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Jung R, Kempf M, Righetti G, Nasser F, Kühlewein L, Stingl K, Stingl K. Age-dependencies of the electroretinogram in healthy subjects. Doc Ophthalmol 2024:10.1007/s10633-024-09991-w. [PMID: 39251480 DOI: 10.1007/s10633-024-09991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 08/19/2024] [Indexed: 09/11/2024]
Abstract
OBJECTIVE The purpose of this study was to evaluate the age-dependency of amplitudes and implicit times in the electroretinograms (ERGs) of healthy individuals and provide clinicians and researchers with a reference for a variety of stimulus paradigms. DESIGN AND METHODS Full-field electroretinography was conducted on 73 healthy participants aged 14-73 using an extended ISCEV standard protocol that included an additional 9 Hz flicker stimulus for assessing rod function and special paradigms for isolated On-Off and S-cone responses. Correlation coefficients and best-fit regression models for each parameter's age-dependency were calculated. RESULTS Dark-adapted ERGs, in particular, displayed notable age-related alterations. The attenuation and delay of the b-wave with higher age were most significant in the dark-adapted, rod-driven 0.001 cd s/m2 flash ERG. The age-dependent reduction of the a-wave amplitude was strongest in the standard dark-adapted 3 cd s/m2 flash condition. Cone-driven, light-adapted responses to either flash or flicker stimuli displayed comparatively small alterations at higher age. S-cone function tended to diminish at an early age, but the effect was not significant in the whole population. CONCLUSION The results suggest that rod and cone function decline at different rates with age, with rods being generally more affected by aging. Nonetheless, response amplitudes displayed a wide variability across the whole sample.
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Affiliation(s)
- Ronja Jung
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany.
| | - Melanie Kempf
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany
- Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Giulia Righetti
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany
| | - Fadi Nasser
- University Eye Hospital, University of Leipzig, Leipzig, Germany
| | - Laura Kühlewein
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany
| | - Katarina Stingl
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany
- Center for Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Krunoslav Stingl
- Center for Ophthalmology, University Eye Hospital, University of Tuebingen, Elfriede-Aulhorn-Str.7, 72076, Tuebingen, Germany
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de Deus M, Petit C, Schwitzer T. ElectroRetinoGraphy toward an exploration of the therapeutic potential of antidepressants in patients with major depressive disorder: A scoping review of the literature. Neurosci Biobehav Rev 2024; 164:105833. [PMID: 39089420 DOI: 10.1016/j.neubiorev.2024.105833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/07/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
Major Depressive Disorder (MDD) is characterized by at least one major depressive episode. It requires medical attention typically involving the prescription of antidepressants. Remission in MDD patients is often difficult to achieve because of the limited effectiveness of these drugs. Nowadays, numerous patients undergo various antidepressant treatments, with subjective changes in their personal experiences being regularly monitored. Therefore, it is essential to find clinical and objective tools that offer a more tailored approach to antidepressant selection. The neurochemistry of the retina being similar to the brain, one promising approach would be to use ElectroRetinoGraphy (ERG) measurements on MDD patients requiring antidepressant treatment. Thus, the aim of this scoping review is to highlight effects of different classes of antidepressants on retinal function evaluated by full-field ERG (ffERG), Pattern ERG (PERG) and multifocal ERG (mfERG) waveforms in MDD patients. These ERG measurements could serve as pivotal indicators in defining patient profiles, facilitating a more objective and personalized approach to therapeutic interventions, thereby advancing precision psychiatry.
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Affiliation(s)
- Marie de Deus
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adulte et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, 1, rue du Docteur Archambault, Laxou 54 520, France
| | - Charlotte Petit
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adulte et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, 1, rue du Docteur Archambault, Laxou 54 520, France
| | - Thomas Schwitzer
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adulte et d'Addictologie du Grand Nancy, Centre Psychothérapique de Nancy, 1, rue du Docteur Archambault, Laxou 54 520, France.
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Pickel L, Kim SJ, Hacibekiroglu S, Nagy A, Lee J, Sung HK. The Circadian Clock of Müller Glia Is Necessary for Retinal Homeostasis and Neuronal Survival. THE AMERICAN JOURNAL OF PATHOLOGY 2024:S0002-9440(24)00290-6. [PMID: 39147235 DOI: 10.1016/j.ajpath.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 08/17/2024]
Abstract
Biological processes throughout the body are orchestrated in time through the regulation of local circadian clocks. The retina is among the most metabolically active tissues, with demands depending greatly on the light/dark cycle. Most cell types within the retina are known to express the circadian clock in rodents; however, retinal clock expression in the human has not previously been localized. Moreover, the effect of local circadian clock dysfunction on retinal homeostasis is incompletely understood. We demonstrate an age-dependent decline in circadian clock gene and protein expression in the human retina. Using an animal model of targeted Bmal1 deficiency, we identify the circadian clock of the retinal Müller glia as essential for neuronal survival, vascular integrity, and retinal function. These results suggest a potential role for the local retinal circadian clock within the Müller glia in age-related retinal disease and retinal degeneration.
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Affiliation(s)
- Lauren Pickel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Soo Jin Kim
- Department of Medical Science, AMIST, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea
| | - Sabiha Hacibekiroglu
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Andras Nagy
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Junyeop Lee
- Department of Medical Science, AMIST, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Translational Biomedical Research Group, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea.
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
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Freitag ST, Lengle MC, Klee S, Heinrich SP. Human Electroretinography Shows Little Polarity Specificity Following Full-Field Ramp Adaptation. Invest Ophthalmol Vis Sci 2024; 65:11. [PMID: 39106057 PMCID: PMC11309038 DOI: 10.1167/iovs.65.10.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose The ramp aftereffect, a visual phenomenon in which perception of light changes dynamically after exposure to sawtooth-modulated light, was first described in 1967. Despite decades of psychophysical research, location and mechanisms of its generation remain unknown. In this study, we investigated a potential retinal contribution to effect formation with specific emphasis on on-/off-pathway involvement. Methods A 100 ms flash electroretinogram (ERG) was employed to probe the adaptive state of retinal neurons after presentation of stimuli that were homogenous in space but modulated in time following a sawtooth pattern (upward or downward ramps at 2 Hz). Additionally, a psychophysical nulling experiment was performed. Results Psychophysics data confirmed previous findings that the ramp aftereffect opposes the adapting stimuli in ramp direction and is stronger after upward ramps. The ERG study revealed significant changes of activity in every response component in the low-frequency range (a-wave, b-wave, on-PhNR, d-wave and off-PhNR) and high-frequency range (oscillatory potentials) in amplitudes, peak times, or both. The changes are neither specific to the on- or off-response nor antagonistic between ramp directions. With downward ramp adaptation, effects were stronger. Neither amplitudes nor peak times were correlated with perception strength. Amplitudes and peak times were uncorrelated, and the effect diminished over time, ceasing almost completely with three seconds. Conclusions Despite abundant effects on retinal responses, the pattern of adaptational effects was not specific to the sawtooth nature of adaptation. Although not ruling out retinal contributions the present findings favor post-retinal mechanisms as the primary locus of the ramp aftereffect.
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Affiliation(s)
- Shalila T. Freitag
- Eye Center, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maren-Christina Lengle
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany
| | - Sascha Klee
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany
- Department of General Health Studies, Division Biostatistics and Data Science, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sven P. Heinrich
- Eye Center, Medical Center—University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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5
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Thompson DA, Bach M, McAnany JJ, Šuštar Habjan M, Viswanathan S, Robson AG. ISCEV standard for clinical pattern electroretinography (2024 update). Doc Ophthalmol 2024; 148:75-85. [PMID: 38488946 PMCID: PMC10954931 DOI: 10.1007/s10633-024-09970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
The pattern electroretinogram (PERG) is a localized retinal response evoked by a contrast-reversing pattern, usually a black and white checkerboard, which provides information about macular and retinal ganglion cell function. This document, from the International Society for Clinical Electrophysiology of Vision (ISCEV; www.iscev.org ) presents an updated and revised Standard for clinical PERG testing. This replaces the 2013 and all earlier versions. Minimum protocols for basic PERG stimuli, recording methods and reporting are specified, to promote consistency of methods for diagnosis and monitoring purposes, while responding to evolving clinical practices and technology. The main changes in the updated ISCEV Standard for clinical PERG include expanded guidance about large stimulus fields, stimulus parameters for simultaneous PERG and pattern visual evoked potential recording, baseline drift correction, and use of consistent ambient room lighting. These changes aim to provide a clinically relevant document about current practice which will facilitate good quality recordings and inter-laboratory comparisons.
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Affiliation(s)
- D A Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Sight and Sound Centre, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3AJ, UK.
- Great Ormond Street Institute for Child Health, University College London, London, UK.
| | - M Bach
- Eye Center, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J J McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA
| | - M Šuštar Habjan
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva ulica 46, 1000, Ljubljana, Slovenia
| | - S Viswanathan
- Department of Biological and Vision Sciences, State University of New York College of Optometry, New York, NY, USA
| | - A G Robson
- Department of Electrophysiology, Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
- Institute of Ophthalmology, University College London, London, UK
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Jolly JK, Grigg JR, McKendrick AM, Fujinami K, Cideciyan AV, Thompson DA, Matsumoto C, Asaoka R, Johnson C, Dul MW, Artes PH, Robson AG. ISCEV and IPS guideline for the full-field stimulus test (FST). Doc Ophthalmol 2024; 148:3-14. [PMID: 38238632 PMCID: PMC10879267 DOI: 10.1007/s10633-023-09962-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 02/21/2024]
Abstract
The full-field stimulus test (FST) is a psychophysical technique designed for the measurement of visual function in low vision. The method involves the use of a ganzfeld stimulator, as used in routine full-field electroretinography, to deliver full-field flashes of light. This guideline was developed jointly by the International Society for Clinical Electrophysiology of Vision (ISCEV) and Imaging and Perimetry Society (IPS) in order to provide technical information, promote consistency of testing and reporting, and encourage convergence of methods for FST. It is intended to aid practitioners and guide the formulation of FST protocols, with a view to future standardisation.
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Affiliation(s)
- J K Jolly
- Vision and Eye Research Institute, Anglia Ruskin University, Young Street, Cambridge, CB1 2LZ, UK.
| | - J R Grigg
- Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Eye Genetics Research Unit, Sydney Children's Hospitals Network, Save Sight Institute, Children's Medical Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - A M McKendrick
- Lions Eye Institute, University of Western Australia, Perth, Australia
- School of Allied Health, University of Western Australia, Crawley, Australia
| | - K Fujinami
- Laboratory of Visual Physiology, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Institute of Ophthalmology, University College London, London, UK
| | - A V Cideciyan
- Center for Hereditary Retinal Degenerations, Scheie Eye Institute, University of Pennsylvania, Philadelphia, USA
| | - D A Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic, Department of Ophthalmology, Sight and Sound Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C Matsumoto
- Department of Ophthalmology, Kindai University, Osakasayama, Japan
| | - R Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
- Seirei Christopher University, Hamamatsu, Shizuoka, Japan
- Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Shizuoka, Japan
| | - C Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
- School of Optometry, The Ohio State University, Columbus, IA, USA
| | - M W Dul
- Department of Biological and Vision Science, College of Optometry, State University of New York, New York, USA
| | - P H Artes
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - A G Robson
- Institute of Ophthalmology, University College London, London, UK
- Department of Electrophysiology, Moorfields Eye Hospital, London, UK
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Günter A, Belhadj S, Seeliger MW, Mühlfriedel R. The Mongolian gerbil as an advanced model to study cone system physiology. Front Cell Neurosci 2024; 18:1339282. [PMID: 38333056 PMCID: PMC10850313 DOI: 10.3389/fncel.2024.1339282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
In this work, we introduce a diurnal rodent, the Mongolian gerbil (Meriones unguiculatus) (MG) as an alternative to study retinal cone system physiology and pathophysiology in mice. The cone system is of particular importance, as it provides high-acuity and color vision and its impairment in retinal disorders is thus especially disabling. Despite their nocturnal lifestyle, mice are currently the most popular animals to study cone-related diseases due to the high availability of genetically modified models. However, the potential for successful translation of any cone-related results is limited due to the substantial differences in retinal organization between mice and humans. Alternatively, there are diurnal rodents such as the MG with a higher retinal proportion of cones and a macula-like specialized region for improved visual resolution, the visual streak. The focus of this work was the evaluation of the MG's cone system functionality using full-field electroretinography (ERG), together with a morphological assessment of its retinal/visual streak organization via angiography, optical coherence tomography (OCT), and photoreceptor immunohistochemistry. We found that rod system responses in MGs were comparable or slightly inferior to mice, while in contrast, cone system responses were much larger, more sensitive, and also faster than those in the murine counterparts, and in addition, it was possible to record sizeable ON and OFF ERG components. Morphologically, MG cone photoreceptor opsins were evenly distributed throughout the retina, while mice show a dorsoventral M- and S-opsin gradient. Additionally, each cone expressed a single opsin, in contrast to the typical co-expression of opsins in mice. Particular attention was given to the visual streak region, featuring a higher density of cones, elongated cone and rod outer segments (OSs), and an increased thickness of the inner and outer retinal layers in comparison to peripheral regions. In summary, our data render the MG a supreme model to investigate cone system physiology, pathophysiology, and to validate potential therapeutic strategies in that context.
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Affiliation(s)
- Alexander Günter
- Division of Ocular Neurodegeneration, Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
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Kaggwa MM, Prat S, Davids A, Robbins A, Erb B, Mamak M, Chaimowitz GA, Olagunju AT. Electroretinography and suicidal behaviors: a systematic review. BMC Psychiatry 2023; 23:948. [PMID: 38102572 PMCID: PMC10724949 DOI: 10.1186/s12888-023-05453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Electroretinogram (ERG) is one of the tools used to investigate the electrophysiological underpinnings of mental health illnesses and major clinical phenomena (e.g., suicide) to improve their diagnosis and care. While multiple studies have reported specific ERG changes among individuals with suicidal behaviors, we know of no review that has been done to characterize their findings to inform future research. METHODS This review included available literature concerning ERG and suicidal behaviors. The paper's first section briefly overviews the theoretical basis of ERG and neurotransmitters involved in suicidal behaviors. The second section describes the findings of a review of studies reporting ERG findings among individuals with suicidal behaviors. RESULTS Most reviewed studies reported normal amplitude and implicit time of the a-waves, but the latency in individuals with suicidal behaviors was lower than normal. Additionally, the b-waves amplitude was reduced, but the implicit time and latency were increased. The b-a amplitude ratio and oscillatory potential were decreased. CONCLUSION Despite identifying certain ERG correlates with suicidal behaviors in the existing studies, there is a need for adequately powered and methodologically robust studies to advance clinical translation.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada.
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Sebastien Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Arianna Davids
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Amara Robbins
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Bailea Erb
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Mini Mamak
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Gary Andrew Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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Constable PA, Loh L, Grigg JR. Suspected case of benign familial fleck retina with functional loss. Clin Case Rep 2023; 11:e8362. [PMID: 38130850 PMCID: PMC10733792 DOI: 10.1002/ccr3.8362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
Key Clinical Message Inherited retinal dystrophies typically affect vision in early childhood; however, this case highlights a late onset retinal dystrophy presenting in midlife and the need for extended visual electrophysiology testing to determine the etiology. Abstract A 53-year-old female was referred for visual electrophysiology following a routine optometric eye examination in which yellow flecks were noted in both fundi and the patient had reported a recent near accident whilst driving at night. There was no reported family history of eye disease. Retinal examination identified bilateral yellow punctate and irregularly shaped lesions throughout the posterior poles sparing the macula region. Fundus autofluorescence showed coinciding hyperfluorescence with the lesions and bilateral hypofluorescent crescents superior to the macular with corresponding retinal thinning. Visual fields and color vision were normal. ISCEV standard 20 min and extended 60-min dark adapted electroretinograms were recorded. Recovery to normal b-wave amplitudes was noted in the DA0.01 flash but reduced a-wave amplitudes were noted in the DA3 and DA10 flash following both dark adapted periods. Cone function was reduced but within normal limits. Genetic screening revealed a previously unreported variant of unknown significance in the gene PLA2G5:c.40 + 5del (rs1364254561) which is a member of the phospholipase A2 family and is associated with familial benign flecked retina.
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Affiliation(s)
- Paul A. Constable
- Flinders University, College of Nursing and Health SciencesCaring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Lynne Loh
- Flinders University, College of Nursing and Health SciencesCaring Futures InstituteAdelaideSouth AustraliaAustralia
| | - John R. Grigg
- Save Sight Institute, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Igawa Y, Amaki H, Kanno J, Tachibana M, Konno S, Yoshikawa Y, Matsumoto S, Shoji T, Makita J, Shinoda K. Evaluations of microvascular density by optical coherence tomography, angiography, and function by multifocal electroretinography of the macular area in eyes with branch retinal artery occlusion. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1255098. [PMID: 38983019 PMCID: PMC11182117 DOI: 10.3389/fopht.2023.1255098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/18/2023] [Indexed: 07/11/2024]
Abstract
Introduction It is reported that eyes with a branch retinal artery occlusion (BRAO) had normal full-field electroretinography (ERG) but the response of the multifocal electroretinography (mfERG) was reduced in the area of the arterial occlusion. Optical coherence tomography angiography (OCTA) is a recently appeared modality that can evaluate microvascularizations in different retinal layers and in different regions of the retina. The purpose of this study was to determine the density of the microcirculation and the function of the macular area of eyes with BRAO, and to determine whether they are significantly correlated. Methods The OCTA and mfERG findings of 7 eyes of 6 patients (3 men, 3 women) were studied. The mean age of the patients was 71.7±10.6 years. The OCTA examinations were made with volume scans of 3 × 3 and 6 × 6 mm squares centered on the fovea. The macular vessel densities (mVD) in the superficial retinal layer (SRL) and deep retinal layer (DRL) were measured for the superior and inferior halves of 3 × 3 and 6 × 6 mm diameter concentric circles. The mfERGs were recorded with targets set to stimulate the focal areas of the retina corresponding to the areas examined by OCTA. Results The OCTA examinations showed that the mVD of the 3 mm concentric circle in the SRL was significantly lower on the affected side than on the unaffected side (P = 0.022). No such difference was observed in the DRL. The N1 amplitude of the 20.2° concentric circle and the N1-P1 amplitude of the 10.1° concentric circle of the mfERGs were significantly smaller on the affected side than on the unaffected side (P = 0.047 and 0.031). A significant positive correlation was found between the mVD of the 6 mm concentric circle in the DRL and the P1-N2 amplitude of the 20.2° concentric circle (ρ = -0.929 and p = 0.003). Discussion These findings indicate that OCTA images may be able to show changes in the density of the retinal macular microcirculation, and the mfERGs may be able to show alterations in the function of the macular area of the eyes with BRAO. A layer-by-layer analysis of the local retinal microcirculation and function should help in determining the pathogenesis of BRAO.
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Affiliation(s)
- Yuro Igawa
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Haruna Amaki
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Junji Kanno
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Midori Tachibana
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Satomi Konno
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Yuji Yoshikawa
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Soiti Matsumoto
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
- Department of Ophthalmology, Matsumoto Eye Clinic, Awa, Japan
| | - Takuhei Shoji
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
- Department of Ophthalmology, Koedo Eye Institute, Kawagoei, Saitama, Japan
| | - Jun Makita
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
| | - Kei Shinoda
- Department of Ophthalmology, Saitama Medical University, Faculty of Medicine, Saitama, Japan
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Constable PA, Lim JKH, Thompson DA. Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies. Front Neurosci 2023; 17:1215097. [PMID: 37600004 PMCID: PMC10433210 DOI: 10.3389/fnins.2023.1215097] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.
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Affiliation(s)
- Paul A. Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jeremiah K. H. Lim
- Discipline of Optometry, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Dorothy A. Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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12
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Mahroo OA. Visual electrophysiology and "the potential of the potentials". Eye (Lond) 2023; 37:2399-2408. [PMID: 36928229 PMCID: PMC10397240 DOI: 10.1038/s41433-023-02491-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/09/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Visual electrophysiology affords direct, quantitative, objective assessment of visual pathway function at different levels, and thus yields information complementary to, and not necessarily obtainable from, imaging or psychophysical testing. The tests available, and their indications, have evolved, with many advances, both in technology and in our understanding of the neural basis of the waveforms, now facilitating more precise evaluation of physiology and pathophysiology. After summarising the visual pathway and current standard clinical testing methods, this review discusses, non-exhaustively, several developments, focusing particularly on human electroretinogram recordings. These include new devices (portable, non-mydiatric, multimodal), novel testing protocols (including those aiming to separate rod-driven and cone-driven responses, and to monitor retinal adaptation), and developments in methods of analysis, including use of modelling and machine learning. It is likely that several tests will become more accessible and useful in both clinical and research settings. In future, these methods will further aid our understanding of common and rare eye disease, will help in assessing novel therapies, and will potentially yield information relevant to neurological and neuro-psychiatric conditions.
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Affiliation(s)
- Omar A Mahroo
- Institute of Ophthalmology, University College London, 11-43 Bath Street, London, UK.
- Retinal and Genetics Services, Moorfields Eye Hospital, 162 City Road, London, UK.
- Section of Ophthalmology and Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Hospital Campus, Westminster Bridge Road, London, UK.
- Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, UK.
- Department of Translational Ophthalmology, Wills Eye Hospital, Philadelphia, PA, USA.
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13
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McCulloch DL, Bach M, Brigell M, Chan H, Hamilton R, Hogg C, Odom JV, Robson AG. ISCEV guidelines for calibration and verification of stimuli and recording instruments (2023 update). Doc Ophthalmol 2023:10.1007/s10633-023-09932-z. [PMID: 37269394 DOI: 10.1007/s10633-023-09932-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 06/05/2023]
Abstract
This document developed by the International Society for Clinical Electrophysiology of Vision (ISCEV) provides guidance for calibration and verification of stimulus and recording systems specific to clinical electrophysiology of vision. This guideline provides additional information for those using ISCEV Standards and Extended protocols and supersedes earlier Guidelines. The ISCEV guidelines for calibration and verification of stimuli and recording instruments (2023 update) were approved by the ISCEV Board of Directors 01, March 2023.
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Affiliation(s)
- Daphne L McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.
| | - Michael Bach
- Eye Center, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Hoover Chan
- Department of Ophthalmology, University of California, San Francisco, USA
- The Smith-Kettlewell Eye Research Institute, San Francisco, USA
| | - Ruth Hamilton
- Department of Clinical Physics and Bioengineering, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Chris Hogg
- Institute of Ophthalmology, University College London, London, UK
| | - J Vernon Odom
- Department of Ophthalmology and Visual Science, West Virginia University, Morgantown, WV, USA
- Department of Neuroscience, West Virginia University, Morgantown, WV, USA
| | - Anthony G Robson
- Institute of Ophthalmology, University College London, London, UK
- Department of Electrophysiology, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK
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14
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Flitcroft I, Ainsworth J, Chia A, Cotter S, Harb E, Jin ZB, Klaver CCW, Moore AT, Nischal KK, Ohno-Matsui K, Paysse EA, Repka MX, Smirnova IY, Snead M, Verhoeven VJM, Verkicharla PK. IMI-Management and Investigation of High Myopia in Infants and Young Children. Invest Ophthalmol Vis Sci 2023; 64:3. [PMID: 37126360 PMCID: PMC10153576 DOI: 10.1167/iovs.64.6.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children. Findings High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health of the child through a clinical evaluation that targets the commonest features associated with syndromic forms of myopia. Biometric evaluation (including axial length and corneal curvature) is important to distinguishing axial myopia from refractive myopia associated with abnormal development of the anterior segment. Additional investigation includes ocular imaging, electrophysiological tests, genetic testing, and involvement of pediatricians and clinical geneticists is often warranted. Following investigation, optical correction is essential, but this may be more challenging and complex than in older children. Application of myopia control interventions in this group of children requires a case-by-case approach due to the lack of evidence of efficacy and clinical heterogeneity of high myopia in young children. Conclusions High myopia in infants and young children is a rare condition with a different pattern of etiology to that seen in older children. The clinical management of such children, in terms of investigation, optical correction, and use of myopia control treatments, is a complex and often multidisciplinary process.
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Affiliation(s)
- Ian Flitcroft
- Children's Health Ireland (CHI) at Temple Street, Dublin, Ireland
- Centre for Eye Research Ireland, Technological University of Dublin, Dublin, Ireland
| | - John Ainsworth
- Birmingham Children's Hospital, Steelhouse Lane Birmingham, United Kingdom
| | | | - Susan Cotter
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, United States
| | - Elise Harb
- Wertheim School Optometry and Vision Science, Berkeley, California, United States
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Anthony T Moore
- University of California - San Francisco, School of Medicine, San Francisco, California, United States
| | - Ken K Nischal
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Evelyn A Paysse
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Michael X Repka
- Wilmer Eye Institute, The John Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | - Martin Snead
- Department of Vitreoretinal Research, John van Geest Centre for Brain Repair, University of Cambridge, United Kingdom
| | - Virginie J M Verhoeven
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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15
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Hagedorn JL, Dunn TM, Bhattarai S, Stephan C, Mathews KD, Pfeifer W, Drack AV. Electroretinogram abnormalities in FKRP-related limb-girdle muscular dystrophy (LGMDR9). Doc Ophthalmol 2023; 146:7-16. [PMID: 36399172 PMCID: PMC11171413 DOI: 10.1007/s10633-022-09909-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dystroglycanopathies are a heterogeneous group of membrane-related muscular dystrophies. The dystroglycanopathy phenotype includes a spectrum of severity ranging from severe congenital muscular dystrophy to adult-onset limb-girdle muscular dystrophy (LGMD). LGMDR9 is a dystroglycanopathy caused by mutations in the FKRP gene. Previous studies have characterized electroretinogram findings of dystroglycanopathy mouse models but have not been reported in humans. PURPOSE This study set out to characterize the electroretinogram in eight participants with LGMDR9. METHODS Eight participants were recruited from an ongoing dystroglycanopathy natural history study at the University of Iowa (NCT00313677). Inclusion criteria for the current study were children and adults > 6 years old with confirmed LGMDR9. Age similar controls were identified from our electrophysiology service normative control database. Full-field electroretinograms were recorded using ISCEV standards. Six of the eight participants underwent light-adapted ON/OFF testing. RESULTS The electronegative electroretinogram was not seen in any participants with LGMDR9. An unusual sawtooth pattern in the 30 Hz flicker with faster rise than descent was noted in all 8 participants. Our cases showed a decreased b-wave amplitude in light-adapted ON responses (p = 0.011) and decreased d-wave amplitude in light-adapted OFF responses (p = 0.015). Decreased b-wave amplitude in light-adapted 3.0 testing (p = 0.015) and decreased flicker ERG amplitudes were also detected (p = 0.0018). Additionally, compared to controls, participants with LGMDR9 had decreased a-wave amplitudes on dark-adapted 10 testing (p = 0.026). CONCLUSIONS Abnormal ON/OFF bipolar cell responses and sawtooth 30 Hz flicker waveforms on full-field electroretinogram may be specific for LGMDR9. If confirmed in a larger population and if related to disease stage, these tests are potential biomarkers which could be useful as endpoints in clinical treatment trials.
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Affiliation(s)
- Joshua L Hagedorn
- University of Iowa Carver College of Medicine, Iowa City, USA
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Taylor M Dunn
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sajag Bhattarai
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Carrie Stephan
- Stead Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Katherine D Mathews
- Stead Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Wanda Pfeifer
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
| | - Arlene V Drack
- University of Iowa Carver College of Medicine, Iowa City, USA.
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA.
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16
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Lindovsky J, Palkova M, Symkina V, Raishbrook MJ, Prochazka J, Sedlacek R. OCT and ERG Techniques in High-Throughput Phenotyping of Mouse Vision. Genes (Basel) 2023; 14:genes14020294. [PMID: 36833221 PMCID: PMC9956909 DOI: 10.3390/genes14020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
The purpose of the study is to demonstrate coherent optical tomography and electroretinography techniques adopted from the human clinical practice to assess the morphology and function of the mouse retina in a high-throughput phenotyping environment. We present the normal range of wild-type C57Bl/6NCrl retinal parameters in six age groups between 10 and 100 weeks as well as examples of mild and severe pathologies resulting from knocking out a single protein-coding gene. We also show example data obtained by more detailed analysis or additional methods useful in eye research, for example, the angiography of a superficial and deep vascular complex. We discuss the feasibility of these techniques in conditions demanding a high-throughput approach such as the systemic phenotyping carried out by the International Mouse Phenotyping Consortium.
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17
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Hung WC, Cheng HC, Wang AG. Melanoma-associated retinopathy with anti-TRPM1 autoantibodies showing concomitant Off-bipolar cell dysfunction. Doc Ophthalmol 2022; 145:263-270. [PMID: 36173494 DOI: 10.1007/s10633-022-09901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND To report the clinical features of a patient with melanoma-associated retinopathy (MAR) with anti-transient receptor potential cation channel, subfamily M, member 1 (TRPM1) autoantibodies showing concomitant Off-bipolar cell dysfunction. METHODS We evaluated a patient with a past history of scalp melanoma presented with sudden-onset shimmering photopsia in both eyes. MAR was confirmed with complete ophthalmic examinations, electronegative electroretinogram (ERG), and the presence of anti-TRPM1 autoantibodies by Western blot analysis. S-cone ERG and photopic On-Off ERG were studied in this patient as well. RESULTS The patient's best-corrected visual acuity was 6/30 in the right eye and 6/8.6 in the left eye. Fundus and OCT findings were unremarkable. Visual field test showed severe constriction in both eyes. His full-field ERG was electronegative. S-cone ERG recorded preservation of L/M-cone-mediated response and undetectable S-cone-mediated response. Photopic On-Off ERG disclosed attenuated On- and Off-response. Western blot analysis confirmed immunoreactivity of the patient's serum to a 30 kDa TRPM1 recombinant protein. Whole-body positron emission tomography scan detected lymph node metastases in the neck. CONCLUSIONS Anti-TRPM1 autoantibody-positive MAR varies greatly in its presentation and clinical course. We present a case of anti-TRPM1 autoantibody-positive MAR with atypical feature of Off-bipolar cell involvement. A complete electroretinographic study together with identification of the pathogenic antiretinal autoantibodies may help better understand and subclassify the disease in the future.
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Affiliation(s)
- Wei-Che Hung
- Department of Ophthalmology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan
| | - Hui-Chen Cheng
- Department of Ophthalmology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Program in Molecular Medicine, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Life Sciences and Institute of Genome Sciences, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. .,Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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18
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Barboni MTS, Joachimsthaler A, Roux MJ, Nagy ZZ, Ventura DF, Rendon A, Kremers J, Vaillend C. Retinal dystrophins and the retinopathy of Duchenne muscular dystrophy. Prog Retin Eye Res 2022:101137. [DOI: 10.1016/j.preteyeres.2022.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
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19
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Petersen-Jones SM, Pasmanter N, Occelli LM, Gervais KJ, Mowat FM, Querubin J, Winkler PA. An unusual inherited electroretinogram feature with an exaggerated negative component in dogs. Vet Ophthalmol 2022; 25:385-397. [PMID: 35713167 PMCID: PMC9540982 DOI: 10.1111/vop.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess an inherited abnormal negative response electroretinogram (NRE) that originated in a family of Papillon dogs. ANIMALS STUDIED Thirty-eight dogs (Papillons, or Papillon cross Beagles or Beagles). PROCEDURES Dogs underwent routine ophthalmic examination and a detailed dark-adapted, light-adapted and On-Off electroretinographic study. Vision was assessed using a four-choice exit device. Spectral-domain optical coherence tomography (SD-OCT) was performed on a subset of dogs. Two affected males were outcrossed to investigate the mode of inheritance of the phenotype. RESULTS The affected dogs had an increased underlying negative component to the ERG. This was most pronounced in the light-adapted ERG, resulting in a reduced b-wave and an exaggerated photopic negative response (PhNR). Changes were more pronounced with stronger flashes. Similarly, the On-response of the On-Off ERG had a reduced b-wave and a large post-b-wave negative component. The dark-adapted ERG had a significant increase in the scotopic threshold response (STR) and a significant reduction in the b:a-wave ratio. Significant changes could be detected at 2 months of age but became more pronounced with age. Vision testing using a four-choice device showed affected dogs had reduced visual performance under the brightest light condition. There was no evidence of a degenerative process in the affected dogs up to 8.5 years of age. Test breeding results suggested the NRE phenotype had an autosomal dominant mode of inheritance. CONCLUSIONS We describe an inherited ERG phenotype in Papillon dogs characterized by an underlying negative component affecting both dark- and light-adapted ERG responses.
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Affiliation(s)
- Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Nate Pasmanter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Laurence M Occelli
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Kristen J Gervais
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.,South Shore Animal Hospital, Boston, Massachusetts, USA
| | - Freya M Mowat
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.,Department of Surgical Sciences School of Veterinary Medicine, and Department of Ophthalmology and Visual Sciences School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Janice Querubin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Paige A Winkler
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
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20
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Tyler CW, Likova LT. Brain trauma impacts retinal processing: photoreceptor pathway interactions in traumatic light sensitivity. Doc Ophthalmol 2022; 144:179-190. [PMID: 35445376 PMCID: PMC9192363 DOI: 10.1007/s10633-022-09871-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/12/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Concussion-induced light sensitivity, or traumatic photalgia, is a lifelong debilitating problem for upwards of 50% of mild traumatic brain injury (mTBI) cases, though of unknown etiology. We employed spectral analysis of electroretinographic (ERG) responses to assess retinal changes in mTBI as a function of the degree of photalgia. METHODS The design was a case-control study of the changes in the ERG waveform as a function of level of light sensitivity in individuals who had suffered incidents of mild traumatic brain injury. The mTBI participants were categorized into non-, mild-, and severe-photalgic groups based on their spectral nociophysical settings. Light-adapted ERG responses were recorded from each eye for 200 ms on-off stimulation of three spectral colors (R:red, G:green, and B:blue) and their sum (W:white) at the highest pain-free intensity level for each participant. The requirement of controls for testing hypersensitive individuals at lower light levels was addressed by recording a full light intensity series in the control group. RESULTS Both the b-wave and the photopic negative response (PhNR) were significantly reduced in the non-photalgic mTBI group relative to controls. In the photalgic groups, the main b-wave peak shifted to the timing of the rod b-wave, with reduced amplitude at the timing of the cone response. CONCLUSION These results suggest the interpretation that the primary etiology of the painful light sensitivity in mTBI is release of the rod pathway from cone-mediated inhibition at high light levels, causing overactivation of the rod pathway.
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Affiliation(s)
- Christopher W Tyler
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore Street, San Francisco, 94115, USA.
- Division of Optometry and Vision Science, School of Health Sciences, City University of London, London, UK.
| | - Lora T Likova
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore Street, San Francisco, 94115, USA
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21
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Schiff ER, Aychoua N, Nutan S, Davagnanam I, Moore AT, Robson AG, Patel CK, Webster AR, Arno G. Variability of retinopathy consequent upon novel mutations in LAMA1. Ophthalmic Genet 2022; 43:671-678. [PMID: 35616092 DOI: 10.1080/13816810.2022.2076283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Bi-allelic mutations in LAMA1 (laminin 1) (OMIM # 150320) cause Poretti-Boltshauser Syndrome (PTBHS), a rare non-progressive cerebellar dysplasia disorder with ophthalmic manifestations including oculomotor apraxia, high myopia, and retinal dystrophy. Only 38 variants, nearly all loss of function have been reported. Here, we describe novel LAMA1 variants and detailed retinal manifestations in two unrelated families. METHODS Whole-genome sequencing was conducted on three siblings of a consanguineous family with myopia and retinal dystrophy and on a child from an unrelated non-consanguineous couple. Clinical evaluation included full ophthalmic examination, detailed colour, autofluorescence retinal imaging, retinal optical coherence tomography (OCT), fluorescein angiography under anesthesia, and pattern and full-field electroretinography. RESULTS Genetic analysis revealed a novel homozygous LAMA1 frameshift variant, c.1492del p.(Arg498Glyfs *25), in the affected siblings in family 1 and a novel frameshift c.3065del p.(Gly1022Valfs *2) and a deletion spanning exons 17-23 in an unrelated individual in family 2. Two of the three siblings and the unrelated child had oculomotor apraxia in childhood; none of the siblings had symptoms of other neurological dysfunction as adults. All four had myopia. The affected siblings had a qualitatively similar retinopathy of wide-ranging severity. The unrelated patient had a severe abnormality of retinal vascular development, which resulted in vitreous haemorrhage and neovascular glaucoma in the left eye and a rhegmatogenous retinal detachment in the right eye. CONCLUSIONS This report describes the detailed retinal structural and functional consequences of LAMA1 deficiency in four patients from two families, and these exhibit significant variability with evidence of both retinal dystrophy and abnormal and incomplete retinal vascularisation.
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Affiliation(s)
- Elena R Schiff
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Savita Nutan
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - Indran Davagnanam
- Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK.,UCL Institute of Neurology, London, UK
| | - Anthony T Moore
- UCL Institute of Ophthalmology, London, UK.,University of California, San Francisco, San Francisco, California, USA
| | - A G Robson
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - C K Patel
- Great Ormond Street Hospital, London, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Andrew R Webster
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Gavin Arno
- Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
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22
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Robson AG, Frishman LJ, Grigg J, Hamilton R, Jeffrey BG, Kondo M, Li S, McCulloch DL. ISCEV Standard for full-field clinical electroretinography (2022 update). Doc Ophthalmol 2022; 144:165-177. [PMID: 35511377 PMCID: PMC9192408 DOI: 10.1007/s10633-022-09872-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 100.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
The full-field electroretinogram (ERG) is a mass electrophysiological response to diffuse flashes of light and is used widely to assess generalized retinal function. This document, from the International Society for Clinical Electrophysiology of Vision (ISCEV), presents an updated and revised ISCEV Standard for clinical ERG testing. Minimum protocols for basic ERG stimuli, recording methods and reporting are specified, to promote consistency of methods for diagnosis, monitoring and inter-laboratory comparisons, while also responding to evolving clinical practices and technology. The main changes in this updated ISCEV Standard for clinical ERGs include specifying that ERGs may meet the Standard without mydriasis, providing stimuli adequately compensate for non-dilated pupils. There is more detail about analysis of dark-adapted oscillatory potentials (OPs) and the document format has been updated and supplementary content reduced. There is a more detailed review of the origins of the major ERG components. Several tests previously tabulated as additional ERG protocols are now cited as published ISCEV extended protocols. A non-standard abbreviated ERG protocol is described, for use when patient age, compliance or other circumstances preclude ISCEV Standard ERG testing.
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Affiliation(s)
- Anthony G Robson
- Department of Electrophysiology, Moorfields Eye Hospital, 162 City Road, London, EC1V2PD, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | | | - John Grigg
- Save Sight Institute Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ruth Hamilton
- Department of Clinical Physics and Bioengineering, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Brett G Jeffrey
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, MD, 20892-1860, USA
| | - Mineo Kondo
- Mie University Graduate School of Medicine, Tsu, Japan
| | - Shiying Li
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian, China
- Eye Institute of Xiamen University (EIXU), Fujian, China
| | - Daphne L McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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Pasmanter N, Occelli LM, Komáromy AM, Petersen-Jones SM. Use of extended protocols with nonstandard stimuli to characterize rod and cone contributions to the canine electroretinogram. Doc Ophthalmol 2022; 144:81-97. [PMID: 35247111 PMCID: PMC10426558 DOI: 10.1007/s10633-022-09866-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In this study, we assessed several extended electroretinographic protocols using nonstandard stimuli. Our aim was to separate and quantify the contributions of different populations of retinal cells to the overall response, both to assess normal function and characterize dogs with inherited retinal disease. METHODS We investigated three different protocols for measuring the full-field flash electroretinogram-(1) chromatic dark-adapted red and blue flashes, (2) increasing luminance blue-background, (3) flicker with fixed frequency and increasing luminance, and flicker with increasing frequency at a fixed luminance-to assess rod and cone contributions to electroretinograms recorded in phenotypically normal control dogs and dogs lacking rod function. RESULTS Temporal separation of the rod- and cone-driven responses is possible in the fully dark-adapted eye using dim red flashes. A- and b-wave amplitudes decrease at different rates with increasing background luminance in control dogs. Flicker responses elicited with extended flicker protocols are well fit with mathematical models in control dogs. Dogs lacking rod function demonstrated larger amplitude dark-adapted compared to light-adapted flicker responses. CONCLUSIONS Using extended protocols of the full-field electroretinogram provides additional characterization of the health and function of different populations of cells in the normal retina and enables quantifiable comparison between phenotypically normal dogs and those with retinal disease.
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Affiliation(s)
- Nate Pasmanter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, D-208, East Lansing, MI, 48824, USA
| | - Laurence M Occelli
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, D-208, East Lansing, MI, 48824, USA
| | - András M Komáromy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, D-208, East Lansing, MI, 48824, USA
| | - Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, D-208, East Lansing, MI, 48824, USA.
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Blum MC, Hunold A, Solf B, Klee S. Ocular direct current stimulation affects retinal ganglion cells. Sci Rep 2021; 11:17573. [PMID: 34475417 PMCID: PMC8413326 DOI: 10.1038/s41598-021-96401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Ocular current stimulation (oCS) with weak current intensities (a few mA) has shown positive effects on retinal nerve cells, which indicates that neurodegenerative ocular diseases could be treated with current stimulation of the eye. During oCS, a significant polarity-independent reduction in the characteristic P50 amplitude of a pattern-reversal electroretinogram was found, while no current stimulation effect was found for a full field electroretinogram (ffERG). The ffERG data indicated a trend for a polarity-dependent influence during oCS on the photopic negative response (PhNR) wave, which represents the sum activity of the retinal ganglion cells. Therefore, an ffERG with adjusted parameters for the standardized measurement of the PhNR wave was combined with simultaneous oCS to study the potential effects of direct oCS on cumulative ganglion cell activity. Compared with that measured before oCS, the PhNR amplitude in the cathodal group increased significantly during current stimulation, while in the anodal and sham groups, no effect was visible (α = 0.05, pcathodal = 0.006*). Furthermore, repeated-measures ANOVA revealed a significant difference in PhNR amplitude between the anodal and cathodal groups as well as between the cathodal and sham groups (p* ≤ 0.0167, pcathodal − anodal = 0.002*, pcathodal − sham = 0.011*).
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Affiliation(s)
- Maren-Christina Blum
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany.
| | - Alexander Hunold
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Benjamin Solf
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Sascha Klee
- Institute for Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany.,Department of General Health Studies, Division Biostatistics and Data Science, Karl Landsteiner University of Health Sciences, Krems, Austria
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Jiang X, Mahroo OA. Negative electroretinograms: genetic and acquired causes, diagnostic approaches and physiological insights. Eye (Lond) 2021; 35:2419-2437. [PMID: 34127841 PMCID: PMC8377097 DOI: 10.1038/s41433-021-01604-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 02/07/2023] Open
Abstract
The dark-adapted human electroretinogram (ERG) response to a standard bright flash includes a negative-going a-wave followed by a positive-going b-wave that crosses the baseline. An electronegative waveform (or negative ERG) results when the b-wave is selectively reduced such that the ERG fails to cross the baseline following the a-wave. In the context of a normally sized a-wave, it indicates a site of retinal dysfunction occurring after phototransduction (commonly at the photoreceptor to bipolar cell synapse). This is an important finding. In genetic disease, the pattern of ERG abnormality can point to variants in a small group of genes (frequently those associated with congenital stationary night blindness and X-linked retinoschisis, but negative ERGs can also be seen in other conditions including syndromic disease). In acquired disease, there are numerous causes, but specific features may point to melanoma-associated retinopathy (MAR). In some cases, the visual symptoms precede the diagnosis of the melanoma and so the ERG findings can initiate investigations facilitating early detection and treatment. Negative ERGs can occur in other paraneoplastic conditions, and in a range of other diseases. This review will outline the physiological basis for the negative ERG, report prevalences in the literature from different cohorts, discuss the range of causes, displaying examples of a number of ERG phenotypes, highlight features of a clinical approach to patients, and briefly discuss further insights relating to current flows shaping the a-wave trough and from single-cell transcriptome analysis.
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Affiliation(s)
- Xiaofan Jiang
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.439257.e0000 0000 8726 5837Retinal and Genetics Services, Moorfields Eye Hospital, London, UK ,grid.425213.3Section of Ophthalmology and Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital Campus, London, UK
| | - Omar A. Mahroo
- grid.83440.3b0000000121901201Institute of Ophthalmology, University College London, London, UK ,grid.439257.e0000 0000 8726 5837Retinal and Genetics Services, Moorfields Eye Hospital, London, UK ,grid.425213.3Section of Ophthalmology and Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital Campus, London, UK ,grid.5335.00000000121885934Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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26
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Abstract
A 45-year-old man presented with longstanding poor vision in both eyes. His medical history was significant for a remote overdose of quinine. After the ingestion, he fell into a coma and on awakening was not able to see light out of both eyes. Several days later, his central vision began to gradually recover and continued to improve over the span of several months. Presently, he had 20/20 visual acuity in both eyes with severely constricted peripheral visual fields. There were bilateral iris transillumination defects, and both optic nerves were diffusely pale with attenuated vasculature and inner retinal thinning on ocular coherence tomography. We present a patient with the stereotypical findings and natural history of quinine toxicity, a rare and not widely known cause of toxic optic neuropathy and retinopathy.
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Kong AW, Turner ML, Chan H, Stamper RL, Arnold BF, Della Santina L, Ou Y. Asymmetric Functional Impairment of ON and OFF Retinal Pathways in Glaucoma. OPHTHALMOLOGY SCIENCE 2021; 1:100026. [PMID: 35756578 PMCID: PMC9232180 DOI: 10.1016/j.xops.2021.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
Purpose To investigate ON-pathway versus OFF-pathway dysfunction in glaucoma using handheld electroretinography (ERG) with a temporally modulated sinusoidal flicker stimulus. Design Cross-sectional study. Participants Fifty-nine participants accounting for 104 eyes, comprised of 19 control eyes, 26 glaucoma suspect eyes, and 59 glaucoma eyes. Methods Participants underwent portable ERG testing, which included the photopic flash, photopic flicker, photopic negative response stimulus, ON-OFF stimulus, and a custom-written sinusoidal flicker stimulus that was modulated from 50 to 0.3 Hz. Main Outcome and Measures The ERG response amplitudes were measured by the handheld ERG. For the custom-written sinusoidal flicker stimulus, we derived and compared the log10 first harmonic frequency response amplitudes. Patient discomfort and fatigue after ERG testing were rated on a scale from 1 to 5. Results Baseline demographics were not significantly different between groups, except for ocular characteristics. Analysis was performed adjusting for participant age, sex, race, and dilation status, and the sinusoidal frequency responses were stratified at 10 Hz because higher frequencies are associated with the OFF-pathway, whereas lower frequencies are associated with the ON-pathway. After stratification, glaucoma eyes showed an adjusted decrease of 32.1% at frequencies of more than 10 Hz (95% confidence interval [CI], -51.8% to -4.1%; P = 0.03). For 10 Hz stimulus frequencies or less, an adjusted 11.5% reduction was found (95% CI, -39.5% to 29.1%; P = 0.50). Glaucoma suspect eyes did show a decreased response, but this was not significant at either frequency range. When comparing handheld ERG with traditional visual field assessments, participants found the handheld ERG to result in much less discomfort and fatigue. Conclusions Our finding that glaucoma participants showed greater decreases in ERG response at higher frequencies supports the hypothesis that the OFF-pathway may be more vulnerable in human glaucoma. Using a handheld ERG device with a sinusoidal flicker stimulus may provide an objective assessment of visual function in glaucoma.
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Affiliation(s)
- Alan W. Kong
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Marcus L. Turner
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Hoover Chan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Robert L. Stamper
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Benjamin F. Arnold
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Luca Della Santina
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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28
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Clinical electrophysiology of vision-commentary on current status and future prospects. Eye (Lond) 2021; 35:2341-2343. [PMID: 34045684 PMCID: PMC8376889 DOI: 10.1038/s41433-021-01592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/17/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
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29
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Georgiou M, Robson AG, Fujinami K, Leo SM, Vincent A, Nasser F, Cabral De Guimarães TA, Khateb S, Pontikos N, Fujinami-Yokokawa Y, Liu X, Tsunoda K, Hayashi T, Vargas ME, Thiadens AAHJ, de Carvalho ER, Nguyen XTA, Arno G, Mahroo OA, Martin-Merida MI, Jimenez-Rolando B, Gordo G, Carreño E, Ayuso C, Sharon D, Kohl S, Huckfeldt RM, Wissinger B, Boon CJF, Banin E, Pennesi ME, Khan AO, Webster AR, Zrenner E, Héon E, Michaelides M. KCNV2-Associated Retinopathy: Genetics, Electrophysiology, and Clinical Course-KCNV2 Study Group Report 1. Am J Ophthalmol 2021; 225:95-107. [PMID: 33309813 PMCID: PMC8186730 DOI: 10.1016/j.ajo.2020.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate genetics, electrophysiology, and clinical course of KCNV2-associated retinopathy in a cohort of children and adults. STUDY DESIGN This was a multicenter international clinical cohort study. METHODS Review of clinical notes and molecular genetic testing. Full-field electroretinography (ERG) recordings, incorporating the international standards, were reviewed and quantified and compared with age and recordings from control subjects. RESULTS In total, 230 disease-associated alleles were identified from 117 patients, corresponding to 75 different KCNV2 variants, with 28 being novel. The mean age of onset was 3.9 years old. All patients were symptomatic before 12 years of age (range, 0-11 years). Decreased visual acuity was present in all patients, and 4 other symptoms were common: reduced color vision (78.6%), photophobia (53.5%), nyctalopia (43.6%), and nystagmus (38.6%). After a mean follow-up of 8.4 years, the mean best-corrected visual acuity (BCVA ± SD) decreased from 0.81 ± 0.27 to 0.90 ± 0.31 logarithm of minimal angle of resolution. Full-field ERGs showed pathognomonic waveform features. Quantitative assessment revealed a wide range of ERG amplitudes and peak times, with a mean rate of age-associated reduction indistinguishable from the control group. Mean amplitude reductions for the dark-adapted 0.01 ERG, dark-adapted 10 ERG a-wave, and LA 3.0 30 Hz and LA3 ERG b-waves were 55%, 21%, 48%, and 74%, respectively compared with control values. Peak times showed stability across 6 decades. CONCLUSION In KCNV2-associated retinopathy, full-field ERGs are diagnostic and consistent with largely stable peripheral retinal dysfunction. Report 1 highlights the severity of the clinical phenotype and established a large cohort of patients, emphasizing the unmet need for trials of novel therapeutics.
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Affiliation(s)
- Michalis Georgiou
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Anthony G Robson
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Kaoru Fujinami
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Ontario, Japan
| | - Shaun M Leo
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Fadi Nasser
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Samer Khateb
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nikolas Pontikos
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Yu Fujinami-Yokokawa
- University College London Institute of Ophthalmology, London, United Kingdom; Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Xiao Liu
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Ontario, Japan
| | - Kazushige Tsunoda
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Ophthalmology, Keio University School of Medicine, Tokyo, Ontario, Japan
| | - Takaaki Hayashi
- Department of Ophthalmology, Katsushika Medical Center, The Jikei University School of Medicine, Tokyo, Japan
| | - Mauricio E Vargas
- Department of Ophthalmology, Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, USA
| | | | - Emanuel R de Carvalho
- University College London Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Xuan-Thanh-An Nguyen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gavin Arno
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Omar A Mahroo
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Maria Inmaculada Martin-Merida
- Department of Genetics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Belen Jimenez-Rolando
- Department of Ophthalmology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain
| | - Gema Gordo
- Department of Genetics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Ester Carreño
- Department of Ophthalmology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Ayuso
- Department of Genetics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital-Universidad Autónoma de Madrid, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Dror Sharon
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Susanne Kohl
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Rachel M Huckfeldt
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Bernd Wissinger
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Camiel J F Boon
- Department of Ophthalmology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands; Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eyal Banin
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mark E Pennesi
- Department of Ophthalmology, Oregon Health and Science University, Casey Eye Institute, Portland, Oregon, USA
| | - Arif O Khan
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, Ohio, USA; Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Andrew R Webster
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Elise Héon
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom.
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Delayed on- and off-retinal responses of cones pathways in regular cannabis users: An On-Off flash electroretinogram case-control study. J Psychiatr Res 2021; 136:312-318. [PMID: 33636687 DOI: 10.1016/j.jpsychires.2021.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
Abstract
The retina is considered a useful area for investigating synaptic transmission abnormalities in neuropsychiatric disorders, including as a result of using cannabis, the most widely consumed illicit substance in the developed world. The impact of regular cannabis use on retinal function has already been evaluated, using pattern and flash electroretinogram (ERG) to demonstrate a delay in ganglion and bipolar cell response. Using multifocal ERG, it was showed that the delay to be preferentially located in the central retina. ERG tests do not separately examine the impact of cannabis on the On and Off pathways. The purpose of this study is to assess On and Off pathway function using On-Off ERG. We conducted an On-Off ERG test in 42 regular cannabis users and 26 healthy controls. The protocol was compliant with the International Society for Clinical Electrophysiology of Vision (ISCEV) standards. Amplitude and peak time were measured for the a-, b- and d-waves. Results in the regular cannabis users showed a significant increase in the latencies of both the b- and the d-wave (p = 0.020, p = 0.022, respectively, Mann-Whitney U test), with no change in the wave amplitudes. A-wave peak time and amplitude were unchanged. These findings are reflective of an effect of regular cannabis use on the On and Off pathways and are consistent with previous findings which also identified increases in retinal neuron response times. We confirm here that regular cannabis use impacts the post-receptoral cones pathway at the level of bipolar cells, affecting the On and Off pathways.
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31
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Memmi B, Miere A, Zambrowski O, Souied EH. [Decreased visual acuity as presenting sign of a late case of congenital stationary night blindness: The role of ERG]. J Fr Ophtalmol 2021; 44:e365-e368. [PMID: 33608178 DOI: 10.1016/j.jfo.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 11/18/2022]
Affiliation(s)
- B Memmi
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est-Créteil, 40, avenue de Verdun, 94000 Créteil, France.
| | - A Miere
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est-Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - O Zambrowski
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est-Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - E H Souied
- Service d'ophtalmologie, centre hospitalier intercommunal de Créteil, université Paris Est-Créteil, 40, avenue de Verdun, 94000 Créteil, France
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ISCEV standard for clinical multifocal electroretinography (mfERG) (2021 update). Doc Ophthalmol 2021; 142:5-16. [PMID: 33492495 PMCID: PMC7906932 DOI: 10.1007/s10633-020-09812-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/09/2020] [Indexed: 11/15/2022]
Abstract
The multifocal electroretinogram (mfERG) is an electrophysiological test that allows the function of multiple discrete areas of the retina to be tested simultaneously. This document, from the International Society for Clinical Electrophysiology of Vision (ISCEV), presents an updated and revised ISCEV standard for clinical mfERG and defines minimum protocols for basic clinical mfERG recording and reporting so that responses can be recognized and compared from different laboratories worldwide. The major changes compared with the previous mfERG standard relate to the minimum length of m-sequences used for recording, reporting of results and a change in document format, to be more consistent with other ISCEV standards.
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Széll N, Fehér T, Maróti Z, Kalmár T, Latinovics D, Nagy I, Orosz ZZ, Janáky M, Facskó A, Sohajda Z. Myopia-26, the female-limited form of early-onset high myopia, occurring in a European family. Orphanet J Rare Dis 2021; 16:45. [PMID: 33482870 PMCID: PMC7825233 DOI: 10.1186/s13023-021-01673-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Female-limited early-onset high myopia, also called Myopia-26 is a rare monogenic disorder characterized by severe short sightedness starting in early childhood and progressing to blindness potentially by the middle ages. Despite the X-linked locus of the mutated ARR3 gene, the disease paradoxically affects females only, with males being asymptomatic carriers. Previously, this disease has only been observed in Asian families and has not gone through detailed investigation concerning collateral symptoms or pathogenesis. Results We found a large Hungarian family displaying female-limited early-onset high myopia. Whole exome sequencing of two individuals identified a novel nonsense mutation (c.214C>T, p.Arg72*) in the ARR3 gene. We carried out basic ophthalmological testing for 18 family members, as well as detailed ophthalmological examination (intraocular pressure, axial length, fundus appearance, optical coherence tomography, visual field- testing) as well as colour vision- and electrophysiology tests (standard and multifocal electroretinography, pattern electroretinography and visual evoked potentials) for eight individuals. Ophthalmological examinations did not reveal any signs of cone dystrophy as opposed to animal models. Electrophysiology and colour vision tests similarly did not evidence a general cone system alteration, rather a central macular dysfunction affecting both the inner and outer (postreceptoral and receptoral) retinal structures in all patients with ARR3 mutation. Conclusions This is the first description of a Caucasian family displaying Myopia-26. We present two hypotheses that could potentially explain the pathomechanism of this disease.
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Affiliation(s)
- Noémi Széll
- Kenézy Gyula University Hospital, Debrecen Medical University, Debrecen, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Fehér
- Institute of Biochemistry, Biological Research Centre, Szeged, Hungary.
| | - Zoltán Maróti
- Genetic Diagnostic Laboratory, University of Szeged, Szeged, Hungary
| | - Tibor Kalmár
- Genetic Diagnostic Laboratory, University of Szeged, Szeged, Hungary
| | | | - István Nagy
- Institute of Biochemistry, Biological Research Centre, Szeged, Hungary.,Seqomics Biotechnology Ltd, Mórahalom, Hungary
| | - Zsuzsanna Z Orosz
- Department of Ophthalmology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Márta Janáky
- Department of Ophthalmology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Facskó
- Department of Ophthalmology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Sohajda
- Kenézy Gyula University Hospital, Debrecen Medical University, Debrecen, Hungary. .,Department of Ophthalmology, Faculty of Medicine, University of Szeged, Szeged, Hungary.
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Abstract
This chapter reviews common applications of visual electrophysiology relevant to neuro-ophthalmology practice. The use of standard tests and extended protocols are described including the cortical visual evoked potential and pattern and full-field electroretinogram (PERG; ERG) methods, the latter including the photopic negative response. Abnormalities of these recordings are rarely specific but provide valuable diagnostic guidance and an objective measure of visual pathway function, difficult or impossible to infer by other methods. The electrophysiological phenotypes associated with Leber hereditary optic neuropathy, OPA1- and SSBP1-associated dominant optic atrophy, and WFS1-related syndromes are described. Typical changes in retinal and optic nerve function tests associated with acquired disease are highlighted, including those related to demyelination, ischemic, compressive, nutritional and toxic, and nonorganic etiologies. The importance of complementary testing using different electrophysiological techniques is emphasized, for the purposes of differential diagnosis and in disorders that may masquerade as optic nerve pathology.
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Affiliation(s)
- Neringa Jurkute
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Genetics Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony G Robson
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Department of Electrophysiology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
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Zhang H, Sajdak BS, Merriman DK, McCall MA, Carroll J, Lipinski DM. Electroretinogram of the Cone-Dominant Thirteen-Lined Ground Squirrel during Euthermia and Hibernation in Comparison with the Rod-Dominant Brown Norway Rat. Invest Ophthalmol Vis Sci 2021; 61:6. [PMID: 32492111 PMCID: PMC7415905 DOI: 10.1167/iovs.61.6.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose The majority of small animal species used in research are nocturnal, with retinae that are anatomically and functionally dissimilar from humans, complicating their use as disease models. Herein we characterize the retinal structure and electrophysiological function of the diurnal, cone-dominant 13-lined ground squirrel (13-LGS) retina during euthermia and in hibernation. Methods Full-field electroretinography (ERG) was performed in 13-LGS and Brown Norway (BN) rat models to establish baseline values for retinal function in each species, including following intravitreal injection of pharmacologic agents to selectively block the contributions of ON- and OFF-bipolar cells. The effect of hibernation-associated retinal remodeling on electrophysiological function was assessed in 13-LGS during torpor and emergence, with correlative histology performed using transmission electron microscopy. Results Under light-adapted conditions, the a-, b-, and d-wave amplitude of the 13-LGS was significantly greater than that of the BN rat. Retinal function was absent in the 13-LGS during hibernation and correlated to widespread disruption of photoreceptor and RPE structure. Remarkably, both retinal function and structure recovered rapidly on emergence from hibernation, with ERG responses reaching normal amplitude within 6 hours. Conclusions ERG responses for both BN rats and 13-LGS reflect the relative proportions of cone photoreceptors present within the retinae, indicating that the cone-dominant 13-LGS may be a potentially useful model for studying human central retinal function and disease. That retinal remodeling and restoration of electrophysiological function occurs rapidly on emergence from hibernation implies the 13-LGS may also be a useful tool for studying aspects of retinal physiology and recovery from injury.
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Hirasawa H, Miwa N, Watanabe SI. GABAergic and glycinergic systems regulate ON-OFF electroretinogram by cooperatively modulating cone pathways in the amphibian retina. Eur J Neurosci 2020; 53:1428-1440. [PMID: 33222336 DOI: 10.1111/ejn.15054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
The network mechanisms underlying how inhibitory circuits regulate ON- and OFF-responses (the b- and d-waves) in the electroretinogram (ERG) remain unclear. The purpose of this study was to investigate the contribution of inhibitory circuits to the emergence of the b- and d-waves in the full-field ERG in the newt retina. To this end, we investigated the effects of several synaptic transmission blockers on the amplitudes of the b- and d-waves in the ERG obtained from newt eyecup preparations. Our results demonstrated that (a) L-APB blocked the b-wave, indicating that the b-wave arises from the activity of ON-bipolar cells (BCs) expressing type six metabotropic glutamate receptors; (b) the combined administration of UBP310/GYKI 53655 blocked the d-wave, indicating that the d-wave arises from the activity of OFF-BCs expressing kainate-/AMPA-receptors; (c) SR 95531 augmented both the b- and the d-wave, indicating that GABAergic lateral inhibitory circuits inhibit both ON- and OFF-BC pathways; (d) the administration of strychnine in the presence of SR 95531 attenuated the d-wave, and this attenuation was prevented by blocking ON-pathways with L-APB, which indicated that the glycinergic inhibition of OFF-BC pathway is downstream of the GABAergic inhibition of the ON-system; and (e) the glycinergic inhibition from the ON- to the OFF-system widens the response range of OFF-BC pathways, specifically in the absence of GABAergic lateral inhibition. Based on these results, we proposed a circuitry mechanism for the regulation of the d-wave and offered a tentative explanation of the circuitry mechanisms underlying ERG formation.
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Affiliation(s)
- Hajime Hirasawa
- Department of Physiology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Naofumi Miwa
- Department of Physiology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shu-Ichi Watanabe
- Department of Physiology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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Kong AW, Della Santina L, Ou Y. Probing ON and OFF Retinal Pathways in Glaucoma Using Electroretinography. Transl Vis Sci Technol 2020; 9:14. [PMID: 33117606 PMCID: PMC7571283 DOI: 10.1167/tvst.9.11.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
Glaucoma is a progressive neurodegenerative disease involving damage and eventually death of retinal ganglion cells (RGCs) that comprise the optic nerve. This review summarizes current understanding of specific RGC type vulnerability in glaucoma and how electroretinography (ERG) may provide an objective measure of these functional perturbations. There is building evidence to suggest that ON RGCs, which respond to light increments, may be more resilient to elevated intraocular pressure and glaucoma, whereas OFF RGCs, which respond to light decrements, may be more susceptible. ERG experiments in nonhuman primates and mice have also shown that the ON- and OFF-pathways can be separated using a variety of techniques such as pattern ERG and the photopic negative response. Another ERG paradigm of interest to separate the ON and OFF responses is a flicker stimulus at varying temporal frequencies. Response to lower temporal frequencies is associated with the ON-pathway, and ERG response to higher frequencies is associated with the OFF-pathway. In mice, experimental glaucoma models have shown greater decreases in ERG response at higher frequencies, suggesting that the OFF-pathway is more susceptible. We also summarize current clinical ERG protocols used for glaucoma and discuss innovations for developing new types of stimuli that can further separate the ON- and OFF-pathways. Applying these novel paradigms that distinguish ON- and OFF-pathways may ultimately improve glaucoma diagnostics and monitoring of glaucoma progression.
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Affiliation(s)
- Alan W Kong
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Luca Della Santina
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
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Schiff ER, Daich Varela M, Robson AG, Pierpoint K, Ba-Abbad R, Nutan S, Zein WM, Ullah E, Huryn LA, Tuupanen S, Mahroo OA, Michaelides M, Burke D, Harvey K, Arno G, Hufnagel RB, Webster AR. A genetic and clinical study of individuals with nonsyndromic retinopathy consequent upon sequence variants in HGSNAT, the gene associated with Sanfilippo C mucopolysaccharidosis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:631-643. [PMID: 32770643 PMCID: PMC8125330 DOI: 10.1002/ajmg.c.31822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/02/2020] [Accepted: 07/21/2020] [Indexed: 11/06/2022]
Abstract
Pathogenic variants in the gene HGSNAT (heparan-α-glucosaminide N-acetyltransferase) have been reported to underlie two distinct recessive conditions, depending on the specific genotype, mucopolysaccharidosis type IIIC (MPSIIIC)-a severe childhood-onset lysosomal storage disorder, and adult-onset nonsyndromic retinitis pigmentosa (RP). Here we describe the largest cohort to-date of HGSNAT-associated nonsyndromic RP patients, and describe their retinal phenotype, leukocyte enzymatic activity, and likely pathogenic genotypes. We identified biallelic HGSNAT variants in 17 individuals (15 families) as the likely cause of their RP. None showed any other symptoms of MPSIIIC. All had a mild but significant reduction of HGSNAT enzyme activity in leukocytes. The retinal condition was generally of late-onset, showing progressive degeneration of a concentric area of paramacular retina, with preservation but reduced electroretinogram responses. Symptoms, electrophysiology, and imaging suggest the rod photoreceptor to be the cell initially compromised. HGSNAT enzymatic testing was useful in resolving diagnostic dilemmas in compatible patients. We identified seven novel sequence variants [p.(Arg239Cys); p.(Ser296Leu); p.(Phe428Cys); p.(Gly248Ala); p.(Gly418Arg), c.1543-2A>C; c.1708delA], three of which were considered to be retina-disease-specific alleles. The most prevalent retina-disease-specific allele p.(Ala615Thr) was observed heterozygously or homozygously in 8 and 5 individuals respectively (7 and 4 families). Two siblings in one family, while identical for the HGSNAT locus, but discordant for retinal disease, suggest the influence of trans-acting genetic or environmental modifying factors.
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Affiliation(s)
- Elena R Schiff
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Malena Daich Varela
- Ophthalmic Genetics and Visual Function branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anthony G Robson
- UCL Institute of Ophthalmology, London, UK.,Department of Electrophysiology, Moorfields Eye Hospital, London, UK
| | | | - Rola Ba-Abbad
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Savita Nutan
- North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - Wadih M Zein
- Ophthalmic Genetics and Visual Function branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ehsan Ullah
- Ophthalmic Genetics and Visual Function branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Laryssa A Huryn
- Ophthalmic Genetics and Visual Function branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Omar A Mahroo
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,Section of Ophthalmology, King's College London, London, UK
| | - Michel Michaelides
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
| | - Derek Burke
- Enzyme Unit, Chemical Pathology, Paediatric Laboratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Katie Harvey
- Enzyme Unit, Chemical Pathology, Paediatric Laboratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Gavin Arno
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK.,North Thames Genomic Laboratory Hub, Great Ormond Street NHS Foundation Trust, London, UK
| | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrew R Webster
- Genetics Service, Moorfields Eye Hospital, London, UK.,UCL Institute of Ophthalmology, London, UK
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Hamilton R, Bach M, Heinrich SP, Hoffmann MB, Odom JV, McCulloch DL, Thompson DA. VEP estimation of visual acuity: a systematic review. Doc Ophthalmol 2020; 142:25-74. [PMID: 32488810 PMCID: PMC7907051 DOI: 10.1007/s10633-020-09770-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/05/2020] [Indexed: 01/23/2023]
Abstract
Purpose Visual evoked potentials (VEPs) can be used to measure visual resolution via a spatial frequency (SF) limit as an objective estimate of visual acuity. The aim of this systematic review is to collate descriptions of the VEP SF limit in humans, healthy and disordered, and to assess how accurately and precisely VEP SF limits reflect visual acuity. Methods The protocol methodology followed the PRISMA statement. Multiple databases were searched using “VEP” and “acuity” and associated terms, plus hand search: titles, abstracts or full text were reviewed for eligibility. Data extracted included VEP SF limits, stimulus protocols, VEP recording and analysis techniques and correspondence with behavioural acuity for normally sighted healthy adults, typically developing infants and children, healthy adults with artificially degraded vision and patients with ophthalmic or neurological conditions. Results A total of 155 studies are included. Commonly used stimulus, recording and analysis techniques are summarised. Average healthy adult VEP SF limits vary from 15 to 40 cpd, depend on stimulus, recording and analysis techniques and are often, but not always, poorer than behavioural acuity measured either psychophysically with an identical stimulus or with a clinical acuity test. The difference between VEP SF limit and behavioural acuity is variable and strongly dependent on the VEP stimulus and choice of acuity test. VEP SF limits mature rapidly, from 1.5 to 9 cpd by the end of the first month of life to 12–20 cpd by 8–12 months, with slower improvement to 20–40 cpd by 3–5 years. VEP SF limits are much better than behavioural thresholds in the youngest, typically developing infants. This difference lessens with age and reaches equivalence between 1 and 2 years; from around 3–5 years, behavioural acuity is better than the VEP SF limit, as for adults. Healthy, artificially blurred adults had slightly better behavioural acuity than VEP SF limits across a wide range of acuities, while adults with heterogeneous ophthalmic or neurological pathologies causing reduced acuity showed a much wider and less consistent relationship. For refractive error, ocular media opacity or pathology primarily affecting the retina, VEP SF limits and behavioural acuity had a fairly consistent relationship across a wide range of acuity. This relationship was much less consistent or close for primarily macular, optic nerve or neurological conditions such as amblyopia. VEP SF limits were almost always normal in patients with non-organic visual acuity loss. Conclusions The VEP SF limit has great utility as an objective acuity estimator, especially in pre-verbal children or patients of any age with motor or learning impairments which prevent reliable measurement of behavioural acuity. Its diagnostic power depends heavily on adequate, age-stratified, reference data, age-stratified empirical calibration with behavioural acuity, and interpretation in the light of other electrophysiological and clinical findings. Future developments could encompass faster, more objective and robust techniques such as real-time, adaptive control. Registration International prospective register of systematic reviews PROSPERO (https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42018085666.
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Affiliation(s)
- Ruth Hamilton
- Department of Clinical Physics and Bioengineering, Royal Hospital for Children, NHS Greater Glasgow and Clyde, Glasgow, UK. .,College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | - Michael Bach
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven P Heinrich
- Eye Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael B Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - J Vernon Odom
- Departments of Ophthalmology and Neuroscience, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Daphne L McCulloch
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Dorothy A Thompson
- The Department of Clinical and Academic Ophthalmology, Great Ormond Street Hospital for Children, London, UK.,University College London Great Ormond Street Institute of Child Health, London, UK
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Guimaraes TACD, Georgiou M, Robson AG, Michaelides M. KCNV2 retinopathy: clinical features, molecular genetics and directions for future therapy. Ophthalmic Genet 2020; 41:208-215. [PMID: 32441199 PMCID: PMC7446039 DOI: 10.1080/13816810.2020.1766087] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
-associated retinopathy or “cone dystrophy with supernormal rod responses” is an
autosomal recessive cone-rod dystrophy with pathognomonic ERG findings. This gene
encodes Kv8.2, a voltage-gated potassium channel subunit that acts as a modulator by
shifting the activation range of the K+ channels in photoreceptor inner
segments. Currently, no treatment is available for the condition. However, there is a
lack of prospective long-term data in large molecularly confirmed cohorts, which is a
prerequisite for accurate patient counselling/prognostication, to identify an optimal
window for intervention and outcome measures, and ultimately to design future therapy
trials. Herein we provide a detailed review of the clinical features, retinal imaging,
electrophysiology and psychophysical studies, molecular genetics, and briefly discuss
future prospects for therapy trials.
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Affiliation(s)
- Thales A C De Guimaraes
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Michalis Georgiou
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Anthony G Robson
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London , London, UK.,Moorfields Eye Hospital , London, UK
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41
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Pasmanter N, Petersen-Jones SM. A review of electroretinography waveforms and models and their application in the dog. Vet Ophthalmol 2020; 23:418-435. [PMID: 32196872 DOI: 10.1111/vop.12759] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 02/04/2023]
Abstract
Electroretinography (ERG) is a commonly used technique to study retinal function in both clinical and research ophthalmology. ERG responses can be divided into component waveforms, analysis of which can provide insight into the health and function of different types and populations of retinal cells. In dogs, ERG has been used in the characterization of normal retinal function, as well as the diagnosis of retinal diseases and measuring effects of treatment. While many components of the recorded waveform are similar across species, dogs have several notable features that should be differentiated from the responses in humans and other animals. Additionally, modifications of standard protocols, such as changing flash frequency and stimulus color, and mathematical models of ERG waveforms have been used in studies of human retinal function but have been infrequently applied to visual electrophysiology in dogs. This review provides an overview of the origins and applications of ERG in addition to potential avenues for further characterization of responses in the dog.
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Affiliation(s)
- Nathaniel Pasmanter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Simon M Petersen-Jones
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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42
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Karatsai E, Robson AG, Taylor SRJ. Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated Retinopathy Treated Without Systemic Immunosuppression. JAMA Ophthalmol 2020; 137:564-567. [PMID: 30896772 DOI: 10.1001/jamaophthalmol.2019.0284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome in which antiretinal antibodies crossreact with retinal ON-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin, corticosteroids, or plasmapheresis, but their effectiveness is limited and may be contraindicated, given the possible protective role of circulating autoantibodies against metastatic spread. We report 3-year follow-up of the first case (to our knowledge) of MAR treated with intravitreal long-acting steroid implants. Objective To report on a patient with MAR who was treated with intravitreal fluocinolone acetonide implants in the absence of systemic immunosuppression. Design, Setting, and Participants This is a 3-year follow-up of a 73-year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence, and optical coherence tomography were normal, with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized ON-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral fluocinolone acetonide intravitreal implants. Main Outcomes and Measures Visual acuity, visual field, and electroretinography testing for 3 years after treatment. Results Visual fields improved in this 73-year-old patient from 20/30 (Snellen measured as 6/9) OD and 20/16 (6/5) OS at baseline to 20/20 OU within 1 week of treatment. Detailed electroretinography monitoring indicated characteristic abnormalities that partly resolved after treatment, consistent with improved inner retinal ON-bipolar cell function. Bilateral cataracts developed approximately 2 years after injection; cataract surgery was performed uneventfully. At 3 years posttreatment, the patient remained visually stable and in systemic disease remission, with best-corrected visual acuity remaining at 20/20 OU. Conclusions and Relevance We report what is, to our knowledge, the first case of MAR treated with intravitreal slow-release corticosteroid implants, which shows improvements in visual symptoms, visual fields, and retinal function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR, although results from 1 case should be generalized with abundant caution.
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Affiliation(s)
| | - Anthony G Robson
- Moorfields Eye Hospital, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Simon R J Taylor
- Royal Surrey County Hospital, Guildford, United Kingdom.,University of Surrey, Guildford, United Kingdom
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Jurkute N, Leu C, Pogoda HM, Arno G, Robson AG, Nürnberg G, Altmüller J, Thiele H, Motameny S, Toliat MR, Powell K, Höhne W, Michaelides M, Webster AR, Moore AT, Hammerschmidt M, Nürnberg P, Yu-Wai-Man P, Votruba M. SSBP1 mutations in dominant optic atrophy with variable retinal degeneration. Ann Neurol 2019; 86:368-383. [PMID: 31298765 PMCID: PMC8855788 DOI: 10.1002/ana.25550] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Autosomal dominant optic atrophy (ADOA) starts in early childhood with loss of visual acuity and color vision deficits. OPA1 mutations are responsible for the majority of cases, but in a portion of patients with a clinical diagnosis of ADOA, the cause remains unknown. This study aimed to identify novel ADOA-associated genes and explore their causality. METHODS Linkage analysis and sequencing were performed in multigeneration families and unrelated patients to identify disease-causing variants. Functional consequences were investigated in silico and confirmed experimentally using the zebrafish model. RESULTS We defined a new ADOA locus on 7q33-q35 and identified 3 different missense variants in SSBP1 (NM_001256510.1; c.113G>A [p.(Arg38Gln)], c.320G>A [p.(Arg107Gln)] and c.422G>A [p.(Ser141Asn)]) in affected individuals from 2 families and 2 singletons with ADOA and variable retinal degeneration. The mutated arginine residues are part of a basic patch that is essential for single-strand DNA binding. The loss of a positive charge at these positions is very likely to lower the affinity of SSBP1 for single-strand DNA. Antisense-mediated knockdown of endogenous ssbp1 messenger RNA (mRNA) in zebrafish resulted in compromised differentiation of retinal ganglion cells. A similar effect was achieved when mutated mRNAs were administered. These findings point toward an essential role of ssbp1 in retinal development and the dominant-negative nature of the identified human variants, which is consistent with the segregation pattern observed in 2 multigeneration families studied. INTERPRETATION SSBP1 is an essential protein for mitochondrial DNA replication and maintenance. Our data have established pathogenic variants in SSBP1 as a cause of ADOA and variable retinal degeneration. ANN NEUROL 2019;86:368-383.
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Affiliation(s)
- Neringa Jurkute
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Costin Leu
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, US
- Genomic Medicine Institute, Lerner Research Institute Cleveland Clinic, Cleveland, OH 44195, US
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Hans-Martin Pogoda
- Institute for Zoology, Developmental Biology Unit, University of Cologne, D-50674 Cologne, Germany
| | - Gavin Arno
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Anthony G. Robson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Gudrun Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
| | - Janine Altmüller
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, D-50931 Cologne, Germany
| | - Holger Thiele
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
| | - Susanne Motameny
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
| | - Mohammad Reza Toliat
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
| | - Kate Powell
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - Wolfgang Höhne
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Andrew R Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Anthony T. Moore
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
| | - Matthias Hammerschmidt
- Institute for Zoology, Developmental Biology Unit, University of Cologne, D-50674 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, D-50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D-50931 Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics (CCG), University of Cologne, D-50931 Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, D-50931 Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, D-50931 Cologne, Germany
| | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
- Cambridge Eye Unit, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Marcela Votruba
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
- Cardiff Eye Unit, University Hospital Wales, Cardiff, UK
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McCulloch DL, Kondo M, Hamilton R, Lachapelle P, Messias AMV, Robson AG, Ueno S. ISCEV extended protocol for the stimulus-response series for light-adapted full-field ERG. Doc Ophthalmol 2019; 138:205-215. [PMID: 30929108 DOI: 10.1007/s10633-019-09685-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 12/21/2022]
Abstract
The International Society for Clinical Electrophysiology of Vision (ISCEV) standard for full-field electroretinography (ERG) describes a minimum protocol for clinical testing but encourages additional ERG testing when appropriate. This ISCEV extended protocol describes methods to record and evaluate a light-adapted (LA) ERG stimulus-response series with increasing flash strengths. The LA ERG stimulus-response series (also referred to as the luminance-response or intensity-response series in the published literature) can characterise generalised cone system function more comprehensively than the ISCEV standard LA ERGs alone. The amplitude of LA ERG a-waves, arising from cones and cone off-bipolar cells, typically shows a saturating function. The LA ERG b-wave amplitudes, which arise primarily from activity of retinal bipolar cells, show an amplitude peak followed by a nonzero plateau (the "photopic hill" phenomenon). This ISCEV extended protocol specifies a stimulus-response series suitable to evaluate generalised dysfunction affecting the LA retina, to aid in distinguishing between the on- and off-responses of the cone system and to monitor ERG changes in these characteristics. The LA ERG stimulus-response series for a- and b-waves is recorded to a sequence of nine flash stimuli ranging from 0.03 to 300 cd s m-2, superimposed on a standard background of 30 cd m-2. A shorter protocol is also presented to measure the mid-range of the function (the "photopic hill") using 5 flash stimuli.
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Affiliation(s)
- Daphne L McCulloch
- School of Optometry and Vision Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Mineo Kondo
- Mie University Graduate School of Medicine, Mie, Japan
| | - Ruth Hamilton
- Clinical Physics and Bio-engineering, Royal Hospital for Children, NHS Greater Glasgow & Clyde, Glasgow, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pierre Lachapelle
- Department of Ophthalmology and Neurology-Neurosurgery, McGill University, Montreal, QC, Canada
| | - André M V Messias
- Oftalmologia e Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Anthony G Robson
- Department of Electrophysiology, Moorfields Eye Hospital, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Shinji Ueno
- Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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