Electroretinography

Improved retinal and visual function following panmacular subthreshold diode micropulse laser for retinitis pigmentosa

Objectives

To examine the effect of subthreshold diode micropulse laser (SDM) on pattern electroretinography (PERG) and visual function in retinitis pigmentosa (RP).

Methods

The records of all patients (pts) undergoing SDM in a vitreoretinal subspecialty practice were reviewed. Inclusion criteria included the presence of RP evaluated before and after SDM by PERG. As a secondary outcome measure, the results of automated omnifield resolution perimetry (ORP) were also reviewed.

Results

All eyes undergoing SDM for RP were eligible study, including 26 eyes of 15 pts; seven male and eight female, aged 16–69 (avg. 47) years. Retinal function by PERG improved by all indices, with significant improvements in the 24° field signal latency measures; the MagD(µV)/ Mag(µV) ratio (P < 0.0001) and the MagD(µV) amplitude (P = 0.0003). ORP significantly improved by all indices (p = 0.02–0.002). Average best-corrected chart visual acuities improved from 0.6 to 0.4 logMAR units (p = 0.02). There were no adverse treatment effects.

Conclusions

SDM significantly improved chart visual acuity, mesopic logMAR visual acuity perimetry, and retinal function by PERG in RP without adverse treatment effects. Treatment responses indicate a significant capacity for rescue of dysfunctional retina. These results suggest that early and periodic treatment with SDM might slow disease progression and reduce long-term vision loss.

Amyloid Precursor-Like Protein 2 deletion-induced retinal synaptopathy related to congenital stationary night blindness: structural, functional and molecular characteristics

Background

Amyloid precursor protein knockout mice (APP-KO) have impaired differentiation of amacrine and horizontal cells. APP is part of a gene family and its paralogue amyloid precursor-like protein 2 (APLP2) has both shared as well as distinct expression patterns to APP, including in the retina. Given the impact of APP in the retina we investigated how APLP2 expression affected the retina using APLP2 knockout mice (APLP2-KO).

Results

Using histology, morphometric analysis with noninvasive imaging technique and electron microscopy, we showed that APLP2-KO retina displayed abnormal formation of the outer synaptic layer, accompanied with greatly impaired photoreceptor ribbon synapses in adults. Moreover, APLP2-KO displayed a significant decease in ON-bipolar, rod bipolar and type 2 OFF-cone bipolar cells (36, 21 and 63 %, respectively). Reduction of the number of bipolar cells was accompanied with disrupted dendrites, reduced expression of metabotropic glutamate receptor 6 at the dendritic tips and alteration of axon terminals in the OFF laminae of the inner plexiform layer. In contrast, the APP-KO photoreceptor ribbon synapses and bipolar cells were intact. The APLP2-KO retina displayed numerous phenotypic similarities with the congenital stationary night blindness, a non-progressive retinal degeneration disease characterized by the loss of night vision. The pathological phenotypes in the APLP2-KO mouse correlated to altered transcription of genes involved in pre- and postsynatic structure/function, including CACNA1F, GRM6, TRMP1 and Gα0, and a normal scotopic a-wave electroretinogram amplitude, markedly reduced scotopic electroretinogram b-wave and modestly reduced photopic cone response. This confirmed the impaired function of the photoreceptor ribbon synapses and retinal bipolar cells, as is also observed in congenital stationary night blindness. Since congenital stationary night blindness present at birth, we extended our analysis to retinal differentiation and showed impaired differentiation of different bipolar cell subtypes and an altered temporal sequence of development from OFF to ON laminae in the inner plexiform layer. This was associated with the altered expression patterns of bipolar cell generation and differentiation factors, including MATH3, CHX10, VSX1 and OTX2.

Conclusions

These findings demonstrate that APLP2 couples retina development and synaptic genes and present the first evidence that APLP2 expression may be linked to synaptic disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s13041-016-0245-z) contains supplementary material, which is available to authorized users.

Electrophysiological assessment of retinal ganglion cell function

The function of retinal ganglion cells (RGCs) can be non-invasively assessed in experimental and genetic models of glaucoma by means of variants of the ERG technique that emphasize the activity of inner retina neurons. The best understood technique is the Pattern Electroretinogram (PERG) in response to contrast-reversing gratings or checkerboards, which selectively depends on the presence of functional RGCs. In glaucoma models, the PERG can be altered before histological loss of RGCs; PERG alterations may be either reversed with moderate IOP lowering or exacerbated with moderate IOP elevation. Under particular luminance-stimulus conditions, the Flash-ERG displays components that may reflect electrical activity originating in the proximal retina and be altered in some experimental glaucoma models (positive Scotopic Threshold response, pSTR; negative Scotopic Threshold Response, nSTR; Photopic Negative Response, PhNR; Oscillatory Potentials, OPs; multifocal ERG, mfERG). It is not yet known which of these components is most sensitive to glaucomatous damage. Electrophysiological assessment of RGC function appears to be a necessary outcome measure in experimental glaucoma models, which complements structural assessment and may even predict it. Neuroprotective strategies could be tested based on enhancement of baseline electrophysiological function that results in improved RGC survival. The use of electrophysiology in glaucoma models may be facilitated by specifically designed instruments that allow high throughput, robust assessment of electrophysiological function.

Anthocyanins from the seed coat of black soybean reduce retinal degeneration induced by N-methyl-N-nitrosourea

Anthocyanins are known to have antioxidant effects and thus may play an important role in preventing various degenerative diseases. In this study, we examined the effect of anthocyanins extracted from the seed coat of black soybean on an animal model of retinal degeneration (RD), a leading cause of photoreceptor cell death resulting in blindness. RD was induced in rats by an intraperitoneal injection of N-methyl-N-nitrosourea (MNU) (50mg/kg), a DNA-methylating agent that causes photoreceptor damage. Anthocyanins extracted from black soybean seed coat (50mg/kg) were daily administered, orally, for 1, 2, and 4 weeks after MNU injection. Electroretinographic (ERG) recordings and morphological analyses were performed. In control rats with MNU-induced retinal damage, the ERG recordings showed a gradual significant time-dependent reduction in both a- and b-wave amplitudes compared with those of normal animals. In the MNU-induced RD rats given anthocyanins for 4 weeks, ERG responses were significantly increased compared with untreated RD rats, more apparently in scotopic stimulation than in the photopic condition. However, in the MNU-injected rats given anthocyanins for 1 and 2 weeks, the increase in ERG responses was not significant. Morphologically, the outer nuclear layer, where photoreceptors reside, was well preserved in the anthocyanin-treated rat retinas throughout the experimental period. In addition, retinal injury, evaluated by immunolabeling with an antibody against glial fibrillary acidic protein, was markedly reduced in anthocyanin-treated retinas. These results demonstrate that anthocyanins extracted from black soybean seeds can protect retinal neurons from MNU-induced structural and functional damages, suggesting that anthocyanins from black soybean seed coat may be used as a useful supplement to modulate RD.

Morphological and functional evaluation of an animal model for the retinal degeneration induced by N-methyl-N-nitrosourea

The retinal degeneration (RD) is a general cause of blindness. To study its pathophysiology and evaluate the effects of new therapeutic agents before clinical trials, it is essential to establish reliable and stable animal models. This study evaluated a RD animal model in which blindness was induced by N-methyl-N-nitrosourea (MNU), a potent retinotoxin leading to apoptosis of photoreceptors. MNU was applied to the Sprague-Dawley rats by a single intraperitoneal injection in different doses (40, 50, and 60 mg/kg). The retinal functions were examined at 1 week after MNU injection by electroretinogram (ERG). Afterwards, each retina was examined by hematoxylin and eosin stain and immunohistochemistry with anti-glial fibrillary acidic protein antibody. Upon MNU injection of 40, 50 and 60 mg/kg, the ERG amplitude of a-waves showed significant reductions of 7, 26, and 44%, respectively, when compared to that of normal a-waves. The b-wave amplitudes were about 89, 65, and 58% of normal b-waves in the response to scotopic light stimulus. At 1 week, 2 weeks, and 4 weeks after MNU injection (50 mg/kg), all scotopic ERG components decreased progressively. In addition, degeneration of retinal neurons was observed in a time- and dose-dependent manner after MNU injection. Taken together, functional reduction following RD induced by MNU correlates with morphological changes. Thus, this RD rat model may be a useful model to study its pathophysiology and to evaluate the effects of new therapeutic agents before clinical trials.

Preservation of visual cortical function following retinal pigment epithelium transplantation in the RCS rat using optical imaging techniques

The aim of this study was to determine the extent of cortical functional preservation following retinal pigment epithelium (RPE) transplantation in the Royal College of Surgeons (RCS) rat using single-wavelength optical imaging and spectroscopy. The cortical responses to visual stimulation in transplanted rats at 6 months post-transplantation were compared with those from age-matched untreated dystrophic and non-dystrophic rats. Our results show that cortical responses were evoked in non-dystrophic rats to both luminance changes and pattern stimulation, whereas no response was found in untreated dystrophic animals to any of the visual stimuli tested. In contrast, a cortical response was elicited in most of the transplanted rats to luminance changes and in many of those a response was also evoked to pattern stimulation. Although the transplanted rats did not respond to high spatial frequency information we found evidence of preservation in the cortical processing of luminance changes and low spatial frequency stimulation. Anatomical sections of transplanted rat retinas confirmed the capacity of RPE transplantation to rescue photoreceptors. Good correlation was found between photoreceptor survival and the extent of cortical function preservation determined with optical imaging techniques. This study determined the efficacy of RPE transplantation to preserve visual cortical processing and established optical imaging as a powerful technique for its assessment.

The mouse pattern electroretinogram

Mouse models of optic nerve disease such as glaucoma, optic neuritis, ischemic optic neuropathy, and mitochondrial optic neuropathy are being developed at increasing rate to investigate specific pathophysiological mechanisms and the effect of neuroprotective treatments. The use of these models may be greatly enhanced by the availability of non-invasive methods able to monitor retinal ganglion cell (RGC) function longitudinally such as the Pattern Electroretinogram (PERG). While the use of the PERG as a tool to probe inner retina function in mammals is known since 25 years, relatively less information is available for the mouse. Here, the PERG technique and the main applications in the mouse are reviewed.

Enolase autoantibodies and retinal function in multiple sclerosis patients

BACKGROUND

Electroretinographic (ERG) abnormalities have been reported in multiple sclerosis (MS), as well as the presence of circulating antiretinal antibodies. We and others have reported cases of impaired vision and diminished ERGs in MS patients with alpha-enolase autoantibodies. Anti-enolase antibodies have been implicated in autoimmune retinopathy. We performed this study to further explore the relationship between antiretinal antibodies and ERG changes in patients with MS.

METHODS

Patients with clinically definite MS and normal visual acuity were recruited for this study, along with healthy controls. All patients and controls had ERG testing done according to ISCEV standards. Patient and control sera were analyzed for the presence of antiretinal antibodies using Western blot and ELISA techniques, and HLA class II typing was performed using polymerase chain reaction.

RESULTS

We found a statistically significant difference between MS patients and controls in the rod-cone b-wave implicit time (p < 0.005). We found autoantibodies against alpha-enolase in 38% of MS patients and 11% of controls (p < 0.02). There was no statistically significant difference between ERG parameters of MS patients with alpha-enolase autoantibodies compared to those without alpha-enolase antibodies. Furthermore, the presence of alpha-enolase did not associate with a particular HLA haplotype.

CONCLUSIONS

Factors affecting the retina other than alpha-enolase antibodies may account for the delayed rod-cone b-wave implicit times observed in MS patients in this study. Anti-enolase antibodies are likely an epiphenomenon of autoimmune disease, and are not causing retinopathy in MS patients with normal visual acuity. However, the possibility of rare cases of patients with pathogenic alpha-enolase autoantibodies can not be excluded. The pathogenic contribution of these antibodies in MS patients with visual impairment deserves further investigation.

Contribution to the kinetics and amplitude of the electroretinogram b-wave by third-order retinal neurons in the rabbit retina

The ERG b-wave is widely believed to reflect mainly light-induced activity of on-center bipolar cells and Müller cells. Third-order retinal neurons are thought to contribute negligibly to generation of the b-wave. Here we show that pharmacological agents which affect predominantly third-order neurons alter significantly both the kinetics and amplitude of the b-wave. Our results support the notion that changes in the amplitude and kinetics of light-induced membrane depolarization in third-order neurons produce similar changes in the amplitude and kinetics of the b-wave. We conclude that activity in third-order neurons makes a significant contribution to b-wave generation. Our results also provide evidence that spiking activity of third-order neurons truncates the a-wave by accelerating the onset of the b-wave.

Analysis of pharmacologically isolated components of the ERG

An harmonic analysis was applied to the electroretinogram (ERG) measured in intact cat eyes in control conditions and after pharmacological isolation of the components attributed to photoreceptors (PIII) and bipolar neurons (PII). The frequency response curves obtained in various conditions showed that the bandwidth of the PII component extends over a range of stimulus frequencies higher than the bandwidth of PIII. The enhancement of the PII response to stimuli of high temporal frequency suggests the presence of a frequency dependent gain control located either pre- and/or post-synaptically in the transmission line between the phototransductive cascade and bipolar neurons. A possible role of these processes is to enhance relevant visual information whilst selectively attenuating low frequency signals originating in the transductive cascade.

The pattern electroretinogram in Parkinson's disease reveals lack of retinal spatial tuning

Spatio-temporal visual abnormalities, involving processing of medium coarse stimuli, are known to occur in Parkinson's disease (PD). While these deficits have been related to retinal dopaminergic deficiency, previous ERG studies in PD patients have provided conflicting results, probably due to differences in stimulus conditions. The influence of pattern element size (spatial frequency, SF) on the pattern electroretinogram (PERG) in PD has not been systematically studied. We recorded steady-state PERG to sinusoidal gratings of 50% contrast, counterphase modulated at 7.5 Hz with a series of SFs ranging from 0.5 to 6.9 c/deg in 20 PD patients and 20 healthy volunteers, subdivided in 10 "young" and 10 "age-matched" (AM) subjects. The PERG was analyzed by means of Fast Fourier Transform and the amplitude and the phase of the second harmonic response (15 Hz) were taken into account. We evaluated the medium-to-low SF amplitude ratio and termed it "PERG tuning ratio" (TR). The results indicate that aging affects all the studied SF, but the pattern of age-related loss differs from that observed in PD. Compared to AM subjects, PD patients show a specific deficit at medium SF, with a distorted PERG SF response function. Consequently, all PD patients show an attenuated PERG TR and 17 of them (85%) have an inverted TR. A significant TR decrease is correlated with the clinical stage of PD. There is a marked TR difference between patients receiving and not receiving L-DOPA. We conclude that stimulus SF is a crucial variable of the PERG in PD. PERG measurements and the derived PERG TR may provide a simple tool to evaluate retinal dopaminergic mechanisms and could contribute to the clinical assessment and monitoring of dopaminergic therapy in PD.

Measurement of the micro-electroretinogram and component analysis

The authors propose a new technique for detecting micro-electroretinograms (muERG) which uses light-emitting diode (LED) stimulation and frequency analysis. The advantage of this method is the applicability of linear system analysis to a muERG obtained by partial stimulation of a computer-controlled waveform. The paper discusses two basic techniques for detecting the muERG. One is Fourier analysis of a synchronised ERG obtained by sine-wave stimulus, and the other is correlation analysis using a random stimulus. The results of the two methods are compared, and the usefulness of the proposed method is indicated; the muERG is analysed by means of a model consisting of five components of a second-order transfer function with delay. Functions of the central and peripheral areas of the retina could be analysed in more detail by this technique.

Red-green flicker photometry and nonlinearities in the flicker electroretinogram

We investigated whether responses from different cone classes are combined before or after the nonlinearity that is responsible for generating nonlinear response components of the flicker electroretinogram (ERG). We measured the nonlinear response of the retina while systematically varying the modulation in the long-wavelength-sensitive and middle-wavelength-sensitive cones by changing the proportions of flickering 633- and 543-nm lights that compose a sum-of-sinusoids temporal waveform. We found that at high temporal frequencies the ERG responses are best accounted for by a model in which the principal retinal nonlinearity is located before the convergence of signals from the two cone classes. At low temporal frequencies the ERG signal is dominated by cone-antagonistic responses. At frequencies of 30 Hz and higher, the flicker ERG and psychophysical flicker photometry give similar estimates of the relative proportions of long- and middle-wavelength-sensitive cones. The ERG photometric null is frequency dependent, whereas the psychophysically determined ratio is much less sensitive to changes in frequency.

Temporal spacing of pattern alternation and human visual response

The electroretinogram and the visual evoked potential were recorded in response to checkerboard stimuli presented in phase alternation. The times in which the pattern was in its two positions were changed within a fixed total cycle time of two seconds. Both the amplitude of the electroretinogram and the evoked potential were affected by the length of the time interval between alternations, but in opposite directions. An electroretinogram that closely followed a preceding response was reduced in size while an evoked potential was larger. The results indicate that there is an interaction between adjacent pattern areas at the retinal level.