1
|
Wang X, Wang P. Spectral-domain optical coherence tomography combined with electroretinography in the assessment of conbercept for neovascular age-related macular degeneration: a preliminary study. Front Neurosci 2023; 17:1179421. [PMID: 37179553 PMCID: PMC10166866 DOI: 10.3389/fnins.2023.1179421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/31/2023] [Indexed: 05/15/2023] Open
Abstract
Objective To observe the effect of three consecutive intravitreal injections of conbercept in the treatment of neovascular age-related macular degeneration (nAMD), to investigate the correlation between retinal anatomy and retinal function by spectral-domain optical coherence tomography (SD-OCT) and electroretinography (ERG), to evaluate the short-term clinical efficacy of conbercept in the treatment of nAMD, and to explore the value of ERG as a predictor of treatment efficacy. Method A retrospective investigation was conducted on 36 patients (36 eyes) treated with intravitreal injections of conbercept at 0.5 mg a month for three consecutive courses. Data collected included the best corrected visual acuity (BCVA), central retinal thickness (CRT), retinal pigment epithelium (RPE) elevation volume in 1 mm-diameter (1RV), 3 mm-diameter (3RV), and 6 mm-diameter circles around the fovea (6RV), amplitude density and latency of the P1 wave in the multifocal electroretinography (mf-ERG) R1 ring and amplitude and latency in full-field electroretinography (ff-ERG) at baseline and monthly. The paired t test was used to compare the difference between pre- and posttreatment. Pearson correlation analysis was used to analyze the correlation between macular retinal structure and function. The difference was significant when p < 0.05. Results At 12 weeks, the BCVA, CRT, 1RV, 3RV, 6RV, the P1 wave amplitude density of the mf-ERG R1 ring and the ff-ERG amplitude parameters were all significantly improved (p < 0.001). The BCVA in logMAR was positively correlated with CRT; 1RV, 3RV, and 6RV were negatively correlated with the amplitude density and latency of the mf-ERG R1 ring P1 wave. There were no severe ocular or systemic complications during the follow-up period. Conclusion Conbercept is useful for the short-term treatment of nAMD. It can safely improve the visual acuity of affected eyes and restore the structure and function of the retina. ERG could serve as an objective indicator of function for evaluating the efficacy of and determining the need for retreatment during nAMD treatment.
Collapse
Affiliation(s)
| | - Peng Wang
- Chongqing Key Laboratory of Ophthalmology, Department of Ophthalmology, Chongqing Eye Institute, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
2
|
Borrelli E, Sacconi R, Zuccaro B, Cavalleri M, Bordato A, Zucchiatti I, Querques L, Bandello F, Querques G. Photoreceptor alteration in intermediate age-related macular degeneration. Sci Rep 2020; 10:21036. [PMID: 33273666 PMCID: PMC7713116 DOI: 10.1038/s41598-020-78201-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to analyze photoreceptor alterations occurring in eyes with intermediate age-related macular degeneration (AMD) and to investigate their associations with choriocapillaris (CC) flow. In this retrospective case-control study, we collected data from 35 eyes with intermediate AMD from 35 patients who had swept source optical coherence tomography structural and angiography imaging obtained. A control group of 35 eyes from 35 healthy subjects was included for comparison. Our main outcome measure for comparison between groups was the normalized reflectivity of en face image segmented at the ellipsoid zone (EZ) level, which was calculated to quantify the photoreceptor damage. OCTA metrics to quantify CC flow signal were also computed. These metrics were measured in a circle centered on the fovea and with a diameter of 5 mm. In intermediate AMD eyes, the macular area occupied by drusen was identified. Therefore, the EZ reflectivity and CC flow signal were separately measured in regions without drusen ("drusen-free" region). Measurements were generated using previously published algorithms. Mean ± SD age was 74.1 ± 6.8 years in the intermediate AMD group and 72.1 ± 6.0 years in the control group (p = 0.206). The normalized EZ reflectivity was 0.76 ± 0.10 in the intermediate AMD group and 0.85 ± 0.08 in the control group (p < .0001). In the "drusen-free" region, the normalized EZ reflectivity was 0.77 ± 0.10 (p < .0001 vs. healthy controls) and was positively correlated with the CC flow signal density (ρ = - 0.340 and p = 0.020). In conclusion, eyes with intermediate AMD exhibit a diffuse reduced EZ normalized reflectivity, and this reduction is correlated with CC flow signal in the regions without drusen. This study supports the concept of the damage of the unit comprised of photoreceptor, CC, and intervening tissues as an early event in AMD.
Collapse
Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele Cavalleri
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Bordato
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Zucchiatti
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy. .,IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
3
|
Huang J, Gu S, Chen M, Zhang SJ, Jiang Z, Chen X, Jiang C, Liu G, Radu RA, Sun X, Vollrath D, Du J, Yan B, Zhao C. Abnormal mTORC1 signaling leads to retinal pigment epithelium degeneration. Am J Cancer Res 2019; 9:1170-1180. [PMID: 30867823 PMCID: PMC6401408 DOI: 10.7150/thno.26281] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/24/2018] [Indexed: 12/13/2022] Open
Abstract
Retinal pigment epithelial (RPE) degeneration is potentially involved in the pathogenesis of several retinal degenerative diseases. mTORC1 signaling is shown as a crucial regulator of many biological processes and disease progression. In this study, we aimed at investigating the role of mTORC1 signaling in RPE degeneration. Methods: Western blots were conducted to detect mTORC1 expression pattern during RPE degeneration. Cre-loxP system was used to generate RPE-specific mTORC1 activation mice. Fundus, immunofluorescence staining, transmission electron microscopy, and targeted metabolomic analysis were conducted to determine the effects of mTORC1 activation on RPE degeneration in vivo. Electroretinography, spectral-domain optical coherence tomography, and histological experiments were conducted to determine the effects of mTORC1 activation on choroidal and retinal function in vivo. Results: RPE-specific activation of mTORC1 led to RPE degeneration as shown by the loss of RPE-specific marker, compromised cell junction integrity, and intracellular accumulation of lipid droplets. RPE degeneration further led to abnormal choroidal and retinal function. The inhibition of mTORC1 signaling with rapamycin could partially reverse RPE degeneration. Targeted metabolomics analysis further revealed that mTORC1 activation affected the metabolism of purine, carboxylic acid, and niacin in RPE. Conclusion: This study revealed that abnormal activation of mTORC1 signaling leads to RPE degeneration, which could provide a promising target for the treatment of RPE dysfunction-related diseases.
Collapse
|
4
|
Moschos MM, Nitoda E. The Role of mf-ERG in the Diagnosis and Treatment of Age-Related Macular Degeneration: Electrophysiological Features of AMD. Semin Ophthalmol 2017; 33:461-469. [PMID: 28328288 DOI: 10.1080/08820538.2017.1301496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Age-related macular cegeneration (AMD) is the leading cause of visual dysfunction worldwide, affecting 9-25% of individuals between 65 and 75 years old. METHODS We have reviewed the published articles investigating the role of multifocal electroretinogram (mf-ERG) in the diagnosis and treatment of AMD. RESULTS Visual evoked potentials have revealed decreased amplitudes and higher latencies in patients with AMD, while the degeneration of photoreceptors and abnormalities of retinal pigment epithelium can be identified by electro-oculogram recordings. Moreover, ERG can detect the functional abnormalities observed in AMD and evaluate each therapeutic approach. The record of local electrophysiological responses coming from different retinal areas can be accurately performed by mfERG. CONCLUSION The accuracy of mfERG in detecting the degeneration of photoreceptors, as well the disturbances of macular function, could be useful both in the early diagnosis of AMD and the assessment of treatment efficacy.
Collapse
Affiliation(s)
- Marilita M Moschos
- a First Department of Ophthalmology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Eirini Nitoda
- a First Department of Ophthalmology , Medical School, National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
5
|
Panorgias A, Tillman M, Sutter EE, Moshiri A, Gerth-Kahlert C, Werner JS. Senescent Changes and Topography of the Dark-Adapted Multifocal Electroretinogram. Invest Ophthalmol Vis Sci 2017; 58:1323-1329. [PMID: 28241320 PMCID: PMC5341623 DOI: 10.1167/iovs.16-20953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the topographic changes of the dark-adapted multifocal electroretinogram (mfERG) across adulthood in the central retina and compare the topography between macular versus extramacular, nasal versus temporal, and inferior versus superior retinal areas. Methods Sixty-five subjects (18–88 years) received a comprehensive dilated eye examination to ensure the health of their retina and were tested with a dark-adapted mfERG protocol using a 61-hexagon pattern. The lens absorption of each subject was also estimated using a heterochromatic flicker photometry (HFP) paradigm. Results The response amplitude and latency of the dark-adapted mfERG showed a significant change with age, which was best described with a linear model. All the retinal areas examined demonstrated similar aging effects. The extramacular and temporal retina showed higher response amplitude and faster response latency when compared with the macular and nasal retinae, respectively. No difference was found in response amplitude and latency between the inferior and superior retina. The HFP results also showed a significant correlation with age, consistent with senescent increases in short wavelength absorption by the crystalline lens. However, the change in lens absorption did not exceed the magnitude of the change in response amplitude and latency. Discussion Our results indicate that there is a decline in dark-adapted retinal activity as measured with the mfERG. These aging processes affect rods and rod-bipolar cells. Their decrease in response can be attributed to both optical and neural factors.
Collapse
Affiliation(s)
- Athanasios Panorgias
- Department of Ophthalmology & Vision Science, University of California Davis Medical Center, Sacramento, California, United States 2Department of Vision Science, New England College of Optometry, Boston, Massachusetts, United States
| | - Megan Tillman
- Department of Ophthalmology & Vision Science, University of California Davis Medical Center, Sacramento, California, United States
| | - Erich E Sutter
- Electro-Diagnostic Imaging, Inc., Redwood City, California, United States
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California Davis Medical Center, Sacramento, California, United States
| | | | - John S Werner
- Department of Ophthalmology & Vision Science, University of California Davis Medical Center, Sacramento, California, United States 5Department of Neurobiology, Physiology & Behavior, University of California Davis, Davis, California, United States
| |
Collapse
|
6
|
Maynard ML, Zele AJ, Feigl B. Mesopic Pelli-Robson contrast sensitivity and MP-1 microperimetry in healthy ageing and age-related macular degeneration. Acta Ophthalmol 2016; 94:e772-e778. [PMID: 27225020 DOI: 10.1111/aos.13112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine whether decreasing illumination of the Pelli-Robson contrast sensitivity (CS) chart and MP-1 microperimeter to low mesopic conditions is more sensitive to vision changes occurring with healthy ageing and in early and intermediate age-related macular degeneration (AMD) and whether these mesopic tests can differentiate visual function between healthy older participants with and without AMD risk genotypes. METHODS Retinal sensitivity was measured in 98 healthy participants (19-85 years) and 21 AMD (AREDS Grade 2/3) patients (73.9 ± 6.5 years) using the Pelli-Robson CS chart and MP-1 microperimeter under low mesopic and standard illumination. The effect of ageing and AMD on retinal sensitivity was estimated using regression analysis. Healthy older participants (>50 years; n = 24) were genotyped for AMD risk genes CFH and/or ARMS2 and retinal sensitivity was compared between genotypes. RESULTS With healthy ageing, photopic and mesopic Pelli-Robson CS showed a similar decline (-0.004 log CS/year). In AMD, photopic CS showed a similar decline to healthy ageing (-0.004 log CS/year) while mesopic CS was significantly reduced (-0.007 log CS/year). Both standard and low mesopic microperimetry showed a significant decline (-0.51 and -0.73% contrast/year) with healthy ageing and greater decline (-0.73 and -0.99% contrast/year) with AMD onset. Pelli-Robson CS and microperimetry sensitivity did not differ between AMD risk genotypes in healthy participants. CONCLUSIONS Mesopic Pelli-Robson CS detects functional deficits before photopic CS in early and intermediate AMD that can be differentiated from ageing. This test can be easily administered in clinical practice and may provide a means for early detection of retinal dysfunction.
Collapse
Affiliation(s)
- Michelle L. Maynard
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Biomedical Sciences Queensland University of Technology (QUT) Brisbane QLD Australia
| | - Andrew J. Zele
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Optometry and Vision Science Queensland University of Technology (QUT) Brisbane QLD Australia
| | - Beatrix Feigl
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Biomedical Sciences Queensland University of Technology (QUT) Brisbane QLD Australia
- Queensland Eye Institute South Brisbane QLD Australia
| |
Collapse
|
7
|
Marquioni-Ramella MD, Suburo AM. Photo-damage, photo-protection and age-related macular degeneration. Photochem Photobiol Sci 2015. [DOI: 10.1039/c5pp00188a] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The course of Age-related Macular Degeneration (AMD) is described as the effect of light (400–580 nm) on various molecular targets in photoreceptors and the retinal pigment epithelium (RPE). Photo-damage is followed by inflammation, increasing oxidative stress and, probably, unveiling new photosensitive molecules.
Collapse
Affiliation(s)
| | - Angela M. Suburo
- Medicina Celular y Molecular
- Facultad de Ciencias Biomédicas
- Universidad Austral
- Pilar B1629AHJ
- Argentina
| |
Collapse
|
8
|
Whatham AR, Nguyen V, Zhu Y, Hennessy M, Kalloniatis M. The value of clinical electrophysiology in the assessment of the eye and visual system in the era of advanced imaging. Clin Exp Optom 2014; 97:99-115. [PMID: 23865913 DOI: 10.1111/cxo.12085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/24/2014] [Accepted: 02/12/2013] [Indexed: 11/28/2022] Open
Abstract
Electrophysiological techniques allow clinical investigations to include a 'dissection' of the visual system. Using suitable electrophysiological techniques, the 'dissection' allows function to be ascribed to the different photoreceptors (rod and cone photoreceptors), retinal layers, retinal location or the visual pathway up to the visual cortex. Combined with advances in genetics, retinal biochemistry, visual fields and ocular imaging, it is now possible to obtain a better understanding of diseases affecting the retina and visual pathways. This paper reviews core electrophysiological principles that can complement other examination techniques, including advanced ocular imaging, and help the interpretation of other clinical data and thus, refine and guide clinical diagnosis.
Collapse
Affiliation(s)
- Andrew R Whatham
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia; School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | | | | | | | | |
Collapse
|
9
|
Ogino K, Tsujikawa A, Yamashiro K, Ooto S, Oishi A, Nakata I, Miyake M, Takahashi A, Ellabban AA, Yoshimura N. Multimodal evaluation of macular function in age-related macular degeneration. Jpn J Ophthalmol 2013; 58:155-65. [DOI: 10.1007/s10384-013-0295-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
|
10
|
Nunes RP, Gregori G, Yehoshua Z, Stetson PF, Feuer W, Moshfeghi AA, Rosenfeld PJ. Predicting the Progression of Geographic Atrophy in Age-Related Macular Degeneration With SD-OCT En Face Imaging of the Outer Retina. Ophthalmic Surg Lasers Imaging Retina 2013; 44:344-59. [DOI: 10.3928/23258160-20130715-06] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/28/2013] [Indexed: 11/20/2022]
|
11
|
Panorgias A, Zawadzki RJ, Capps AG, Hunter AA, Morse LS, Werner JS. Multimodal assessment of microscopic morphology and retinal function in patients with geographic atrophy. Invest Ophthalmol Vis Sci 2013; 54:4372-84. [PMID: 23696601 DOI: 10.1167/iovs.12-11525] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To correlate retinal function and visual sensitivity with retinal morphology revealed by ultrahigh-resolution imaging with adaptive optics-optical coherence tomography (AO-OCT), on patients with geographic atrophy. METHODS Five eyes from five subjects were tested (four with geographic atrophy [66.3 ± 6.4 years, mean ± 1 SD] and one normal [61 years]). Photopic and scotopic multifocal electroretinograms (mfERGs) were recorded. Visual fields were assessed with microperimetry (mP) combined with a scanning laser ophthalmoscope for high-resolution confocal retinal fundus imaging. The eye tracker of the microperimeter identified the preferred retinal locus that was then used as a reference for precise targeting of areas for advanced retinal imaging. Images were obtained with purpose-built, in-house, ultrahigh resolution AO-OCT. Fundus autofluorescence (FAF) and color fundus (CF) photographs were also acquired. RESULTS The AO-OCT imaging provided detailed cross-sectional structural representation of the retina. Up to 12 retinal layers were identified in the normal subject while many severe retinal abnormalities (i.e., calcified drusen, drusenoid pigment epithelium detachment, outer retinal tubulation) were identified in the retinae of the GA patients. The functional tests showed preservation of sensitivities, although somewhat compromised, at the border of the GA. CONCLUSIONS The images provided here advance our knowledge of the morphology of retinal layers in GA patients. While there was a strong correlation between altered retinal structure and reduction in visual function, there were a number of examples in which the photoreceptor inner/outer segment (IS/OS) junctions lost reflectivity at the margins of GA, while visual function was still demonstrated. This was shown to be due to changes in photoreceptor orientation near the GA border.
Collapse
Affiliation(s)
- Athanasios Panorgias
- Department of Ophthalmology and Vision Science, University of California, Davis, Davis, California 95817, USA.
| | | | | | | | | | | |
Collapse
|
12
|
Yin L, Shi Y, Liu X, Zhang H, Gong Y, Gu Q, Wu X, Xu X. A Rat Model for Studying the Biological Effects of Circulating LDL in the Choriocapillaris-BrM-RPE Complex. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 180:541-9. [DOI: 10.1016/j.ajpath.2011.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
|
13
|
Anti-amyloid therapy protects against retinal pigmented epithelium damage and vision loss in a model of age-related macular degeneration. Proc Natl Acad Sci U S A 2011; 108:E279-87. [PMID: 21690377 DOI: 10.1073/pnas.1100901108] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of visual dysfunction worldwide. Amyloid β (Aβ) peptides, Aβ1-40 (Aβ40) and Aβ1-42 (Aβ42), have been implicated previously in the AMD disease process. Consistent with a pathogenic role for Aβ, we show here that a mouse model of AMD that invokes multiple factors that are known to modify AMD risk (aged human apolipoprotein E 4 targeted replacement mice on a high-fat, cholesterol-enriched diet) presents with Aβ-containing deposits basal to the retinal pigmented epithelium (RPE), histopathologic changes in the RPE, and a deficit in scotopic electroretinographic response, which is reflective of impaired visual function. Strikingly, these electroretinographic deficits are abrogated in a dose-dependent manner by systemic administration of an antibody targeting the C termini of Aβ40 and Aβ42. Concomitant reduction in the levels of Aβ and activated complement components in sub-RPE deposits and structural preservation of the RPE are associated with anti-Aβ40/42 antibody immunotherapy and visual protection. These observations are consistent with the reduction in amyloid plaques and improvement of cognitive function in mouse models of Alzheimer's disease treated with anti-Aβ antibodies. They also implicate Aβ in the pathogenesis of AMD and identify Aβ as a viable therapeutic target for its treatment.
Collapse
|
14
|
Abstract
PURPOSE Flickering stimuli increase the metabolic demand of the retina, making it a sensitive perimetric stimulus to the early onset of retinal disease. We determine whether flickering stimuli are a sensitive indicator of vision deficits resulting from acute, mild systemic hypoxia when compared to standard static perimetry. METHODS Static and flicker visual perimetry were performed in 14 healthy young participants while breathing 12% oxygen (hypoxia) under photopic illumination. The hypoxia visual field data were compared with the field data measured during normoxia. Absolute sensitivities (in dB) were analysed in seven concentric rings at 1°, 3°, 6°, 10°, 15°, 22° and 30° eccentricities as well as mean defect (MD) and pattern defect (PD) were calculated. Preliminary data are reported for mesopic light levels. RESULTS Under photopic illumination, flicker and static visual field sensitivities at all eccentricities were not significantly different between hypoxia and normoxia conditions. The mean defect and pattern defect were not significantly different for either test between the two oxygenation conditions. CONCLUSION Although flicker stimulation increases cellular metabolism, flicker photopic visual field impairment is not detected during mild hypoxia. These findings contrast with electrophysiological flicker tests in young participants that show impairment at photopic illumination during the same levels of mild hypoxia. Potential mechanisms contributing to the difference between the visual fields and electrophysiological flicker tests including variability in perimetric data, neuronal adaptation and vascular autoregulation are considered. The data have implications for the use of visual perimetry in the detection of ischaemic/hypoxic retinal disorders under photopic and mesopic light levels.
Collapse
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | | |
Collapse
|
15
|
Feigl B, Cao D, Morris CP, Zele AJ. Persons with age-related maculopathy risk genotypes and clinically normal eyes have reduced mesopic vision. Invest Ophthalmol Vis Sci 2011; 52:1145-50. [PMID: 20881291 PMCID: PMC3053098 DOI: 10.1167/iovs.10-5967] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/29/2010] [Accepted: 09/07/2010] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine whether participants with normal visual acuity, no ophthalmoscopically signs of age-related maculopathy (ARM) in both eyes, and who are carriers of the CFH, LOC387715, and HRTA1 high-risk genotypes (gene-positive) have impaired rod- and cone-mediated mesopic visual function compared with persons who do not carry the risk genotypes (gene-negative). METHODS Fifty-three Caucasian study participants (mean 55.8 ± 6.1) were genotyped for CFH, LOC387715/ARMS2, and HRTA1 polymorphisms. Single-nucleotide polymorphisms were genotyped in the CFH (rs380390), LOC387715/ARMS2 (rs10490924), and HTRA1 (rs11200638) genes using optimized gene-expression assays. The critical fusion frequency (CFF) mediated by cones alone (long-, middle-, and short-wavelength sensitive cones, LMS) and by the combined activities of cones and rods (LMSR) were determined. The stimuli were generated using a four-primary photostimulator that provides independent control of the photoreceptor excitation under mesopic light levels. Visual function was further assessed using standard clinical tests, flicker perimetry, and microperimetry. RESULTS The mesopic CFF mediated by rods and cones (LMSR) was significantly reduced in gene-positive compared to gene-negative participants after correction for age (P = 0.03). Cone-mediated CFF (LMS) was not significantly different between gene-positive and -negative participants. There were no significant associations between flicker perimetry and microperimetry and genotype. CONCLUSIONS This is the first study to relate ARM risk genotypes with mesopic visual function in clinically normal persons. These preliminary results could become of clinical importance because mesopic vision may be used as a biomarker to document subclinical retinal changes in persons with risk genotypes and to determine whether those persons progress into manifest disease.
Collapse
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | | | | | | |
Collapse
|
16
|
Berrow EJ, Bartlett HE, Eperjesi F, Gibson JM. The electroretinogram: a useful tool for evaluating age-related macular disease? Doc Ophthalmol 2010; 121:51-62. [PMID: 20232109 DOI: 10.1007/s10633-010-9226-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
With an ageing population, the number of age-related macular disease (ARMD) cases will inevitably rise. This gives greater impetus for the need to identify the disease earlier and assess treatments to slow disease progression. Differing electroretinogram (ERG) modalities have been reviewed in relation to the objective assessment of retinal function in ARMD and for monitoring the effectiveness of clinical interventions. Conflicting results have been found with regard to the efficacy of ERG findings in the investigation of ARMD in previous years. The newer multifocal ERG paradigm provides spatial topographical information about retinal function in ARMD. It has shown promising results in monitoring effectiveness of clinical interventions and studies are continuing in this area. Better knowledge of retinal function in ARMD may lead to enhanced treatments at each phase of the disease.
Collapse
Affiliation(s)
- Emma J Berrow
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, United Kingdom.
| | | | | | | |
Collapse
|
17
|
Feigl B. Age-related maculopathy – Linking aetiology and pathophysiological changes to the ischaemia hypothesis. Prog Retin Eye Res 2009; 28:63-86. [PMID: 19070679 DOI: 10.1016/j.preteyeres.2008.11.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059 QLD, Australia.
| |
Collapse
|
18
|
Ying GS, Maguire MG, Liu C, Antoszyk AN. Night vision symptoms and progression of age-related macular degeneration in the Complications of Age-related Macular Degeneration Prevention Trial. Ophthalmology 2008; 115:1876-82. [PMID: 18672295 DOI: 10.1016/j.ophtha.2008.05.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 05/12/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To describe baseline night vision symptoms and their association with >/=3-lines loss in visual acuity (VA), choroidal neovascularization (CNV), and geographic atrophy (GA). DESIGN Cohort study within a multicenter randomized clinical trial. PARTICIPANTS A total of 1052 participants with >/=10 large (>125 mu) drusen and VA >/=20/40 in each eye. METHODS At baseline, participants self-administered a 10-item Night Vision Questionnaire (NVQ-10). VA testing was performed at baseline, 6 months, and annually. One eye of each participant was randomly assigned to laser treatment, and the contralateral eye was assigned to observation. During follow-up, trained readers identified CNV on the basis of fluorescein angiograms and end point GA, defined as >1 disc area of new GA, based on color photographs. Evaluation was performed by repeated-measures logistic regression for NVQ-10 score as a risk factor for >/=3-lines loss in VA and by survival analysis for CNV and GA, with and without adjustment for participant and ocular characteristics. Evaluations were based on observed eyes and treated eyes, considered separately and combined. MAIN OUTCOME MEASURES A >/=3-lines loss in VA, development of CNV and end point GA. RESULTS At baseline, NVQ-10 scores ranged from 3 to 100 with a mean of 70 (100 corresponds to no night vision symptoms). Compared with participants with the best night vision (fourth quartile of scores), participants with the worst night vision (first quartile of scores) were at increased risk of >/=3-lines loss in VA in both observed and treated eyes; odds ratios (95% confidence interval) were 2.85 (1.85-4.39) and 2.00 (1.27-3.14), respectively. The relative risk for the first quartile versus the fourth quartile for development of GA was 4.18 (1.80-9.68) in observed eyes and 2.59 (1.13-5.95) in treated eyes. The relative risk for CNV incidence was 1.99 (1.12-3.54) in observed eyes and 1.33 (0.81-2.19) in treated eyes. These relationships were maintained after adjustment for baseline participant and ocular characteristics. CONCLUSIONS Participants who perceived the most problems in their night vision at baseline had an increased risk of >/=3-lines loss in VA, CNV, and GA. These associations are independent of established risk factors.
Collapse
Affiliation(s)
- Gui-Shuang Ying
- Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
19
|
Gerth C. The role of the ERG in the diagnosis and treatment of Age-Related Macular Degeneration. Doc Ophthalmol 2008; 118:63-8. [PMID: 18536949 DOI: 10.1007/s10633-008-9133-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 05/23/2008] [Indexed: 11/24/2022]
Abstract
Age-related macular degeneration (AMD) is affecting an increasing number of people, with 2.95 million people estimated to be affected in the USA by 2020. Possible preventive agents, such as vitamins and supplements have been studied and new treatment options for AMD have been developed in recent years. What role does electrophysiology play as a sensitive outcome measure? The most commonly used tests are the full-field electroretinogram (ffERG) and the multifocal ERG (mfERG). Test results from patients with AMD and reduced central vision need special attention in respect to fixation pattern, age-matched control data, and retinal luminance. Advantages, disadvantages and limitations of techniques will be considered, together with a review of published studies.
Collapse
Affiliation(s)
- Christina Gerth
- Department of Ophthalmology, University of Rostock, Doberaner Str. 140, 18055, Rostock, Germany.
| |
Collapse
|
20
|
Feigl B, Zele AJ. A method for investigating the temporal dynamics of local neuroretinal responses. J Neurosci Methods 2008; 167:207-12. [PMID: 17913236 DOI: 10.1016/j.jneumeth.2007.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 08/15/2007] [Accepted: 08/15/2007] [Indexed: 11/25/2022]
Abstract
Visual sensitivity improves with prolonged exposure to light. Global neuroretinal responses increase, but little is known about the dynamics of local retinal responses over brief time intervals after changes in light level. This study applies the time-slice multifocal electroretinogram (TS mfERG) paradigm for the measurement of local electrical responses of the human eye over brief time intervals. Sixty-one, localised retinal areas were assessed over 25 degrees of the visual field. Cone-mediated contributions to the time-slice waveform were established. The time-slice mfERG waveforms were similar in shape and timing for pre- and post-photopigment bleach conditions after saturation of rod-mediated responses, suggesting there was no rod-mediated intrusion in the waveform. The temporal dynamics of the mfERG components show that N1P1 amplitudes decrease with each successive time-slice probe, with larger amplitude responses in the central retina compared to nasal and temporal retina. The time-slice mfERG waveform is a technique for assessing the temporal dynamics of cone-generated neural responses over time. The data are interpreted in terms of the vascular supplies and lower-level visual adaptation mechanisms.
Collapse
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation and the School of Optometry, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, 4059 Qld, Australia.
| | | |
Collapse
|
21
|
Complement factor H deficiency in aged mice causes retinal abnormalities and visual dysfunction. Proc Natl Acad Sci U S A 2007; 104:16651-6. [PMID: 17921253 DOI: 10.1073/pnas.0705079104] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Age-related macular degeneration is the most common form of legal blindness in westernized societies, and polymorphisms in the gene encoding complement factor H (CFH) are associated with susceptibility to age-related macular degeneration in more than half of affected individuals. To investigate the relationship between complement factor H (CFH) and retinal disease, we performed functional and anatomical analysis in 2-year-old CFH-deficient (cfh(-/-)) mice. cfh(-/-) animals exhibited significantly reduced visual acuity and rod response amplitudes on electroretinography compared with age-matched controls. Retinal imaging by confocal scanning laser ophthalmoscopy revealed an increase in autofluorescent subretinal deposits in the cfh(-/-) mice, whereas the fundus and vasculature appeared normal. Examination of tissue sections showed an accumulation of complement C3 in the neural retina of the cfh(-/-) mice, together with a decrease in electron-dense material, thinning of Bruch's membrane, changes in the cellular distribution of retinal pigment epithelial cell organelles, and disorganization of rod photoreceptor outer segments. Collectively, these data show that, in the absence of any specific exogenous challenge to the innate immune system, CFH is critically required for the long-term functional health of the retina.
Collapse
|
22
|
Lai TYY, Chan WM, Lai RYK, Ngai JWS, Li H, Lam DSC. The clinical applications of multifocal electroretinography: a systematic review. Surv Ophthalmol 2007; 52:61-96. [PMID: 17212991 DOI: 10.1016/j.survophthal.2006.10.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
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.
Collapse
Affiliation(s)
- Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | | | | | | | | | | |
Collapse
|
23
|
Feigl B, Brown B, Lovie-Kitchin J, Swann P. The rod-mediated multifocal electroretinogram in aging and in early age-related maculopathy. Curr Eye Res 2006; 31:635-44. [PMID: 16877272 DOI: 10.1080/02713680600762739] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To measure function with the rod-mediated multifocal electroretinogram (mfERG) in younger and older subjects with normal vision and with early age-related maculopathy (ARM). METHODS Thirty subjects were studied: 10 healthy subjects with a mean age of 31 years (young group), 10 healthy subjects with a mean age of 71 years (old group), and 10 early ARM subjects with a mean age of 71 years (early ARM group). The influence of cataract was approximated by retesting five subjects of the young group through an 0.3 neutral density filter (ND filter group). We analyzed first-order N1P1-amplitude and P1-implicit time (P1-IT) mfERG responses and correlated them with funduscopic changes as defined by the Age-Related Eye Disease Study (AREDS) group. RESULTS Averaged concentric ring P1-ITs were significantly delayed in the old (p = 0.02) and early ARM (p < 0.001) compared with the young group and in the early ARM group compared with the old and ND group (p < or = 0.01). There were no significant differences in N1P1-amplitudes between groups, but there was a significant location effect for all groups with highest mean amplitudes for the most peripheral ring of hexagons (p < 0.01). Significantly delayed overall P1-ITs (p < 0.05) were correlated with progressive funduscopic changes. CONCLUSIONS Aging and early ARM affects the rod-mediated mfERG, and there is good correlation with funduscopic changes. Although a lens effect cannot be excluded, a neuronal transmission alteration at the postreceptoral level is suggested.
Collapse
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia.
| | | | | | | |
Collapse
|
24
|
Chen JC, Brown B, Schmid KL. Changes in implicit time of the multifocal electroretinogram response following contrast adaptation. Curr Eye Res 2006; 31:549-56. [PMID: 16769614 DOI: 10.1080/02713680600744869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Contrast adaptation, produced by prolonged viewing of high contrast gratings, has been suggested to occur at both retinal and cortical locations within the visual pathway. We sought to investigate the characteristics of retinal contrast adaptation using the multifocal electroretinogram (mfERG). METHODS Twenty subjects, with a mean age of 27.8 +/- 5.3 years, underwent mfERG testing using VERIS I. The mfERG was measured after 10 minutes of adaptation to 94% contrast, 5 cyc/deg, sinusoidal, vertical gratings and to an equi-luminance blank control. The mfERG stimulus array consisted of 61-scaled hexagons and flickered according to a pseudorandom binary m-sequence (213-1). Changes in amplitude and implicit time of the first-order kernel were analyzed to determine the effect of contrast adaptation on retinal responses. RESULTS Adaptation to the vertical grating pattern produced a 2.5 ms increase in implicit time, and the response delay was greatest in the more peripheral parts of the retina (7.6 degrees to 30 degrees ). Contrast adaptation did not produce statistically significant changes to the amplitude of the mfERG waveform. CONCLUSIONS Contrast adaptation produced by prolonged viewing of high contrast gratings had a significant effect on retinal responses. It has been suggested that contrast adaptation may play a role in the development of nearwork induced myopia; further work investigating retinal contrast adaptation in myopic individuals may be of interest.
Collapse
Affiliation(s)
- Jennifer C Chen
- School of Optometry and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | | | | |
Collapse
|
25
|
Feigl B, Brown B, Lovie-Kitchin J, Swann P. Functional loss in early age-related maculopathy: the ischaemia postreceptoral hypothesis. Eye (Lond) 2006; 21:689-96. [PMID: 16680100 DOI: 10.1038/sj.eye.6702389] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We review proposed models and psychophysical and electrophysiological tests performed in many studies for early age-related maculopathy (ARM). We suggest that ischaemia is the trigger for impaired retinal pigment epithelium function causing imbalance of secretion of vascular growth factors, reduced disc degradation capability and reduced metabolic activity and possible inflammatory response. This results in increased deposition of cell debris, such as drusen and thickens Bruch's membrane causing even more ischaemia of the overlying neurosensory retina. The photoreceptors are more resistant to ischaemia given their proximity to the choroid. Furthermore, being 'upstream' from the inner retinal layers, they act as an oxygen sink depriving retinal layers further from the choroid. Postreceptoral cell layers and especially parts of the inner nuclear layer that are located in the watershed zone between two sources of blood supply are preferentially vulnerable to ischaemia. Based on psychophysical and electrophysiological findings we propose that most of the function impairment in early ARM starts postreceptorally.
Collapse
Affiliation(s)
- B Feigl
- Institute of Health and Biomedical Innovation, School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
| | | | | | | |
Collapse
|
26
|
Abstract
Late age-related maculopathy (ARM) is responsible for the majority of blind registrations in the Western world among persons over 50 years of age. It has devastating effects on quality of life and independence and is becoming a major public health concern. Current treatment options are limited and most aim to slow progression rather than restore vision; therefore, early detection to identify those patients most suitable for these interventions is essential. In this work, we review the literature encompassing the investigation of visual function in ARM in order to highlight those visual function parameters which are affected very early in the disease process. We pay particular attention to measures of acuity, contrast sensitivity (CS), cone function, electrophysiology, visual adaptation, central visual field sensitivity and metamorphopsia. We also consider the impact of bilateral late ARM on visual function as well as the relationship between measures of vision function and self-reported visual functioning. Much interest has centred on the identification of functional changes which may predict progression to neovascular disease; therefore, we outline the longitudinal studies, which to date have reported dark-adaptation time, short-wavelength cone sensitivity, colour-match area effect, dark-adapted foveal sensitivity, foveal flicker sensitivity, slow recovery from glare and slower foveal electroretinogram implicit time as functional risk factors for the development of neovascular disease. Despite progress in this area, we emphasise the need for longitudinal studies designed in light of developments in disease classification and retinal imaging, which would ensure the correct classification of cases and controls, and provide increased understanding of the natural course and progression of the disease and further elucidate the structure-function relationships in this devastating disorder.
Collapse
Affiliation(s)
- R E Hogg
- Ophthalmology and Vision Science, Queen's University and Royal Victoria Hospitals, Belfast BT12 6BA, UK
| | | |
Collapse
|
27
|
Gerth C, Delahunt PB, Alam S, Morse LS, Werner JS. Cone-mediated multifocal electroretinogram in age-related macular degeneration: progression over a long-term follow-up. ACTA ACUST UNITED AC 2006; 124:345-52. [PMID: 16534054 PMCID: PMC2583225 DOI: 10.1001/archopht.124.3.345] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the progression of change in the cone-driven multifocal electroretinogram (mfERG) responses in patients previously identified as having high-risk, soft drusen 63 mum or greater. METHODS Seventeen eyes of 14 patients were reevaluated after 28 to 41 months. Fundus changes were graded depending on drusen size and extent. Each of the 103 mfERG responses was analyzed and compared with age-matched normal controls and with the baseline measurement. RESULTS Stable visual acuity was found in 12 of the 17 eyes. Drusen size or extent was increased, decreased, and unchanged in 6, 3, and 8 eyes, respectively. The mfERG responses demonstrated a significant progression in the response density loss and in N1 and P1 implicit time delay compared with the baseline evaluation regardless of drusen change. The extent of response deterioration occurred over the entire retinal area tested. Eyes having decreased drusen at follow-up were typically associated with higher response delays at baseline and follow-up than eyes with stable or increased drusen. CONCLUSIONS Early age-related macular degeneration is associated with a progressive loss in the cone-driven mfERG response despite stable visual acuity. The response deterioration extended beyond the visible drusen area. Implicit times seem to be an important predictor of drusen regression.
Collapse
Affiliation(s)
- Christina Gerth
- Department of Ophthalmology and Vision Sciences and Section of Neurobiology, Physiology, and Behavior, University of California, Davis, USA.
| | | | | | | | | |
Collapse
|
28
|
Feigl B, Brown B, Lovie-Kitchin J, Lee L. Dynamics of Retinal Function after Multiple Photodynamic Therapies in Age-Related Macular Degeneration: A Report of Cases. Doc Ophthalmol 2006; 111:135-48. [PMID: 16523231 DOI: 10.1007/s10633-005-5319-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To monitor retinal function after multiple laser treatments by photodynamic therapy (PDT) with the multifocal electroretinogram (mfERG) in age-related macular degeneration (AMD). METHODS Five eyes of five subjects with AMD were investigated before the first and 1 month after each of three PDT treatments. Function was assessed using the cone- and rod-mediated mfERG, high-contrast distance visual acuity, central visual fields and contrast sensitivity. For each subject the local first-order mfERG results before treatment were used as a template and fitted against the local post-treatment results (Matlab, Mathworks). RESULTS We found transient reduction of the cone- and rod-mediated amplitudes between the first and second treatments but stable or improved mfERG function in four of five eyes for the cone-mediated mfERG and in all eyes for the rod-mediated mfERG after three treatments. Visual acuities and contrast sensitivities remained stable between treatments in four and two eyes respectively, whereas visual fields showed substantially higher mean defects in two subjects after all treatments. CONCLUSION As found in previous studies of the cone-mediated mfERG after one PDT treatment, objective function was stabilized after multiple treatments in this case report. Similarly, although poor at baseline, rod-mediated function was not further compromised. Transiently reduced amplitudes after 1 month possibly reflected choroidal hypoperfusion. A larger sample size is needed to confirm if additional evaluation using electrophysiological criteria might be helpful in re-treatment decisions during PDT.
Collapse
Affiliation(s)
- Beatrix Feigl
- Centre for Health Research, School of Optometry, Queensland University of Technology, Brisbane, Australia.
| | | | | | | |
Collapse
|
29
|
Feigl B, Lovie-Kitchin J, Brown B. Objective functional assessment of age‐related maculopathy: a special application for the multifocal electroretinogram. Clin Exp Optom 2005; 88:304-12. [PMID: 16255689 DOI: 10.1111/j.1444-0938.2005.tb06714.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 07/25/2005] [Accepted: 07/28/2005] [Indexed: 11/30/2022] Open
Abstract
This paper gives a brief review of methods that assess objectively function in age-related maculopathy (ARM) with emphasis on a newer method, the multifocal electroretinogram (mfERG). In contrast to other electrophysiological tests, such as the full-field and focal electroretinogram (ERG) or the electro-oculogram (EOG), which measure summed responses from various cells from larger areas of the retina, the multifocal electroretinogram maps function locally with a resolution as small as four degrees within the central 30 degrees. By using different paradigms it can measure local cone- and rod-mediated functional impairment at early and late stages of ARM. This improved mapping and higher resolution of the posterior pole compared to other objective methods might lead to earlier detection of ARM. Its usefulness has been demonstrated in documenting the effects of treatment after established laser treatments, such as photodynamic therapy (PDT) and in documenting function after retinal pigment epithelial transplantation, a possible future treatment in late neovascular ARM.
Collapse
Affiliation(s)
- Beatrix Feigl
- Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | | | | |
Collapse
|
30
|
Feigl B, Brown B, Lovie-Kitchin J, Swann P. Monitoring retinal function in early age-related maculopathy: visual performance after 1 year. Eye (Lond) 2004; 19:1169-77. [PMID: 15389263 DOI: 10.1038/sj.eye.6701711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To monitor visual performance in early age-related maculopathy (ARM). METHODS We measured monocular visual function-high-contrast visual acuity (HC-VA), central visual fields (mean sensitivity, MS), colour vision (desaturated Panel D-15), Pelli-Robson (P-R), and cone- and rod-mediated multifocal electroretinograms (mfERG) in 13 ARM subjects and 13 age-matched control subjects with normal fundi at baseline and after 1 year. All had visual acuity of 6/12 or better. The mfERG data were compared to templates derived from the control group at baseline. We analysed the mfERG results by averaging the central and peripheral fields and the superior and inferior fields (CP and SI methods) and by calculating the local responses. RESULTS The mean rod-mediated responses were significantly delayed in the ARM group for the CP (P=0.04) and the SI methods (P=0.03) at baseline compared to the control group. This did not change significantly after 1 year, whereas the mean cone-mediated responses were within the normal range at both times. Although the local analysis revealed lower amplitudes for the cone- and rod-mediated responses at baseline this was not found after 1 year and only the local rod-mediated latencies were delayed at both times (P<0.01). HC-VA, desaturated Panel D-15 and P-R were significantly worse in the ARM group (P< or =0.01) at baseline but did not show further significant deterioration. Progressive fundus changes were found in only two subjects (18%). CONCLUSION Although there was significant impairment of retinal function in early ARM at baseline no further deterioration was evident after 1 year.
Collapse
Affiliation(s)
- B Feigl
- Department of Ophthalmology, University of Graz, Austria.
| | | | | | | |
Collapse
|
31
|
Feigl B. Das multifokale Elektroretinogramm in der altersabhängigen Makulopathie. SPEKTRUM DER AUGENHEILKUNDE 2004. [DOI: 10.1007/bf03163598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|