Variability in clinically measured photopic oscillatory potentials

The importance of electrode position in visual electrophysiology

PURPOSE

The DTL fibre electrode is commonly used to record the electric potentials elicited by stimulation of the retina. Two positions are commonly used: it is placed either on the cornea along the lower lid or in the conjunctival fornix. The PERG and OPs have previously been examined and compared under both conditions. The aim of this study was to examine the ERG, flicker response and on-off responses with differing electrode positions.

METHODS

Before recruitment, all subjects underwent an ophthalmological examination. We enrolled 13 normal control subjects into the study aged 13-64 years, all with a visual acuity of ≥1.0. We recorded scotopic and photopic ERGs, flicker and on-off responses, for both electrode positions. On the first day, one eye had the electrode placed on the cornea along the lower lid and the other eye had it positioned in the conjunctival sac. On a second day, the recordings were repeated with the alternative electrode placements.

RESULTS

ERG, on-off and flicker responses were all smaller by between 20 and 25% when the DTL electrode was positioned in the conjunctival sac, compared to when it was positioned on the cornea, as did the scatter in the data points. This indicates that there is no advantage clinically for one or the other placement.

CONCLUSIONS

Our results confirm other reports examining the effect of electrode position on electrophysiological potentials. When recording with the DTL electrode, it is important to ensure that it is placed at the same position in repeat recordings or in multicentre trials and that it is stable and does not move during recording.

Electrophysiological function of the retina and optic nerve in patients with atrial fibrillation

Purpose

To evaluate the effects of atrial fibrillation (AF) and ablation procedures on electrophysiological function in the retina and optic nerve.

Methods

Thirty two eyes of 17 patients with AF were analyzed. The full-field electroretinogram (ERG), pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) were performed. The results were compared to age-matched healthy controls (n = 30). In 12 eyes, electrophysiological tests were performed before and 3 months after ablation treatment.

Results

Statistically significant differences between AF patients and healthy controls were detected. In the full-field ERG, a reduction in the oscillatory potentials wave index (OPs WI; p = 0.012) and scotopic (0 dB) a-wave amplitude (p = 0.009) was observed. The amplitude of b-waves, scotopic (24 dB; p = 0.011), photopic single flash (p = 0.008) and photopic flicker (p = 0.009), was decreased. The photopic flicker b-wave peak time was increased (p = 0.005). Other parameters of ERG/PERG/PVEP did not differ significantly from controls. After the ablation procedure, the only statistically significant change was an increase in the OPs WI (p = 0.002).

Conclusions

In the analyzed series of AF patients, retinal dysfunction was detected in the ERG test. The AF ablation may improve the retinal function as indicated by an increase in the OPs WI. The OPs WI has a potential value in the estimation of the effectiveness of AF ablation.

Transient reduction of the ocular perfusion pressure and the oscillatory potentials of the ERG

PURPOSE

To evaluate the changes of the Oscillatory Potentials (OPs) of Electroretinogram (ERG) caused by short-term hypertension in human subjects, and their relationship with ocular perfusion pressure (OPP).

METHODS

Suction cup technique in 12 normal volunteers with OPs simultaneously recording.

RESULTS

Scotopic and photopic OPs were altered during OPP drop. Scotopic OPs showed more sensitiveness, with higher reduction (from 21% to 47%), when compared to the basal value, than in photopic recordings (from 14% to 34%). In both conditions, the relationship between OPP and OPs presented a steady amplitude before the trough after the +30 step, and rapid recovery after OPP normalisation. ANOVA and correlation analysis confirmed the data.

CONCLUSION

The ERG OPs seemed to reflect the OPP modification. The features of OPs amplitudes suggest involvement of the retinal autoregulation mechanism and support development for further clinical studies.

Background light adaptation of the retinal neuronal adaptive system. I. Effect of background light intensity

The behaviour of the neuronal adaptive retinal mechanisms to environmental light exposures was studied by measuring the oscillatory potentials (OPs) of the electroretinogram. Dark adapted rats were exposed to four levels of background light (BG), starting at a 'low scotopic' level of 1.43x 10(6) cd/m2, increased by steps of two log units, through 'high scotopic' -, 'low mesopic' - and finally the 'high mesopic' BG of 1.43x 10(0) cd/m2. The summed oscillatory response significantly increased as the BG intensity was raised, except at the 'high mesopic' level. The amplitudes of the a- and b-waves reduced as the BG light increased above the 'high scotopic' level. Each OP responded individually to the different BGs. O1 and O2, significantly enhanced at the 'low scotopic' BG. The amplitudes of the three later OPs increased significantly at the 'low mesopic' BG. The adaptational behaviour of the retinal oscillatory response to BG illumination was different to that of the a- and b- waves. The results indicate that the adaptational neuronal system, as reflected by the OPs, seems to be relatively robust and is separate from the slower photochemical adaptive process in the distal retina. The tentative corollary suggests the oscillatory system to play a vision-preserving role, possibly as an alert against undue depletion of the slowly regenerating visual pigment. The enhancement of the oscillatory response at the 'mesopic' illumination levels indicate both scotopic and photopic processes to contribute to neuronal adaptive activity of the retina.

Electrophysiology in the investigation of acquired retinal disorders

Electrophysiological research on acquired retinal disorders, both common and rare, is reviewed. Age is a major factor influencing electroretinogram (ERG) and electro-oculogram (EOG) findings. Bipolar or Müller cell death in the aging retina could account for much of the amplitude decline that is observed with age. In diabetic retinopathy, the oscillatory potentials can monitor the progression of the disease and indicate neuronal alterations rather than diabetic angiopathy of the retina. Human ERG studies on glaucoma concentrated on ERG measures that are dominated by inner retinal contributions. It has been shown that the pattern ERG can serve as a predictor of ocular hypertension's progression to glaucoma. In retinal disorders caused by endogenous intoxication, such as hepatic retinopathy, or exogenous intoxication from chronic lead exposure, ERG changes give an objective measure of the damage and allow to study the pathophysiological mechanisms that are involved. Inflammations of the choroid and the retina affect the standard ERG when they are diffuse. In central serous chorioretinopathy, functional disturbances can be revealed not only in the photoreceptors but also in the middle and inner retinal layers with the use of focal stimuli. Choroidal melanoma leads to large reductions of the EOG light peak-to-dark trough ratio through its influence on the transepithelial potential of the retinal pigment epithelium (RPE). In cancer-associated retinopathy, both the rod and cone ERGs are reduced. However, selective cone dysfunction has been described. In melanoma-associated retinopathy, the long flash ERG may reveal a specific pathophysiological mechanism, namely the affection of the ON-pathway with preservation of the OFF-pathway. ERG measurements can reveal vitamin A deficiency and are altered in cases with a mutation in the gene for the retinol binding protein in which other organs are not affected. Photochemical damage to the retina from light emission by the operating microscope can be assessed by electrophysiological methods.

Oscillatory potentials in the retina: what do they reveal

This chapter is an overview of current knowledge on the oscillatory potentials (OPs) of the retina. The first section describes the characteristics of the OPs. The basic, adaptational, pharmacological and developmental characteristics of the OPs are different from the a- and b-waves, the major components of the electroretinogram (ERG). The OPs are most easily recorded in mesopic adaptational conditions and reflect rapid changes of adaptation. They represent photopic and scotopic processes, probably an interaction between cone and rod activity in the retina. The OPs are sensitive to disruption of inhibitory (dopamine, GABA-, and glycine-mediated) neuronal pathways and are not selectively affected by excitatory amino acids. The earlier OPs are associated with the on-components and the late OPs with the off-components in response to a brief stimulus of light. The postnatal appearance of the first oscillatory activity is preceded by the a- and b-waves. The earlier OPs appear postnatally prior to, and mature differently from, the later ones. The second section deals with present views on the origin of the OPs. These views are developed from experimental studies with the vertebrate retina including the primate retina and clinical studies. Findings favor the conclusion that the OPs reflect neuronal synaptic activity in inhibitory feedback pathways initiated by the amacrines in the inner retina. The bipolar (or the interplexiform) cells are the probable generators of the OPs. Dopaminergic neurons, probably amacrines (or interplexiform cells), are involved in the generation of the OPs. The earlier OPs are generated in neurons related to the on-pathway of the retina and the later ones to the off-channel system. Peptidergic neurons may be indirectly involved as modulators. The individual OPs seem to represent the activation of several retinal generators. The earlier OPs are more dependent on an intact rod function and the later ones on an intact cone system. Thus, the OPs are good indicators of neuronal adaptive mechanisms in the retina and are probably the only post-synaptic neuronal components that can be recorded in the ERG except when structured stimuli are used. The last section describes the usefulness of the oscillatory response as an instrument to study the postnatal development of neuronal adaptation of the retina. In this section clinical examples of of the sensitivity of the OPs for revealing early disturbance in neuronal function in different retinal diseases such as pediatric, vascular and degenerative retinopathies are also given.

Electroretinographic evaluation in adult diabetics

In cross-sectional fashion, we recorded the maximal combined response and 30-Hz flicker responses in 178 adult diabetics and 40 normal controls according to the recommendations of the International Society of Clinical Electrophysiology of Vision. The oscillatory potentials were extracted from the maximal combined response by high-pass filtering. The clear media and attached retina were criteria for inclusion in this study. The data were statistically analyzed with the expectation that this procedure may provide a new feature that could have some clinical significance. Timing delays occurred more frequently than amplitude reductions in the maximal combined response and flicker responses, while amplitude reductions were more common in the first and second oscillatory potentials. The hypernormal b-wave amplitude was rare. The summed amplitude of the oscillatory potentials was highly correlated with the total power of the oscillatory potentials (the frequency domain). A reduction of the second oscillatory potential amplitude was more common than a reduction of the summed amplitude or total power. The electroretinographic component that demonstrates retinal dysfunction in the earlier stage may be a valuable indicator. In the early stage, a delay in the a-wave time and a reduction in the second oscillatory potential amplitude were the most frequent abnormalities: analysis of variance demonstrated that the summed amplitude of the oscillatory potentials and second oscillatory potential amplitude and time were the most sensitive measures of the diabetic retina. Hence, the second oscillatory potential amplitude may be the most sensitive and valuable indicator representing a quantitative measure of overall retinal dysfunction.

Inhibition of NMDA receptors and nitric oxide synthase reduces ischemic injury of the retina

This study was performed to examine the roles of body temperature, NMDA receptors and nitric oxide (NO) synthase in post-ischemic retinal injury in rats. Cell loss in the ganglion cell layer and thinning of the inner plexiform layer were observed 7 days after ischemia. Cell loss in the ganglion cell layer but not thinning of the inner plexiform layer was reduced by hypothermia during ischemia. Intravenous injection of dizocilpine (MK-801) or Nomega-nitro-L-arginine methyl ester (L-NAME) prior to ischemia ameliorated retinal injury. These results suggest that activation of NO synthase following NMDA receptor stimulation is involved in ischemia-induced retinal injury.

Electrical responses from diabetic retina

Diabetic retinopathy has long been considered to be a retinal manifestation of systemic diabetic angiopathy. Indeed, it is therapeutically true. However, the prolongation of OP peak latency in diabetic eyes without any angiographic evidence of angiopathy leads us to presume that certain neuronal disorders occur early in diabetic eyes. Even though we cannot neglect the possibility that the prolongation of the OP peak latency may derive from undetectable retinal hypoperfusion, it is still far from conventional diabetic angiopathy. Rather, the status should be properly termed "intraretinal diabetic neuropathy" in that the neurones are the disturbed cells to cause visual dysfunction. Thereafter, the OP amplitude diminishes as retinopathy advances, probably depending on the degree of retinal circulatory disturbance. Marked diminution of the OP amplitude predicts rapid progression and poor prognosis of retinopathy. Diabetic retinal pigment epitheliopathy as manifested by one of our non-photic EOG responses is another kind of early ocular involvement of diabetes. Because its mechanisms are not yet known, so far we have not succeeded in correlating it to any kind of subjective visual index. Routine fundus inspection or fluorescent fundus angiography is incapable of detecting the compromised neural retina and/or retinal pigment epithelial integrity and thus the electrophysiology of vision has the edge in ophthalmology.

Beta wave of the scotopic (rod) electroretinogram as a measure of the activity of human on-bipolar cells

The beta wave of the human electroretinogram (ERG) is widely believed to reflect the activation of on-bipolar cells. However, the shape of the beta wave is also influenced by the activity of other cell types. To assess how the activity of on-bipolar cells is reflected in the human ERG, rod ERG's were recorded in the dark and on the steady fields. Derived P2 responses were obtained by computer subtraction of the receptor contribution to the ERG. The light-adapted derived P2 was shown to have properties similar to those predicted from previous studies of on-bipolar activity. This was also true of the dark-adapted derived P2 if a small (less than 10%) contribution from a negative potential was taken into consideration. The derived P2, and under certain conditions the beta wave, can be used to study rod on-bipolar activity.

Effect of pharmacologically induced mydriasis on the normal variability of retinal oscillatory potentials in man

In this study we describe certain aspects of normal variability of oscillatory potentials, with particular reference to interaction between pupil size and stimulus intensity. The mean latencies of the earlier oscillatory potentials, O1 and O2, were significantly shorter when adopting the dilated pupil condition than when stimulating with a normal pupil. This occurred at various light intensities, although the difference was more significant at the highest intensity. O1 and O2 latencies became significantly longer as the stimulus intensity was progressively reduced. The latencies of the later components O3 and O4 were unaffected. The O1 and O2 amplitudes were not influenced by pupil size, but a significant reduction occurred with the progressive decrease in stimulus intensity. The later components O3 and O4 are greatly reduced in amplitude after pupil dilatation using higher stimulus intensities; the O4 potential may even disappear in 10% of the cases. These data provide further support for the existence of two distinct behavior patterns for earlier and later oscillatory potentials. Although light adaptation may affect oscillatory potentials, we suggest that in our experimental conditions, oscillatory potential changes may occur as a result of the activity of the neural modulating system, not only as a result of photoreceptor interaction.

Recording the oscillatory potentials of the electroretinogram with the DTL electrode

Suprathreshold photopic oscillatory potentials recorded with a DTL electrode were compared to those obtained with a Lovac corneal electrode. The overall oscillatory potential response (sum of oscillatory potentials) recorded with the DTL electrode was half of that obtained with the Lovac electrode. However, there was no evidence of a selective attenuation (or amplification) of any given oscillatory potential with the DTL electrode. Similarly, the oscillatory potential relative amplitude ratios and the peak times of the oscillatory potentials were identical for both electrodes. Our findings clearly indicate that the DTL electrode is adequate to record the high-frequency oscillatory potentials. Given the low cost and ease of use, as well as the disposable nature of the DTL electrode, we believe that electroretinographic specialists should seriously consider a wider utilization.

Effects of light adaptation on the response characteristics of human oscillatory potentials

We have examined the response characteristics of the oscillatory potentials (OPs) of the human electroretinogram (ERG) obtained to ganzfeld flash stimuli presented against adapting fields. First, we determined the extent to which the OPs obtained to high luminance flashes change during the course of light adaptation to a cone-isolating adapting field. Regardless of the number of OP wavelets, the last OP wavelet increased in amplitude and decreased in implicit time to a greater extent than did the earlier wavelet(s). In addition, we examined the role of both flash and adapting field luminance in determining the wave form of the OPs. For each adapting field luminance that was tested, the number of OP wavelets increased as flash luminance increased, primarily resulting from the splitting of the last OP into 2 distinct wavelets. While the number of OP wavelets generally decreased as adapting field luminance increased, the amplitude of the last OP became larger. These functional distinctions between the last and the earlier wavelets are consistent with their representing the activity of different retinal generators.

The influence of adaptation on the oscillatory potentials of the human electroretinogram

The influence of adaptation on the oscillatory potentials of the human electroretinogram was studied in the domains of frequency and time. The amplitude of OP1 to OP4, the summed amplitude of OP1 to OP4, as well as the area, decreased from dark adaptation to light adaptation. With increasing intensities of background illumination, they increased slightly and appeared to decrease with the strongest background illumination. The implicit time of oscillatory potentials 3 and 4 increased with stronger background illumination and decreased with the strongest background illumination. The results of the dominant frequency and the total power of the OPs correspond to the results in the time domain. The dominant power decreased from dark adaptation into light adaptation and did not show any systematic changes with increasing intensity of background illumination.

Measurement of the oscillatory potential of the electroretinogram in the domains of frequency and time

The dark-adapted and light-adapted electroretinograms of 13 subjects with 23 normal eyes were analyzed by means of Fourier spectrum. The oscillatory potentials in the time domain were filtered out from the electroretinogram after a corresponding bandpass was given in the frequency domain. The coefficient of variation of total power, dominant power and dominant frequency of the isolated oscillatory potentials in the frequency domain, summed amplitudes and area of the isolated oscillatory potentials, each amplitude and implicit time of the first four major oscillatory potential wavelets in the time domain were compared. The implicit time showed the smallest coefficient of variation; summed amplitudes of OP1 to OP4 showed smaller coefficients of variation than those of the area, the amplitude of each oscillatory potential wavelet, dominant frequency and dominant and total power. The coefficient of variation of these measurement parameters in light-adapted electroretinograms was smaller than those in dark-adapted electroretinograms.