The scotopic electroretinogram to blue flashes and pattern reversal visual evoked potentials in insulin dependent diabetes

Efficacy of ozone therapy on visual evoked potentials in diabetic patients

BACKGROUND

The involvement of the central nervous system is a frequent yet underestimated complication of diabetes mellitus. Visual evoked potentials (VEP) are a simple, sensitive, and noninvasive method for detecting early alterations in central optic pathways. The objective of this paralleled randomized controlled trial was to evaluate the impact of ozone therapy on visual pathways in diabetic patients.

METHODS

Sixty patients with type 2 diabetes visiting clinics of Baqiyatallah university in Tehran (Iran) hospital were randomly assigned to two experimental groups: Group 1 (N = 30) undergoing a cycle of 20 sessions of systemic oxygen-ozone therapy in addition to standard therapy for metabolic control; Group 2 (N = 30)-serving as control-receiving only standard therapy against diabetes. The primary study endpoints were two VEP parameters; P100 wave latency and P100 amplitude at 3 months. Moreover, HbA_1c levels were measured before the start of treatment and three months later as secondary study endpoint.

RESULTS

All 60 patients completed the clinical trial. P100 latency significantly reduced at 3 months since baseline. No correlation was found between repeated measures of P100 wave latency and HbA_1c (Pearson's r = 0.169, p = 0.291). There was no significant difference between baseline values and repeated measures of P100 wave amplitude over time in either group. No adverse effects were recorded.

CONCLUSIONS

Ozone therapy improved the conduction of impulses in optic pathways of diabetic patients. The improved glycemic control following ozone therpay may not fully explain the reduction of P100 wave latency though; other mechanistic effects of ozone may be involved.

Novel Detection and Restorative Levodopa Treatment for Preclinical Diabetic Retinopathy

Diabetic retinopathy (DR) is diagnosed clinically by directly viewing retinal vascular changes during ophthalmoscopy or through fundus photographs. However, electroretinography (ERG) studies in humans and rodents have revealed that retinal dysfunction is demonstrable prior to the development of visible vascular defects. Specifically, delays in dark-adapted ERG oscillatory potential (OP) implicit times in response to dim-flash stimuli (<-1.8 log cd · s/m²) occur prior to clinically recognized DR. Animal studies suggest that retinal dopamine deficiency underlies these early functional deficits. In this study, we randomized individuals with diabetes, without clinically detectable retinopathy, to treatment with either low- or high-dose Sinemet (levodopa plus carbidopa) for 2 weeks and compared their ERG findings with those of control subjects (no diabetes). We assessed dim-flash-stimulated OP delays using a novel handheld ERG system (RETeval) at baseline and 2 and 4 weeks. RETeval recordings identified significant OP implicit time delays in individuals with diabetes without retinopathy compared with age-matched control subjects (P < 0.001). After 2 weeks of Sinemet treatment, OP implicit times were restored to control values, and these improvements persisted even after a 2-week washout. We conclude that detection of dim-flash OP delays could provide early detection of DR and that Sinemet treatment may reverse retinal dysfunction.

Role of Arginase 2 in Murine Retinopathy Associated with Western Diet-Induced Obesity

Western diet-induced obesity is linked to the development of metabolic dysfunctions, including type 2 diabetes and complications that include retinopathy, a leading cause of blindness. Aberrant activation of the inflammasome cascade leads to the progression of obesity-induced pathologies. Our lab showed the critical role of arginase 2 (A2), the mitochondrial isoform of this ureahydrolase, in obesity-induced metabolic dysfunction and inflammation. A2 deletion also has been shown to be protective against retinal inflammation in models of ischemic retinopathy and multiple sclerosis. We investigated the effect of A2 deletion on western diet-induced retinopathy. Wild-type mice fed a high-fat, high-sucrose western diet for 16 weeks exhibited elevated retinal expression of A2, markers of the inflammasome pathway, oxidative stress, and activation of microglia/macrophages. Western diet feeding induced exaggerated retinal light responses without affecting visual acuity or retinal morphology. These effects were reduced or absent in mice with global A2 deletion. Exposure of retinal endothelial cells to palmitate and high glucose, a mimic of the obese state, increased expression of A2 and inflammatory mediators and induced cell death. These effects, except for A2, were prevented by pretreatment with an arginase inhibitor. Collectively, our study demonstrated a substantial role of A2 in early manifestations of diabetic retinopathy.

Taurine Protects Retinal Cells and Improves Synaptic Connections in Early Diabetic Rats

Purpose: Taurine has long been thought to be involved in retinal protection from retinal degenerative diseases, but the underlying molecular mechanisms remain unclear. Retinal neurodegeneration is an early event in the pathogenesis of diabetic retinopathy (DR) that precedes and participates in the microcirculatory abnormalities that occur in DR. Our objective was to investigate the role and mechanisms of taurine in early diabetic retinas.Methods: Eight-week-old STZ-induced diabetic rats and control animals were randomly assigned to receive taurine or vehicle by intraperitoneal injection or by intragastric administration. The retinal function and retinal cell counts were evaluated using an electroretinography (ERG) and immunofluorescence microscopy. Plasma amino acids were measured by ion-exchange chromatography (IEC). The expression levels of retinal taurine transporter (Tau-T), mitochondria-dependent apoptosis-associated genes and reactive gliosis markers were studied by western blotting and immunofluorescence. Pre- and post-synaptic markers (PSD95 and mGluR6) in outer plexiform layer (OPL), and the bipolar cell marker protein kinase C alpha (PKCα) were localized by immunofluorescence. Levels of PSD95 and mGluR6 were determined by quantitative western blot.Results: Taurine significantly prevented the reduction of photopic b-wave amplitude and retinal cone cells and ganglion cells loss and maintained the Bcl-2/Bax ratio balance in diabetic rats. Taurine also prevented the upregulation of glial fibrillary acidic protein (GFAP) and reduced retinal reactive gliosis. Taurine reduced plasma glutamate and tyrosine levels, which were elevated in diabetic rats. Moreover, mGluR6 levels reduction detected by western blot and immunofluorescence in diabetic retinas was inhibited and the displacement of mGluR6 in OPL into the inner nuclear layer (INL) detected by immunofluorescence was reduced by Taurine treatment.Conclusion: Taurine may protect retinal cells from diabetic attacks by activating Tau-T, reducing retinal reactive gliosis, improving retinal synaptic connections and decreasing retinal cell apoptosis. Thus, taurine treatment may be a novel approach for early DR.

Evaluation of visual pathways using visual evoked potentials in the patients with impaired fasting glucose and impaired glucose tolerance

PURPOSE

There are many studies on degeneration of the ganglion cells using visual evoked potential (VEP) in Diabetes mellitus (DM). The present study intended to investigate whether the retinopathy findings would be helpful for detecting the degeneration to develop or not in retinal ganglion cells with the VEP test before being detectable in ophthalmoscopic examination on prediabetic patients.

MATERIALS AND METHODS

The present study was conducted prospectively after obtaining approval from the Ethics Committee. In our study, the subjects were divided into three groups as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and normal patients. They also underwent physical, ophthalmological and VEP examination. Three main components of VEP obtained from these groups were N75, P100, and N145 latency and N75-P100 amplitude.

RESULTS

The study participants consisted of the IFG group (n: 30, female/male ratio: 21/9; mean age: 49.17 ± 10.52 years), the IGT group (n: 30, female/male ratio: 23/7; mean age: 47.00 ± 11.09 years), and the Control Group (n: 40, female/male ratio: 30/10; mean age: 48.03 ± 10.96 years). Difference in sex and age between the study groups (p > 0.05). P100 latency was found to increase significantly in comparison between the IGT and Control Group for both eyes (p right: 0.003, p left: 0.001) whereas it did not increase significantly in the comparison between the IFG and the Control Group (p right: 0.065, p left: 0.116).

CONCLUSION

It was observed that VEP may be a parameter of predictive value that might be used in evaluating prediabetic cases in terms of retinopathies similar to DM.

Shades of grey; Assessing the contribution of the magno- and parvocellular systems to neural processing of the retinal input in the human visual system from the influence of neural population size and its discharge activity on the VEP

INTRODUCTION

Retinal input processing in the human visual system involves a phasic and tonic neural response. We investigated the role of the magno- and parvocellular systems by comparing the influence of the active neural population size and its discharge activity on the amplitude and latency of four VEP components.

METHOD

We recorded the scalp electric potential of 20 human volunteers viewing a series of dartboard images presented as a pattern reversing and pattern on-/offset stimulus. These patterns were designed to vary both neural population size coding the temporal- and spatial luminance contrast property and the discharge activity of the population involved in a systematic manner.

RESULTS

When the VEP amplitude reflected the size of the neural population coding the temporal luminance contrast property of the image, the influence of luminance contrast followed the contrast response function of the parvocellular system. When the VEP amplitude reflected the size of the neural population responding to the spatial luminance contrast property the image, the influence of luminance contrast followed the contrast response function of the magnocellular system. The latencies of the VEP components examined exhibited the same behavior across our stimulus series.

CONCLUSIONS

This investigation demonstrates the complex interplay of the magno- and parvocellular systems on the neural response as captured by the VEP. It also demonstrates a linear relationship between stimulus property, neural response, and the VEP and reveals the importance of feedback projections in modulating the ongoing neural response. In doing so, it corroborates the conclusions of our previous study.

Neurodegeneration in diabetic retinopathy: Potential for novel therapies

The complex pathology of diabetic retinopathy (DR) affects both vascular and neural tissue. The characteristics of neurodegeneration are well-described in animal models but have more recently been confirmed in the clinical setting, mostly by using non-invasive imaging approaches such as spectral domain optical coherence tomography (SD-OCT). The most frequent observations report loss of tissue in the nerve fiber layer and inner plexiform layer, confirming earlier findings from animal models. In several cases the reduction in inner retinal layers is reported in patients with little evidence of vascular lesions or macular edema, suggesting that degenerative loss of neural tissue in the inner retina can occur after relatively short durations of diabetes. Animal studies also suggest that neurodegeneration leading to retinal thinning is not limited to cell death and tissue loss but also includes changes in neuronal morphology, reduced synaptic protein expression and alterations in neurotransmission, including changes in expression of neurotransmitter receptors as well as neurotransmitter release, reuptake and metabolism. The concept of neurodegeneration as an early component of DR introduces the possibility to explore alternative therapies to prevent the onset of vision loss, including neuroprotective therapies and drugs targeting individual neurotransmitter systems, as well as more general neuroprotective approaches to preserve the integrity of the neural retina. In this review we consider some of the evidence for progressive retinal neurodegeneration in diabetes, and explore potential neuroprotective therapies.

To see or not to see; the ability of the magno- and parvocellular response to manifest itself in the VEP determines its appearance to a pattern reversing and pattern onset stimulus

INTRODUCTION

The relationship between stimulus property, brain activity, and the VEP is still a matter of uncertainty.

METHOD

We recorded the VEP of 43 volunteers when viewing a series of dartboard images presented as both a pattern reversing and pattern onset/offset stimulus. Across the dartboard images, the total stimulus area undergoing a luminance contrast change was varied in a graded manner.

RESULTS

We confirmed the presence of two independent neural processing stages. The amplitude of VEP components across our pattern reversing stimuli signaled a phasic neural response based on a temporal luminance contrast selective mechanism. The amplitude of VEP components across the pattern onset stimuli signaled both a phasic and a tonic neural response based on a temporal- and spatial luminance contrast selective mechanism respectively. Oscillation frequencies in the VEP suggested modulation of the phasic neural response by feedback from areas of the dorsal stream, while feedback from areas of the ventral stream modulated the tonic neural response. Each processing stage generated a sink and source phase in the VEP. Source localization indicated that during the sink phase electric current density was highest in V1, while during the source phase electric current density was highest in extra-striate cortex. Our model successfully predicted the appearance of the VEP to our images whether presented as a pattern reversing or a pattern onset/offset stimulus.

CONCLUSIONS

Focussing on the effects of a phasic and tonic response rather than contrast response function on the VEP, enabled us to develop a theory linking stimulus property, neural activity and the VEP.

Rod function in diabetic patients without and with early diabetic retinopathy

PURPOSE

To compare rod function among diabetic patients without and with mild nonproliferative diabetic retinopathy (DR) and healthy controls by means of scotopic microperimetry and dark-adapted electroretinography.

METHODS

Sixty-one diabetic patients and 30 age-matched controls (control group) underwent complete ophthalmic examination, scotopic microperimetry, and dark-adapted 0.01 electroretinography (DA-ERG).

RESULTS

In 32 eyes, DR was absent (no-DR group); in 29 eyes, only microaneurysms were observed (DR group). No statistically significant differences in fixation stability, fixation location, or scotopic sensitivity among the 3 groups were observed. Implicit time and amplitude of the DA-ERG b-wave of no-DR and DR groups were not different from controls. Scotopic microperimetry showed a dense scotoma centered onto the fovea in all subjects, consistent with the rod-free zone. Greater scotopic sensitivity was found in a ring located 8° from the fovea (9.33 ± 1.33 dB).

CONCLUSIONS

Diabetic patients without DR and with mild nonproliferative DR did not show alterations in rod-based function, as examined by microperimetry and confirmed by DA-ERG. Scotopic microperimetry measures rod-based function and offers additional information in the evaluation of the aspects of involvement of retinal cells in diabetes.

Ophthalmic markers of the diabetic polyneuropathy

In the article, a world literature analysis is presented on the relationship between structural and functional changes of the retina and of the optic nerve and the diabetic polyneuropathy severity degree. Diabetic polyneuropathy is one of the most common and severe complications of diabetes mellitus leading in many patients to ulcer formation and to foot amputation. Modern methods for neuropathy diagnosis either do not allow revealing early stage changes, or include invasive procedures. Ophthalmologists, involved in diabetic patients care, due to objective reasons focus on diabetic retinopathy. However, the evidence that the corneal nerves state is a marker of peripheral neuropathy suggests a new and very important role of the ophthalmologist in diabetic patient care. Several studies obtained promising results about structural and functional retinal changes could be found in diabetic patients before retinopathy start; this allows to suggest the neuropathy role at their origin.

Role of Electrophysiology in the Early Diagnosis and Follow-Up of Diabetic Retinopathy

Retinopathy is a severe and common complication of diabetes, representing a leading cause of blindness among working-age people in developed countries. It is estimated that the number of people with diabetic retinopathy (DR) will increase from 126.6 million in 2011 to 191 million by 2030. The pathology seems to be characterized not only by the involvement of retinal microvessels but also by a real neuropathy of central nervous system, similar to what happens to the peripheral nerves, particularly affected by diabetes. The neurophysiological techniques help to assess retinal and nervous (optic tract) function. Electroretinography (ERG) and visual evoked potentials (VEP) allow a more detailed study of the visual function and of the possible effects that diabetes can have on the visual function. These techniques have an important role both in the clinic and in research: the central nervous system, in fact, has received much less attention than the peripheral one in the study of the complications of diabetes. These techniques are safe, repeatable, quick, and objective. In addition, both the ERG (especially the oscillatory potentials and the flicker-ERG) and VEP have proved to be successful tools for the early diagnosis of the disease and, potentially, for the ophthalmologic follow-up of diabetic patients.

Multifocal electroretinogram in diabetic subjects

PURPOSE

To identify local retinal abnormalities and evaluate the nature and extent of retinal dysfunction in diabetics using full field electroretinogram (ERG) and multifocal ERG (MF-ERG) and to determine the correlation between features of optical coherence tomography (OCT) and MF-ERG.

METHODS

Twenty-eight normal subjects (Control Group; 56 eyes) and 37 patients (72 eyes) with diabetes mellitus (DM Group) were evaluated. In the DM Group, 17 eyes had no retinopathy (grade 1), 18 eyes had early non proliferative diabetic retinopathy (NPDR) (grade 3), 16 eyes had late NPDR (grade 4), 21 eyes had proliferative diabetic retinopathy (PDR) (grade 5). Full field ERG and MF-ERG, were used to assess the effects of diabetic retinopathy on retinal function. OCT and fluorescein angiography were used to assess and compare morphological changes with functional changes in diabetes mellitus.

RESULTS

In diabetic patients without retinopathy (17 eyes), the amplitudes of the second order component of MF-ERG were reduced and implicit times were delayed, while only implicit times of first order component of MF-ERG were delayed but the amplitudes of first order component were normal. In diabetic patients with retinopathy (55 eyes), the overall amplitudes were reduced and peak implicit time increased in the first order component and second order component. OCT of the DM Group showed the fovea of eyes with edema were thicker than the Normal Group. The fovea of eyes with cystoid macular edema (CME) were significantly thicker than the fovea of eyes with diffuse swelling. The implicit times of MF-ERG were directly correlated with foveal thickness.

CONCLUSION

MF-ERG reveals local retinal dysfunction in diabetic patients. MF-ERG offers the advantage of topographic mapping of retinal dysfunction. The magnitude of delay of MF-ERG implicit time reflects the degree of local clinical abnormalities in eyes with retinopathy. Local response delays found in eyes without retinopathy detects subclinical local retinal dysfunction in diabetics. The combination of OCT and MF-ERG may provide objective criteria for evaluation and assessment of diabetic retinopathy.

Retinal adaptation to changing glycemic levels in a rat model of type 2 diabetes

PURPOSE

Glucose concentrations are elevated in retinal cells in undiagnosed and in undertreated diabetes. Studies of diabetic patients suggest that retinal function adapts, to some extent, to this increased supply of glucose. The aim of the present study was to examine such adaptation in a model of type 2 diabetes and assess how the retina responds to the subsequent institution of glycemic control.

METHODS

Electroretinography (ERG) was conducted on untreated Zucker diabetic fatty (ZDF) rats and congenic controls from 8-22 weeks of age and on ZDFs treated with daily insulin from 16-22 weeks of age. Retinal sections from various ages were prepared and compared histologically and by immunocytochemistry.

PRINCIPAL FINDINGS/CONCLUSIONS

Acute hyperglycemia did not have an effect on control rats while chronic hyperglycemia in the ZDF was associated with scotopic ERG amplitudes which were up to 20% higher than those of age-matched controls. This change followed the onset of hyperglycemia with a delay of over one month, supporting that habituation to hyperglycemia is a slow process. When glycemia was lowered, an immediate decrease in ZDF photoreceptoral activity was induced as seen by a reduction in a-wave amplitudes and maximum slopes of about 30%. A direct effect of insulin on the ERG was unlikely since the expression of phosphorylated Akt kinase was not affected by treatment. The electrophysiological differences between untreated ZDFs and controls preceded an activation of Müller cells in the ZDFs (up-regulation of glial fibrillary acidic protein), which was attenuated by insulin treatment. There were otherwise no signs of cell death or morphological alterations in any of the experimental groups. These data show that under chronic hyperglycemia, the ZDF retina became abnormally sensitive to variations in substrate supply. In diabetes, a similar inability to cope with intensive glucose lowering could render the retina susceptible to damage.

Protective Effects of Adeno-associated Virus Mediated Brain-derived Neurotrophic Factor Expression on Retinal Ganglion Cells in Diabetic Rats

Adeno-associated virus vector plasmid carrying the expression cassette of brain-derived neurotrophic factor (BDNF), pAAV-BDNF, was constructed and packaged into recombinant adeno-associated virus (rAAV-BDNF). The rAAV-BDNF was intravitreally injected into streptzotocin (STZ)-induced diabetic Sprague-Dawley (SD) Rats. Data showed that over-expression of BDNF could increase alive retinal ganglion cell (RGC) number and improve its function in streptzotocin(STZ)-induced diabetic rats, which might be a new method to treat diabetic neuropathy and retinopathy.

The Glenn A. Fry award lecture 2010: Ophthalmic markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is a debilitating condition that affects about 50% of diabetic patients. The symptoms of DPN include numbness, tingling, or pain in the arms and legs. Patients with numbness may be unaware of foot trauma, which could develop into a foot ulcer. If left untreated, this may ultimately require amputation. Currently, the only method of directly examining peripheral nerves is to conduct skin punch or sural/peroneal nerve biopsies, which are uncomfortable and invasive. Indirect methods include quantitative sensory testing (assessing responses to heat, cold, and vibration) and nerve electrophysiology. Here, I describe research undertaken in my laboratory, investigating the possibility of using a range of ophthalmic markers to assess DPN. Corneal nerve structure and function can be assessed using corneal confocal microscopy and non-contact corneal esthesiometry, respectively. Retinal nerve structure and visual function can be evaluated using optical coherence tomography and perimetry, respectively. These techniques have been used to demonstrate that DPN is associated with morphological degradation of corneal nerves, reduced corneal sensitivity, retinal nerve fiber layer thinning, and peripheral visual field loss. With further validation, these ophthalmic markers could become established as rapid, painless, non-invasive, sensitive, reiterative, cost-effective, and clinically accessible means of screening for early detection, diagnosis, staging severity, and monitoring progression of DPN, as well as assessing the effectiveness of possible therapeutic interventions. Looking to the future, this research may pave the way for an expanded role for the ophthalmic professions in diabetes management.

Exploring retinal and functional markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most debilitating complications of diabetes. DPN is a major cause of foot ulceration and lower limb amputation. Early diagnosis and management are key factors in reducing morbidity and mortality. Current techniques for clinical assessment of DPN are relatively insensitive for detecting early disease or involve invasive procedures such as skin biopsies. There is a need for less painful, non-invasive, safe evaluation methods. Eye-care professionals already play an important role in the management of diabetic retinopathy but recent studies have indicated that the eye may also be an important site for the diagnosis and monitoring of neuropathy. Corneal nerve morphology is a promising marker of diabetic neuropathy occurring elsewhere in the body. Emerging evidence tentatively suggests that retinal anatomical markers and a range of functional visual indicators could similarly provide useful information regarding neural damage in diabetes, although this line of research is less well established. This review outlines the growing body of evidence supporting a potential diagnostic role for retinal structure and visual functional markers in the diagnosis and monitoring of peripheral neuropathy in diabetes.

The effect of post prandial glucose changes on oscillatory potentials in subjects with type 2 diabetes mellitus

PURPOSE

To investigate the effect of elevated plasma glucose levels on oscillatory potentials (OPs) in patients with diabetes mellitus.

METHOD

15 patients with type 2 diabetes mellitus, with no ophthalmoscopically visible signs of diabetic retinopathy (NDR), were recruited, mean (SD) age 65.1 (10.91) years and duration 5.95 (4.95) years. Plasma glucose levels and OPs were recorded before, during and after a meal tolerance test (MTT), at times 0, 90 and 210 min. OPs were recorded following 5 min adaptation to a blue mesopic background (1.17 cd m(-2)), and elicited using a white 5 ms stimulus flickering at 5 Hz frequency over the blue background.

RESULTS

Plasma glucose increased significantly from 0 to 90 min during the MTT. This corresponded with an increase in mean amplitude of OP1-4, and a significant increase in the summed amplitudes. Summed OP amplitudes were 14.52 microv and 18.38 microv at time 0 and 90 min respectively. Between times 90 and 210 min plasma glucose levels decreased significantly back to baseline. OP1 and OP2 amplitudes increased slightly and OP3 and OP4 amplitudes decreased markedly, resulting in a non-significant reduction of the summed amplitudes. No significant changes in latencies were seen.

CONCLUSIONS

Summed OP amplitudes, which are known to reflect the efficiency of the retinal circulation, increased with elevated plasma glucose. This effect was not immediately reversible. Latencies appear not to be affected.

The electroretinogram in diabetic retinopathy

Electroretinography (ERG) is an objective method of evaluating retinal function. Since its introduction to clinical practice in the 1940s, it has become a useful and routine diagnostic clinical tool in ophthalmology. This review summarizes the role of ERG as a clinical technique for evaluating the progression of diabetic retinopathy and as a research tool for increasing our understanding of the pathophysiology of diabetic retinopathy. Most studies show unequivocally that the different types of ERG tests detect local abnormalities or widespread pathology, even in very early stages of the disease. It seems plausible that measurements from ERG recordings, particularly the oscillatory potentials, may be useful for predicting progression from nonproliferative to the more sight-threatening stages--preproliferative or proliferative--of diabetic retinopathy. Some recent work implies that the ERG can also be a useful diagnostic method for discriminating between eyes with diabetic retinopathy and those without the condition.

Altered rhodopsin regeneration in diabetic mice caused by acid conditions within the rod photoreceptors

PURPOSE

The experiments were designed to provide details on the characteristics of rhodopsin regeneration in the rod photoreceptors of diabetic mice and to evaluate their mechanistic basis.

METHODS

A genetically-derived diabetic albino mouse was developed. An excised albino mouse eye preparation was used. The preparation allows for direct measurements of rhodopsin concentration and other spectrally distinct intermediates, and maintains the structural integrity of the compartments involved in rhodopsin regeneration. The experiments were conducted at moderate bleaching levels, averaging 13-14%, with mice that exhibited moderate levels of blood glucose concentration.

RESULTS

Rhodopsin regeneration was delayed in both genetically-derived and streptozotocin-injected diabetic mice when compared to non-diabetic mice. During the delay an intermediate of rhodopsin, N-Retinylidene Opsin (NRO440), that precedes the hydrolysis of the bleached chromophore from the opsin and that is associated with acidic conditions was observed. This intermediate was not observed in non-diabetic mice. The delay in rhodopsin regeneration of the diabetic mice was partially eliminated, and the relative concentration of NRO440 was decreased, when the internal pH of the rod photoreceptor was raised by modifying the perfusate composition.

CONCLUSIONS

Following a bleach, both genetic and streptozotocin diabetic mice exhibited abnormalities in rhodopsin regeneration. When studied at moderate bleaching levels with animals that were moderately diabetic, both groups of diabetic mice exhibited a delay in the start of the rhodopsin regeneration. The delay appears to be caused by the formation of an acid intermediate of the bleached rhodopsin resulting from acid conditions within the rod photoreceptors.

Seeing beyond retinopathy in diabetes: electrophysiological and psychophysical abnormalities and alterations in vision

Contrast sensitivity testing, in common with color vision (another test of psychophysical function), demonstrates significant changes in diabetic subjects compared with nondiabetic controls, and there is some evidence for a relationship with grade of retinopathy. Changes in contrast sensitivity have been demonstrated in children and adults with diabetes of short duration, and some evidence exists for a correlation with poor glycemic control, although prospective studies are required to assess this relationship over a longer time period. Although both color vision and contrast sensitivity demonstrate similar patterns, studies that directly compare the two tests suggest that measurement of contrast sensitivity is the more sensitive and specific.

Electrical responses from diabetic retina

Diabetic retinopathy has long been considered to be a retinal manifestation of systemic diabetic angiopathy. Indeed, it is therapeutically true. However, the prolongation of OP peak latency in diabetic eyes without any angiographic evidence of angiopathy leads us to presume that certain neuronal disorders occur early in diabetic eyes. Even though we cannot neglect the possibility that the prolongation of the OP peak latency may derive from undetectable retinal hypoperfusion, it is still far from conventional diabetic angiopathy. Rather, the status should be properly termed "intraretinal diabetic neuropathy" in that the neurones are the disturbed cells to cause visual dysfunction. Thereafter, the OP amplitude diminishes as retinopathy advances, probably depending on the degree of retinal circulatory disturbance. Marked diminution of the OP amplitude predicts rapid progression and poor prognosis of retinopathy. Diabetic retinal pigment epitheliopathy as manifested by one of our non-photic EOG responses is another kind of early ocular involvement of diabetes. Because its mechanisms are not yet known, so far we have not succeeded in correlating it to any kind of subjective visual index. Routine fundus inspection or fluorescent fundus angiography is incapable of detecting the compromised neural retina and/or retinal pigment epithelial integrity and thus the electrophysiology of vision has the edge in ophthalmology.

Some recent applications of clinical psychophysiology

In this paper, major trends in the recent applications of Clinical Psychophysiology are summarized. These clinical applications pertain to neurosurgical interventions, and to neurological, psychiatric, pediatric, and ophthalmological diseases. Other applications of Clinical Psychophysiology include psychosomatic diseases such as cardiovascular, gastrointestinal, respiratory and sleep-related disorders. The International Organization of Psychophysiology based on its Constitution and By-Laws (IOP, 1981, 1982) is promoting high scientific standards in the applications of Clinical Psychophysiology to various medical conditions.