies showed reduced amplitudes and prolonged implicit times to red when dark adapted. The light-adapted responses were equally reduced to all color stimuli in cone dystrophy and cone dystrophy with supernormal b-waves. Contrary to other cone dystrophies, in cone dystrophy with missing b-waves, responses to red were severely reduced and responses to green were preserved, indicating a predominantly red cone dysfunction. Blue cone hypersensitivity was clearly distinct from other dystrophies in having large response to blue and blue-green and much smaller responses to all other colors in all stimulus conditions. The electroretinogram with color stimuli allowed separation of different cone dysfunctions and identification of new retinal dysfunction syndromes.

Empiric limits of rod photocurrent component underlying a-wave response in the electroretinogram

The corneally recorded rod photocurrent component (photoresponse) underlying the a-wave feature of the electroretinogram was analyzed. The results set empiric limits on critical photoresponse variables. Measurements were obtained from four normal adult subjects on a-wave amplitude, a-wave velocity, b-wave amplitude, b-wave implicit time and b-wave height above baseline. At high intensity, interference from the b-wave component was minimized and the amplitude of the saturated photoresponse component was approximated by the a-wave feature. At lower intensities, the a-wave feature represented progressively less of the underlying photoresponse amplitude. Photoresponse amplitude saturation was signaled by the abrupt slowing of the rate of decline of b-wave peak latency and occurred at an intensity about 2.5 log units above the first appearance of the b-wave. At the intensity of photoresponse saturation, the peak amplitude of the a-wave feature was only about 25% of the maximum amplitude of the underlying photoresponse component. A-wave leading edge velocity was found to increase up to 3 log units above the intensity of photoresponse amplitude saturation and to provide a good estimate of photoresponse velocity at higher intensities. A cascaded low-pass filter model with modifications to accommodate amplitude and timing nonlinearities was used to generate a set of probable underlying photoresponses from the analysis of a-wave amplitude and velocity. Movement of the a-wave leading edge to the left at higher intensities in algebraic combination with a static b-wave leading edge above the intensity of photoresponse amplitude saturation was found to explain the second rise of the b-wave amplitude function and the decline of b-wave amplitude above baseline at high intensities. This analysis provides a basis for modeling the underlying photoresponse on a biochemical level and for interpreting photoreceptor damage in disease states.

Analysis of the electroretinogram in toxoplasma retinochorioiditis

The decision to use therapy in toxoplasma retinochorioiditis depends on the location of the active lesion and the presence of vitreous activity. In eyes with dense vitreous clouding it can be difficult to see whether the macular region is involved or not. In theory the localisation of a lesion can be estimated on the basis of the flash ERG. The standard flash electroretinogram was recorded in 23 patients with inactive toxoplasma retinochorioiditis lesions in the retina. In 17 cases a lesion was present within the central 12 degrees of the visual field, 8 of these had a reduced photopic ERG. In 15 patients lesions were found outside the central 12 degrees, in 8 of whom the scotopic ERG was reduced. We conclude that the ERG can be of use in indicating the scar location in patients with dense vitreous clouding.

Clinical and ERG data in a family with autosomal dominant RP and Pro-347-Arg mutation in the rhodopsin gene

In a family with autosomal dominant retinitis pigmentosa, documented over six generations, a previously undescribed point mutation in the rhodopsin gene could be identified. The mutation found in the six affected members examined but in none of the controls, including healthy members of the family, was a point mutation in codon 347 predicting a substitution of the amino acid arginine for proline, designated Pro-347-Arg. Six affected members from two generations were examined clinically and with ganzfeld rod and cone electroretinography. The cone and, more dramatically, the rod electroretinograms were reduced to residual b-wave amplitudes or were non-detectable as early as ages 18 to 22 years. The Pro-347-Arg mutation resulted in a subjectively and clinically homogeneous phenotype: early onset of night blindness before age 11, relatively preserved usable visual fields until about age 30, blindness at ages 40 to 60, and change from an initial apparently sine pigmento to a hyperpigmented and atrophic fundus picture between 30 and 50 years of age.