Precision LED-based stimulator for focal electroretinography

Antioxidant Saffron and Central Retinal Function in ABCA4-Related Stargardt Macular Dystrophy

Retinal oxidative damage, associated with an ATP-binding cassette, sub-family A, member 4, also known as ABCA4 gene mutation, has been implicated as a major underlying mechanism for Stargardt disease/fundus flavimaculatus (STG/FF). Recent findings indicate that saffron carotenoid constituents crocins and crocetin may counteract retinal oxidative damage, inflammation and protect retinal cells from apoptosis. This pilot study aimed to evaluate central retinal function following saffron supplementation in STG/FF patients carrying ABCA4 mutations. Methods: in a randomized, double-blind, placebo-controlled study (clinicaltrials.gov: NCT01278277), 31 patients with ABCA4-related STG/FF and a visual acuity >0.25 were randomly assigned to assume oral saffron (20 mg) or placebo over a six month period and then reverted to P or S for a further six month period. Full ophthalmic examinations, as well as central 18° focal electroretinogram (fERG) recordings, were performed at baseline and after six months of either saffron or placebo. The fERG fundamental harmonic component was isolated by Fourier analysis. Main outcome measures were fERG amplitude (in µV) and phase (in degrees). The secondary outcome measure was visual acuity. Results: supplement was well tolerated by all patients throughout follow-up. After saffron, fERG amplitude was unchanged; after placebo, amplitude tended to decrease from baseline (mean change: −0.18 log µV, p < 0.05). Reverting the treatments, amplitude did not change significantly. fERG phase and visual acuity were unchanged throughout follow-up. Conclusions: short-term saffron supplementation was well tolerated and had no detrimental effects on the electroretinographic responses of the central retina and visual acuity. The current findings warrant further long-term clinical trials to assess the efficacy of saffron supplementation in slowing down the progression of central retinal dysfunction in ABCA4-related STG/FF.

A low-cost, portable, micro-controlled device for multi-channel LED visual stimulation

Light emitting diodes (LEDs) are extensively used as light sources to investigate visual and visually related function and dysfunction. Here, we describe the design of a compact, low-cost, stand-alone LED-based system that enables the configuration, storage and presentation of elaborate visual stimulation paradigms. The core functionality of this system is provided by a microcontroller whose ultra-low power consumption makes it well suited for long lasting battery applications. The effective use of hardware resources is managed by multi-layered architecture software that provides an intuitive and user-friendly interface. In the configuration mode, different stimulation sequences can be created and memorized for ten channels, independently. LED-driving current output can be set either as continuous or pulse modulated, up to 500 Hz, by duty cycle adjustments. In run mode, multiple-channel stimulus sequences are automatically applied according to the pre-programmed protocol. Steady state visual evoked potentials were successfully recorded in five subjects with no visible electromagnetic interferences from the stimulator, demonstrating the efficacy of combining our prototyped equipment with electrophysiological techniques. Finally, we discuss a number of possible improvements for future development of our project.

Lack of habituation in the light adapted flicker electroretinogram of normal subjects: a comparison with pattern electroretinogram

OBJECTIVE

Sustained pattern stimulation (SPS) induces habituation in the normal pattern electroretinogram (PERG). In this study, the authors evaluated whether sustained flicker stimulation (SFS) induces habituation in the normal flicker ERG (FERG).

METHODS

FERGs were elicited in normal volunteers by an 8Hz flicker stimulus, presented continuously over 3 min after 20 min of light adaptation. One stimulus temporal period was sampled and averaged in packets (n=20) of 60 events, each of 8s duration. Amplitudes and phases of the response 1st and 2nd harmonics (1F and 2F, respectively) were measured. FERG results were compared with those obtained by recording PERGs with a similar SPS paradigm.

RESULTS

During SFS, FERG 2F showed a modest increase in amplitude (about 25%, p<0.05). No changes were observed for the 1F amplitude and for the phase of both components. In contrast, PERG amplitude showed SPS-induced habituation, described by an exponential decay with a time constant of approximately 20s.

CONCLUSIONS

The normal FERG, unlike PERG, does not show habituation, suggesting that the adaptive changes of retinal neurons underlying FERG are different from those of PERG generators.

SIGNIFICANCE

Our findings may have implications for diagnosis and/or pathophysiology of retinal disorders involving the inner retina.

Retinal function following transpupillary thermotherapy for occult choroidal neovascularization in age-related macular degeneration: a short-term study by focal electroretinography

PURPOSE

To assess short-term changes in macular function after transpupillary thermotherapy (TTT) in patients with occult subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), using focal electroretinography (FERG).

METHODS

Twenty-five patients with occult subfoveal CNV due to AMD were treated with TTT delivered using an infrared (810 nm) diode laser (spot size 3.0 mm, laser power 400-600 mW, duration 60 seconds). All patients were clinically evaluated before, 1 and 6 weeks after treatment. Snellen visual acuity (VA) was measured at each visit. Fluorescein angiography (FA) was performed at baseline and 6 weeks after TTT. Focal ERGs were recorded in all patients immediately before and 1 week after TTT in response to an 18-degree diameter, 41 Hz flickering spot (630 nm) centred on the fovea, presented on a steady background in Maxwellian view. A subgroup of 12 patients was also re-tested by FERG at 6-weeks post-TTT.

RESULTS

No significant changes in mean FERG amplitude and phase were observed across the different recording sessions before and after TTT. One week after TTT, four patients had significant (> 2 SD from baseline variability) increases in FERG amplitude and/or phase advances, one had a decrease in amplitude and four had phase delays, compared to baseline. The remaining 15 patients had stable FERGs. Six weeks after TTT, four patients had significant increases in FERG amplitude and/or phase advances, four had decreases in amplitude and/or phase delays, and four had stable FERGs, compared to baseline. Improvement in FERG parameters after TTT was always associated with an improvement in VA and a decrease in exudation. Patients with post-TTT FERG deterioration had stable or deteriorated clinical pictures. At either 1 or 6 weeks post-TTT, the FERG amplitude increase was inversely correlated (p < 0.05) with the baseline FERG amplitude and VA.

CONCLUSIONS

Three major conclusions can be drawn: in a short-term follow-up, TTT was not found to be associated with significant changes in macular function; FERG improvement was associated with VA improvement, and the increase in FERG amplitude was greatest in patients with the worst baseline acuity.

The fundamental and second harmonic of the photopic flicker electroretinogram: temporal frequency-dependent abnormalities in retinitis pigmentosa

OBJECTIVES

The flicker electroretinogram (FERG) consists mainly of a linear (fundamental, 1F) and a non linear (second harmonic, 2F) component. Previous results indicate that 2F originates more proximally in the retina than 1F, and that retinitis pigmentosa (RP) may affect 2F to a greater extent than 1F. The aim of this study was to evaluate FERG 1F and 2F abnormalities in RP as a function of the stimulus temporal frequency (TF).

METHODS

Twelve patients with typical RP and 10 age-matched controls were examined. FERGs were recorded in response to uniform fields (18 degrees) presented in the macula on a light-adapting background. Stimuli were flickered sinusoidally at different, closely spaced TFs between 3.7 and 52 Hz. Amplitudes and phases of the Fourier analysed 1F and 2F components were measured. Components' apparent latencies were estimated from the rate at which phase lagged with TF.

RESULTS

When compared to controls, mean 1F amplitudes of patients were reduced at both low (3.7-12.6 Hz) and high (14-52 Hz) TFs, with greatest losses (0.5 log units) around the peaks (3.7 and 41 Hz) of the normal TF function. Mean 2F amplitudes were reduced mainly at low TFs, with greatest losses (0.5 log units) at 5-8 Hz. On average, the shape of the 2F, but not 1F amplitude versus TF function, differed between patients and controls, showing a selective attenuation at low TFs. Mean 1F apparent latencies were delayed at both low and high TFs, with greater delays at low (85 ms) than at high (33 ms) TFs. Mean 2F apparent latencies were delayed only at low TFs (58 ms).

CONCLUSIONS

In RP, 1F and 2F phase delays as well as 2F amplitude losses are dependent on TF, suggesting that FERG generators' subpopulations in both distal and proximal retina are differentially affected. Analysis of the FERG TF response is potentially useful to characterize cone system dysfunction in different genetic subtypes of RP.