C-wave versus electrooculogram in diseases of the retinal pigment epithelium

Colour vision testing as an aid to diagnosis and management of age related maculopathy

AIM

To provide a simple test that detects the onset of age related maculopathy (ARM), and can be used to monitor its severity.

METHODS

Colour contrast sensitivity was measured using computer graphics techniques. Colour thresholds were measured along tritan and protan colour confusion axes in the presence of dynamic luminance noise. Thresholds were determined separately for two sizes of optotypes (6.5 degrees and 1.5 degrees). Natural pupils were used. Normal values for the test have been established.

RESULTS

In all patients with unilateral age related macular degeneration, the smaller optotype was invisible in that eye and in almost all, the larger optotype could not be seen. In the symptomless fellow eyes (with ARM) the larger optotype thresholds were raised. The degree of loss was larger for tritan. For the smaller optotype, protan thresholds were elevated in the majority of patients. Tritan losses were greater and disproportionate to the loss seen with the larger optotype. Every person including those with minimal fundal changes had tritan test results for 1.5 degree optotypes >2 SD above the normal mean. Tritan thresholds varied with the severity of the ARM.

CONCLUSIONS

The test is sensitive, simple and quick to administer, and easy for patients. Therefore, it should be useful in detecting and monitoring elderly people with age related changes in their fundi before irreversible loss of vision has occurred.

Symptomatic abnormalities of dark adaptation in patients with EFEMP1 retinal dystrophy (Malattia Leventinese/Doyne honeycomb retinal dystrophy)

PURPOSE

To investigate the nature of symptomatic visual disturbance in patients with EFEMP1 retinal dystrophy in the absence of geographic atrophy or choroidal neovascularization.

METHODS

Patients presenting to a tertiary referral centre underwent clinical evaluation, fluorescein angiography, colour contrast sensitivity, focal, pattern, and standard electroretinography, electrooculography, scotopic threshold perimetry and dark adaptometry.

RESULTS

Clinical features included reduced central vision, difficulty passing from light to dark, and diffuse submacular and peripapillary deposits, which were hyperfluorescent by fluorescein angiography. Colour contrast thresholds were abnormal in all six patients studied and both pattern and focal electroretinograms were abnormal in five of six patients. The scotopic and mixed rod-cone single flash ERG was normal but two patients demonstrated reduced oscillatory potentials and one had borderline delayed 30 Hz responses. Scotopic thresholds were elevated and rod-mediated dark adaptation kinetics were markedly prolonged in all six patients when measured over the central visible confluent deposits.

CONCLUSIONS

In patients with EFEMP1 retinal dystrophy with confluent macular deposits, scotopic sensitivity is reduced and dark adaptation kinetics are prolonged over the macular deposits but are normal elsewhere. These results emphasize the localised nature of functional deficits in some patients with EFEMP1 retinal dystrophy and correlate well with the patient's visual symptoms. Symptomatic visual dysfunction may precede the development of clinically evident geographic atrophy or choroidal neovascularization in this disorder.

The c-wave of the electroretinogram possesses a third component from the proximal retina

ERG and light-induced extracellular potassium ([K+]o) changes have been measured in isolated retinas of both Rana esculenta and Rana temporaria. The conditions of the preparations have been varied. Isolated frog retinas kept receptor side-upward in a moist chamber without perfusion showed the well-known slow PIII in the ERG. Retinas superfused from the receptor side, with O2 enrichment at their vitreal surface, however, exhibit a slow cornea-positive potential in the ERG. The slow ERG-potentials relate to different light-induced potassium changes in the proximal retina. There was a long lasting and larger proximal potassium increase in adequately maintained retinas but a smaller and shorter one in preparations lacking superfusion and oxygen. There was no significant difference between the size of potassium decrease around receptors of retinas superfused from their vitreal side and those superfused from receptor side. A reduction of slow PIII should therefore not be responsible for the slow cornea-positive potential. The long lasting and larger (by 59%) potassium increase in the proximal retina may counteract the potential in the Müller cells caused by the potassium decrease around receptors and thereby cancel slow PIII and generate a third component of the electroretinogram c-wave.