Rod-cone interaction in the distal human retina

Partial rescue of the full-field electroretinogram in patients with RPE65-related retinal dystrophy following gene augmentation therapy with voretigene neparvovec-rzyl

PURPOSE

To present a series of patients with RPE65-related retinal dystrophy showing a partial rescue of the full-field electroretinogram (ERG) following gene replacement therapy with voretigene neparovec-rzyl (Luxturna®).

METHODS

This retrospective chart review examined 17 patients treated with voretigene neparovec-rzyl (VN) at the Casey Eye Institute (2018-2022). The last pre-operative ERG and all available post-operative ERGs were analyzed to identify subjects with functional rescue. Measurements of amplitudes and implicit times were compared to data from age-matched controls and the attenuation relative to the lower limit of normal (LLN) was calculated. For comparison with other functional exams, the last pre-operative and all post-treatment best-corrected visual acuity (BCVA) data, visual field (VF) tests and full-field threshold stimulus tests (FST) were also described.

RESULTS

Of patients who underwent ERGs, most had unrecordable ERGs that did not change after treatment. However, we identified three patients, treated bilaterally, who demonstrated partial rescue of the full-field ERG in both eyes which was sustained during the course of the study.

CONCLUSIONS

This is the largest series of patients treated with VN showing a partial rescue of the ERG. This is also the first report of bilateral ERG rescue, as well as the first description of ERG recovery occurring in non-pediatric subjects. Full-field ERG could be used in combination with other psychophysical tests and imaging modalities to detect and deepen our understanding of the response to this gene therapy approach.

Cone phototransduction and growth of the ERG b-wave during light adaptation

The purpose of this study was to determine whether cone redepolarization accounts for the amplitude increase of the b-wave of the human electroretinogram (ERG) during light adaptation. The time course of the b-wave amplitude increase was compared to the time course of the change in the activation phase of cone phototransduction, as derived from a delayed Gaussian model applied to the leading edge of the ERG a-wave. ERG recordings were obtained from five visually normal subjects, alternately in the presence of the adapting field (adapt-on condition) and 300ms after its temporary extinction (adapt-off condition). The proportional increase in amplitude was less for R(mp3) (maximum amplitude of P3, the massed cone photoreceptor response) than for the b-wave for both adaptation conditions, and the time course of the amplitude increase for R(mp3) was faster than that for the b-wave in the adapt-off condition. The results demonstrate that time-dependent changes in the activation phase of cone phototransduction have only a minimal role in governing the increase in the amplitude of the human cone-derived ERG b-wave during light adaptation. In addition, the systematic increase in b-wave amplitude and the decrease in b-wave implicit time in the adapt-off condition indicates that the ERG response measured shortly after adapting field offset does not necessarily represent the waveform of the dark-adapted cone ERG.

Retinal Bipolar Cell Input Mechanisms in Giant Danio. II. Patch-Clamp Analysis of on Bipolar Cells

Glutamate receptors on giant danio retinal on bipolar cells were studied with whole cell patch clamping using a slice preparation. Cone-driven on bipolars (Cbs) and mixed-input on bipolars (Mbs) were identified morphologically. Most Cbs responded to the excitatory amino acid transporter (EAAT) substrate d-aspartate but not to the group III metabotropic glutamate receptor (mGluR) agonist l-(+)-2-amino-4-phosphonobutyric acid (l-AP4) or the AMPA/kainate receptor agonist kainate, suggesting EAATs are the primary glutamate receptors on Cbs. The EAAT inhibitor dl- threo-β-benzyloxyasparate (TBOA) blocked all light-evoked responses of Cbs, suggesting these responses are mediated exclusively by EAATs. Conversely, all Mbs responded to d-aspartate and l-AP4 but not to kainate, indicating they have both EAATs and group III mGluRs (presumably mGluR6). The light responses of Mbs involve both receptors because they could be blocked by TBOA plus (RS)-α-cyclopropyl-4-phosphonophenylglycine (CPPG, a group III mGluR antagonist) but not by either alone. Under dark-adapted conditions, the responses of Mbs to green (rod-selective) stimuli were reduced by CPPG but enhanced by TBOA. In contrast, both antagonists reduced the responses to red (cone-selective) stimuli, although TBOA was more effective. Furthermore, under photopic conditions, TBOA failed to eliminate light-evoked responses of Mbs. Thus on Mbs, rod inputs are mediated predominantly by mGluR6, whereas cone inputs are mediated mainly by EAATs but also by mGluR6 to some extent. Finally, we explored the interactions between EAATs and mGluR6 in Mbs. Responses to d-aspartate were reduced by l-AP4 and vice versa. Therefore mGluR6 and EAATs suppress each other, and this might underlie mutual suppression between rod and cone signals in Mbs.

Mesopic state: cellular mechanisms involved in pre- and post-synaptic mixing of rod and cone signals

At least twice daily our retinas move between a light adapted, cone-dominated (photopic) state and a dark-adapted, color-blind and highly light-sensitive rod-dominated (scotopic) state. In between is a rather ill-defined transitional state called the mesopic state in which retinal circuits express both rod and cone signals. The mesopic state is characterized by its dynamic and fluid nature: the rod and cone signals flowing through retinal networks are continually changing. Consequently, in the mesopic state the retinal output to the brain contained in the firing patterns of the ganglion cells consists of information derived from both rod and cone signals. Morphology, physiology, and psychophysics all contributed to an understanding that the two systems are not independent but interact extensively via both pooling and mutual inhibition. This review lays down a rationale for such rod-cone interactions in the vertebrate retinas. It suggests that the important functional role of rod-cone interactions is that they shorten the duration of the mesopic state. As a result, the retina is maintained in either in the (rod-dominated) high sensitivity photon counting mode or in the second mode, which emphasizes temporal transients and spatial resolution (the cone-dominated photopic state). Experimental evidence for pre- and postsynaptic mixing of rod and cone signals in the retina of the clawed frog, Xenopus, is shown together with the preeminent neuromodulatory role of both light and dopamine in controlling interactions between rod and cone signals. Dopamine is shown to be both necessary and sufficient to mediate light adaptation in the amphibian retina.

Erosive vitreoretinopathy. A new clinical entity

PURPOSE

Vitreoretinopathies are disorders characterized by an abnormal vitreous gel structure and associated retinal changes. The authors report a pedigree with vitreous changes characteristic of the vitreoretinopathies, but with retinal pigment epithelial changes, electroretinographic abnormalities, and a clinical course distinct from previously described entities.

METHODS

Twenty-six family members were examined. Complete ophthalmologic examinations, electroretinography, and perimetry were performed on patients who were at genetic risk for the disease. Particular attention was given to vitreous morphology and examination of the retinal and retinal pigment epithelium (RPE).

RESULTS

Fifteen individuals affected with an autosomal dominant vitreoretinal degeneration were identified. The disease is characterized by nyctalopia, progressive visual field loss, marked vitreous syneresis, progressive RPE atrophy, and combined traction-rhegmatogenous retinal detachments (11 patients). Thinning or "erosion" of the RPE in younger patients permits increased visualization of the choroidal vessels. In advanced conditions, equatorial areas are seen that appear clinically devoid of RPE, with extensive posterior atrophy in older patients. Diffuse rod-cone dysfunction is demonstrated by electroretinography. High myopia, epiphyseal dysplasia, orofacial anomalies, and systemic manifestations characteristic of other vitreoretinopathies are not present.

CONCLUSION

The authors describe an entity clinically distinct from other vitreoretinopathies. The disease is characterized by pronounced vitreous abnormalities, complicated retinal detachments, and a progressive pigmentary retinopathy. The most unusual and constant feature is the progressive change in RPE with concurrent visual field constriction and electroretinographic abnormalities. Because the RPE initially seems normal and progressively thins or "erodes" in the equatorial periphery, the descriptive name "erosive" vitreoretinopathy is proposed.

Heterozygous missense mutation in the rhodopsin gene as a cause of congenital stationary night blindness

A number of mutations in the rhodopsin gene have been shown to cause both dominant and recessive retinitis pigmentosa. Here we describe another phenotype associated with a defect in this gene. We discovered a patient with congenital stationary night blindness who carries the missense mutation Ala292Glu. When coupled with 11-cis-retinal in vitro, Ala292Glu rhodopsin is able to activate transducin in a light-dependent manner like wild-type rhodopsin. However, without a chromophore, Ala292Glu opsin anomalously activates transducin. We speculate that the rod dysfunction in this patient is due to an abnormal, continuous activation of transducin by mutant opsin molecules in photoreceptor outer segments.

Retinitis pigmentosa and inner retina. Functional study by means of oscillatory potentials of the electroretinogram

The alterations of the inner retina in retinitis pigmentosa have been described in previous papers less often than the external retina alterations, both from the electrophysiological and morphological point of view. The oscillatory potentials (OPs) of the electroretinogram (ERG) are a good tool to investigate the inner part of the retina because of the deep anatomical location of their generators. We studied the photopic OPs in a group of 25 subjects affected with retinitis pigmentosa and compared them with other ERG components to obtain information about the functional damage of the inner retina. The OPs were recordable in 9 patients. No analogies were found with the inheritance modes. No relationship was found between OPs and 20 Hz ERG photopic response which was still present in a consistent number of eyes when OPs were no longer recordable. Such finding can be interpreted as an expression of inner retinal damage paralleling the photoreceptors and retinal pigment epithelium impairment.

An electroretinographic and molecular genetic study of X-linked cone degeneration

We evaluated full-field electroretinograms from members of a family with X-linked cone degeneration. The 15-year-old propositus had near normal visual acuity and a protan deficiency. His maternal grandfather and great uncle had a visual acuity of 20/200, a deficiency in color vision, and signs of macular degeneration; all had normal rod electroretinographic responses and diminished cone electroretinographic responses. The mother and maternal aunt of the propositus had normal visual acuity and diminished cone electroretinograms with predominant loss of red cone function. Their cone responses were greater than those of affected males. Genomic DNA isolated from these patients was analyzed with a red cone pigment gene cDNA probe that disclosed a 6.5-kilobase deletion in the red cone pigment gene. These findings substantiate that a defect in a gene encoding for a cone photoreceptor protein can lead to a cone photoreceptor degeneration.

Rod-cone interaction in monocular but not binocular pathways

Photopic background stimulation elevates scotopic increment thresholds (rod-cone interaction) at moderate background levels when both test and concentric disk-background stimuli enter the same eye (monocular condition) but not when they enter different eyes (dichoptic condition). Only when background levels are made extremely high is there any measurable dichoptic interaction, and this interaction does not resemble that observed monocularly. Rod-cone interaction, as usually studied, is a property of monocular pathways in human vision.

Dependence of cone b-wave implicit time on rod amplitude in retinitis pigmentosa

Computer-averaged full-field rod and cone electroretinograms (ERGs) were evaluated in 63 patients with retinitis pigmentosa and 116 normal subjects. Cone b-wave implicit times to 30 Hz white flicker and to 1.0 Hz white flashes on a white background were both inversely proportional to the log amplitude of the dark-adapted rod b-wave, even when controlling for the log amplitude of the dark-adapted cone b-wave. Cone ERGs were also obtained from a subset of 12 patients with retinitis pigmentosa in the presence of photopically-matched red and blue backgrounds that allowed direct assessment of the effect of rod function on cone b-wave implicit time in the patients. The effectiveness of the blue background in reducing cone b-wave implicit time relative to that obtained with the red background varied with the amplitude of the rod ERG. The results of both experiments suggest that delays in cone b-wave implicit time obtained with 30 Hz white flicker or with background adaptation in patients with retinitis pigmentosa are due, at least in part, to rod disease.