Multifocal electroretinogram in trichromat and dichromat observers under cone isolating conditions

Topographical alterations of inner retinal activity during systemic hyperoxia-hypercapnia in normal subjects and patients with type 1 diabetes

The purpose of this study was to investigate whether an increase in the circulating oxygen supply can alter inner retinal function, assessed by recordings of multifocal oscillatory potentials. We studied 9 subjects with type 1 diabetes (8 without overt retinopathy, one with 2 microaneurysms) and 10 similar-aged normal subjects. The central 60 degrees of the retina was stimulated by an array of 61 hexagonal elements, and mfOP recordings were obtained while breathing room air or carbogen. First-order kernel analysis of the recordings shows 2 potentials (first-order OP1, OP2), whereas second-order kernel analysis produces 3 potentials (second-order OP1, OP2, OP3). Two methods were used to analyze the results: First, we performed a ring analysis for each subject and measured the amplitudes and latencies of the five potentials. We demonstrate that during carbogen inhalation, the control subjects, but not the patients with diabetes, showed significantly increased second-order OP3 amplitudes, for a retinal ring from around 1.8-13 degrees eccentricity. Secondly, a topographical analysis was performed on the amplitude of the second-order OP3 in all 61 traces (from the average recordings of each subject group), which revealed significant alterations not visible in a ring analysis. A similar topographical analysis of the amplitude of the first-order OP2 revealed a small increase in its amplitude during carbogen inhalation for both subject groups. This study demonstrates that some aspects of inner retinal function are modified by the inhalation of carbogen. The reduced effect of carbogen inhalation on the recordings from the patients with diabetes may be due to compromised vascular perfusion in these subjects.

The multifocal pattern electroretinogram (mfPERG) and cone-isolating stimuli

The number of L cones in the retina normally exceeds that of the M cones. Because normal color vision does not depend on the ratio of L- and M-photoreceptors, their signals must undergo an alteration in gain before being analyzed in the cortex. Previous studies have shown that this gain must take place before the cortex, but after the bipolar/amacrine cell layer of the retina. The aim of this study was to obtain topographical information about L- and M-cone activity at the ganglion cell layer using multifocal pattern electroretinography (mfPERG). A standard (black and white) stimulus was used, as well as stimuli modulating only the long wavelength-sensitive (L) or only the middle wavelength-sensitive (M) cones. The L:M ratio was calculated from the amplitude of the L-cone isolating mfPERG to that of the M-cone isolating mfPERG of 10 trichromats. Both the positive and negative components of the waveform were analyzed. Additional recordings of single cone modulated mfERGs were obtained from nine of the 10 subjects. We also recorded from one protanope and one deuteranope. The L:M cone amplitude ratios for both deflections of the mfPERG in the trichromats were around unity (medians 1.18 and 1.16, respectively) for the central 8° of retina. In the peripheral retina between 12.8° and 26°, this ratio increased to 1.42 for the positive component, and 1.37 for the negative component. The median L:M cone amplitude ratios for the mfPERG were higher and ranged between 1.00–2.78 in the central 8° and 1.29–2.78 in the periphery. The results indicate that a major gain adjustment of the retinal signals takes place at the ganglion cell level, and that the ratio is higher at eccentric locations than in the central retinal area.

The clinical applications of multifocal electroretinography: a systematic review

Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40-50 degrees of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

L:M-cone ratio estimates of the outer and inner retina and its impact on sex differences in ERG amplitudes

The relative number of L- and M-cones varies greatly between individuals. Differences in the relative number of L- and M-cones may also contribute to the sex difference in the ERG response amplitude reported several times. We therefore investigated the relative number of L- and M-cones and its impact on sex differences in ERG amplitudes. Multifocal ERG (mfERG) and multifocal oscillatory potentials (mfOP) combined with a cone silent substitution technique were used to investigate outer and inner retinal signals recorded from 7 female and 7 male trichromats. L:M ratios were estimated from peak amplitude as well as from area under curve (AUC) analysis. For mfERGs the L:M ratios estimates were independent of the method of analysis, while for mfOPs, differences were found which are possibly due to an artefact in the calculation of ratios for small responses. There was a tendency for lower L:M ratios in female than in male subjects for both analysis of mfERG and mfOP responses. The (L+M)-response amplitudes at both sites were slightly higher and the L:M ratios were lower for female than for male observers. Because the magnitude of the ERG amplitude differences is larger than could be explained by L:M-ratio and axial length differences, we conclude that it may be due to a direct effect of sex hormones on ion channel function.

Progressive cone dystrophy with deutan genotype and phenotype

PURPOSE

To study the electroretinographic signals originating in the long-wavelength-sensitive (L) and middle-wavelength-sensitive (M) cone pathways by means of large-field and multifocal cone type-specific electroretinograms (ERGs) in a patient with progressive cone dystrophy.

METHODS

A 65-year-old male patient with colour vision disturbances (age at onset 10 years), loss of visual acuity (14 years), and central visual field defects (40 years) was investigated. Large-field flicker-ERG responses to stimuli that exclusively modulated the L-cones or the M-cones, or the two simultaneously (both in-phase and in counter-phase), were measured. Short-wavelength-sensitive (S) cones were not modulated. Multifocal ERGs (mfERGs) were also recorded, with a pattern-reversing display that modulated only the L- or the M-cones at equal cone contrasts and average quantal catches. Genetic analysis of L- and M-pigment genes was performed on genomic DNA isolated from peripheral venous blood.

RESULTS

The patient showed a normal rod-driven ERG but reduced cone-driven electroretinographic amplitudes with normal implicit times in the International Society for Clinical Electrophysiology of Vision (ISCEV) standard ERG. The large-field flicker-ERG responses to pure L-cone modulation were significantly above noise level but were substantially reduced in comparison with both normal trichromatic subjects and (otherwise normal) deuteranopes. The L-cone driven electroretinographic implicit times and phases were within normal limits. The M-cone driven electroretinographic responses were not detectable. A model fit of all the L- and M-cone driven flicker-ERG data revealed that the responses were exclusively driven by the L-cones. Consistently, the cone type-specific mfERGs showed severely reduced but detectable responses to L-cone-isolating stimuli. The M-cone driven multifocal-ERG responses were undistinguishable from noise. The L- and M-pigment gene array consisted of only a single L-pigment gene. The complete coding sequence of this gene was determined and showed no abnormality.

CONCLUSIONS

This patient exhibits a coincidence of progressive cone dystrophy and deuteranopia. The molecular genetic data of the L/M-pigment gene array is consistent with the deutan phenotype. It cannot be excluded that the rearrangement of the X-chromosome pigment gene array is responsible for the cone dystrophy in this patient. It is, however, suggested that the dichromacy and the cone dystrophy have different and independent genetic origins.