Asymmetry of focal macular photopic negative responses (PhNRs) in monkeys

Significant correlations between focal photopic negative response and focal visual sensitivity and ganglion cell complex thickness in glaucomatous eyes

PURPOSE

To determine whether there are significant correlations between the focal photopic negative response (PhNR), the focal visual sensitivity and the ganglion cell complex (GCC) thickness in glaucomatous eyes.

STUDY DESIGN

Single-center observational study.

METHODS

Fifty-two eyes of 52 patients (71.4 ± 9.42 years) with clinically diagnosed open angle glaucoma were studied. Thirty-six age-matched normal subjects served as controls. The focal PhNR of the focal macular electroretinograms (fmERGs) were elicited by a 15° circular, a superior semicircular or an inferior semicircular stimulus centered on the fovea. The thickness of the GCC was measured in the corresponding retinal areas in the spectral-domain optical coherence tomographic images. The visual sensitivities (dB) were measured by microperimetry at the retinal area where the fmERGs were elicited and were converted to liner values (1/Lambert).

RESULTS

The focal PhNR amplitudes were significantly correlated with the visual sensitivities of the full-circle (R = 0.532), the superior (R = 0.530) and inferior (R = 0.526) semicircular responses (P < 0.0001). The GCC thickness was correlated with the visual sensitivities in the same areas with stronger correlations (R = 0.700, 0.759 and 0.650, respectively; P < 0.0001). The focal PhNR amplitudes were proportionally reduced with the thinning of the GCC thickness (R = 0.494, 0.518 and 0.511, respectively; P < 0.0001).

CONCLUSIONS

The significant correlations between the focal PhNR amplitudes, the focal visual sensitivities and the GCC thickness indicate that these may be good biomarkers to track the changes in the physiology and anatomy of the macular area in glaucomatous eyes.

Relation between macular retinal ganglion cell/inner plexiform layer thickness and multifocal electroretinogram measures in experimental glaucoma

PURPOSE

We investigated relations between macular retinal ganglion cell plus inner plexiform layer (RGC+IPL) thickness and macular retinal function revealed by multifocal electroretinonography (mfERG) in a nonhuman primate model of experimental glaucoma.

METHODS

Retinal ganglion cell (RGC) structure and function were followed with spectral-domain optical coherence tomography (SD-OCT) and ERGs in five macaques with unilateral experimental glaucoma. Linear regression was used to study correlations in control (Con) and experimental (Exp) eyes between peripapillary retinal nerve fiber layer (RNFL) thickness, macular RGC+IPL thickness, multifocal photopic negative response (mfPhNR) and high-frequency multifocal oscillatory potentials (mfOP) in slow-sequence mfERG, and low-frequency component (mfLFC) in global-flash mfERG. We used ANOVA and paired t-tests to compare glaucoma-related mfERG changes between superior and inferior hemifields, foveal hexagon, inner three rings, and four quadrants of macula.

RESULTS

Average macular RGC+IPL and temporal RNFL thickness were strongly correlated (r(2) = 0.90, P < 0.001). In hexagon-by-hexagon analysis, all three mfERG measures were correlated (P < 0.001) with RGC+IPL thickness for Con (r(2), 0.33-0.51) and Exp eyes (r(2), 0.17-0.35). The RGC structural and functional metrics decreased as eccentricity increased. The reduction in amplitude of mfERG measures in Exp eyes relative to Con eyes was proportionally greater, in general, than the relative thinning of RGC+IPL at the same location for eyes in which structural loss was not evident, or mild to moderate. Although not statistically significant, percent amplitude reduction of mfERG measures was greatest in the inferior temporal quadrant.

CONCLUSIONS

Macular RGC+IPL thickness and mfERG measures of RGC function can be complementary tools in assessing glaucomatous neuropathy.

The photopic negative response of the flash electroretinogram in multiple sclerosis

PURPOSE

To use the photopic electroretinogram (ERG) to evaluate retinal function in eyes of multiple sclerosis (MS) patients with and without a history of optic neuritis (ON) and to compare the functional and structural status of the inner retina.

METHODS

Full-field ERG responses to brief red flashes (0.04-2.8 cd · s/m²) on a rod-saturating blue background were recorded from 51 MS patients and 33 age-matched control subjects. In patients, perimetry was performed and peripapillary retinal nerve fiber layer thickness (RNFLT) was assessed by optical coherence tomography (OCT) and scanning laser polarimetry (SLP). MS eyes were separated into groups: "ON >6" months (n = 25), "ON <6" months (n = 29), and "no ON" (n = 33) based on positive or negative history of ON and time since the last episode. Thirteen ON<6 eyes were re-evaluated 1 year later.

RESULTS

PhNR amplitudes were lower in ON>6, ON<6, and no-ON eyes (mean ± SD, 17.3 ± 7.6, 16.0 ± 6.5, and 23.8 ± 9.3 μV, respectively), than in control eyes (29.8 ± 6.5 μV; P < 0.001) for a standard stimulus of 1.42 cd · s/m²; a- and b-wave amplitudes were unaffected. PhNR amplitudes correlated with visual fields mean deviation (MD) in ON>6 (r² = 0.43; P < 0.001) and no-ON eyes (r² = 0.10; P < 0.05), with similar results for weaker stimuli. PhNR amplitudes correlated with RNFLT in ON>6 eyes: OCT (r² = 0.52; P < 0.0001) and SLP (r² = 0.51; P < 0.01); and in no-ON eyes, OCT (r² = 0.21; P < 0.01) and SLP (r² = 0.17; P < 0.05). ON<6 amplitudes did not correlate significantly with other measures, but increased after 1 year by 5.1 ± 3.1 μV (P < 0.001), visual fields MD increased by 1.8 ± 2.3 dB (P < 0.05), and RNFL loss persisted.

CONCLUSIONS

Photopic ERG PhNR amplitudes in MS patients are significantly reduced in eyes with and without a history of ON.

Reduced Retinal Function in the Absence of Na(v)1.6

Background

Mice with a function-blocking mutation in the Scn8a gene that encodes Na_v1.6, a voltage-gated sodium channel (VGSC) isoform normally found in several types of retinal neurons, have previously been found to display a profoundly abnormal dark adapted flash electroretinogram. However the retinal function of these mice in light adapted conditions has not been studied.

Methodology/Principal Findings

In the present report we reveal that during light adaptation these animals are shown to have electroretinograms with significant decreases in the amplitude of the a- and b-waves. The percent decrease in the a- and b-waves substantially exceeds the acute effect of VGSC block by tetrodotoxin in control littermates. Intravitreal injection of CoCl₂ or CNQX to isolate the a-wave contributions of the photoreceptors in littermates revealed that at high background luminance the cone-isolated component of the a-wave is of the same amplitude as the a-wave of mutants.

Conclusions/Significance

Our results indicate that Scn8a mutant mice have reduced function in both rod and the cone retinal pathways. The extent of the reduction in the cone pathway, as quantified using the ERG b-wave, exceeds the reduction seen in control littermates after application of TTX, suggesting that a defect in cone photoreceptors contributes to the reduction. Unless the postreceptoral component of the a-wave is increased in Scn8a mutant mice, the reduction in the b-wave is larger than can be accounted for by reduced photoreceptor function alone. Our data suggests that the reduction in the light adapted ERG of Scn8a mutant mice is caused by a combination of reduced cone photoreceptor function and reduced depolarization of cone ON bipolar cells. This raises the possibility that Na_v1.6 augments signaling in cone bipolar cells.

Hemispherical focal macular photopic negative response and macular inner retinal thickness in open-angle glaucoma

PURPOSE

To investigate in open-angle glaucoma the focal macular photopic negative response and spectral-domain optical coherence tomography measurements of retinal thicknesses in the superior and inferior macula.

DESIGN

Comparative case series.

METHODS

We studied 63 eyes of 63 patients with open-angle glaucoma and 41 normal eyes of 41 volunteers. Photopic negative responses were recorded using a spotlight (diameter of 15 degrees of circle), projected onto the whole or superior or inferior macula. Ganglion cell complex (nerve fiber + ganglion cell + inner plexiform layers) thickness was measured using spectral-domain optical coherence tomography.

RESULTS

Mean photopic negative response amplitude over the entire macula was significantly (P < .001) decreased compared with that of controls in eyes with early (n = 24; to 62.1%), moderate (n = 21; to 57.2%), and severe (n = 18; to 49.3%) open-angle glaucoma, but not significantly different among eyes with various stages of glaucoma. Mean ganglion cell complex thickness was significantly (P < .001) decreased compared with that of controls in eyes with early (86.0%), moderate (78.3%), and severe (71.2%) glaucoma, and thinning correlated positively with glaucoma severity (P < .001). Mean photopic negative response amplitude correlated significantly (P < .001) with ganglion cell complex thickness over the whole, superior, and inferior macular areas (r = 0.57 to 0.74). In 16 eyes without visual field defect in the inferior hemifield, mean photopic negative response amplitude was 56.5% of normal (P < .001), and mean ganglion cell complex thickness in the superior macula was 92.1% of normal (P = .004).

CONCLUSIONS

Focal macular photopic negative response amplitude correlates with ganglion cell complex thickness, but decreases more abruptly in early glaucoma compared with ganglion cell complex thickness.

Focal macular photopic negative response in patients with optic neuritis

PURPOSE

To investigate, by focal macular electroretinography (ERG), the change of photopic negative response (PhNR) in the recovery of visual function in patients with optic neuritis.

METHODS

Focal macular ERG was recorded from nine patients with acute optic neuritis (38.6 ± 10.2 years). The photostimulator device projected 15° visual angle spotlight onto the macula. Focal macular ERG recording was performed at the onset and at 1 month and 6 months after the onset of optic neuritis. The results were compared between each recording for seven of the patients.

RESULTS

All patients decreased in the vision below 20/100 and had central scotoma. Vision improved more than 20/20 within 1 month and full-visual field recovered within 6 months after the onset in all patients. The amplitude of the a-wave, b-wave, and PhNR of focal macular ERG at the onset was significantly attenuated in eyes with optic neuritis (66.8 ± 15.5, 65.8 ± 17.7, and 65.2 ± 14.4% of normal control, respectively). The amplitude of the a-wave and b-wave increased gradually after steroid pulse therapy. The increase in a-wave amplitude was significant at 6 months (P = 0.046), whereas the PhNR amplitude did not show any significant change over 6 months after the onset of optic neuritis.

CONCLUSIONS

Our results suggest that inflammation at the onset of optic neuritis leads to functional deficits that extend to at least the inner nuclear layers of the retina, and that all but the ganglion cell layers of retina recover.

Comparison of photopic negative response of full-field and focal electroretinograms in detecting glaucomatous eyes

Purpose. To compare the photopic negative response (PhNR) of the full-field electroretinogram (ERG) to the PhNR of the focal ERGs in detecting glaucoma. Methods. One hundred and three eyes with glaucoma and 42 normal eyes were studied. Full-field ERGs were elicited by red stimuli on a blue background. The focal ERGs were elicited by a 15° white stimulus spot centered on the macula, the superotemporal or the inferotemporal areas of the macula. Results. In early glaucoma, the areas under the receiver operating characteristic curves (AUCs) were significantly larger for the focal PhNR (0.863–0.924) than those for the full-field PhNR (0.666–0.748) (P < .05). The sensitivity was significantly higher for the focal PhNR than for the full-field PhNR in early (P < .01) and intermediate glaucoma (P < .05). In advanced glaucoma, there was no difference in the AUCs and sensitivities between the focal and full-field PhNRs. Conclusions. The focal ERG has the diagnostic ability with higher sensitivity in detecting early and intermediate glaucoma than the full-field ERG.

Inter-subject, inter-ocular and inter-session repeatability of the photopic negative response of the electroretinogram recorded using DTL and skin electrodes

The photopic negative response (PhNR) has attracted interest as a flash ERG component reflecting inner retinal activity, with investigators adopting various approaches to analysing the response. This study has two principal aims: first to determine the most reliable technique for assessing the PhNR amplitude; secondly to compare the repeatability characteristics of the PhNR recorded using DTL and skin active electrodes. Electroretinograms were recorded in 31 subjects, using both electrode types, in response to a Ganzfeld red stimulus (Lee filter "bright red"; 1.76 log phot td.s; 4 Hz) presented over a steady blue background (Schott glass filter BG28; 3.9 log scot td). Sixteen subjects returned to assess repeatability. PhNR amplitude was measured from b-wave peak-to-PhNR trough, pre-stimulus baseline to trough, and from peak and baseline to a fixed time-point; a ratio of b-wave/PhNR amplitude was also calculated. Coefficients of variation (CoV), and inter-ocular and inter-session limits of agreement (LoA) were calculated for all measures. The ratio of b-wave/PhNR amplitude showed the lowest CoV (14.3% DTL; 23.2% skin), inter-ocular LoA (22.2% DTL; 25.0% skin), and inter-session LoA (22.8% DTL; 20.3% skin). The peak-to-trough and peak-to-fixed-time measurements were also consistently reliable. Least reliable measures were those measured from baseline. While skin electrode responses were significantly smaller than DTL responses (P < 0.0001), the variability was only slightly increased. This study suggests that peak-to-trough measurements are the most reliable means of measuring the PhNR and ratio calculation further improves repeatability. Skin electrodes provided a viable alternative to DTL electrodes for recording the PhNR.

Correlation between photopic negative response of focal electroretinograms and local loss of retinal neurons in glaucoma

PURPOSE

To determine the relationship between the photopic negative response of the focal electroretinogram and the structural parameters of the inner retina and optic nerve head in glaucoma.

METHODS

Sixty-one eyes of 61 patients with open angle glaucoma, 13 eyes of 13 patients who were classified as glaucoma suspects, and 30 eyes of 30 normal subjects were studied. The focal electroretinograms were elicited by a 15 degrees circular white stimulus on a white background centered on the fovea. The focal electroretinograms were also elicited by half of an annulus placed above or below the macula. The diameter of the inner border of the annulus was 15 degrees and that of the outer border was 30 degrees. The structure of the optic nerve head and retinal nerve fiber layer thickness were evaluated by scanning laser ophthalmoscopy and laser scanning polarimetry, respectively.

RESULTS

The amplitudes of the focal photopic negative responses and the ratio of the focal photopic negative response/b-wave amplitude were linearly correlated with the corresponding retinal nerve fiber layer thickness in the superior/temporal and inferior/temporal regions (r = 0.43 to 0.47; P < 0.0001) but not in the temporal region. The focal photopic negative response amplitude and focal photopic negative response/b-wave amplitude ratio were also linearly and significantly correlated with the corresponding rim areas and cup/disc area ratio (r = 0.38 to 0.50, P < 0.0001).

CONCLUSIONS

These results strongly suggest that the anatomical losses of retinal neurons in local areas of the retina or optic nerve head are a cause of the reduction in the amplitude of the focal photopic negative response in open angle glaucoma.

Photopic negative response of full-field and focal macular electroretinograms in patients with optic nerve atrophy

PURPOSE

To determine alterations of the photopic negative response (PhNR) in the full-field and focal macular electroretinograms (ERGs) of patients with optic nerve atrophy (ONA).

METHODS

Ten eyes of eight patients, five women and three men with a mean age of 55.1 years, with ONA were studied. Thirty-six age-matched controls were examined using the same protocol. Full-field cone ERGs were elicited by red stimuli on a blue background, and focal ERGs were elicited by a 15 degrees white stimulus spot centered on the macular region.

RESULTS

The a- and b-wave amplitudes of the full-field and focal ERGs of the affected eyes were similar to those of the control eyes. The full-field PhNR amplitudes were significantly reduced in six of ten affected eyes. Four eyes with normal full-field PhNR amplitudes had central scotomas. The focal PhNR amplitudes were smaller than the normal limits in all affected eyes.

CONCLUSIONS

The reduction of the full-field and focal PhNR in eyes with ONA indicates that both originate from the retinal ganglion cells (RGCs) and their axons. The findings also indicate that focal PhNR amplitudes can be used to assess focal damages of both the RGCs and their axons in eyes with ONA.