Effects of systemic hypoxia on pH outside rod photoreceptors in the cat retina

OCT imaging of rod mitochondrial respiration in vivo

There remains a need for high spatial resolution imaging indices of mitochondrial respiration in the outer retina that probe normal physiology and measure pathogenic and reversible conditions underlying loss of vision. Mitochondria are involved in a critical, but somewhat underappreciated, support system that maintains the health of the outer retina involving stimulus-evoked changes in subretinal space hydration. The subretinal space hydration light-dark response is important because it controls the distribution of vision-critical interphotoreceptor matrix components, including anti-oxidants, pro-survival factors, ions, and metabolites. The underlying signaling pathway controlling subretinal space water management has been worked out over the past 30 years and involves cGMP/mitochondria respiration/pH/RPE water efflux. This signaling pathway has also been shown to be modified by disease-generating conditions, such as hypoxia or oxidative stress. Here, we review recent advances in MRI and commercially available OCT technologies that can measure stimulus-evoked changes in subretinal space water content based on changes in the external limiting membrane-retinal pigment epithelium region. Each step within the above signaling pathway can also be interrogated with FDA-approved pharmaceuticals. A highlight of these studies is the demonstration of first-in-kind in vivo imaging of mitochondria respiration of any cell in the body. Future examinations of subretinal space hydration are expected to be useful for diagnosing threats to sight in aging and disease, and improving the success rate when translating treatments from bench-to-bedside.

Water-induced poly(vinyl alcohol)/carbon quantum dot nanocomposites with tunable shape recovery performance and fluorescence

Water-induced shape memory polymers (SMPs) show promising applications in biomedicine, biosensing, anti-counterfeiting and intelligent actuating systems. However, the dual function of shape morphing and color switching has not been achieved in the water-induced SMP system. Herein, a novel water-induced SMP with both color-switching fluorescence behavior and shape memory performance is reported. The material is fabricated by crosslinking poly(vinyl alcohol) (PVA) and pH-responsive fluorescent carbon quantum dots (CQDs). The incorporation of CQDs with PVA not only improves the shape recovery performance but also endows the material with color-switching features. To our best knowledge, such smart ability is first realized in this PVA/CQD SMP system, and this report provides a novel strategy for fabricating smart water-induced SMPs with adjustable shape recovery performance and fluorescence.

Retinal pH and Acid Regulation During Metabolic Acidosis

PURPOSE

Changes in retinal pH may contribute to a variety of eye diseases. To study the effect of acidosis alone, we induced systemic metabolic acidosis and hypothesized that the retina would respond with altered expression of genes involved in acid/base regulation.

METHODS

Systemic metabolic acidosis was induced in Long-Evans rats for up to 2 weeks by adding NH4Cl to the drinking water. After 2 weeks, venous pH was 7.25 ± 0.08 (SD) and [HCO3-] was 21.4 ± 4.6 mM in acidotic animals; pH was 7.41 ± 0.03 and [HCO3-] was 30.5 ± 1.0 mM in controls. Retinal mRNAs were quantified by quantitative reverse transcription polymerase chain reaction. Protein was quantified with Western blots and localized by confocal microscopy. Retinal [H+]o was measured in vivo with pH microelectrodes in animals subjected to metabolic acidosis and in controls.

RESULTS

NH4Cl in drinking water or given intravenous was effective in acidifying the retina. Cariporide, a blocker of Na+/H+ exchange, further acidified the retina. Metabolic acidosis for 2 weeks led to increases of 40-100% in mRNA for carbonic anhydrase isoforms II (CA-II) and XIV (CA-XIV) and acid-sensing ion channels 1 and 4 (ASIC1 and ASIC4) (all p < 0.005). Expression of anion exchange protein 3 (AEP-3) and Na+/H+ exchanger (NHE)-1 also increased by ≥50% (both p < 0.0001). Changes were similar after 1 week of acidosis. Protein for AEP-3 doubled. NHE-1 co-localized with vascular markers, particularly in the outer plexiform layer. CA-II was located in the neural parenchyma of the ganglion cell layer and diffusely in the rest of the inner retina.

CONCLUSIONS

The retina responds to systemic acidosis with increased expression of proton and bicarbonate exchangers, carbonic anhydrase, and ASICs. While responses to acidosis are usually associated with renal regulation, these studies suggest that the retina responds to changes in local pH presumably to control its acid/base environment in response to systemic acidosis.

Retinal oxygen: from animals to humans

This article discusses retinal oxygenation and retinal metabolism by focusing on measurements made with two of the principal methods used to study O₂ in the retina: measurements of PO₂ with oxygen-sensitive microelectrodes in vivo in animals with a retinal circulation similar to that of humans, and oximetry, which can be used non-invasively in both animals and humans to measure O₂ concentration in retinal vessels. Microelectrodes uniquely have high spatial resolution, allowing the mapping of PO₂ in detail, and when combined with mathematical models of diffusion and consumption, they provide information about retinal metabolism. Mathematical models, grounded in experiments, can also be used to simulate situations that are not amenable to experimental study. New methods of oximetry, particularly photoacoustic ophthalmoscopy and visible light optical coherence tomography, provide depth-resolved methods that can separate signals from blood vessels and surrounding tissues, and can be combined with blood flow measures to determine metabolic rate. We discuss the effects on retinal oxygenation of illumination, hypoxia and hyperoxia, and describe retinal oxygenation in diabetes, retinal detachment, arterial occlusion, and macular degeneration. We explain how the metabolic measurements obtained from microelectrodes and imaging are different, and how they need to be brought together in the future. Finally, we argue for revisiting the clinical use of hyperoxia in ophthalmology, particularly in retinal arterial occlusions and retinal detachment, based on animal research and diffusion theory.

Development of diabetes-induced acidosis in the rat retina

We hypothesized that the retina of diabetic animals would be unusually acidic due to increased glycolytic metabolism. Acidosis in tumors and isolated retina has been shown to lead to increased VEGF. To test the hypothesis we have measured the transretinal distribution of extracellular H(+) concentration (H(+)-profiles) in retinae of control and diabetic dark-adapted intact Long-Evans rats with ion-selective electrodes. Diabetes was induced by intraperitoneal injection of streptozotocin. Intact rat retinae are normally more acidic than blood with a peak of [H(+)]o in the outer nuclear layer (ONL) that averages 30 nM higher than H(+) in the choroid. Profiles in diabetic animals were similar in shape, but diabetic retinae began to be considerably more acidic after 5 weeks of diabetes. In retinae of 1-3 month diabetics the difference between the ONL and choroid was almost twice as great as in controls. At later times, up to 6 months, some diabetics still demonstrated abnormally high levels of [H(+)]o, but others were even less acidic than controls, so that the average level of acidosis was not different. Greater variability in H(+)-profiles (both between animals and between profiles recorded in one animal) distinguished the diabetic retinae from controls. Within animals, this variability was not random, but exhibited regions of higher and lower H(+). We conclude that retinal acidosis begins to develop at an early stage of diabetes (1-3 months) in rats. However, it does not progress, and the acidity of diabetic rat retina was diminished at later stages (3-6 months). Also the diabetes-induced acidosis has a strongly expressed local character. As result, the diabetic retinas show much wider variability in [H(+)] distribution than controls. pH influences metabolic and neural processes, and these results suggest that local acidosis could play a role in the pathogenesis of diabetic retinopathy.

Light-induced pH changes in the intact retinae of normal and early diabetic rats

Double-barreled H(+)-selective microelectrodes were used to measure local extracellular concentration of H(+) ([H(+)]o) in the retina of dark-adapted anesthetized Long-Evans rats. The microelectrode advanced in steps of 30 μm throughout the retina from the vitreal surface to retinal pigment epithelium and then to the choroid, recording changes in [H(+)]o evoked by light stimulation. Recordings were performed in diabetic rats 1-3 months after intraperitoneal injection of streptozotocin and the results were compared with data obtained in age-matched control animals. Brief light stimulation (2.5 s) evoked changes of [H(+)]o with amplitudes of a few nM. Throughout the retina, there was a transient initial acidification for ∼200 ms followed by steady alkalinization, although amplitudes and kinetics of these components were slightly variable in different retinal layers. No significant difference was found when the light-induced [H(+)]o changes recorded in various retinal layers of early diabetic rats were compared with the [H(+)]o changes from corresponding layers of control animals. Also, when H(+)-selective microelectrodes were located in the retinal pigment epithelium (RPE) layer, an increase in H(+) was recorded, whose time course and amplitude were similar in control and diabetic rats. However, a striking difference between light-induced [H(+)]o changes in controls and diabetics was observed in the choriocapillaris, in the thin layer (10-20 μm) distal to the basal membrane of the RPE. In control rats, choroidal [H(+)]o decreased in a few cases, but much more often practically did not change. In contrast, diabetic rats demonstrated either an increase (in half of the cases) or no change in choroidal [H(+)]o. The data suggest that the active participation of the choroidal blood supply in stabilization of [H(+)]o could be partially compromised already at early stages of diabetes in rats. Interestingly, it appeared that the acid removal by the choroidal circulation was compromised most after 1 month of diabetes and tended to improve later.

Ouabain inhibition of Na/K-ATPase across the retina prevents signed refractive compensation to lens-induced defocus, but not default ocular growth in young chicks

Purpose: The relevance of retinal integrity and energy pathways to ocular growth and induction of refractive errors has seldom been investigated. Thus, we used ouabain to target the channels that are essential for the maintenance of membrane potentials in cells, sodium potassium ATPase (Na/K-ATPase), to examine refractive compensation and ocular growth in response to lens-induced defocus in the chick.

Methods:  A single intravitreal injection of 1 mM ouabain in dimethyl sulfoxide (DMSO) carrier or DMSO alone was followed by monocular defocus with positive or negative 10 D lens (or no lens) from post-hatching days 5-9 under 12/12 hr light/dark conditions. Biometry and dark-adapted flash and electroretinography (ERG) were conducted on day 9, followed by immunohistological analyses.

Results: Ouabain inhibited differential ocular growth and refractive compensation to signed defocus compared to DMSO. By 4-days post-ouabain injection all components of the typical ERG responses to light had been eliminated, and widespread histological damage was apparent, though some ‘default state’ ocular growth was measurable. Immunohistochemistry demonstrated reduction in the specialized water channel Aquaporin 4 (AQP4) expression and increased evidence of caspase 3 expression (a cell death associated protein) in ouabain-treated eyes compared with DMSO alone.

Conclusion: The current study demonstrates that blockade of photoreceptor and inner retinal responses to light onset and offset by ouabain inhibits differential refractive compensation to optical blur, but does not prevent ocular growth.

Aviation-related respiratory gas disturbances affect dark adaptation: a reappraisal

This study examined the time course of early scotopic threshold sensitivity during dark adaptation under mild to moderate hypoxia, moderate hypocapnia and hyperoxia, measuring detection time displacement relative to normoxia. Cone rod inflection and early rod adaptation were highlighted using progressively dimmer green flash stimuli. Early scotopic sensitivity was significantly delayed by hypoxia and hastened by hypocapnia and hyperoxia. Effects of respiratory disturbance on dark adaptation include temporal shifts of early scotopic sensitivity while human rod photoreceptors appear functionally hypoxic when breathing air at one atmosphere. At night, supplementary oxygen may benefit aircrew visual sensitivity, even at ground level.

Retinal arterial occlusion leads to acidosis in the cat

This study investigated the changes in pH during retinal artery occlusion by means of extracellular H+ concentration ([H+]o) measurements in the retina under both air and 100% O2 ventilation. Occlusion was produced in intact anesthetised cats by pressing with a probe onto a retinal artery. [H+]o profiles were recorded across the retina with pH sensitive microelectrodes. The average inner retinal [H+]o increased during occlusion, resulting in an acidification of as much as 0.10 pH units, even under 100% O2 ventilation. The inner retinal H+ profile magnitude decreased during occlusion due to impaired clearance. The average outer retinal H+ profile magnitude also increased even though outer retinal H+ production did not increase during occlusion. This might be due to H+ diffusion from the inner retina to the outer retina, which is opposite to the flux in the normal retina. After reperfusion, [H+]o returned to its preocclusion value. In conclusion, arterial occlusion leads to acidification of the retina. Enhanced oxygenation during occlusion did not decrease this acidification. This may explain why increasing PO2 in the retina by enhanced O2 breathing improves retinal function during and after occlusion, but does not totally reverse the effect of occlusion.

Regulation of inwardly rectifying K+ channels in retinal pigment epithelial cells by intracellular pH

Inwardly rectifying K+ (Kir) channels in the apical membrane of the retinal pigment epithelium (RPE) play a key role in the transport of K+ into and out of the subretinal space (SRS), a small extracellular compartment surrounding photoreceptor outer segments. Recent molecular and functional evidence indicates that these channels comprise Kir7.1 channel subunits. The purpose of this study was to determine whether Kir channels in the RPE are modulated by extracellular (pHo) or intracellular pH (pHi), both of which change upon illumination of the dark-adapted retina. The Kir current (IKir) in acutely dissociated bovine RPE cells was recorded in the whole-cell configuration while altering pHo or pHi. In cells dialysed with pipette solution buffered to pH 7.2, step changes in pHo from 7.4 to 8.0, 7.0 or 6.5 had little effect on IKir. Acidification to pHo 6.0, however, caused a transient activation of IKir followed by a slower inhibition. To determine the dependence of IKir on pHi, we altered pHi within individual RPE cells at constant pHo by imposing transmembrane acetate concentration gradients. These experiments revealed a biphasic relationship between IKir and pHi: IKir was maximal at about pHi 7.1, but decreased sharply at more acidic or alkaline levels. To evaluate the role of Kir7.1 channels in the pHi-dependent changes in IKir, we tested the effect of transmembrane acetate concentration gradients on Rb+ currents, which are 10-fold larger than K+ currents for this channel subtype. Inwardly rectifying Rb+ currents were maximal at about pHi 7.0 and were inhibited by intracellular alkalinization or acidification. We conclude that the Kir conductance in the RPE is modulated by intracellular pH in the physiological range and that this reflects the behaviour of Kir7.1 channels. This sensitivity to pHi may provide an important mechanism linking photoreceptor activity and RPE function.

Cloning and functional expression of human retinal kir2.4, a pH-sensitive inwardly rectifying K(+) channel

To identify novel potassium channel genes expressed in the retina, we screened a human retina cDNA library with an EST sequence showing partial homology to inwardly rectifying potassium (Kir) channel genes. The isolated cDNA yielded a 2,961-base pair sequence with the predicted open reading frame showing strong homology to the rat Kir2. 4 (rKir2.4). Northern analysis of mRNA from human and bovine tissues showed preferential expression of Kir2.4 in the neural retina. In situ hybridization to sections of monkey retina detected Kir2.4 transcript in most retinal neurons. Somatic hybridization analysis and dual-color in situ hybridization to metaphase chromosomes mapped Kir2.4 to human chromosome 19 q13.1-q13.3. Expression of human Kir2. 4 cRNA in Xenopus oocytes generated strong, inwardly rectifying K(+) currents that were enhanced by extracellular alkalinization. We conclude that human Kir2.4 encodes an inwardly rectifying K(+) channel that is preferentially expressed in the neural retina and that is sensitive to physiological changes in extracellular pH.

Distribution of monocarboxylate transporters MCT1 and MCT2 in rat retina

Transport of lactic acid and other monocarboxylates such as pyruvate and the ketone bodies through cellular membranes is facilitated by specific transport proteins. We used chicken polyclonal antibodies to the monocarboxylate transporters-1 and -2 to determine their cellular and subcellular distributions in rat retina, and we compared these distributions to those of the glucose transporters-1 and -3. Monocarboxylate transporter-1 was most highly expressed by the apical processes of retinal pigment epithelium that surround the outer segments of the photoreceptor cells. In contrast to glucose transporter-1, monocarboxylate transporter-1 was not detected on the basal membranes of pigment epithelium. The luminal and abluminal endothelial plasma membranes in retina also exhibited heavy labeling by antibody to monocarboxylate transporter-1. In addition, this transporter was associated with the Müller cell microvilli, the plasma membranes of the rod inner segments, and all retinal layers between the inner and external limiting membranes. Monocarboxylate transporter-2 was found to be abundantly expressed on the inner (basal) plasma membrane of Müller cells and by glial cell processes surrounding retinal microvessels. This transporter was also present in the plexiform and nuclear layers but was not detected beyond the external limiting membrane. Recent studies have shown that lactic acid transport is of particular importance at endothelial and epithelial barriers where membranes of adjoining cells are linked by tight junctions. Our results suggest that monocarboxylate transporter-1 functions to transport lactate between the retina and the blood, both at the retinal endothelium and the pigment epithelium. The location of monocarboxylate transporter-2 on glial foot processes surrounding retinal vessels suggests that this transporter is also important in blood-retinal lactate exchange. In addition, the abundance of these transporters in Müller cells and synaptic (plexiform) layers suggests that they function in lactate exchange between neurons and glia, supporting the notion that lactate plays a key role in neural metabolism.

Effects of adaptation level and hypoglycemia on function of the cat retina during hypoxemia

Acute hypoxemia (low PaO2) leads to changes in oxygen consumption and electrical responses of the outer retina of cats, but inner retinal ERG components and ganglion cell responses have been shown to be quite resistant to hypoxemia. The purpose of this study was to determine whether the resistance of the inner retina depends on (1) the stimulus conditions, specifically the degree of light adaptation; and (2) the ability of the photoreceptors to increase glycolysis during hypoxemia. To address these issues, recordings of single ganglion cell action potentials and of the b-wave and scotopic threshold response (STR) of the electroretinogram (ERG) were made from the eyes of anesthetized cats during hypoxemia alone and hypoxemia plus hypoglycemia. Ganglion cells appeared to be equally resistant to hypoxemia at high and low backgrounds (3.3 to 9.7 log equivalent quanta(555 nm)-deg-2(-s)-1), and the STR, recorded with dim stimuli during dark adaptation, when photoreceptor oxygen consumption is most susceptible to hypoxemia, was unchanged until PaO2 was below 30 mm Hg. The amplitude of the b-wave was similarly resistant to hypoxemia when the animal was normoglycemic. During hypoglycemia, however, both the b-wave and the STR became more sensitive to hypoxemia, beginning to change at PaO2s as high as 50 mm Hg when blood glucose was 40-50 mg/dl. It is argued that hypoglycemia limits or prevents the increased glycolytic ATP production that would ordinarily occur when the photoreceptor oxygen supply decreases, and that increased photoreceptor glycolysis is essential in the protection of the retina against mild hypoxemia.

Intraretinal analysis of electroretinogram with K+ microelectrodes during acute intraocular pressure elevation

We examined the effects of acute intraocular pressure elevation on the intraretinal electroretinogram in the cat dark-adapted eye. Perfusion pressure of the eye (mean arterial pressure minus intraocular pressure) was regulated within the range of 25-75 mm Hg by increasing the intraocular pressure, which was adjusted by changing the height of the reservoir of balanced salt solution perfused into the eye through a needle placed in the anterior chamber. The vitreal electroretinogram, transepithelial c-wave, slow PIII and light-evoked decrease in extracellular K+ concentration were recorded during intraocular pressure elevation in the dark-adapted retina. The c-wave increased in amplitude between 40 and 75 mm Hg of perfusion pressure and decreased below 40 mm Hg in some cases. These changes were unrelated to the standing potential. The transepithelial c-wave, slow PIII and light-evoked decrease in extracellular K+ concentration were larger in the range of perfusion pressure examined. These suggest that some factor induces electroretinographic changes that are not readily explained by hypoxia or pH changes alone.

Proton modulation of M-like potassium current (IKx) in rod photoreceptors

The effect of extracellular pH (pHe 6.9-8.1) and intracellular pH (pHi 6.4-8.1) on the non-inactivating voltage-sensitive M-like potassium current (IKx) was studied in patch-clamped salamander rod photoreceptors. The midpoint of the IKx activation curve shifted by 6.6 mV per pHe unit, with acidification producing positive shifts and alkalinization producing negative shifts. The time constant of IKx activation shifted with pHe in a manner consistent with the shifts in the activation curve. Maximum conductance and gating charge were unaffected by changes in pHe. IKx did not depend on pHi. Given the importance of IKx in rod function, these results suggest that pHe could affect the signal transmitted from rods by changing IKx activation parameters.

The effects of acetazolamide in albino rabbits, pigmented rabbits, and humans

In three separate experiments albino rabbits, pigmented rabbits, and humans were tested following administration of acetazolamide and without acetazolamide. In all three experiments, we recorded electroretinograms (ERGs) under dark adapted and light adapted conditions and measured the b-wave amplitudes. Dark adapted ERG b-wave amplitudes were increased following administration of acetazolamide as compared to control conditions, in albino rabbits, pigmented rabbits and humans. Light adapted b-wave amplitudes showed no statistically significant changes as a function of acetazolamide administration although in all three experiments there was a trend toward light adapted b-wave amplitude reduction following administration of acetazolamide. In the human experiments, ERG a-wave amplitudes were also measured. Light adapted a-wave amplitudes were reduced following administration of acetazolamide. In the human experiments, several behavioral tests were performed, including L'Anthony desaturated D-15, Farnsworth-Munsell 100 hue, Cogan-Gunkel chromatograph, Nagel anomaloscope, Goldmann-Weekers dark adaptometry. There were no consistent changes in the human dark adaptation thresholds or color discrimination, although several measures approached significance.

Effects of intraocular pressure on pH outside rod photoreceptors in the cat retina

Double-barreled H(+)-selective microelectrodes were used to study the effect of raising intraocular pressure (ocular hypertension) on intraretinal pH in the cat. A surprising alkalinizing response was observed in the subretinal space on the first experimental day in seven of 11 experiments. Of the three retinal regions studied, the alkalinizing response was present in the area centralis and in the adjoining near-discal region, but was absent in the superior temporal periphery. The alkalinizing response was relatively fragile, diminishing and then extinguishing with repetition of episodes of ocular hypertension. It was also never observed on the second experimental day. The alkalinizing response had a relatively low threshold, appearing with 10 mmHg elevations of intraocular pressure, i.e. when the perfusion pressure was still relatively high, but was also present across a wide range of perfusion pressures. It was maximal in amplitude in the most distal portion of the subretinal space and consisted of two components, an 'on' alkalinization during the episode of ocular hypertension, and an 'off' alkalinization following it. When the alkalinizing response was present in the subretinal space, it also could be recorded with placement of the microelectrode in the choroid. Elevations of systemic arterial blood pressure with epinephrine (intravenous), by raising perfusion pressure, also alkalinized the subretinal space, indicating that an increase in choroidal blood flow can produce this type of pH response. While pH recordings do not directly monitor blood flow, we tentatively interpreted the alkalinizing response with ocular hypertension as originating from a regional increase in choroidal blood flow, but we cannot rule out other explanations. Acidification of the subretinal space in response to ocular hypertension replaced the alkalinizing response when the latter extinguished, or acidification was the sole response in the absence of an alkalinization. The acidification also had a low threshold, was maximal in the most distal portion of the subretinal space, and increased in size with decreases in perfusion pressure. The acidification was reduced in amplitude by breathing 100% oxygen (hyperoxia). This was interpreted as suppression of the component of acidification that originated from an increase in glycolysis by the rod photoreceptors during ocular hypertension.

Effects of light and darkness on pH outside rod photoreceptors in the cat retina

We recorded pH in the extracellular space surrounding rod photoreceptors in the dark-adapted eye of the cat and during illumination with double-barreled H(+)-selective microelectrodes. A pH of 7.17 was recorded in the vitreous at the retinal surface of the dark-adapted eye and this became more alkaline during light adaptation. In dark adaptation, a pH close to 7.00 was recorded in a region of maximal acidity in the extracellular space surrounding rods in the outer nuclear layer (ONL). pH steeply alkalinized as the microelectrode was moved more distally towards the retinal pigment epithelium (RPE), and almost reached the pH of the arterial blood at the apical surface of the RPE. Illumination produced an intraretinal alkalinization that was largest (up to 0.2 pH units) in the ONL, maximal in amplitude at rod-saturating intensities, and that was sustained during steady background illumination. The light-evoked alkalinization was relatively slow in onset, having a time constant (1/e) of 64 sec, and took 8-12.5 min to return to the dark-adapted level after the offset of maintained illumination. These results show that acid production by cat rods is highest in the dark, reflecting a high rate of energy metabolism, and suggest that glycolysis is required to support the dark current. Illumination, by suppressing both glycolysis and respiration, alkalinizes the extracellular space surrounding rods. The substantial change in pH outside rods from dark to light could alter pH dependent properties of the interphotoreceptor matrix.

Effects of intravenous acetazolamide on retinal pH in the cat

Double-barreled H(+)-selective microelectrodes were used to study the effect on intravenous acetazolamide on intraretinal pH in the cat. Acetazolamide (11.4-27.8 mg kg-1 intravenously) caused a rapid acidification of the subretinal space. This change in pH originated in the most distal portion of the subretinal space and could not be attributed to a change in pH or PCO2 of the arterial blood. Slow light-evoked alkalinizations in distal retina, attributable to a decrease in rod photoreceptor energy metabolism, were relatively unaltered by acetazolamide. This result indicated that acetazolamide had not crossed the blood-retinal barrier in sufficient amounts to change this response. In time, following intravenous perfusion of acetazolamide, continuous depth profiles of intraretinal pH showed an acidification of the entire retina and the vitreous also became more acidic. These results indicate that the rapid or primary effect of acetazolamide is an acidification of the distal portion of the subretinal space, which is thought to originate in a change in the transport of H+ or HCO3- by the retinal pigment epithelium. This is followed by an acidification of the entire retina and vitreous, presumably due to diffusion of acid from the distal retina, although there could be additional causes.