Equivalent intrinsic noise, sampling efficiency, and contrast sensitivity in patients with retinitis pigmentosa

PURPOSE

To determine the relationships among equivalent intrinsic noise (Neq), sampling efficiency, and contrast sensitivity (CS) in patients with retinitis pigmentosa (RP), where Neq is an estimate of the amount of noise within the visual pathway and sampling efficiency represents the subject's ability to use stimulus information optimally.

METHODS

Participants included 10 patients with RP aged 10 to 54 years, who had visual acuities of 20/40 or better, and 10 visually normal control subjects aged 22 to 65 years. CS was measured for 2-cycles-per-degree Gabor patch targets presented in the absence of noise (CS0) and in five levels of noise spectral density. Data were fit with a standard linear amplifier model, which provided estimates of Neq and sampling efficiency.

RESULTS

CS0 for the patients ranged from normal to as much as a factor of 3 below the lower limit of normal. All 10 patients had abnormally high Neq, including two patients with normal CS0. In comparison, only two patients had lower-than-normal sampling efficiency, and these two patients also had below-normal CS0. Log CS0 for the patients was correlated significantly with log Neq (r = -0.80, P < 0.05), but not with log efficiency (r = 0.54, P = 0.11).

CONCLUSIONS

Low CS was associated with elevated intrinsic noise in this group of RP patients, but even patients with normal CS had elevated noise levels. The results suggest that CS measurement in both the presence and absence of luminance noise can provide important information about visual dysfunction in RP patients.

Electroretinographic findings in a patient with congenital stationary night blindness due to a novel NYX mutation

PURPOSE

To document a novel NYX gene mutation in a patient with X-linked complete congenital stationary night blindness and to describe this patient's electroretinogram (ERG) characteristics.

METHODS

ERGs were recorded from a 17-year-old male with a previously unreported NYX mutation (819G > A) that results in a missense codon change (Trp237Ter). ERGs were recorded in response to brief-flash stimuli, 6.33-Hz sawtooth flicker, and sinusoidal flicker ranging from 6.33-100 Hz. The omitted stimulus response (OSR) of the flicker ERG, which is thought to be generated within the ON-pathway, was also assessed.

RESULTS

The patient's single-flash responses were consistent with previously documented NYX ERG characteristics, including a high-luminance flash response that was electronegative under dark-adapted conditions and a square-like a-wave followed by an abnormally shaped positive potential under light-adapted conditions, both of which are consistent with an ON-pathway deficit. Further evidence for an ON-pathway deficit included: (1) ERGs to rapid-on sawtooth flicker in which b-wave amplitude was reduced more than a-wave amplitude, and (2) responses to sinusoidal flicker that lacked the normal amplitude minimum and phase inflection near 12 Hz, ERG characteristics that are like those of patients with other NYX mutations. Novel findings included a pronounced amplitude attenuation for sinusoidal flicker at frequencies above approximately 50 Hz and an absent OSR, suggesting ON-pathway dysfunction at high frequencies.

CONCLUSION

The substantial loss of ERG amplitude and apparent ON-pathway dysfunction at high temporal frequencies distinguish this patient with a Trp237Ter NYX mutation from those with other previously reported NYX mutations.

Characteristics of late negative ERG responses elicited by sawtooth flicker

BACKGROUND

This study aimed to determine whether the properties of the late negative responses (LNRs) of the electroretinogram (ERG) elicited by sawtooth flicker are consistent with the characteristics of the photopic negative response generated by a light pulse (PhNRpulse).

METHODS

ERG recordings were obtained from 10 visually normal individuals and from 6 patients with optic atrophy (OA) in response to 8-Hz rapid-on and rapid-off sawtooth flicker and to brief (4 ms) light pulses. All stimuli were either long wavelength (R), middle wavelength (G), or a combination of equal luminances of long and middle wavelengths (Y) presented on a short-wavelength, rod-saturating adapting field. Amplitudes of LNRs were obtained in response to rapid-on (LNRon) and rapid-off (LNRoff) sawtooth flicker and were also derived from the sum of the ERG waveforms to the two sawtooth phases (LNRadd).

RESULTS

For the control subjects, PhNRpulse amplitude varied with stimulus wavelength, being largest in response to a long-wavelength pulse, as expected. However, the amplitudes of LNRon, LNRoff, and LNRadd were not significantly different for R, Y, and G sawtooth flicker. Despite the absence of a chromatic effect, LNRoff and LNRadd amplitudes were significantly smaller in the OA patients than in the controls, similar to the results for the PhNRpulse, implying an inner retinal origin for the LNRoff and LNRadd. However, LNRon amplitudes did not differ significantly between the OA patients and controls, although there was a significant correlation between the LNRon and PhNRpulse for R stimuli.

CONCLUSION

We conclude that LNRoff and LNRadd but not LNRon can be useful measures to assess the integrity of the inner retina that can complement the PhNRpulse.

Stimulus chromatic properties affect period doubling in the human cone flicker ERG

Period doubling in the full-field cone flicker electroretinogram (ERG) refers to an alternation in waveform amplitude and/or shape from cycle to cycle, presumably owing to the operation of a nonlinear gain control mechanism. This study examined the influence of stimulus chromatic properties on the characteristics of period doubling in order to better understand the underlying mechanism. ERGs were acquired from 5 visually normal subjects in response to sinusoidally modulated flicker presented at frequencies from 25 to 100 Hz. The test stimuli and the pre-stimulus adaptation were either long wavelength (R), middle wavelength (G), or an equal combination of long and middle wavelengths (Y), all equated for photopic luminance. Fourier analysis was used to obtain the response amplitude at the stimulus frequency F and at a harmonic frequency of 3F/2, which was used as the index of period doubling. The frequency-response function for 3F/2 typically showed two peaks, occurring at approximately 33.3 and 50 Hz. However, the magnitude of period doubling within these frequency regions was dependent on the chromatic properties of both the test stimulus and the pre-stimulus adaptation. Period doubling was generally smallest when an R test was used, even though the stimuli were luminance-equated and the amplitude of F did not differ between the various conditions. The pattern of results indicates that the mechanism that generates period doubling is influenced by chromatic signals from both the test stimulus and the pre-stimulus adaptation, even though the high stimulus frequencies presumably favor the achromatic luminance system.

Object frequency characteristics of visual acuity

PURPOSE

To examine the extent to which visual acuity (VA) for broadband optotypes is scale invariant by determining whether the same object frequencies mediate VA for individuals with different levels of VA.

METHODS

LogMAR (minimum angle of resolution) VA for briefly presented tumbling E's was measured in 10 visually normal individuals and in five patients with VA loss. The E's were either unblurred or blurred with Gaussian low-pass filters that had cutoff frequencies spanning a 1.2-log unit range. The data were fit with a standard equivalent intrinsic blur model to estimate each subject's unblurred VA (MAR(0) in minutes of arc) and equivalent intrinsic blur (σ(int) in minutes of arc). From these estimates, the high-frequency cutoff of the band of retinal frequencies (cpd(crit) in cycles per degree) and object frequencies (cpl(crit) in cycles per letter) mediating VA were derived.

RESULTS

LogMAR(0) was related linearly to log σ(int) with a slope of 1.47, which is steeper than that predicted by scale invariance. Log cpd(crit) was related linearly to logMAR(0) by a slope of -0.64, which is shallower than that predicted by scale invariance. This lack of scale invariance is due to a linear relationship between log cpl(crit) and logMAR(0) that had a slope of 0.36.

CONCLUSIONS

The overall pattern of results is not consistent with the expectation of scale invariance underlying the MAR scale. Optotypes that conform to the expectations of scale invariance are needed to improve vision assessment and to provide equivalency of VA defined in terms of MAR and cpd.

Structural and functional measures of inner retinal integrity following visual acuity improvement in a patient with hereditary motor and sensory neuropathy type VI

PURPOSE

To report measures of inner retinal integrity following improvement in visual acuity and visual fields in a patient with hereditary motor and sensory neuropathy type VI (HMSN VI).

CASE REPORT

The patient is a Caucasian male with HMSN VI (type 2A Charcot-Marie-Tooth disease and associated optic atrophy) and a c.1090C→T (p.R364W) mutation in the mitofusin 2 (MFN2) gene. The patient's best-corrected visual acuity improved from 20/200 (OD) and 20/400 (OS) at the initial visit to 20/25 in each eye when tested 7 years later. The visual field defects in both eyes that were present at the initial visit were absent at the follow-up visit. The structural integrity of the inner retina was assessed by an evaluation of retinal nerve fiber layer thickness (RNFLT) using optical coherence tomography (OCT), and the functional integrity was assessed by the amplitude of the photopic negative response (PhNR) of the electroretinogram (ERG). At the follow-up visit, the patient's RNFLT was less than the 5th percentile for control subjects in the superior and inferior quadrants OD and in one sector of the temporal quadrant OS, but was within normal limits elsewhere. The PhNR amplitude of each eye was below the lower limit of the normal range.

CONCLUSION

The abnormally low PhNR amplitudes and abnormally thin RNFL in certain quadrants of the retina following improvement of visual acuity and visual fields to near-normal values illustrates the potential usefulness of assessing the structure and function of the inner retina in HMSN VI patients.

Harmonic analysis of the cone flicker ERG of rabbit

Harmonic analysis was used to characterize the rabbit flicker ERG elicited by sinusoidally modulated full-field stimuli under light-adapted conditions. The frequency-response function for fundamental amplitude, derived from Fourier analysis of the ERG waveforms, exhibited two limbs, with an amplitude minimum at approximately 30Hz, and a high-frequency region peaking at around 45Hz and extending to more than 100Hz at higher adapting levels. At low frequencies (<20Hz), the fundamental response amplitude was independent of mean luminance (Weber law behavior), whereas the response amplitude at high stimulus frequencies varied nonlinearly with mean luminance. At low frequencies, intravitreal administration of L-AP4, which blocks ON-pathway activity, reduced the fundamental response amplitude and produced a phase shift. On the other hand, PDA, which reduces OFF-pathway activity, had a minimal effect on both the response amplitude and phase at low frequencies. At high frequencies, L-AP4 increased the fundamental response amplitude at low mean luminances, whereas PDA had only a small effect on amplitude and phase. Both pharmacologic agents removed the minimum in the amplitude-frequency function as well as the abrupt change in phase at stimulus frequencies near 30Hz. The results suggest that there is a nonlinear interaction between ON- and OFF-pathway activity over the entire stimulus frequency range examined in this study. These findings provide a basis for formulating protocols to evaluate the effect of pharmacologic agents and/or disease on the cone flicker ERG of rabbit.

Spatial contrast sensitivity in dynamic and static additive luminance noise

The purpose of this study was to define the quantitative relationship between the temporal characteristics of additive luminance noise and the properties of the spatial contrast sensitivity function (CSF). CSFs were obtained from two observers using Gabor patch targets of short duration that were added to white luminance noise with a range of root-mean-square contrasts (c(rms)). The noise was either dynamic or static and was either of the same duration as the test target (synchronous) or of longer duration (asynchronous). For targets presented in asynchronous dynamic, synchronous dynamic, and synchronous static noise, the CSFs became increasingly band-pass with increasing c(rms), whereas the CSFs were low-pass at all levels of c(rms) for targets presented in asynchronous static noise. For all noise types, the properties of the CSFs were well-predicted by the linear amplifier model (LAM), in which the signal energy at threshold (E(t)) is related linearly to noise spectral density (N). The fundamentally different characteristics of CSFs obtained in asynchronous static noise can be accounted for by a previous proposal that this noise type biases contrast sensitivity toward transient (inferred magnocellular) mechanisms. The other three modes of noise presentation appear to emphasize detection by sustained (inferred parvocellular) mechanisms.

Contrast thresholds in additive luminance noise: Effect of noise temporal characteristics

This study investigated the way in which the temporal properties of additive luminance noise influence threshold contrast and affect estimates of equivalent noise and sampling efficiency. Threshold contrast was obtained from four visually normal observers for a 2-cycle-per-degree Gabor patch across a range of target durations in the absence and presence of additive luminance noise that was either static or dynamic. In addition, the temporal relationship between target and noise was either synchronous (simultaneous presentation of both) or asynchronous (noise duration longer than target duration). For both synchronous and asynchronous presentation modes, the extent of temporal integration differed for targets presented in dynamic vs. static noise. Furthermore, for a fixed-duration target, increasing the degree of temporal asynchrony between target and noise monotonically increased threshold contrast in dynamic noise, but had a non-monotonic effect on threshold contrast in static noise. For both dynamic and static noise, estimates of equivalent noise and sampling efficiency were dependent on the degree of temporal asynchrony between target and noise. The observed differences between the effects of dynamic and static noise are consistent with a previous proposal that detection of targets of intermediate spatial frequency in the presence of these two noise types is governed by sustained-like and transient-like visual mechanisms, respectively.

Two distinct processes are evident in rat cone flicker ERG responses at low and high temporal frequencies

The electroretinogram (ERG) provides a noninvasive, objective measure of retinal function, and is one of the most widely used diagnostic tools in the study of visual disorders. Although rodents are often used in the study of retinal disease, the properties of the flicker ERG of the rodent retina have not been fully characterized. Here, we show that the fundamental response of the rat ERG to sine-wave flicker exhibited a low-pass pattern in the frequency range from 2 to 30 Hz, whereas the second harmonic (F2) showed a more complex frequency-response relation. The F2 component represented only a small fraction of the ERG response at low temporal frequencies (below 12 Hz), but it made a substantial contribution to responses at high frequencies. The contrast-response relation was linear when tested with a low-frequency (6 Hz) stimulus, but saturated in response to a high-frequency (20 Hz) stimulus. After intravitreal injection of L-AP4, a specific blocker of the retinal ON pathway, the flicker responses elicited by either 6- or 20-Hz stimuli were greatly reduced in amplitude, whereas only a very slight enhancement was seen after the application of PDA, a drug that blocks retinal OFF-pathway activity. Based on the observed differences in the degree of nonlinearity, and contrast-response properties of the rat flicker ERG at low and high frequencies, as well as the pharmacological results, we postulate that sustained and transient ON bipolar cells generate the flicker ERG responses elicited at low and high temporal frequencies, respectively.

Spatial frequencies used in Landolt C orientation judgments: relation to inferred magnocellular and parvocellular pathways

The purpose of this study was to define the spatial frequencies that underlie judgments of Landolt C orientation under test conditions designed to favor either the magnocellular (MC) or parvocellular (PC) pathway. Contrast thresholds of two observers were measured for briefly presented Landolt Cs of four sizes, using steady- and pulsed-pedestal paradigms to bias performance toward the MC and PC pathways, respectively. Contrast thresholds were derived from a two-alternative forced-choice orientation judgment task using the QUEST procedure. The Landolt Cs were either low-pass or high-pass Gaussian filtered with a range of cutoff object spatial frequencies (cycles per letter) to limit their frequency content. Center object frequencies were derived from plots of log contrast threshold for orientation judgments vs. log filter cutoff object frequency. The function relating center object frequency to Landolt C angular subtense was nonlinear on log-log coordinates for both the steady- and pulsed-pedestal paradigms, indicating that different object frequencies were used to judge Landolt C orientation at different optotype sizes. However, the function was substantially steeper under the pulsed-pedestal than under the steady-pedestal paradigm, such that a large change in optotype size produced a relatively small change in retinal spatial frequency (cycles per degree). The pattern of results is consistent with previously reported differences between the spatial contrast sensitivity functions of the inferred MC and PC pathways.

Comparison of spectral measures of period doubling in the cone flicker electroretinogram

PURPOSE

Under certain conditions, the full-field flicker electroretinogram (ERG) of the cone system can show period doubling, such that the shape of the ERG waveform alternates from cycle to cycle. The purpose of this study was to determine the relationship between stimulus temporal frequency and the amplitudes of the spectral components of the ERG that correspond to period doubling.

METHOD

ERGs were recorded from 10 visually normal subjects in response to full-field sinusoidal flicker presented at frequencies ranging from 12.5 to 100 Hz. Period doubling was apparent over the stimulus frequency range from 25 to 100 Hz and was quantified in terms of the amplitudes of spectral components of the ERG waveform that corresponded to half the stimulus frequency (f/2) and three and five times that frequency (3f/2 and 5f/2).

RESULTS

At stimulus frequencies between 30 and 40 Hz, the amplitude of f/2 was significantly lower than either 3f/2 or 5f/2, which themselves did not differ significantly. At stimulus frequencies between 40 and 60 Hz, all three response components were equivalent in amplitude. At stimulus frequencies above 60 Hz, however, the amplitudes of 3f/2 and 5f/2 were reduced significantly compared to f/2.

CONCLUSION

There is a frequency-dependent relationship among the spectral components of the flicker ERG that correspond to period doubling. The amplitude of f/2 underestimates the magnitude of period doubling at stimulus frequencies between 30 and 40 Hz, whereas the amplitudes of 3f/2 and 5f/2 underestimate the degree of period doubling at stimulus frequencies above 60 Hz. The explanation for the frequency dependence of these spectral components remains to be resolved.

Intersession repeatability of humphrey perimetry measurements in patients with retinitis pigmentosa

PURPOSE

To determine the relationship between intersession test repeatability in static perimetry and the degree of local sensitivity reduction in patients with retinitis pigmentosa (RP).

METHODS

Visual field data were obtained from 27 patients with RP using FASTPAC 30-2 of the Humphrey Field Analyzer and stimulus sizes III and V. Each test was repeated at two subsequent visits after an initial practice session. An intersession sensitivity difference was defined for each patient at each measured point in the visual field by subtracting the sensitivity value obtained during session 2 from the value obtained during session 3 at the corresponding test location. In addition, the mean sensitivity value for sessions 2 and 3 was determined at each location for each patient.

RESULTS

Bland-Altman plots of intersession sensitivity differences as a function of mean sensitivities showed that test-retest variability was greatest at test regions with sensitivities of approximately 10 dB, with lower variability at locations with higher or lower sensitivity. The pattern of findings was similar for sizes III and V stimuli. The mean intersession sensitivity difference was +0.26 dB for stimulus size III and +0.45 dB for stimulus size V, representing a small improvement in sensitivity from session 2 to session 3.

CONCLUSIONS

Intersession repeatability of visual field measurements in patients with RP is nonmonotonically related to the magnitude of the sensitivity loss. Therefore, apparent changes in visual field sensitivity as a result of time or treatment should be evaluated in light of the degree of the expected variability at particular sensitivity levels.

Retinal thickness and visual thresholds measured in patients with retinitis pigmentosa

PURPOSE

: To determine the association between retinal thickness and visual function in patients with retinitis pigmentosa (RP).

METHODS

: Retinal thickness was estimated from optical coherence tomography (OCT) images obtained for six patients with RP. The thickness measurements were compared with dark-adapted rod and minimally light-adapted cone thresholds obtained by psychophysical testing using a Tübinger perimeter and with standard light-adapted Humphrey visual field (HVF) perimetric thresholds.

RESULTS

: Four patterns of association between retinal thickness and visual function were observed: normal retinal thickness and normal visual thresholds; normal retinal thickness and normal cone thresholds but elevated rod thresholds; reduced retinal thickness and elevated rod and cone thresholds; and normal retinal thickness and normal Humphrey thresholds but elevated rod and cone thresholds by Tübinger perimetry.

CONCLUSION

: Retinal thinning was observed only when both rod and cone thresholds were elevated. However, normal retinal thickness was not necessarily accompanied by normal visual sensitivity. The determination of retinal thickness by OCT and its association with psychophysical measurements of visual function could be useful for identifying those RP patients who might respond most optimally to therapeutic interventions.

Effect of contrast on the frequency response of synchronous period doubling

At temporal frequencies between approximately 30 and 70 Hz, the flicker electroretinogram (ERG) of the cone system can exhibit an alternation in response amplitude from cycle to cycle that has been termed synchronous period doubling. This phenomenon has been attributed to a nonlinear feedback mechanism at an early retinal locus. The purpose of the present study was to define the effect of stimulus contrast on period doubling in order to better understand the nature of the underlying mechanism. ERGs were recorded from three visually normal subjects in response to sinusoidal flicker ranging from 20 to 100 Hz, using stimulus contrasts of 37.7, 56.5, 75.4, and 94.2%. Period doubling was quantified as: (1) the amplitude of an harmonic component of the ERG waveform that was 1.5 times the stimulus frequency, and (2) the difference between the mean trough-to-peak amplitudes on even and odd cycles of the ERG waveform. Amplitudes were converted to responsivity by dividing by stimulus contrast. By both measures, subjects showed discrete regions of period doubling that were displaced to lower temporal frequencies as stimulus contrast was increased. The temporal frequency shift of period doubling with altered stimulus contrast can be accounted for quantitatively by postulating a neural threshold for the nonlinear feedback signal that is presumed to generate synchronous period doubling.

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.

Contrast sensitivity for letter optotypes vs. gratings under conditions biased toward parvocellular and magnocellular pathways

This study examined the extent to which letter optotypes and grating stimuli provide equivalent measures of contrast sensitivity under conditions designed to favor the magnocellular (MC) and parvocellular (PC) pathways. The contrast sensitivity functions (CSFs) of three visually normal observers were measured for Sloan letters and Gabor patches, using steady- and pulsed-pedestal paradigms to bias processing toward MC and PC pathways, respectively. CSFs for Gabor patches were low-pass for the steady-pedestal paradigm and band-pass for the pulsed-pedestal paradigm, in agreement with previous reports. However, CSFs for letters were low-pass for both testing paradigms. CSFs for letters restricted in frequency content by spatial filtering were equivalent to those for Gabor patches for both testing paradigms. Results indicate that conventional letter optotypes can provide a misleading measure of contrast sensitivity, especially under conditions emphasizing the PC pathway. The use of spatially band-pass filtered letters can provide a more appropriate evaluation of spatial contrast sensitivity while maintaining some of the potential advantages of letters.

Activation phase of cone phototransduction and the flicker electroretinogram in retinitis pigmentosa

This study examined the relationship between the activation phase of cone phototransduction and the flicker electroretinogram (ERG) in 15 patients with retinitis pigmentosa (RP) and 12 age-equivalent, visually normal control subjects. Values of Rmp3 (maximum amplitude of P3, the massed cone photoreceptor response) and S (sensitivity of cone phototransduction) were derived from a delayed Gaussian model applied to the leading edge of the ERG a-wave. Fundamental amplitude and phase of the flicker ERG were derived from responses to sinusoidal flicker presented at temporal frequencies ranging from 7.8 to 100 Hz. Patients with RP who had a reduced value of Rmp3 alone had an overall reduction in flicker ERG amplitude with a normal response phase across temporal frequency. Patients with RP who had a reduced value of S, whether or not Rmp3 was reduced, had the greatest amplitude reduction at temporal frequencies above 40 Hz and phase lags across a range of temporal frequencies. At high temporal frequencies, the amplitude reduction of the flicker ERG was predicted by the product of Rmp3 and S for all of the subjects except the three patients with RP who had the lowest fundamental amplitudes. The results indicate that there is a systematic relationship between the derived parameters of the activation phase of cone phototransduction and the characteristics of the flicker ERG in patients with RP, although the phase changes in the flicker ERG were generally greater than predicted by the derived parameters alone.

Characteristics of period doubling in the human cone flicker electroretinogram

Electroretinogram (ERG) responses of the cone system to a flickering stimulus can exhibit a cyclic variation in amplitude. This phenomenon of synchronous period doubling has been attributed to a nonlinear feedback mechanism within the retina that alters response gain. The aim of the present study was to investigate intersubject variability in period doubling in the ERG of the human cone system, and to assess the implications of this variability for signal processing within the retina. Period doubling was examined in a group of 12 visually normal subjects, using sinusoidal full-field flicker and harmonic analysis of the ERG waveforms. For all subjects, the ERG responses to 32-Hz flicker (a frequency commonly used clinically) were characterized by a harmonic component at the stimulus frequency and at higher harmonics that were integral multiples of the stimulus frequency, as expected. In addition, six of the subjects showed period doubling at 32 Hz, characterized by harmonic components at integer multiples of a frequency that was half the stimulus frequency (the subharmonic). However, the subharmonic itself did not exceed the noise level. These findings suggest that the subharmonic is generated prior to or at the site that produces the nonlinear higher harmonics of the ERG response, and that a subsequent band-pass filter attenuates this subharmonic. Examination of harmonic components of the subjects' ERG waveforms at other stimulus frequencies, as well as a cycle-by-cycle analysis of the ERG waveforms, suggested that individual differences in period doubling may be due to intersubject variation in the strength of the hypothesized feedback signal and/or the time constant of its decay.

A Method for Differentiating Ocular Higher-Order Aberrations From Light Scatter Applied to Retinitis Pigmentosa

PURPOSE

The purpose of this study is to report a method for differentiating ocular higher-order aberrations and intraocular light scatter based on a deconvolution technique.

METHODS

An optical system was used to image a laser slit on the retina and also to perform Shack-Hartmann wavefront sensing. From the laser slit image, the line spread function, incorporating both ocular higher-order aberrations and light scatter, was derived. The laser slit image was deconvolved with a point spread function obtained from the Shack-Hartmann image. The area under the line spread function that was derived from the laser slit image after deconvolution provided a measurement of intraocular light scatter. The deconvolution technique was applied to images obtained in a group of 13 patients (mean age +/- 1 standard deviation: 42 +/- 12 years) with retinitis pigmentosa (RP), a retinal disease in which, by clinical examination, changes in the lens of the eye can be manifested. Measurements were compared with those obtained from 20 visually normal control subjects (mean age +/- 1 standard deviation: 43 +/- 17 years).

RESULTS

Combined higher-order aberrations and light scatter, measured as the area under the line spread function derived from the laser slit image, were increased significantly in the patients with RP as compared with the control subjects (p = 0.004). Ocular higher-order aberrations obtained from the Shack-Hartmann images were higher in the patients with RP than in the control subjects (p = 0.05). Intraocular light scatter derived from the deconvolved laser slit image was significantly higher in the patients with RP than in the control subjects (p = 0.009). Minimizing the contribution of ocular higher-order aberrations by deconvolution reduced the area under the line spread function in the control subjects and patients with RP, denoting an improvement in retinal image quality.

CONCLUSIONS

A method for differentiating ocular higher-order aberrations and intraocular light scatter based on deconvolution was developed that may be useful for determining the level of improvement in retinal image quality that can be anticipated by the application of adaptive optics to aging and diseased human eyes.

Higher-order wavefront aberrations in retinitis pigmentosa

PURPOSE

The purpose of this study was to characterize higher-order wavefront aberrations associated with posterior subcapsular (PSC) cataracts in patients with retinitis pigmentosa (RP).

METHODS

Wavefront aberrations were measured by Shack-Hartmann (SH) aberrometry in eight patients with RP who had PSC cataracts, 10 patients with RP who had minimal or no PSC cataracts, and 16 age-equivalent visually normal control subjects. Higher-order wavefront aberrations for 3-mm and 6-mm pupil diameters were defined as the root mean square (RMS) of the wavefront aberration functions.

RESULTS

For a 6-mm pupil diameter, the mean RMS for total higher-order wavefront aberrations was significantly larger for the patients with RP than for the control subjects, both for patients with PSC cataract (F = 17.30, p < 0.001) and for those with minimal or no PSC cataract (F = 4.80, p < 0.05). The mean RMS for third-order aberrations was not significantly different for patients with RP than for the control subjects. However, the mean RMS for fourth-order aberrations was significantly larger for the patients with RP than for the control subjects, both for patients with PSC cataract (F = 8.85, p < 0.01) and those with minimal or no PSC cataract (F = 5.07, p < 0.05). There were no significant differences in higher-order aberrations between the patients with RP and the control subjects for a 3-mm pupil diameter.

CONCLUSIONS

Increased higher-order wavefront aberrations were present in patients with RP with and without clinically observable PSC cataracts. The measurement of wavefront aberrations in patients with RP provides an objective and quantitative method for detecting and monitoring disease-related changes in the optics of the eye.

Characteristics of contrast processing deficits in X-linked retinoschisis

Contrast sensitivity and contrast discrimination were evaluated in six males with X-linked retinoschisis (XLRS), a form of early-onset macular degeneration, using testing paradigms designed to favor either the magnocellular (MC) or parvocellular (PC) pathway. Compared to a group of age-similar control observers, the patients with XLRS showed a pronounced loss of contrast sensitivity at high spatial frequencies, consistent with their reduced visual acuities. At low spatial frequencies, the patients' deficits were greater under conditions favoring the MC pathway, for both contrast sensitivity and contrast discrimination. The pattern of contrast sensitivity loss shown by the patients with XLRS could be simulated in control observers by testing at a parafoveal locus, although by optical coherence tomography, none of the patients with XLRS had eccentric fixation. The pattern of findings indicates that the foveas of patients with XLRS functionally resemble the normal parafoveal retina.

Contrast response properties of magnocellular and parvocellular pathways in retinitis pigmentosa assessed by the visual evoked potential

PURPOSE

To evaluate the contrast response of the visual system in retinitis pigmentosa (RP) under conditions designed to emphasize the parvocellular (PC) and magnocellular (MC) pathways.

METHOD

Visual evoked potentials (VEPs) were measured in 10 patients with RP and in 10 age-equivalent control subjects with normal visual acuity and color vision, by using an array of isolated checks that were presented against a steady yellow background. The checks were modulated sinusoidally, either in isoluminant chromatic contrast (5.6 Hz), to favor the chromatic PC pathway, or in luminance contrast (5.6 and 11.2 Hz), to favor the MC pathway. Response amplitude and phase at the stimulus (fundamental) frequency were derived from Fourier analysis, and contrast response functions were fit with a Michaelis-Menten equation to derive R(max), the maximum response amplitude, and sigma, the contrast necessary to produce R(max)/2.

RESULTS

In the control subjects, the mean amplitude function for chromatic modulation increased approximately linearly with increasing contrast, whereas the function for luminance modulation increased sharply at low contrasts and saturated at contrasts above approximately 30% for both temporal frequencies, as expected. The patients with RP showed primarily a reduction in R(max) with little change in sigma in all testing conditions. The reduction in R(max) was equivalent for chromatic modulation and luminance modulation at 5.6 Hz, but was substantially lower for luminance modulation at 11.2 Hz.

CONCLUSION

Contrast processing was impaired within both the MC and PC pathways in these patients with RP, but the degree of impairment within the MC pathway depended on temporal frequency. These VEP results are in general agreement with recent psychophysical studies of contrast sensitivity losses in patients with RP, and further they characterize contrast processing deficits in these patients at suprathreshold levels.

Night blindness and abnormal cone electroretinogram ON responses in patients with mutations in the GRM6 gene encoding mGluR6

We report three unrelated patients with mutations in the GRM6 gene that normally encodes the glutamate receptor mGluR6. This neurotransmitter receptor has been shown previously to be present only in the synapses of the ON bipolar cell dendrites, and it mediates synaptic transmission from rod and cone photoreceptors to this type of second-order neuron. Despite the synaptic defect, best visual acuities were normal or only moderately reduced (20/15 to 20/40). The patients were night blind from an early age, and when maximally dark-adapted, they could perceive lights only with an intensity equal to or slightly dimmer than that normally detected by the cone system (i.e., 2-3 log units above normal). Electroretinograms (ERGs) in response to single brief flashes of light had clearly detectable a-waves, which are derived from photoreceptors, and greatly reduced b-waves, which are derived from the second-order inner retinal neurons. ERGs in response to sawtooth flickering light indicated a markedly reduced ON response and a nearly normal OFF response. There was no subjective delay in the perception of suddenly appearing white vs. black objects on a gray background. These patients exemplify a previously unrecognized, autosomal recessive form of congenital night blindness associated with a negative ERG waveform.

Contrast Sensitivity Deficits in Inferred Magnocellular and Parvocellular Pathways in Retinitis Pigmentosa

PURPOSE

To define the contrast sensitivity deficits of patients with retinitis pigmentosa (RP) under testing conditions designed to emphasize threshold mediation by either the magnocellular (MC) or parvocellular (PC) pathway.

METHOD

Contrast sensitivity was measured with spatially localized, narrow-band test patterns at peak spatial frequencies ranging from 0.25 to 8 cycles per degree (cpd), using a steady-pedestal paradigm (brief presentation of the test stimulus against a continuously presented luminance pedestal) and a pulsed-pedestal paradigm (simultaneous brief presentation of the test stimulus and luminance pedestal) to favor the MC and PC pathways, respectively. The contrast sensitivity functions of 12 patients with RP who had visual acuities ranging between 20/12.5 and 20/40 were compared to those of 10 visually normal, age-equivalent control observers.

RESULTS

Five of the patients with RP who had Snellen visual acuities better than 20/25 had contrast sensitivity functions that were within the normal limits at all spatial frequencies for both testing paradigms. The other seven patients with RP had reduced contrast sensitivities for both paradigms, with the greatest reduction in sensitivity occurring at the highest spatial frequency. Their contrast sensitivity deficits were equivalent for the steady- and pulsed-pedestal paradigms.

CONCLUSIONS

As observed in previous studies, the degree of contrast sensitivity loss shown by the patients with RP was greatest at the highest stimulus spatial frequency. However, in comparison to prior studies of contrast discrimination in patients with RP, there was no evidence of a preferential contrast sensitivity loss within the MC pathway. This apparent discrepancy is attributed to differences in the test targets and psychophysical judgments that were used in the studies, which emphasizes the importance of task characteristics in evaluating relative deficits within the MC and PC processing streams in visual disorders.

The application of chromatic dark-adapted kinetic perimetry to retinal diseases

PURPOSE

To demonstrate the value of a 2-color perimetric procedure for determining cone and rod system contributions to the dark-adapted kinetic visual field (VF).

DESIGN

Prospective evaluation of perimetric testing procedure.

PARTICIPANTS

Five patients with retinal diseases and 6 visually normal individuals.

METHODS

Long- and short-wavelength stimuli were presented under dark-adapted conditions in a Goldmann perimeter. Visual fields were measured for the II and V test target sizes with a long-wavelength filter (cut-on at 600 nm) and a short-wavelength filter (cutoff at 510 nm). Light intensities through these filters were matched scotopically for the rod system by producing equal peripheral boundaries on 6 visually normal individuals. To validate the application of this procedure, we tested a patient with congenital achromatopsia and another patient with congenital stationary night blindness (CSNB). We then tested 2 patients with retinitis pigmentosa (RP) and 1 patient with Usher's syndrome to determine the cone and rod contributions to their VF isopters.

MAIN OUTCOME MEASURES

Isopters for long- and short-wavelength test stimuli, and the appearance of the test stimuli, whether reported as chromatic or achromatic.

RESULTS

The patient with congenital achromatopsia showed superimposed isopters for the 2 stimuli, which were reported as achromatic, demonstrating that the peripheral field boundaries were rod mediated. The patient with CSNB showed an isopter in response to the long-wavelength stimulus that was considerably larger than that in response to the short-wavelength stimulus, both stimuli reported as chromatic, showing that the cone system determined peripheral thresholds for both stimuli. In 2 patients with RP, we observed a mixed pattern of cone or rod system detection of the chromatic stimuli. The peripheral isopters were rod mediated, whereas the cone system determined the central field isopters. In an Usher's syndrome patient, cones mediated both the peripheral and the central field isopters.

CONCLUSIONS

A 2-color dark-adapted Goldmann perimetric procedure was able to determine whether the VF isopters were rod or cone mediated in 5 patients with various forms of retinal disease.

Pharmacological analysis of the rat cone electroretinogram

The electroretinogram (ERG) of the cone system provides a useful noninvasive measure of the activity of the cone pathway. Despite a wide application of the cone ERG in the study of rodent models of human hereditary retinal disease, the cellular origins of the rat cone ERG have not been well defined. Here, we address this issue using a pharmacological approach that has been used previously to derive ERG response components. Agents that impair synaptic transmission at well-defined retinal loci were dissolved in saline and injected into the vitreous of adult Sprague-Dawley rats anesthetized with ketamine/xylazine, and cone ERGs were recorded approximately 2 h later. Analysis of the resulting waveforms indicated that the rat cone ERG includes a relatively small-amplitude component of negative polarity that is derived from the activity of cone photoreceptors, and perhaps retinal glial (Müller) cells. The cone depolarizing bipolar cell pathway contributes a positive potential of large amplitude to the rat cone ERG. In comparison, the contribution of hyperpolarizing bipolar cells is of negative polarity and of much smaller amplitude. The inner retina contributes a negative wave upon which higher frequency oscillations are superimposed. These results provide a foundation for interpreting changes in the waveform of the rat cone ERG that may be observed following genetic alteration or other experimental treatment.

Contrast-processing deficits in melanoma-associated retinopathy

PURPOSE

To evaluate the hypothesis that patients with melanoma-associated retinopathy (MAR) have a selective functional loss within the magnocellular (MC) pathway of the cone system, with sparing of parvocellular (PC) pathway function.

METHODS

Two patients with MAR, ages 57 and 61 years, with normal Snellen visual acuity, participated in the study. Contrast sensitivity was measured at spatial frequencies ranging from 0.25 to 8 cycles per degree (cpd), using two paradigms (steady pedestal and pulsed pedestal) designed to assess the functional integrity of the MC and PC pathways, respectively. Results in patients with MAR were compared with those in 10 visually normal observers, aged 23 to 57 years.

RESULTS

Both patients with MAR showed a loss of contrast sensitivity compared to normal observers, but the pattern of loss differed for the two testing paradigms. For the steady-pedestal paradigm (presumed MC-pathway mediation), the patients' sensitivity loss was greatest at the lowest spatial frequency (0.25 cpd) and the sensitivity loss decreased systematically with increasing spatial frequency. For the pulsed-pedestal paradigm (presumed PC-pathway mediation), the sensitivity loss was greatest at an intermediate spatial frequency of 1 cpd. For both paradigms, the patients' sensitivities were within the normal range at the highest spatial frequency (8 cpd), consistent with their normal visual acuity.

CONCLUSIONS

The contrast sensitivity deficits of patients with MAR under photopic conditions are not specific to the MC pathway, as proposed previously, but instead are related to the spatial frequency of the test target. The overall pattern of contrast sensitivity loss shown by the patients with MAR is consistent with the dysfunction at the level of the retinal bipolar cells that is presumed to underlie the MAR syndrome.

ON-pathway dysfunction and timing properties of the flicker ERG in carriers of X-linked retinitis pigmentosa

PURPOSE

Carriers of X-linked retinitis pigmentosa (XLRP) frequently show prolonged implicit times of the flicker electroretinogram (ERG). This study tested the hypothesis that a preferential response attenuation within the cone depolarizing (ON) bipolar cell (DBC) pathway is a major contributing factor.

METHODS

Light-adapted, full-field ERGs were recorded from 10 XLRP carriers and 12 visually normal control subjects. Fundamental amplitudes and phases of ERG responses to sinusoidally flickering stimuli at temporal frequencies ranging from 8 to 96 Hz were analyzed within the framework of a recent vector summation model of the cone system ERG to test for evidence of a response attenuation within the DBC pathway. In addition, ERG responses to sawtooth flicker were examined for a reduced b- to d-wave amplitude ratio, indicative of ON pathway dysfunction.

RESULTS

The carriers' fundamental response phases at 32 Hz correlated significantly with their log ratios of response amplitudes at 32 versus 12 Hz (r = 0.89, P < 0.001) and with their log b- to d-wave amplitude ratios (r = 0.71, P < 0.05), both of which were used as indices of response attenuation within the DBC pathway. A control experiment demonstrated that a reduced sensitivity of cone phototransduction made at most only a minimal contribution to the timing changes in the carriers' flicker ERG responses.

CONCLUSIONS

The overall pattern of results indicates that a preferential response attenuation within the DBC pathway is the primary source of timing changes in the flicker ERGs of these carriers of XLRP. These findings illustrate the value of analyzing ERG responses to flickering stimuli at multiple temporal frequencies to evaluate mechanisms of disease action in photoreceptor degenerations.

Deficits in temporal integration for contrast processing in retinitis pigmentosa

PURPOSE

The purpose of this study was to evaluate the properties of foveal temporal integration in patients with retinitis pigmentosa (RP) within the framework of contrast processing by the magnocellular (MC) and parvocellular (PC) pathways.

METHODS

Temporal integration functions were measured in eight patients with RP whose visual acuities ranged from 20/25 to 20/63. Contrast thresholds were obtained at durations ranging from 15 to 480 ms, using steady-pedestal and pulsed-pedestal paradigms to bias performance toward the MC and PC pathways, respectively. The patients' results were compared with those of 10 age-similar control observers with normal vision. For both paradigms, contrast thresholds as a function of duration were fit with a two-limbed function to derive the critical duration for temporal integration (t(c)) and the asymptotic threshold at long durations (Delta L(infinity)).

RESULTS

The log t(c)s of the patients with RP were significantly longer than those of the control subjects for the steady-pedestal paradigm (presumed MC-pathway mediation; t = 3.67, P < 0.001), but not for the pulsed-pedestal paradigm (presumed PC-pathway mediation; t = 0.76, P = 0.45). Further, the patients with RP showed a significant correlation between log t(c) and log Delta L(infinity) for the steady-pedestal paradigm (r = 0.72, P < 0.05) but not for the pulsed-pedestal paradigm (r = -0.37, P = 0.36).

CONCLUSIONS

The patients with RP in this study showed greater deficits in contrast sensitivity and a more prolonged critical duration under test conditions that favor the MC rather than the PC pathway. A likely explanation is a high-frequency response attenuation at the level of the cone photoreceptors that has a differential effect on contrast-processing tasks that emphasize different postreceptoral mechanisms.

Comparison of contrast sensitivity, visual acuity, and Humphrey visual field testing in patients with glaucoma

BACKGROUND

Despite their normal or near-normal Snellen visual acuity, patients with glaucoma often complain of "poor" vision.

OBJECTIVE

To investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma who have 20/40 or better visual acuity.

DESIGN

Prospective, cross-sectional case series.

PATIENTS AND METHODS

We evaluated 250 eyes of 144 subjects from the Glaucoma Service at the University of Illinois at Chicago College of Medicine. Subjects with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension who met the 20/40 or better vision requirement were recruited. Visual acuity was measured using the rear-illuminated Lighthouse Visual Acuity Chart at 4 m. Contrast sensitivity was measured using the Pelli-Robson Chart in a front-illuminated box with even luminance across the chart. Visual fields of the patients were measured using the 24-2 full-threshold program on the Humphrey Visual Field Analyzer.

RESULTS

A significant correlation (r = 0.57, P < 0.001, n = 127) was found between the visual field mean deviations and the contrast sensitivity scores. The correlation (r = -0.322, P < 0.001, n = 127) was less between the visual field mean deviation and the log MAR visual acuity values, as was the correlation between the contrast sensitivity scores and log MAR visual acuity values (r = -0.370, P < 0.001, n = 127). In the subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P < or = 0.001, n = 62).

CONCLUSIONS

Reduced contrast sensitivity is significantly correlated with visual field losses in patients with glaucoma and a visual acuity of 20/40 or better. The study data support the conclusion that, compared with visual acuity, the disease process preferentially affects contrast sensitivity. In our previous work, contrast sensitivity was shown to be more related than visual acuity to real-world function in patients with early glaucomatous changes.

Nature of the cone ON-pathway dysfunction in melanoma-associated retinopathy

PURPOSE

To establish the basis for an ON-pathway abnormality of the cone system in melanoma-associated retinopathy (MAR) through analysis of the electroretinogram (ERG) and visual evoked potential (VEP).

METHODS

Two patients with MAR syndrome whose sera produced immunolabeling of retinal bipolar cells participated in the study. Full-field ERGs were recorded in response to brief flashes, to rapid-on and rapid-off sawtooth stimuli at a temporal frequency of 8 Hz, and to sine-wave stimuli at temporal frequencies ranging from 8 to 96 Hz. Fundamental responses to the sine-wave stimuli were evaluated within the context of a vector-summation model of the depolarizing bipolar cell (DBC) and hyperpolarizing bipolar cell (HBC) contributions to the response fundamental. VEPs were recorded to the onset of luminance increments and decrements that had contrasts of 10%, 20%, and 50%. The patients' results were compared with those of age-similar control subjects.

RESULTS

The patients with MAR showed abnormal ERG responses to luminance increments, consisting of a marked attenuation of the initial portion of the b-wave, but their ERG responses to luminance decrements were normal in amplitude and timing. The ERG temporal response functions of the patients with MAR had normal amplitudes at frequencies of 32 Hz and higher, with a constant phase lag across these frequencies, but larger-than-normal amplitudes at frequencies below 32 Hz, and a phase lead at 8 Hz. Their VEP responses showed a marked delay to increments but only a minimal delay to decrements.

CONCLUSIONS

Within the context of the vector-summation model, the ERG findings in the patients with MAR are more consistent with an attenuation of the DBC contribution to the ERG response than with a DBC response delay. The delayed VEP responses of the patients with MAR to luminance increments may represent a late response of the OFF system to increment onset.

A distinctive form of congenital stationary night blindness with cone ON-pathway dysfunction

PURPOSE

To characterize a distinctive form of congenital stationary night blindness (CSNB).

DESIGN

Observational case report.

PARTICIPANTS

A 30-year-old male with a history of night blindness, several members of his family, a patient with "complete" congenital stationary night blindness (CSNB1), and groups of age-similar control subjects.

METHODS

Rod-system function was evaluated by measuring psychophysical dark-adapted thresholds, by recording dark-adapted electroretinograms (ERGs), and by fundus reflectometry. Cone-system function was evaluated by recording light-adapted ERGs, including those to sawtooth flicker, and by recording light-adapted visually evoked potentials (VEPs) to luminance increments and decrements.

MAIN OUTCOME MEASURES

Dark-adapted thresholds, ERGs, rhodopsin double densities, Goldmann visual fields, and VEPs.

RESULTS

The patient's visual acuity, visual fields, and color vision were normal. His peripheral dark-adapted thresholds were rod-mediated but elevated by approximately 3 log units above normal. Rhodopsin double density and bleaching recovery were normal. His dark-adapted maximal-flash ERG showed a "negative" waveform, in which the b-wave was more reduced in amplitude than the a-wave, although the a-wave amplitude was also reduced. The rod photoreceptors contributed to the patient's dark-adapted ERGs, as illustrated by the unequal responses to cone-matched stimuli. The patient's cone-mediated thresholds for long-wavelength stimuli were within the normal range. However, his light-adapted brief-flash b-wave was abnormal in amplitude and implicit time. Selective abnormalities of the ON responses of the cone system were apparent in the patient's reduced b-wave amplitude to rapid-on flicker with a normal response to rapid-off flicker, and his prolonged VEP latencies to increments but not to decrements.

CONCLUSIONS

The overall pattern of findings distinguishes this patient from previously described forms of CSNB. The results suggest that two factors likely contribute to the patient's night blindness: (1) a rod phototransduction defect and (2) a postreceptoral defect. The results also indicate dysfunction within the cone ON pathway.

Comparison of intraocular light scatter in carriers of choroideremia and X-linked retinitis pigmentosa

OBJECTIVE

To compare the extent of intraocular straylight in carriers of choroideremia (CHM) and X-linked recessive retinitis pigmentosa (XLRP) to clarify further the relationship between photoreceptor cell degeneration and intraocular light scatter in retinal diseases.

DESIGN

Prospective case-control study.

PARTICIPANTS

Six obligate carriers of CHM, 12 obligate carriers of XLRP, and 30 age-similar control subjects with normal vision. The controls had no posterior subcapsular (PSC) lens opacities, and the carriers had minimal or no PSC lens opacities, as assessed by slit-lamp biomicroscopy.

MAIN OUTCOME MEASURES

Straylight levels were measured using a van den Berg Straylightmeter. Visual acuity and Goldmann visual field area using a II/4e target were assessed for both eyes of each carrier. Electroretinogram (ERG) data were available on four of six carriers of CHM and all carriers of XLRP. The extent of retinal pigment epithelial degenerative changes was evaluated by fundus examination.

RESULTS

All six carriers of CHM had typical fundus abnormalities with normal visual fields. Five of the six carriers of CHM had age-normal levels of intraocular light scatter, and one showed minimally elevated intraocular light scatter. The 12 carriers of XLRP had a spectrum of fundus abnormalities and varying severity of functional impairment as derived from visual field areas and ERG amplitudes. Seven of the 12 carriers of XLRP showed an elevated level of intraocular light scatter in at least one eye. The degree of straylight elevation above the normal mean age value was correlated significantly with both visual field area and amplitude of the maximal-intensity, dark-adapted ERG b-wave.

CONCLUSIONS

The carriers of XLRP who had evidence of photoreceptor cell dysfunction (as determined by visual field loss and reduced ERG amplitudes) had increased levels of intraocular straylight, whereas the carriers of CHM, who showed fundus abnormalities alone, in the absence of demonstrable photoreceptor cell dysfunction, had normal or minimally elevated levels. This finding supports the hypothesis that the increased levels of intraocular light scatter observed in some patients with hereditary retinal degenerations result from subclinical changes in the PSC region of the lens as a consequence of photoreceptor cell degeneration.

Temporal properties of the mouse cone electroretinogram

To determine the temporal response characteristics of the mouse cone electroretinogram (ERG), we recorded responses to high contrast sinusoidal stimuli ranging from 2 to 52 Hz. The largest response amplitudes obtained from wild-type (WT) mice occurred at stimulus frequencies below 10 Hz, and cone ERG amplitude declined progressively with increasing stimulus frequency above that level. In comparison, human responses recorded under the same stimulus and recording conditions displayed maximal responses to stimulus frequencies near 4 and 40 Hz, and a pronounced dip at 12 Hz. Responses were also obtained from nob (no b-wave) mice, which lack ERG contributions from depolarizing bipolar cells (DBCs). At low temporal frequencies, nob cone ERGs were smaller than those of WT mice and had a different waveform. As temporal frequency increased, nob and WT responses became more similar and came into register at the highest temporal frequencies. To evaluate the contribution of the DBC pathway to the mouse cone ERG, nob responses were vector-subtracted from those of WT mice. The derived DBC response was maximal at low stimulus frequencies and fell sharply as stimulus frequency increased. These results indicate that the mouse cone ERG is more linear than the primate response and that the temporal response of the mouse outer retina is tuned to much lower frequencies than that of primate.

High-frequency attenuation of the cone ERG and ON-response deficits in X-linked retinoschisis

PURPOSE

Individuals with X-linked retinoschisis (XLRS) show a comparatively greater reduction of the ON response than the OFF response of the electroretinogram (ERG) of the cone system. At high temporal frequencies, they also show a marked attenuation of the flicker ERG that has been attributed to an abnormal cone photoreceptor response. The purpose of this study was to determine whether the high-frequency response attenuation contributes to the abnormal ERG ON response in XLRS.

METHODS

Light-adapted ERGs were recorded from three patients with XLRS and from three control subjects, by using rapid-on and rapid-off sawtooth flicker to emphasize ON and OFF responses, respectively, and by using low-pass sawtooth flicker, from which the high temporal frequencies had been removed to mimic the high-frequency attenuation in XLRS.

RESULTS

For the control subjects, removing the high stimulus frequencies reduced the amplitude of the b-wave component of the ON response but had little effect on the amplitude of the d-wave component of the OFF response. In the patients with XLRS, the b-wave component of the ON response was already diminished using the full sawtooth stimulus, and removing the higher stimulus frequencies had no further effect. Patients' ERG responses to the 16-Hz stimulus fundamental alone were also abnormal, in that an initial response component normally present in the ERG was absent.

CONCLUSIONS

The overall pattern of findings indicates that two factors contribute to the preferential ON-response deficit in XLRS: first, a high-frequency attenuation of the cone photoreceptor response that effectively produces a low-pass stimulus for the postreceptoral pathway and that affects the ON response more than the OFF response and, second, a relatively greater attenuation of the ON- than of the OFF-bipolar cell response that is evident in the aberrant response to the sawtooth fundamental.

Origin of deficits in the flicker electroretinogram of the cone system in X-linked retinoschisis as derived from response nonlinearities

The aim of this study was to identify the origin of a high-frequency attenuation in the flicker electroretinogram (ERG) of patients with X-linked retinoschisis (XLRS) through an analysis of nonlinearities in the ERG response. The ERGs of six patients with XLRS and six age-similar control subjects were recorded in response to stimuli that consisted of pairs of sinusoids that had varying temporal frequencies and that differed by either 8 or 16 Hz. Compared with the control subjects, the patients with XLRS showed a significant reduction in the amplitude of the difference frequency to high-frequency stimuli that paralleled the high-frequency attenuation of their ERG response fundamental. This result indicates that a response attenuation at an initial linear filter, most likely photoreceptoral, was a major determinant of the reduced ERG amplitude of the XLRS patients at high temporal frequencies. Additional analyses of nonlinearities in the ERG responses provided evidence of a postreceptoral component to the flicker ERG deficits of the XLRS patients, as well.

Contrast discrimination deficits in retinitis pigmentosa are greater for stimuli that favor the magnocellular pathway

Luminance contrast discrimination was measured in 14 patients with retinitis pigmentosa (RP) and 14 control observers with normal vision, using steady-pedestal and pulsed-pedestal paradigms [Pokorny, J., & Smith, V. C. (1997). Psychophysical signatures associated with magnocellular and parvocellular pathway contrast gain. Journal of the Optical Society of America A, 14, 2477-2486] to bias performance toward the magnocellular (MC) or parvocellular (PC) pathway, respectively. The aim was to determine the relative effects of retinal degeneration on MC- and PC-pathway function in RP. For five of the RP patients, contrast discrimination thresholds were within normal limits for both the steady-pedestal and pulsed-pedestal paradigms. The other nine RP patients showed threshold elevations for the steady-pedestal paradigm (presumed magnocellular mediation), whereas their thresholds for the pulsed-pedestal paradigm (presumed parvocellular mediation) were within normal limits for all but the two patients who had the most extreme threshold elevations using the steady-pedestal paradigm. A control experiment on four of the RP patients, using a greater number of pedestal contrasts, verified that the patients' thresholds for the pulsed-pedestal paradigm showed the pattern expected for contrast discrimination mediated by the PC pathway. The higher threshold elevations for the steady-pedestal paradigm than for the pulsed-pedestal paradigm indicate that the retinal degeneration that occurs in RP predominantly disrupts contrast discrimination under stimulus conditions that favor the MC pathway.

On-response deficit in the electroretinogram of the cone system in X-linked retinoschisis

PURPOSE

The purpose of this study was to evaluate the hypothesis that the reduced b-wave to a-wave ratio of the brief-flash electroretinogram (ERG) of the cone system typically observed in X-linked retinoschisis (XLRS) represents a relatively greater deficit in the ON response (response to light onset) than the OFF response (response to light offset). A second purpose was to investigate the use of sawtooth flicker as a stimulus for eliciting ERG ON and OFF responses.

METHODS

Light-adapted, full-field ERGs were recorded in six patients with XLRS and six age-similar control subjects in response to 8-Hz rapid-on and rapid-off sawtooth flicker to emphasize ON and OFF responses, respectively. ERG responses were analyzed in terms of the amplitudes and implicit times of the a-wave, b-wave, and d-wave components.

RESULTS

There was no significant difference between the patients with XLRS and the control subjects for either the amplitude of the a-wave of the ON response or the amplitude of the d-wave of the OFF response. However, the amplitude of the b-wave of the ON response was reduced significantly in the patients with XLRS, resulting in a significantly reduced b-wave to d-wave ratio. The patients' implicit times were increased significantly for all waveform components.

CONCLUSIONS

The reduced b-wave to d-wave ratio of the ERG of the cone system in these patients with XLRS is consistent with a relative dysfunction of the cone ON bipolar cell pathway in this disorder. The results show further that sawtooth flicker is a promising stimulus for eliciting well-defined ERG waveforms that can provide a quantitative assessment of the properties of ON and OFF responses in retinal disease.

Perceived and actual performance of daily tasks: relationship to visual function tests in individuals with retinitis pigmentosa

PURPOSE

To investigate the functioning in daily task performance of individuals with retinitis pigmentosa (RP). Goals were (1) to quantify the relationships among clinical tests of vision, self-reports, and evaluations of actual task performance to predict difficulty in these tasks; and (2) to validate self-report questionnaire data about daily task performance with observations and measurements of actual task performance conducted by a certified low-vision specialist.

DESIGN

A cross-sectional study and survey.

PARTICIPANTS

Sixty-two individuals with RP (mean age, 37 years) participated in the study.

METHODS

We obtained data about task performance from subjects' reports about their daily performance as assessed by a 53-item questionnaire and from a specialist's rating about actual ability on a 64-item battery of tasks, including ones similar to those assessed with the questionnaire.

MAIN OUTCOME MEASURES

Clinical measures of vision included visual acuity, visual fields using Goldmann perimetry, letter contrast sensitivity, and cone and rod electroretinogram (ERG) function. The questionnaire and functional tasks were clustered into three categories: "reading," "mobility," and "peripheral detection."

RESULTS

Self-report was correlated significantly with actual task performance. Task performance was correlated significantly with clinical test performance. Moderate or worse difficulty in performance was observed only for visual acuity worse than 20/40; log contrast sensitivity less than 1.4; a visual field area smaller than 2000 deg(2) (area equivalent to a 50-degree diameter of visual field to the Goldmann II-4-e target); and ERG amplitudes less than 10 microvolts for 32-Hz light-adapted white flicker.

CONCLUSIONS

Despite the significant correlations, there remains variability in task performance that is unaccounted for in some individuals with low levels of clinical test performance. The assessment of actual task performance validated the use of self-reports in individuals with RP.

Temporal frequency deficits in the electroretinogram of the cone system in X-linked retinoschisis

We investigated the extent of, and basis for, abnormalities in the flicker electroretinogram (ERG) of the cone system of patients with X-linked retinoschisis (XLRS), a form of hereditary vitreoretinal degeneration. ERGs were recorded from six patients with XLRS and from six visually normal subjects using high-contrast sinusoidal flicker that ranged in temporal frequency from 8 to 96 Hz, and that was presented against a rod-desensitizing adapting field. Compared to the control subjects, the patients with XLRS showed a significant reduction in the amplitude of the ERG response fundamental at temporal frequencies of 32 Hz and higher. In addition, their response phases were at or below the lower limits of normal (representing a phase lag) for temporal frequencies greater than 8 Hz. The higher harmonics of the patients' ERG responses to a low frequency stimulus were attenuated over the same temporal frequency range as was the response fundamental. This finding indicates that a major component of the abnormal temporal filtering responsible for the ERG abnormalities in XLRS occurs beyond the level of the early retinal nonlinearity that generates the harmonic components of the ERG response, and therefore is most likely postreceptoral in origin. Consistent with this interpretation, the ERG waveforms of the XLRS patients showed a significant attenuation of the ON-response component, with a normal OFF response. The overall pattern of results suggests that the marked reduction of ERG response amplitudes and the phase lag at the higher temporal frequencies in XLRS stem, at least in part, from a predominant attenuation of the ON-bipolar cell contribution to the flicker ERG.

Coherence and the judgment of spatial displacements in retinitis pigmentosa

We used a motion coherence paradigm to test the hypothesis that patients with retinitis pigmentosa (RP) have difficulty discriminating the direction of spatial displacements because of a random loss of motion-sensitive units owing to cone photoreceptor dropout. Minimum (Dmin) and maximum (Dmax) displacement thresholds of patients with typical RP or Usher syndrome were compared with those of age-similar, visually normal subjects. Two-frame random dot cinematograms were used, in which a group of target dots, which comprised 40-100% of the dot array in steps of 20%, were displaced in one of four directions, whereas the non-target dots were randomly repositioned between frames. Reducing the dot coherence in this way increased Dmin and reduced Dmax for both the RP patients and control subjects. Furthermore, the displacement thresholds of the RP patients were displaced laterally from normal along a log coherence axis, consistent with the hypothesis that the patients had a reduced effective (intrinsic) coherence. However, the displacement thresholds of control subjects, when measured at a reduced coherence, did not mimic those of RP patients at full coherence when both groups were tested with a range of dot contrasts and dot areas. These apparently discrepant findings can be reconciled if it is assumed that the patients' effective coherence varies with stimulus visibility.

ON-pathway dysfunction in a patient with acquired unilateral night blindness

PURPOSE

To investigate possible functional correlates of an apparent ON-pathway defect observed in the cone electroretinogram of a patient with acquired unilateral night blindness.

METHOD

Visual evoked potentials were recorded to the onset of a grid pattern consisting of either incremental or decremental squares. Saccadic eye movements were measured to luminance increments and decrements presented 5 degrees from fixation. The patient's results were compared with normative data.

RESULTS

Visual evoked potential latencies were prolonged to incremental stimulation of the patient's affected left eye but were within normal limits for the other three conditions (increments and decrements, right eye; decrements, left eye). A similar pattern of asymmetry between latencies to incremental and decremental stimulation of the affected eye was observed for saccadic eye movements.

CONCLUSIONS

The observed predominant delay in response to luminance increments supports the hypothesis of an ON-pathway dysfunction in this patient with acquired unilateral night blindness.

X-linked retinitis pigmentosa in two families with a missense mutation in the RPGR gene and putative change of glycine to valine at codon 60

OBJECTIVE

This study describes the ophthalmic findings in two unrelated white families with X-linked retinitis pigmentosa (XLRP) caused by a missense mutation in the retinitis pigmentosa GTPase regulator (RPGR) gene.

DESIGN

Genetic screening and clinical correlation.

PARTICIPANTS

Thirty-six families with XLRP seen by the authors were screened for a possible mutation in the RPGR gene to identify three affected hemizygotes with retinitis pigmentosa and four heterozygote carriers in one family and one hemizygote and one carrier in a second family.

INTERVENTION

All nine patients underwent a routine ocular examination, including slit-lamp biomicroscopy and a dilated fundus examination. Goldmann visual field kinetic perimetry, static threshold perimetry, and electroretinography also were obtained. The DNA screening was performed on the three affected male patients and four obligate carriers examined from one family and the two examined patients, plus an additional male and obligate carrier, from the second family to determine the presence of any causative mutation in the RPGR gene.

MAIN OUTCOME MEASURES

Findings on fundus examination, static threshold and kinetic perimetry, and electroretinography testing were the main outcome measures.

RESULTS

A G-->T nucleotide change at position 238 in exon 3 of the RPGR gene resulting in a putative substitute of Gly-->Val at codon 60 was shown to segregate with RP in affected males and the carrier state in female heterozygotes in these two families. The ophthalmologic findings in hemizygotes as well as the carriers in this family were within the spectrum of findings characteristically noted in XLRP families. A tapetal-like reflex was not observed in any of the five female carriers. Psychophysical and electrophysiologic testing on the carriers indicated that cone and rod functions were impaired equivalently. When present in the carriers, visual field restriction was most apparent in, or limited to, the superotemporal quadrant, which corresponded to the retinal pigmentary changes that tended to occur in the inferonasal retina.

CONCLUSIONS

A mutation in exon 3 of the RPGR gene, which would result in a putative glycine to valine substitution at codon 60, is associated with a severe clinical phenotype in male patients and a patchy retinopathy without a tapetal-like reflex in carrier females. In these families, heterozygote carriers showed equivalent impairment of their cone and rod function.

Effect of noise contrast polarity and temporal asynchrony on visual sensitivity

We evaluated the effect of substitutive noise on contrast sensitivity within the context of linear (Fourier) and nonlinear (non-Fourier) visual processes. Orientation judgments for D6 (sixth spatial derivative of Gaussian) patterns were obtained from three visually normal subjects when random regions of the target and background were occluded by small (1.7 arc min) pixel arrays that were either all of the same contrast polarity or a mixture of equal percentages of negative and positive contrast. The target was presented either synchronously or asynchronously with the occluding elements. Our results indicate that the manipulation of noise characteristics in this way can bias performance either toward a nonlinear process that is insensitive to noise contrast polarity but sensitive to temporal asynchrony or toward a quasi-linear process that is sensitive to noise contrast polarity but insensitive to temporal asynchrony. These findings have relevance to models of the effect of spatial sampling on the visual performance of persons with retinal disease.

Intraocular light scatter in patients with choroideremia

OBJECTIVE

This study aimed to evaluate the extent of intraocular light scatter in patients with choroideremia.

DESIGN

Prospective case-control study.

PARTICIPANTS

Twelve male patients with choroideremia who had predominantly minimal or no posterior subcapsular cataract (PSC) lens opacities and visual acuities of 20/40 or better and 30 age-similar control subjects with normal vision and no lens opacities were studied.

INTERVENTION

Intraocular light scatter was measured using a van den Berg Straylightmeter.

MAIN OUTCOME MEASURES

Visual acuities, letter contrast sensitivities, Goldmann visual fields using a II4e target, and straylight parameters were obtained for each patient. Lenses were assessed by slit-lamp biomicroscopy to determine whether there were PSC opacities. The degree of retinal pigment epithelial and choroidal degenerative changes was evaluated from color fundus photographs.

RESULTS

Three of the patients with choroideremia who had clinically apparent PSC lens opacities showed an increase in intraocular light scatter. More notable was the fact that seven of the remaining nine patients who did not have any clinically apparent changes in the lens also had a considerable increase in the intraocular light scatter as compared to the control subjects. The relative elevations of the log straylight parameters of the patients with choroideremia, as compared to age-similar control subjects, were correlated significantly with their log visual field areas (r = -0.69, P < 0.05).

CONCLUSIONS

Intraocular light scatter may be increased in patients with choroideremia, even in the absence of clinically observable PSC opacities. It is hypothesized that the increase in light scatter may be caused by changes in the posterior subcapsular region of the lens before the formation of frank PSC cataracts. The increased straylight could, at least in part, account for the disability glare reported by these patients.

Discrimination of spatial displacements by patients with retinitis pigmentosa

We compared maximum displacement thresholds (Dmax) with minimum displacement thresholds (Dmin) in patients with retinitis pigmentosa (RP) in order to characterize the nature of their visual disability, as well as to assess possible models of foveal vision loss. Thresholds for discriminating the direction of the spatial displacement of random dot patterns were measured in a group of 20 patients with typical RP or Usher syndrome whose visual acuities were 20/40 or better and who had minimal or no clinical evidence of changes in the ocular media. Findings were compared with those from an age-similar group of 15 visually normal subjects. Displacement thresholds were measured using a two-frame random dot cinematogram and a four-alternative forced-choice procedure. Measurements were made at each of three dot contrasts and three dot sizes. For the patients with RP, reducing either the dot contrast or dot size increased Dmin and decreased Dmax such that the range of discriminable displacements became considerably restricted, even at modest reductions in dot contrast or size. This restriction in the displacement thresholds of the patients with RP was correlated significantly with their visual acuity. By comparison, the control subjects showed little change in either Dmin or Dmax under these conditions. These results indicate that patients with RP who have only relatively minor reductions in their visual acuity can have severely compromised motion perception. The pattern of findings suggests that an abnormal contrast response of the foveal cone system is a major determinant of the impaired displacement thresholds of these patients with RP.

Visual acuity and contrast sensitivity for individual Sloan letters

Sloan letter optotypes are used frequently to evaluate visual impairment, and scoring procedures have been developed that are based on the numbers of letters that are identified correctly. However, previous studies have presented conflicting evidence regarding the relative identifiability of the individual Sloan letters. To investigate this issue further, we measured psychometric functions for the identification of each of the 10 Sloan letters, with individual letters presented in random order on the gray-scale display of a Macintosh computer-based testing system. Data were obtained from three visually normal subjects under each of three conditions: (1) as a function of log contrast at a relatively large letter size; (2) as a function of log contrast at a letter size near the acuity limit; and (3) as a function of log MAR (minimum angle of resolution) at maximum letter contrast. Estimates of threshold log contrast and threshold log MAR were derived from best-fitting Weibull functions. Threshold log contrast for small letters showed the greatest interletter variability. There was relatively little interletter variability in either threshold log contrast for large letters or threshold log MAR for high-contrast letters. However, due to the relatively steep psychometric functions under these latter two conditions, the different Sloan letters had considerably different percent correct values near threshold. The overall pattern of results suggests that the contrast sensitivity functions for individual Sloan letters are displaced laterally along a log MAR axis, while their vertical positions are essentially equivalent.