Proximal retinal contribution to the intraretinal 8-Hz pattern ERG of cat

Identification of early-onset photoreceptor degeneration in transgenic mouse models of Alzheimer's disease

Light sensitivity of the vertebrate retina relies on the integrity of photoreceptors, including rods and cones. Research in patients with Alzheimer's disease (AD) and in AD transgenic mice reports that accumulated amyloid-β (Aβ) plaques in the retina are toxic to retinal neurons. Moreover, Aβ plaques are deposited around the rods and cones, yet photoreceptor anomalies remain unclear in AD. Here, we identify the progressive degeneration of rods and cones characterized by impaired expression of phototransduction proteins, morphological alterations, functional deficits, and even cell loss. Furthermore, we demonstrate that cell senescence and necroptosis were involved in rod degeneration. Importantly, using in vivo scotopic electroretinogram, we detected rod degeneration in early-stage AD transgenic mice before Aβ plaques were observed in the brain. Moreover, we demonstrate that rod degeneration was among the earliest AD retinal manifestations compared with other types of retinal neurons. Overall, our study is the first to identify and detect in vivo, early-onset photoreceptor degeneration in AD.

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Progressive rod degeneration has been identified in AD transgenic mice

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Cell senescence and necroptosis were involved in rod degeneration

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Rod degeneration can be detected by in vivo scotopic electroretinogram

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Rod degeneration has earlier onset than amyloid-β plaques in the brain

Non-invasive electrophysiology in glaucoma, structure and function-a review

Glaucoma, its early diagnosis, and monitoring of interventions remain an ongoing challenge. We here review developments in functional assessment and its relation to morphology, evaluating recent insights in electrophysiology in glaucoma and highlighting how glaucoma research and diagnostics benefit from combined approaches of OCT and electrophysiological investigations. After concise overviews of OCT and non-invasive electrophysiology in glaucoma, we evaluate commonalities and complementarities of OCT and electrophysiology for our understanding of glaucoma. As a specific topic, the dynamic range (floor effects) of the various techniques is discussed.

Retinal Responses to Simulated Optical Blur Using a Novel Dead Leaves ERG Stimulus

Purpose

The purpose of this study was to evaluate retinal responses to different types and magnitudes of simulated optical blur presented at specific retinal eccentricities using naturalistic images.

Methods

Electroretinograms (ERGs) were recorded from 27 adults using 30-degree dead leaves naturalistic images, digitally blurred with one of three types of optical blur (defocus, astigmatism, and spherical aberrations), and one of three magnitudes (0.1, 0.3, or 0.5 µm) of blur. Digitally computed blur was applied to the entire image, or on an area outside the central 6 degrees or 12 degrees of retinal eccentricity.

Results

ERGs were significantly affected by blur type, magnitude, and retinal eccentricity. ERGs were differentially affected by defocus and spherical aberrations; however, astigmatism had no effect on the ERGs. When blur was applied only beyond the central 12 degrees eccentricity, the ERGs were unaffected. However, when blur was applied outside the central 6 degrees, the ERG responses were significantly reduced and were no different from the ERGs recorded with entirely blurred images.

Conclusions

Blur type, magnitude, and location all affect the retinal responses. Our data indicate that the retinal area between 6 and 12 degrees eccentricity has the largest effect on the retinal responses to blur. In addition, certain optical blur types appear to have a more detrimental effect on the ERGs than others. These results cannot be solely explained by changes to image contrast and spatial frequency content, suggesting that retinal neurons might be sensitive to spatial cues in order to differentiate between different blur types.

Retinal and cortical visual acuity in a common inbred albino mouse

While albino mice are widely used in research which includes the use of visually guided behavioral tests, information on their visual capability is scarce. We compared the spatial resolution (acuity) of albino mice (BALB/c) with that of pigmented mice (C57BL/6J). We used a high-throughput pattern electroretinogram (PERG) and pattern visual evoked potential (PVEP) method for objective assessment of retinal and cortical acuity, as well as optomotor head-tracking response/ reflex (OMR). We found that PERG, PVEP, and OMR acuities of C57BL/6J mice were all in the range of 0.5-0.6 cycles/degree (cyc/deg). BALB/c mice had PERG and PVEP acuities in the range of 0.1-0.2 cyc/deg but were unresponsive to OMR stimulus. Results indicate that retinal and cortical acuity can be reliably determined with electrophysiological methods in BALB/c mice, although PERG/PVEP acuities are lower than those of C57BL/6J mice. The reduced acuity of BALB/c mice appears to be primarily determined at retinal level.

The retina as a window to early dysfunctions of Alzheimer's disease following studies with a 5xFAD mouse model

Alzheimer's disease (AD) is a progressive neurodegenerative disease leading to neuronal dysfunctions with cognitive impairment. AD can affect visual pathways and visual cortex and result in various visual changes and problems. However, how early the visual dysfunctions occur in AD is still a matter of discussion. Here, we used electrophysiological techniques to show the presence of early anomalies in AD visual system. To this aim, we used a familial AD (FAD) model, the 5xFAD transgenic mouse, characterized by severe progressive amyloid pathology and cognitive deficits. We investigated the retina and primary visual cortex responsivity together with behavioral assessment of the visual acuity. Visual tests and recordings were conducted at different ages in 5xFAD mice, corresponding to different phases of neurodegeneration and beta amyloid accumulation. We showed that the visual system is impaired in 5xFAD mice. In particular, we found that the inner retina impairment precedes neuronal disorders in other brain areas and cognitive deficits. Thus, noninvasive retinal electrophysiology can provide a support for assessing early visual dysfunctions in AD.

Electrophysiological assessment of retinal ganglion cell function

The function of retinal ganglion cells (RGCs) can be non-invasively assessed in experimental and genetic models of glaucoma by means of variants of the ERG technique that emphasize the activity of inner retina neurons. The best understood technique is the Pattern Electroretinogram (PERG) in response to contrast-reversing gratings or checkerboards, which selectively depends on the presence of functional RGCs. In glaucoma models, the PERG can be altered before histological loss of RGCs; PERG alterations may be either reversed with moderate IOP lowering or exacerbated with moderate IOP elevation. Under particular luminance-stimulus conditions, the Flash-ERG displays components that may reflect electrical activity originating in the proximal retina and be altered in some experimental glaucoma models (positive Scotopic Threshold response, pSTR; negative Scotopic Threshold Response, nSTR; Photopic Negative Response, PhNR; Oscillatory Potentials, OPs; multifocal ERG, mfERG). It is not yet known which of these components is most sensitive to glaucomatous damage. Electrophysiological assessment of RGC function appears to be a necessary outcome measure in experimental glaucoma models, which complements structural assessment and may even predict it. Neuroprotective strategies could be tested based on enhancement of baseline electrophysiological function that results in improved RGC survival. The use of electrophysiology in glaucoma models may be facilitated by specifically designed instruments that allow high throughput, robust assessment of electrophysiological function.

Rescue of retinal function by BDNF in a mouse model of glaucoma

Vision loss in glaucoma is caused by progressive dysfunction of retinal ganglion cells (RGCs) and optic nerve atrophy. Here, we investigated the effectiveness of BDNF treatment to preserve vision in a glaucoma experimental model. As an established experimental model, we used the DBA/2J mouse, which develops chronic intraocular pressure (IOP) elevation that mimics primary open-angle glaucoma (POAG). IOP was measured at different ages in DBA/2J mice. Visual function was monitored using the steady-state Pattern Electroretinogram (P-ERG) and visual cortical evoked potentials (VEP). RGC alterations were assessed using Brn3 immunolabeling, and confocal microscope analysis. Human recombinant BDNF was dissolved in physiological solution (0.9% NaCl); the effects of repeated intravitreal injections and topical eye BDNF applications were independently evaluated in DBA/2J mice with ocular hypertension. BDNF level was measured in retinal homogenate by ELISA and western blot. We found a progressive decline of P-ERG and VEP responses in DBA/2J mice between 4 and 7 months of age, in relationship with the development of ocular hypertension and the reduction of Brn3 immunopositive RGCs. Conversely, repeated intravitreal injections (BDNF concentration = 2 µg/µl, volume = 1 µl, for each injection; 1 injection every four days, three injections over two weeks) and topical eye application of BDNF eye-drops (12 µg/µl, 5 µl eye-drop every 48 h for two weeks) were able to rescue visual responses in 7 month DBA/2J mice. In particular, BDNF topical eye treatment recovered P-ERG and VEP impairment increasing the number of Brn3 immunopositive RGCs. We showed that BDNF effects were independent of IOP reduction. Thus, topical eye treatment with BDNF represents a promisingly safe and feasible strategy to preserve visual function and diminish RGC vulnerability to ocular hypertension.

Relationship between transient and steady-state pattern electroretinograms: theoretical and experimental assessment

PURPOSE

We determined if the overlap of transient (tr) pattern electroretinograms (PERG(tr)) can explain the generation of the steady-state (SS) pattern electroretinogram (PERG(SS)), and investigated the relationship between the two types of responses.

METHODS

Slightly jittered pattern reversals were used to generate quasi SS (QSS) PERG(SS) responses from eight normal subjects, recorded using lower eyelid skin electrodes, at rates between 6.9 and 26.5 reversals per second (rps). Jittered quasi PERG(SS) were deconvolved using the frequency domain continuous loop averaging deconvolution method. Additionally, conventional PERG(tr) at 2.2 rps and PERG(SS) at each of the QSS stimulation rates were obtained from all subjects. Two synthetic PERG(SS) responses were constructed at each stimulation rate, one using the PERG(tr) obtained at that rate, and the other using the conventional 2.2 rps PERG(tr). Synthetic responses then were compared to the recorded PERG(SS) using amplitude, latency, and spectral measurements.

RESULTS

Findings indicate that the PERG(SS) obtained at SS rates can be predicted using the superposition of deconvolved tr PERGs at each particular rate. Although conventional PERG(tr) can explain PERG(SS) obtained at rates below 15.4 rps (≥ 97% correlation), for higher reversal rates only deconvolved responses obtained at that rate can produce the recorded SS responses (96% vs. 65% correlation at 26.5 rps).

CONCLUSIONS

The study shows that PERG(SS) results from the overlapping of tr PERG(tr) waveforms generated at that reversal rate. The first two peaks (N(SS) and P(SS)) of the PERG(SS) reflect N35 and P50 waves of the tr PERG(tr). The N95 amplitude is reduced at conventional (16 rps) SS rates, but contributes to the overall PERG(SS) amplitude.

Robust mouse pattern electroretinograms derived simultaneously from each eye using a common snout electrode

PURPOSE

We recorded pattern electroretinograms (PERGs) simultaneously from each eye in mice using binocular stimulation and a common noncorneal electrode.

METHODS

The PERG was derived simultaneously from each eye in 71 ketamine/xylazine anesthetized mice (C57BL/6J, 4 months old) from subcutaneous needles (active, snout; reference, back of the head; ground, root of the tail) in response to contrast-reversal of gratings (0.05 cycles/deg, >95% contrast) generated on two custom-made light-emitting diode (LED) tablets alternating at slight different frequencies (OD, 0.984 Hz; OS, 0.992 Hz). Independent PERG signals from each eye were retrieved using one channel continuous acquisition and phase-locking average (OD, 369 epochs of 492 ms; OS, 372 epochs of 496 ms). The PERG was the average of three consecutive repetitions.

RESULTS

Binocular snout PERGs had high amplitude (mean, 25.3 μV, SD 6.6) and no measurable interocular cross-talk. Responses were reliable (test-retest variability within-session, 14%, SD 7; between sessions, 25%, SD 9; interocular asymmetry within-session, 9%, SD 7; between sessions, 13%, SD 5). Retinal ganglion cells (RGCs) were the main source of the binocular snout PERG, as optic nerve crush in three mice abolished the signal.

CONCLUSIONS

The PERG, a sensitive measure of RGC function, is used increasingly in mouse models of glaucoma and optic nerve disease. Compared to current methods, the binocular snout PERG represents a substantial improvement in terms of simplicity and speed. It also overcomes limitations of corneal electrodes that interfere with invasive procedures of the eye and facilitates experiments based on comparison between the responses of the two eyes.

Electrophysiology and glaucoma: current status and future challenges

Visual electrophysiology allows non-invasive monitoring of the function of most processing stages along the visual pathway. Here, we consider which of the available methods provides the most information concerning glaucomatous optic nerve disease. The multifocal electroretinogram (ERG), although often employed, is less affected in glaucoma than two direct measurements of retinal ganglion cell function, namely the pattern ERG (PERG) and the photopic negative response (PhNR) of the ERG. For the PERG, longitudinal studies have been reported, suggesting that this method can be used for the early detection of glaucoma; for the PhNR, no longitudinal study is available as yet. The multifocal PERG can spatially resolve ganglion cell function but its glaucomatous reduction is typically panretinal, even with only local field changes and so, its topographic resolution is of no advantage in glaucoma. The multifocal visual evoked potential promises objective perimetry and shows sensitivity and specificity comparable with standard automated perimetry but has not been established as a routine tool to date.

Optical imaging of retina in response to grating stimuli in cats

We examined the intrinsic signals in response to grating stimuli in order to determine whether the light-evoked intrinsic signals of the retina are due to changes in the photoreceptor activities induced by the image projected on to the retina or are due to neural activities of the inner retina. The retinas of the left eye of 12 cats under general anesthesia were examined by a functional imaging fundus camera. Near infrared light was used to monitor the reflectance changes (RCs) of the retina. Vertical grating were used to stimulate the retina at 4 Hz. The spatial frequencies of the gratings were 0.05, 0.11, 0.22, 0.43, 0.86, 1.73, and 3.46 cycles/degree (cpd). Ten images were averaged and used to analyze the RCs to obtain the peak value (PV) of a two dimensional fast Fourier transfer of the RCs. The wavefront aberrations (WA) were measured with a compact wavefront aberrometer and the spatial modulation transfer function (MTF) of the eye was calculated. The retinal reflectance image had a grating pattern. The PV of the spatial sensitivity curve was highest at low spatial frequencies (0.05 and 0.11 cpd), and the sensitivity decreased steeply with an increase in the spatial frequency. RCs were not detectable at 3.46 cpd. The MTF decreased gradually with increases in the spatial frequencies and was 0.68 at 3.46 cpd. The reflectance pattern of the retinal intrinsic signal elicited by grating stimuli of different spatial frequencies was different from that of the MTF. This suggests that the intrinsic signal represents not only the response of the photoreceptors but also other neuronal or vascular changes in the retina.

The bioelectric field of the pattern electroretinogram in the mouse

PURPOSE

To compare the bioelectric field associated with the pattern electroretinogram (PERG) with that of the flash electroretinogram (FERG) in the mouse.

METHODS

PERGs and FERGs were recorded from each eye in 32 C57BL/6J mice using corneal silver loops referenced to a subcutaneous needle on the back of the head. PERG stimuli were horizontal gratings of 0.05 cycles per degree and 98% contrast reversing 2 times per second. Light-adapted FERG stimuli were bright strobe flashes. Stimuli were presented either monocularly or binocularly. In some experiments, TTX was injected in one eye and saline in the contralateral eye.

RESULTS

The PERG recorded from the contralateral, occluded eye had slightly larger amplitude (1.14 ×, P < 0.01) and longer latency (+1.57 ms, P < 0.01) compared with the ipsilateral eye. Under binocular stimulation, the PERG amplitude was much larger (1.67 ×, P < 0.01) than the monocular amplitude. TTX injected in the stimulated eye drastically reduced the PERG in both eyes. Monocular FERGs were recordable from the stimulated eye only and were moderately reduced by TTX. Binocular and monocular FERGs had similar amplitudes.

CONCLUSIONS

PERG and FERG generate different bioelectric fields in the mouse. The PERG bioelectric field is consistent with a dipole model whose axis is orthogonal to the eye axis, whereas the standard dipole model for the FERG is coaxial. Possible sources of the PERG bioelectric field are unmyelinated optic nerve axons adjacent to the sclera. Results provide new insights on the generators of the PERG signal and its alterations in mouse models of glaucoma and optic nerve diseases.

Update on the pattern electroretinogram in glaucoma

PURPOSE

To review the efficacy of the pattern electroretinogram (PERG) in early diagnosis of glaucoma.

METHODS

Stimulation parameters of check size and temporal frequency are considered. Analyses of various peaks (P50, N95, the N95/P50) and Fourier steady-state are considered. The relation to visual field defects is explored.

RESULTS

The PERG is markedly alterated in glaucoma. It shows amplitude reductions in (still) normal areas of the visual field. Optical imaging on the retina needs to be optimal. Higher temporal frequency (>10 reversals/s) improves the sensitivity to detect glaucoma compared with transient stimulation. The ratio between the amplitudes to 0.8 degrees checks and to 16 degrees checks, "PERG ratio," exploits a check size-specific reduction in early glaucoma and reduces variability. Longitudinal studies suggest that the PERG can indicate incipient glaucoma damage before evidence from the visual field.

CONCLUSIONS

The PERG is a demanding electrophysiological technique that can serve as a sensitive biomarker for retinal ganglion cell function. With appropriate paradigms, PERG assists in identifying those patients with elevated interocular pressure in whom glaucoma damage is incipient before visual field changes occur.

Longitudinal evaluation of retinal ganglion cell function and IOP in the DBA/2J mouse model of glaucoma

PURPOSE

To characterize progressive changes of retinal ganglion cell (RGC) function and intraocular pressure (IOP) in the DBA/2J mouse model of spontaneous glaucoma.

METHODS

Serial pattern electroretinograms (PERGs) and IOPs measures were obtained from both eyes of 32 anesthetized DBA/2J mice over an age range of 2 to 12 months at 1-month intervals. Cone-driven flash-ERGs (FERGs) were also recorded. The endpoint was defined as the age at which the PERG amplitude reached the noise level in at least one eye. At that point, both eyes were histologically processed to evaluate the thickness of the retinal fiber layer (RNFL).

RESULTS

IOP increased moderately between 2 and 6 months ( approximately 14-17 mm Hg) and then more steeply, until it leveled off at approximately 28 mm Hg by 9 to 11 months. The mean PERG amplitude decreased progressively after 3 months of age to reach the noise level (85% reduction of normal amplitude) at approximately 9 to 12 months in different animals. When the PERG was at noise level, the RNFL showed a relatively smaller reduction (40%) in normal thickness. The FERG displayed minor changes throughout the observation period. IOP and PERG changes were highly correlated (r(2) = 0.51, P < 0.001).

CONCLUSIONS

Results indicate that inner retina function in DBA/2J mice progressively decreases after 3 months of age, and it is nearly abolished by 10 to 11 months, whereas outer retina function shows little change and the RNFL thickness is relatively spared. This result suggests that surviving RGCs may not be functional. Progression of inner retinal dysfunction is strongly associated with increased IOP.

Temporal and spatial frequencies interact in the contrast transfer function of the pattern electroretinogram

The contrast transfer function (CTF) of the pattern electroretinogram (PERG) depends on temporal frequency. For transient stimulation it is fully linear; at faster stimulation rates it becomes strongly non-linear with an accelerated shape. In this study we investigated a range of stimulus parameters with the aim of studying the influence of temporal and spatial frequencies, as well as contrast levels, on the CTF; effects were quantified via an "index of linearity" IL. Both reversal rate and check size influenced linearity (p<.001), examples: At a constant check size of 0.8 degrees, 7.7 rps: IL=1.0; 0.8 degrees/24 rps: IL=0.5; at a constant reversal rate of 19 rps, IL was 0.5 for 0.8 degrees, but rose to 0.8 both for 0.2 degrees and 18 degrees. The reason for this complex response surface remains a puzzle, it cannot be explained by varying parvo/magnocellular contributions, and its possible influences on recordings in patients merit further studies.

The mouse pattern electroretinogram

Mouse models of optic nerve disease such as glaucoma, optic neuritis, ischemic optic neuropathy, and mitochondrial optic neuropathy are being developed at increasing rate to investigate specific pathophysiological mechanisms and the effect of neuroprotective treatments. The use of these models may be greatly enhanced by the availability of non-invasive methods able to monitor retinal ganglion cell (RGC) function longitudinally such as the Pattern Electroretinogram (PERG). While the use of the PERG as a tool to probe inner retina function in mammals is known since 25 years, relatively less information is available for the mouse. Here, the PERG technique and the main applications in the mouse are reviewed.

Multifocal pattern electroretinogram: cellular origins and clinical implications

PURPOSES

The purposes of this article are to gain insight into the cellular origins of the multifocal pattern electroretinogram (mPERG) and evaluate its potential for clinical use.

METHODS

mPERGs were recorded from four anesthetized monkeys before and after pharmacologic blockade of light-driven activity of inner-retinal neurons and from 55 normal human subjects (19-91 years) and six patients with glaucoma (43-77 years of age). Stimuli consisted of counterphase-modulated black and white triangles organized in 61-scaled hexagons with mean luminance 100 cd/m2 and 100% contrast. The stimulus array subtended 31 degrees vertically and 37 degrees horizontally at 48 cm. The amplifier cutoff frequencies were 3 and 100 Hz. Responses were grouped as quadrants and the first slice of the second-order kernel was analyzed.

RESULTS

The mPERG responses of monkeys and humans were similar. In the monkey responses, there was an early positive potential (P1) around 25 ms and a later positive potential (P2) found selectively in the nasal field quadrants around 31 ms. These responses were seen around 22 and 36 ms in the human responses. After blockade of inner-retinal activity in monkeys, P1 amplitude was greatly reduced at all retinal locations and P2 was eliminated. P1 and P2 amplitudes were significantly reduced in the glaucomatous eyes relative to amplitudes of age-matched controls. Reductions in the amplitudes of P1 and P2 could easily discriminate between glaucomatous visual field quadrants with and without behavioral sensitivity losses. However, these alterations are likely to reflect diffuse losses.

CONCLUSIONS

mPERG responses contain prominent contributions from inner-retinal neurons that can be reduced in glaucomatous eyes. These findings raise the possibility that the mPERG could be potentially useful in the objective estimation of neural damage in glaucoma. However, further refinement of recording techniques will be required if the mPERG is to be used to detect focal damage.

Contributions from lateral interaction mechanisms to the human ERG can be studied with a two-frequency method

We present a two-frequency method to investigate lateral interaction components (liERGs) in the human electroretinogram. Adjacent half cycles of sinusoidal gratings were modulated sinusoidally with different temporal frequencies f1 and f2. The liERGs were defined by the Fourier components at the intermodulation frequencies /f1 - f2/ and f1 + f2 which indicate nonlinear interactions between the half cycles. Significant liERGs were found in all subjects with a monotonic increase of the liERG magnitude in the spatial frequency range from f(s)=0.07 to 2.4 cpd. When /f1 - f2/ was below 5 Hz, liERGs were masked by noise intrusions. In a control experiment we demonstrated that the liERGs were not evoked by stray light artifacts. The liERGs may help to further differentiate the responses that are evoked by patterned stimuli within the retina.

Scotopic threshold response changes after vigabatrin therapy in a child without visual field defects: a new electroretinographic marker of early damage?

Vigabatrin (VGB) has been widely used in patients affected by drug-resistant epilepsy and West syndrome. Following reports of visual field loss associated with vigabatrin therapy, some authors have investigated retinal electrophysiologic variables to identify early electrophysiologic markers and pathogenetic mechanisms of retinal damage. There are no previous reports of a scotopic threshold response (STR) reduction associated with vigabatrin therapy. A 13-year-old male child was submitted to a complete electroretinographic study before and after the start of vigabatrin therapy. Of the electroretinographic responses analyzed, only the scotopic threshold response was altered. The scotopic threshold response is a corneal-negative wave in the electroretinogram (ERG) of a fully dark-adapted eye. In cat, this response has been shown to be mediated by K+ spatial buffer currents that flow from proximal to distal retina in retinal glia as a result of elevated concentration of K+ in proximal retina following depolarization of local neurons in response to light onset. The prospective nature of the study in a previously untreated patient on vigabatrin monotherapy allows us to speculate on the underlying pathogenetic mechanisms and level of action of vigabatrin therapy-related retinal damage. If the predictive value of the scotopic threshold response changes is documented, this ERG response could be used to perform a preliminary evaluation of drugs, which modify gamma-aminobutyric acid (GABA) receptors and/or GABA levels.

The multifocal pattern electroretinogram in glaucoma

BACKGROUND

The pattern ERG can be used to detect early glaucomatous change, because the response of cells in the inner retina from (typically) 20 degrees -40 degrees of area is reduced before perimetric abnormality is certain. The multifocal pattern electroretinogram (mfPERG) allows analysis of many local regions within this area. The aim of this study was to investigate whether in patients with presumed glaucoma the mfPERG permits diagnosis and discrimination from normals.

METHODS

Measurements on 25 age-related normal eyes were compared to those on 23 eyes with different stages of glaucoma. A RETIScan system was used to generate a stimulus pattern of 19 hexagons, each consisting of six triangles. The triangles pattern-reversed black to white at 75 Hz. Those 19 hexagons were grouped into three stimulus regions: a central field, a middle, and a peripheral ring. The complete array subtended 48 degrees at the eye. The hexagons alternated between black and white, in a temporal pattern that followed a corrected binary m-sequence (length 512, 10 cycles with 39 s each). The amplitudes and latencies of positive responses at approximately 50 ms (P-50) and negative responses at approximately 95 ms (N-95) were analyzed.

RESULTS

In patients with glaucoma the P-50 and N-95 components of the mfPERG were significantly reduced for the central area and both outer rings compared to normal volunteers (p<0.001, Mann-Whitney-U). The most distinct reduction was observed for N-95 and the central ring. Changes in latencies were not conclusive. The reduction of the components increased with the stage of glaucoma. A predictive model for detecting early glaucomatous changes was designed based on P-50-N-95 with 88% sensitivity and 76% specificity.

CONCLUSION

In glaucoma a marked reduction of components, especially centrally is observed in the mfPERG. This hints to an early involvement of central ganglion cells and may be useful for future functional tests.

Electrophysiological approaches for early detection of glaucoma

PURPOSE

While elevated intraocular pressure (IOP) is a major risk factor for glaucoma, only about 1% of patients with 25 mmHg develop the condition each year. Since a sizeable proportion of the ganglion cells are already lost when the visual field losses are apparent, the aim is to identify patients with elevated IOP in whom glaucoma damage is incipient before visual field changes occur.

METHODS

This report concerns early diagnosis of glaucoma with electrophysiological techniques, rather than with monitoring the disease using various available psychophysical and morphological methods. Visual electrophysiology offers a wide range of tools to assess function layer-by-layer along the visual pathway. Their clinical value for early detection of glaucoma will be discussed. The pattern electroretinogram (PERG), a direct functional indicator of retinal ganglion cell function, is markedly affected by glaucoma, and in longitudinal studies the PERG correctly indicated eyes at risk before manifest glaucoma occurred.

CONCLUSIONS

Consequently, this report will concentrate on the PERG. Less proven, but promising measures like the "photopic negative response", the motion visually evoked potential (VEP) and the multifocal VEP will also be touched upon.

Pattern electroretinography (PERG) and an integrated approach to visual pathway diagnosis

The pattern electroretinogram (PERG) provides an objective measure of central retinal function, and has become an important element of the author's clinical visual electrophysiological practice. The PERG contains two main components, a positivity at approximately 50ms (P50) and a larger negativity at approximately 95ms (N95). The P50 component is affected by macular dysfunction with concomitant reduction in N95. The PERG therefore complements the Ganzfeld ERG in the assessment of patients with retinal disease. In contrast, the ganglion cell origins of the N95 component allow electrophysiological evaluation of ganglion cell function both in primary disease and in dysfunction secondary to optic nerve disease, where selective loss of N95 can be observed. Both macular dysfunction and optic nerve disease can give abnormalities in the visual evoked cortical potential (VEP), and the PERG thus facilitates more meaningful VEP interpretation. This review addresses the origins and recording of the PERG, and then draws on extensive clinical data from patients with genetically determined retinal and macular dystrophies, other retinal diseases and a variety of optic nerve disorders, to present an integrated approach to diagnosis.

The visual response of retinal ganglion cells is not altered by optic nerve transection in transgenic mice overexpressing Bcl-2

Attempts to rescue retinal ganglion cells from retrograde degeneration have had limited success, and the residual function of surviving neurons is not known. Recently, it has been found that axotomized retinal ganglion cells die by apoptotic mechanisms. We have used adult transgenic mice overexpressing the Bcl-2 protein, a powerful inhibitor of apoptosis, as a model for preventing injury-induced cell death in vivo. Several months after axotomy, the majority of retinal ganglion cells survived and exhibited normal visual responses. In control wild-type mice, the vast majority of axotomized retinal ganglion cells degenerated, and the physiological responses were abolished. These results suggest that strategies aimed at increasing Bcl-2 expression, or mimicking its function, might effectively counteract trauma-induced cell death in the central nervous system. Neuronal survival is a necessary condition in the challenge for promoting regeneration and eventually restoring neuronal function.

Check size tuning of the pattern electroretingoram: a reappraisal

The pattern electroretinogram was recorded to checkerboard stimuli with a wide range of check sizes and two stimulus field sizes. Check sizes ranged from 0.25 degree to 7 degrees (field size, 16 degrees x 14 degrees) and 0.25 degree to 15 degrees (field size, 32 degrees x 27 degrees) in 14 and seven subjects, respectively. Reversal rate was 4.5/s. For minimal intrusion of blink artifacts the interrupted stimulation technique was employed. The P50 and N95 components of the pattern electroretinogram were evaluated separately. With both stimulus field sizes amplitude of P50 and N95 was maximal between 0.75 degree and 1 degree. With smaller check sizes the amplitude dropped monotonically. With larger check sizes field size played a role: with the 16 degrees x 14 degrees field, P50 gradually dropped to 89% from 1 degree to 7 degrees, which was paralleled by N95 only up to 7 degrees, where N95 dropped to 81% (p < 0.05). With the 32 degrees x 27 degrees field, there was no significant difference in size dependency between P50 and N95 for large check, both components staying constant from 1 degree to 15 degrees. We conclude that there is only minor large-check attenuation of the pattern electroretinogram, especially with a large field. The apparent field-size dependency may explain previous discrepancies in the literature.

Correlation of dynamic responses in the ON bipolar neuron and the b-wave of the electroretinogram

2-Amino-4-phosphonobutyrate (APB) is known to selectively suppress the light response of ON bipolar cells in the vertebrate retina, and reduce the b-wave of the electroretinogram (ERG) as a consequence. Using slow drug application, the progressive effect of APB was used to compare the relative response amplitudes of the b-wave and the ON bipolar cell. Simultaneous ERG recordings and ON bipolar intracellular recordings were performed in the amphibian retina. The results indicate that there is a strong positive correlation between these two waveforms. This supports the possibility that the b-wave of the ERG is the direct result of ON bipolar cell activity.

Scalp-recorded oscillatory potentials evoked by transient pattern-reversal visual stimulation in man

Replicable oscillatory potentials, time-locked to pattern stimuli (9.0 degrees central; counterphase reversal at 2.13 Hz) were dissociated from conventional, broad-band VEPs recorded in healthy volunteers at occipital scalp locations by high-pass digital filtering at 17.0-20.0 Hz. Nine consecutive wavelets were identified with a 56.4 +/- 8.4 msec mean latency of the first replicable wavelet and mean peak-to-peak amplitude varying between 0.9 and 2.0 muV. The first 2 wavelets had significantly shorter latencies than wave N70 of unfiltered VEP, whereas the last 2 wavelets had longer latencies than N145. Latency and amplitude values varied as a function of contrast and spatial frequency of the stimulus, with shorter latencies and larger amplitudes at 60-90% contrast level and tuning of amplitude at 5.0 c/deg. All wavelets were correlated with wave P100 of unfiltered VEP, while a correlation with N70 of VEP was observed only for those wavelets with latencies in the range of wave P100. Two patients with documented brain lesions involving the visual system are described as examples of oscillatory responses occurring irrespective of filter bandpass and instead of the expected conventional VEP when the generation of these is interfered with by brain pathology. A substantial cortical contribution to the origin of the oscillatory response is conceivable. It is suggested that the oscillatory response to pattern-reversal stimulation reflects events in the visual system that are parallel to, and partly independent of, the conventional VEP, with potential application in research or for clinical purposes.

Influence of simultaneous pattern-reversal electroretinogram recording on visual evoked potentials

Little is known about the influence of the presence of a gold-foil electrode on pattern-reversal visual evoked potential recording, although simultaneous pattern-reversal electroretinography has been applied in several clinical investigations. We compared the results of pattern-reversal visual evoked potentials simultaneously recorded with pattern-reversal electroretinograms with those obtained during separate pattern-reversal visual evoked potential recording in 10 normal subjects. Transient response (reversal rate, 1 Hz; check size, 30') and steady-state response (reversal rate, 5 Hz; check size, 120', 60', 30', 15' and 7.5') were analyzed under the stimulus contrast condition of 90%. Neither P100 latency in transient responses nor amplitudes in steady-state responses exhibited significant change at any check size when they were recorded separately or simultaneously with pattern-reversal electroretinograms. The results suggest that the gold-foil electrode exerts no significant influence on pattern-reversal visual evoked potentials. Simultaneous pattern-reversal electroretinogram and visual evoked potential recording is therefore confirmed to be a clinically useful method. This procedure makes the synchronous recording of both responses possible under the identical stimulus conditions.

Utility of the color pattern-electroretinogram (PERG) in glaucoma

Pattern-onset electroretinograms (PERGs) with red-green color contrast (CC) and green-"black" luminance contrast (LC) stripe patterns (0.3 c/deg) were recorded in a group of 80 control subjects and in a group of 42 patients having glaucomas of varying etiology and severity. The PERG data were correlated with the results of static perimetry and optic disc morphometry. In the glaucoma group the PERG was reduced significantly and by relatively similar amounts with both CC and LC stimuli. A significant correlation of the PERG reduction with visual field loss was found only with the CC, not with the LC PERG. Correlations between PERG amplitudes and neuroretinal rim areas of the optic disk were similar for the LC and for the CC stimulus. The rather poor percentage of correct classification of controls and patients based on the PERG or the optic disc morphometry alone can be improved by two-dimensional discriminant analysis using both CC PERG and papillometry data.

The different contributions of local luminance decreases and increases to the pattern electroretinogram (PERG)

The typical pattern-onset-offset stimulus (stimulus A) consisting of local luminance increases and decreases was broken down into stimuli presenting only local luminance increases (stimulus B) or only local luminance decreases (stimulus C). With stimulus B the onset ERGs are luminance responses. With stimulus C the onset ERGs are pattern-related responses showing a spatial band-pass function. With stimulus A the response is a linear addition of responses to stimuli B and C. The simultaneously recorded VEP is a pattern-related response with all three stimuli (A-C).

Fundamental differences between the nonlinearities of pattern and focal electroretinograms

We directly compared nonlinear kernels of normal human pattern electroretinograms (PERGs) and corresponding localized flash ERGs (FERGs). The FERG was triphasic and resembled an adaptive process because it decayed slowly without changing shape over several kernel orders and interpulse intervals. The PERG was biphasic in the slice nearest the diagonal of the second-order kernel, similar to the FERG in slices farther from this diagonal, and without power in higher-order kernels. The unique PERG features were short-term effects that immediately followed a contrast transition. The appearance-disappearance PERG had a triphasic first-order kernel and a biphasic second-order kernel. The latter was similar to, but half the size of, that for the contrast-reversal PERG. When the first off-diagonal slices of the two PERG second-order kernels were analyzed in detail, we found in both that the first positive peak was larger than the FERG at intermediate spatial frequencies. Both PERG peaks in the slice had a low contrast threshold and were linear with contrast. The three FERG peaks of the corresponding FERG slice had a higher threshold and were saturated with increasing contrast. These observations show that the PERG contains substantial pattern specific nonlinear components and cannot be dismissed as merely the nonlinear subcomponents of the corresponding FERG.

Pattern ERG in rats following section of the optic nerve

The aim of this study is to investigate in the rat the properties of the pattern electroretinogram (ERG) and to assess whether it depends upon the functional integrity of ganglion cells. Flash and pattern ERG were recorded from urethane anaesthetized hooded rats. The pattern ERG was evoked by phase alternating gratings of various spatial frequencies and contrasts. In the first part of the study we determined how the amplitude of the main harmonic of the pattern ERG (2nd harmonic) varies as a function of stimulus parameters such as spatial and temporal frequency, contrast and mean luminance. In the second part of the study we investigated the effects of the retrograde degeneration of ganglion cells following optic nerve section on the amplitude of pattern ERG. We found that the section of the optic nerve leads to the progressive disappearance of the P-ERG which is almost complete 4 months after surgery. By this time only few axotomized ganglion cells are left. The flash ERG remained unaffected. Thus, the pattern electroretinogram seems to be a simple and sensitive tool to investigate the functional integrity of retinal ganglion cells in rats.

Local pattern electroretinograms and ganglion cell activity in the turtle eye

1. Local electroretinograms and spike activity from ganglion cells were recorded from an eye cup preparation of the turtle retina. The responses were elicited with striped and plaid stimulus patterns. 2. The results obtained with the two forms of recording were highly similar. Both depended on the spatial phase of the pattern with respect to the recording electrode. Both had maximal response at the same stimulus spatial frequency. 3. The optimum spatial frequency (both for maximum electroretinogram amplitudes and spike discharge rates) shifted to lower values with the administration of the GABA antagonist, picrotoxin. 4. The low frequency falloff associated with this spatial tuning may point to a mechanism of lateral interactions common to the local electroretinogram and spike responses.

Sensitivity distribution in the central and midperipheral visual field determined by pattern electroretinography and harmonic analysis

To investigate the value of the extrafoveal pattern electroretinogram for evaluation of local retinal defects, electroretinographic responses to contrast reversal stimulation were recorded at various locations in the central and midperipheral retina. Normal values were established in 20 eyes, and spatial selectivity at different retinal eccentricities was determined in four eyes. The response amplitude was found to decrease steeply from the fovea until about 12 degrees eccentricity and to decline only slowly thereafter. For central stimulation a clear attenuation for coarser patterns was observed. At 20 degrees and at 30 degrees eccentricity the spatial tuning function exhibited a bandpass characteristic, with the maximum amplitude shifting to lower spatial frequencies. Despite the relatively low peripheral amplitudes a satisfactory signal to noise ratio of the second harmonic responses can be obtained by Fourier analysis, which improves clinical applicability. The comparison of sensitivity in the upper and lower retina revealed a considerable asymmetry, with responses in the upper retina approximately 20% higher. No significant difference, however, was found when the temporal or nasal retina was stimulated. The reproducibility of these results is high enough to encourage clinical studies. A case of retinal venous branch occlusion exemplifies the applicability of this technique in eccentric fundus lesions.

Electroretinograms to checkerboard pattern reversal in cats: physiological characteristics and effect of retrograde degeneration of ganglion cells

Pattern electroretinograms (P-ERGs) evoked by alternating checks were studied in cats. Spatial frequency functions for transient and steady-state P-ERG waves showed a bimodal distribution with a preferred frequency at 0.6-0.75 c/deg and a second amplitude increase at frequencies lower than 0.5 c/deg. Decreasing the pattern luminance by 0.5 log units produced a shift of the spatial tuning curve toward lower spatial frequencies. No temporal tuning was noted in the temporal frequency functions. The bimodal distribution suggests that at spatial frequencies higher than 0.5 c/deg, the tuning reflects a 'contrast response' originating in cells with center surround organization. At spatial frequencies below 0.5 c/deg, the 'luminance response' becomes predominant and is generated in cells sensitive to mean luminance changes. Transient and steady-state P-ERGs to medium and high spatial frequencies were abolished by section of the optic nerve, while low spatial frequency stimuli at or below 0.3 c/deg continued to evoke P-ERGs at 1, 5 and 10 months after surgery. Quantitative whole mount retina microscopic examination confirmed the retrograde degeneration of the ganglion cells. It is concluded that both transient and steady-state P-ERGs to small and medium spatial frequencies checks are predominantly related to ganglion cell activity, while P-ERGs to low spatial frequencies reflect preganglionic cell activity.

Current source density analysis of linear and non-linear components of the primate electroretinogram

1. We have used the method of current source density analysis to locate the generators of harmonic electroretinogram (ERG) responses to contrast-modulated pattern and uniform-field stimuli in the primate retina. 2. Sinusoidal steady-state analysis was used, with a stimulus temporal frequency of 8 Hz. Fundamental and second-harmonic response components were measured for the uniform-field response. The second harmonic of the average of contrast-reversal pattern responses obtained at a series of spatial phases was also determined in the same experiments. In addition, retinal tissue resistance was measured. All of these measurements were obtained at a series of equally spaced depths in the retina. 3. Retinal resistivity was not observed to vary systematically with depth. In addition, any plausible undetected inhomogeneities of resistivity with depth were found to slightly affect the relative magnitudes of estimated current sources and sinks, but to have little effect on their localization. 4. In a given penetration, the phase lag of each harmonic component was relatively constant with depth in most cases; however the magnitude of this phase lag sometimes varied in different penetrations. To compare data from different penetrations, the constant phase lag for each harmonic was estimated, and the response data phase-shifted so as to bring all data into a standard (cosine) phase. 5. The resulting current source density analyses were found to be quite consistent in overall form for different penetrations and in different animals. These data were averaged to obtain a final estimate of the depth profiles for generators of different ERG components. 6. The uniform-field fundamental response was found to have a predominant source-sink pair in the distal half of the retina (receptor layer to outer plexiform layer). The pattern (second-harmonic) response generators had a quite different depth profile, consisting mainly of a source-sink pair in the proximal 20% of the retina (encompassing the nerve fibre layer to the middle of the inner plexiform layer). The uniform-field second-harmonic response showed a current source density (CSD) depth profile with multiple sources/sinks, as if it contained contributions from the other two.

Contributions to the electroretinogram of currents originating in proximal retina

We have investigated responses in proximal retina of the cat that contribute to two kinds of electroretinogram (ERG) recordings: (1) the pattern ERG, a light-adapted response and (2) the threshold and near threshold ERG, a dark-adapted response (Sieving et al., 1986a, 1986b; Sieving & Steinberg, 1985). In intraretinal, extracellular recordings, two negative-going responses were identified that are maximal around the inner plexiform layer, and distinct from PII, which is maximal in distal retina: under light-adapted conditions, a spatially tuned response at light and light offset, the "M-wave" (previously described in cold-blooded animals by Karwoski & Proenza (1977, 1980)), and under dark-adapted conditions, the scotopic threshold response, or "STR," a response at light onset. The results under dark-adapted conditions are examined in more detail here. The STR is a very sensitive response whose threshold is 1.5-2.0 log units below that of the dc-component of PII and therefore well below the threshold of the a-, b-, and c-waves. It saturates about 2.4 log units below rod saturation. The STR contributes a negative-going potential to the dark-adapted ERG that is dominant near threshold; while PII (dc-component and b-wave) contributes a positive-going potential that is dominant at higher intensities (Sieving et al., 1986b). Investigation of the mechanism of the proximal retinal responses that contribute to the ERG supports of K(+)-Müller cell hypothesis of their origin.

Clinical applications of pattern electroretinography: melanoma, retinal detachment and glaucoma

A comparison between results obtained by pattern electroretinography (ERG), Ganzfeld cone and rod-ERG was made in 7 patients suffering from melanoma, glaucoma and retinal detachment. It was shown that the extent of the lesions, not seen ophthalmoscopically, can be well monitored by the second harmonic component of pattern electroretinography in cases where conventional Ganzfeld ERG's do not reveal defects. Especially damage caused by acute glaucoma attacks and those stemming from chronic hypertension can be well differentiated.

The pattern electroretinogram

Physiological experiments and the exploitation of clinical conditions have provided compelling evidence that retinal ganglion cells and other inner retinal structures generate the pattern ERG (PERG). As an increasing number of clinical reports have been published some contradictory findings have been reported. These may be ascribed to variation in recording and measuring techniques. The PERG consists of two major portions, the early positive and the following negative component which can be investigated separately if the stimulus conditions allow isolated (or "transient") responses to be recorded. Care has to be taken in positioning the reference electrode, maintaining accurate refraction, and the influence of pupil size must be considered. Furthermore the PERG is contaminated by a luminance component which may be generated in the outer retina. The size of this increases with low spatial frequency (large check-sizes) and high mean luminance. The PERG permits the examination of an additional level of the retina and helps the understanding of pathophysiology of various eye diseases, and is of clinical importance in routine diagnosis and assessment. In glaucoma the PERG amplitude is often reduced before it is possible to detect a scotoma and it is therefore an important prognostic indicator in patients with ocular hypertension. In diabetic retinopathy, retinal ischaemia sufficient to lead to the pre-proliferative state can be demonstrated. The PERG also has a major clinical role in examining localised retinal pathology. If combined with VECP recording, it greatly extends the interpretations possible, since not only can damage to the optic nerve be detected by both tests, but the normal PERG in the presence of an abnormal PVECP implies that the losses are confined to the central pathway.