The frequency response of normal, rod achromat and nyctalope ERGs to sinusoidal monochromatic light stimulation

Nonlinearities in the flicker electroretinogram: A tool for studying retinal dysfunction applied to early-stage diabetic retinopathy

The flicker electroretinogram (ERG) is typically analyzed in terms of peak-to-trough amplitude and implicit time. However, additional important information may be captured by spectral-domain analysis of the ERG harmonics (responses that occur at multiples of the stimulus frequency). This study describes an approach to analyze the harmonic components of the flicker ERG and its application to patients who have early-stage non-proliferative diabetic retinopathy (NPDR). Of particular interest were the sub-harmonic components occurring at 1.5x and 2.5x the stimulus frequency that produce cycle-to-cycle variation in amplitude termed "period doubling." Twenty visually-normal subjects, 20 diabetic subjects who have no clinically-apparent retinopathy (NDR), and 20 diabetic subjects who have mild NPDR participated. ERGs were recorded in response to sinusoidal flicker (27-63 Hz) and Fourier analysis was performed to extract fundamental and harmonic response amplitudes. Linear quantile mixed models (LQMMs) were used to compare the amplitude of the response components among the three subject groups. Results indicated that the maximum sub-harmonic amplitude occurred in the stimulus frequency range of 33-38 Hz for all subjects. The LQMMs showed a significant sub-harmonic amplitude reduction for the mild NPDR subjects compared to the controls; sub-harmonic amplitude for the NDR subjects did not differ significantly from the controls. In contrast, the fundamental response did not differ among the groups for stimulus frequencies between 33 and 38 Hz. Modeling these results indicated that subharmonic amplitude loss in mild NPDR subjects may be attributed to attenuated feedback occurring early in the retina, possibly at the synapse of cone photoreceptors and OFF bipolar cells.

The morphology of human rod ERGs obtained by silent substitution stimulation

Purpose

To record transient ERGs from the light-adapted human retina using silent substitution stimuli which selectively reflect the activity of rod photoreceptors. We aim to describe the morphology of these waveforms and examine how they are affected by the use of less selective stimuli and by retinal pathology.

Methods

Rod-isolating stimuli with square-wave temporal profiles (250/250 ms onset/offset) were presented using a 4 primary LED ganzfeld stimulator. Experiment 1: ERGs were recorded using a rod-isolating stimulus (63 ph Td, rod contrast, C_rod = 0.25) from a group (n = 20) of normal trichromatic observers. Experiment 2: Rod ERGs were recorded from a group (n = 5) using a rod-isolating stimulus (C_rod = 0.25) which varied in retinal illuminance from 40 to 10,000 ph Td. Experiment 3: ERGs were elicited using 2 kinds of non-isolating stimuli; (1) broadband and (2) rod-isolating stimuli which contained varying degrees of L- and M-cone excitation. Experiment 4: Rod ERGs were recorded from two patient groups with rod monochromacy (n = 3) and CSNB (type 1; n = 2).

Results

The rod-isolated ERGs elicited from normal subjects had a waveform with a positive onset component followed by a negative offset. Response amplitude was maximal at retinal illuminances <100 ph Td and was virtually abolished at 400 ph Td. The use of non-selective stimuli altered the ERG waveform eliciting more photopic-like ERG responses. Rod ERGs recorded from rod monochromats had similar features to those recorded from normal trichromats, in contrast to those recorded from participants with CSNB which had an electronegative appearance.

Conclusions

Our results demonstrate that ERGs elicited by silent substitution stimuli can selectively reflect the operation of rod photoreceptors in the normal, light-adapted human retina.

Rod Electroretinograms Elicited by Silent Substitution Stimuli from the Light-Adapted Human Eye

PURPOSE

To demonstrate that silent substitution stimuli can be used to generate electroretinograms (ERGs) that effectively isolate rod photoreceptor function in humans without the need for dark adaptation, and that this approach constitutes a viable alternative to current clinical standard testing protocols.

METHODS

Rod-isolating and non-isolating sinusoidal flicker stimuli were generated on a 4 primary light-emitting diode (LED) Ganzfeld stimulator to elicit ERGs from participants with normal and compromised rod function who had not undergone dark-adaptation. Responses were subjected to Fourier analysis, and the amplitude and phase of the fundamental were used to examine temporal frequency and retinal illuminance response characteristics.

RESULTS

Electroretinograms elicited by rod-isolating silent substitution stimuli exhibit low-pass temporal frequency response characteristics with an upper response limit of 30 Hz. Responses are optimal between 5 and 8 Hz and between 10 and 100 photopic trolands (Td). There is a significant correlation between the response amplitudes obtained with the silent substitution method and current standard clinical protocols. Analysis of signal-to-noise ratios reveals significant differences between subjects with normal and compromised rod function.

CONCLUSIONS

Silent substitution provides an effective method for the isolation of human rod photoreceptor function in subjects with normal as well as compromised rod function when stimuli are used within appropriate parameter ranges.

TRANSLATIONAL RELEVANCE

This method of generating rod-mediated ERGs can be achieved without time-consuming periods of dark adaptation, provides improved isolation of rod- from cone-based activity, and will lead to the development of faster clinical electrophysiologic testing protocols with improved selectivity.

An extended 15 Hz ERG protocol (1): the contributions of primary and secondary rod pathways and the cone pathway

The minimum in the amplitude versus flash strength curve of dark-adapted 15 Hz electroretinograms (ERGs) has been attributed to interactions between the primary and secondary rod pathways. The 15 Hz ERGs can be used to examine the two rod pathways in patients. However, previous studies suggested that the cone-driven pathway also contributes to the 15 Hz ERGs for flash strengths just above that of the minimum. We investigated cone pathway contributions to improve upon the interpretation of (abnormal) 15 Hz ERGs measured in patients. We recorded 15 Hz ERGs in five healthy volunteers, using a range of flash strengths that we extended to high values. The stimuli were varied in both colour (blue, green, amber, and red) and flash duration (short flash and square wave) in order to stimulate rods and cones in various ways. The differences in the responses to the four colours could be fully explained by the spectral sensitivity of rods for flash strengths up to approximately 12.5 log quanta·deg(-2). At higher flash strengths, higher-order harmonics appeared in the responses which could be attributed to cones being more sensitive than rods to higher frequencies. Furthermore, the amplitude curves of the blue and green responses showed a second minimum suggesting rod to cone interactions. We present a descriptive model of the contributions of the rod and cone pathways. In clinical application, we would advise using the short flash flicker instead of the square wave flicker, as the responses are of larger amplitude, and cone pathway contributions can be recognized from large higher-order harmonics.

The second harmonic of the electroretinogram to sinusoidal flicker: spatiotemporal properties and clinical application

The photopic, focal electroretinogram elicited by sinusoidal modulation (8 Hz) of the luminance of a uniform field (flicker electroretinogram) presented in the macular region contains two main components: the first harmonic at the stimulus frequency (1F) and the second harmonic at twice the stimulus frequency (2F). Physiologic and clinical studies have demonstrated that the 1F originates in the outer retina, whereas the 2F has multiple postreceptoral sources, with a contribution of the innermost retina. The 2F, unlike 1F, is selectively altered in amplitude and phase in the early stages of optic neuritis and glaucoma. Both 1F and 2F are altered in maculopathies. An additional property of the focal electroretinogram is that the 2F, unlike 1F, has a very limited summation area (i.e., the function relating 2F amplitude with stimulus area is saturated for central stimulus sizes of the order of the macular region). This overrepresentation of the macular activity suggests that the 2F component of the flicker electroretinogram may provide a specific macular test even for full-field stimuli presented through opacities of the optical media.

Rod flicker perception: scotopic duality, phase lags and destructive interference

Rod vision has a duality of organization: at mesopic luminances rod signals have access to a slow, sensitive pathway (which we refer to, following Stiles, as pi 0) and a fast, insensitive pathway (pi' 0). The phase lag between the two rod signals increases with frequency until at 15-Hz the rod signals transmitted through the two pathways emerge out-of-phase, so that destructive interference produces a nulling of the apparent flicker. Relative to the cones, the phase lag of pi' 0 is roughly half that of pi 0. Thus at 15-Hz pi' 0 signals can be out-of-phase with cone signals, so that the signals from the slower pathway, pi 0, are actually in phase with cone signals. We have investigated the frequency response, adaptation behavior and phase characteristics of the two rod processes. The slower process, pi 0 is more sensitive than pi' 0, and dominates from absolute threshold up to low mesopic levels. The adaptation of pi 0 seems not to be associated with a change in time constant, but rather with simple response compression or sensitivity scaling. The time constant of pi' 0, however, does change with adaptation. There are large differences in the way that light adaptation changes the sensitivity of the two processes: signals from pi'0 may evade part of the postreceptoral sensitivity regulating mechanism normally associated with rod vision. The ability of signals from pi 0 and pi' 0 to reinforce or cancel each other, however, suggests that they are later reunited in a common pathway.

Frequency dependence in scotopic flicker sensitivity

Sensitivity to rod-mediated (scotopic) flicker was parametrically studied in the parafoveal retina of human observers. Confirming prior studies, the present results show that sensitivity to scotopic flicker has many similarities to that at photopic levels. Specifically, our results show that the frequency response function for scotopic flicker is characterized by both low- and high-frequency cutoffs and that sensitivity to low frequencies is described by Weber's law. Overall, however, scotopic flicker sensitivity is characterized by higher increment thresholds and lower frequency tuning than photopic flicker. The influences of spatial factors and the prevailing level of illuminance on sensitivity is sufficiently different for relatively low (less than 3 Hz) and relatively high (greater than 5 Hz) temporal frequencies to suggest that they may be mediated by different channels. This possibility is also suggested by selective adaptation experiments. These show that adaptation to flicker frequencies of 3, 5, and 7 Hz have a similar influence on sensitivity to subsequent flicker which is different from the influence on 1 Hz flicker adaptation. Results are compared with prior evidence for channeling within both the scotopic and photopic visual systems.

Factors influencing threshold of the fundamental electrical response to sinusoidal excitation of human photoreceptors

The amplitude and phase of the fundamental Fourier component of the electroretinogram (e.r.g.) in response to sinusoidally modulated light were studied in the range 7-50 Hz. Sensitivity was best at the lowest frequency. The threshold-frequency relationship divided into two parts. A weak steady background depressed sensitivity of the low, but increased sensitivity of the high, frequency component. At 8 Hz a small test spot was 0.7 log10 units more effective on the most sensitive part of the retina than on the optic disk. On the fovea, it was 0.1-0.2 log10 units less effective than on the disk. The fovea was 0.7 log10 units more sensitive to 25 Hz than the blind spot. Psychophysical and e.r.g. dark-adaptation curves were similar, but the former was 10(4) times more sensitive than the latter. Four sets of experiments examined the possibility that the Fourier component of the e.r.g. response at the modulation frequency of 8 Hz during the 'rod' phase of the e.r.g. dark-adaptation curve arose from excitation of rods alone. The only hint of a possible cone contribution was a very small but systematic increase in phase delay with increase in background wave number found while measuring the field sensitivity action spectrum. No suggestion was found that the fundamental Fourier component of threshold e.r.g. responses at the modulation frequency of 25 Hz was influenced by photons absorbed in rods.

Analysis of the retina via suprafusion electroretinography

Electroretinographic (ERG) transient responses elicited in monkeys by abrupt changes in the periodicity of a rapidly intermittent (suprafusion) luminance stimulus were studied experimentally, and analyzed and interpreted through a theory of dynamic retinal responses. The suprafusion ERG transients are confirmed to behave in accord with theoretical expectation, as elemental responses (retinal Green's functions). By aid of the theory the ERG wave-forms can be reduced to two significant elements. One element, accounting for approximately two-thirds of the total ERG variance, is strictly linear, and correlates well with simultaneously evoked cortical (VEP) transients which were previously related to suprafusion perception in humans. The other element, comprising approximately one-third the ERG transient, is a rectification, with properties indicating that it may arise from a specific layer of retinal neurons (amacrine cells); on this assumption the theory demonstrates that high-frequency nonlinear ERG flicker can isolate activities proximal and distal to the rectifying (amacrine) layer. Thus, the hypothesis of an amacrine origin for the rectifying element entails the possibility that suprafusion ERG studies could accomplish in vivo "dissection" of the human retina.