Discovery and preclinical development of a therapeutically active nanobody-based chimeric antigen receptor targeting human CD22

Chimeric antigen receptor (CAR) T cell therapies targeting B cell-restricted antigens CD19, CD20, or CD22 can produce potent clinical responses for some B cell malignancies, but relapse remains common. Camelid single-domain antibodies (sdAbs or nanobodies) are smaller, simpler, and easier to recombine than single-chain variable fragments (scFvs) used in most CARs, but fewer sdAb-CARs have been reported. Thus, we sought to identify a therapeutically active sdAb-CAR targeting human CD22. Immunization of an adult Llama glama with CD22 protein, sdAb-cDNA library construction, and phage panning yielded >20 sdAbs with diverse epitope and binding properties. Expressing CD22-sdAb-CAR in Jurkat cells drove varying CD22-specific reactivity not correlated with antibody affinity. Changing CD28- to CD8-transmembrane design increased CAR persistence and expression in vitro. CD22-sdAb-CAR candidates showed similar CD22-dependent CAR-T expansion in vitro, although only membrane-proximal epitope targeting CD22-sdAb-CARs activated direct cytolytic killing and extended survival in a lymphoma xenograft model. Based on enhanced survival in blinded xenograft studies, a lead CD22sdCAR-T was selected, achieving comparable complete responses to a benchmark short linker m971-scFv CAR-T in high-dose experiments. Finally, immunohistochemistry and flow cytometry confirm tissue and cellular-level specificity of the lead CD22-sdAb. This presents a complete report on preclinical development of a novel CD22sdCAR therapeutic.

Epitope mapping of a blood-brain barrier crossing antibody targeting the cysteine-rich region of IGF1R using hydrogen-exchange mass spectrometry enabled by electrochemical reduction

Pathologies of the central nervous system impact a significant portion of our population, and the delivery of therapeutics for effective treatment is challenging. The insulin-like growth factor-1 receptor (IGF1R) has emerged as a target for receptor-mediated transcytosis, a process by which antibodies are shuttled across the blood-brain barrier (BBB). Here, we describe the biophysical characterization of VHH-IR4, a BBB-crossing single-domain antibody (sdAb). Binding was confirmed by isothermal titration calorimetry and an epitope was highlighted by surface plasmon resonance that does not overlap with the IGF-1 binding site or other known BBB-crossing sdAbs. The epitope was mapped with a combination of linear peptide scanning and hydrogen-deuterium exchange mass spectrometry (HDX-MS). IGF1R is large and heavily disulphide bonded, and comprehensive HDX analysis was achieved only through the use of online electrochemical reduction coupled with a multiprotease approach, which identified an epitope for VHH-IR4 within the cysteine-rich region (CRR) of IGF1R spanning residues W244-G265. This is the first report of an sdAb binding the CRR. We show that VHH-IR4 inhibits ligand induced auto-phosphorylation of IGF1R and that this effect is mediated by downstream conformational effects. Our results will guide the selection of antibodies with improved trafficking and optimized IGF1R binding characteristics.

Facile Affinity Maturation of Single-Domain Antibodies Using Next-Generation DNA Sequencing

Binding affinity is one of the primary determinants of antibody function. Here, we provide a protocol for simple and rapid affinity maturation of single-domain antibodies (sdAbs) using tandem phage display selection and next-generation DNA sequencing. The sequence of a model camelid sdAb directed against Clostridioides difficile toxin A (A26.8) was diversified using either random or site-saturation mutagenesis and cloned into a phagemid vector upstream of gene 3. The resulting phage-displayed sdAb libraries were panned against C. difficile toxin A and the panning outputs interrogated using Illumina MiSeq sequencing. Through bioinformatic analyses, we were able to identify individual affinity-enhancing amino acid substitutions in the sdAb complementarity-determining regions that, when combined, resulted in affinity improvements of approximately 10-fold. The advantages of this method are that it does not require extensive screening and characterization of individual clones, nor structural information on the mechanism of the sdAb:antigen interaction.

Prostate Lesions in a Tertiary Institution in North Central Nigeria: A Histopathology Review

BACKGROUND

Prostatic lesions are a significant cause of morbidity and mortality among middle aged and elderly men of African ancestry. Reviews on cancer distribution displayed prostate cancer as the most prevalent site specific cancer among adult Nigerian men.

OBJECTIVE

This study provided baseline data of the frequency, histologic spectrum, and pathological characteristics of prostate lesions in a Tertiary institution in North Central Nigeria.

MATERIALS AND METHOD

This was a descriptive review of all histologically diagnosed prostate lesions at the pathology department of the University of Abuja Teaching Hospital over a 5-year period from January 1, 2015 to December 31, 2019.

RESULTS

Prostatic lesions represented 4.1% of all surgical specimens in the period under review. The age range of the patients' was 32 to 95 years with a mean age of 66.5 years at diagnosis and peak age incidence seen in the 7th decade. There were 259 (52.9%) cases of nodular hyperplasia and 231 (47.1%) cases of cancer of the prostate, giving a nodular hyperplasia to prostate cancer ratio of 1.12:1. Fifty two (52, 20.1%) cases of the nodular hyperplasia were associated with chronic inflammation while 7 (2.7%) were associated with prostatic intraepithelial neoplasm. Prostate adenocarcinoma was the predominant subtype, accounting for 99.1% of cases while ductal carcinoma constituted the remaining 0.9% cases. Gleason scores were adapted to the Grade Group system of the International Society of Urological Pathology and showed that high grade cancers; Grade Groups 4 and 5 were the predominant grades (n=130, 60.5%) followed by Grade Group 1 (n=64, 29.8%) cancers.

CONCLUSION

Prostate lesions are common lesions encountered in our setting in keeping with reports from other regions in Nigeria. A significant proportion of these lesions are prostate cancers that are poorly differentiated with higher risk of mortality.

Primary Fibrosarcoma of the Breast: Case Report of a Rare Breast Neoplasm

Breast fibrosarcoma is an uncommon primary breast neoplasm. We report a case of a 57-year old woman who presented at our facility with a right breast mass having histomorphological and immunohistochemical features consistent with fibrosarcoma. She had simple mastectomy and an uneventful hospital stay. The mass recurred 4-weeks later for which she had supportive care and started on cyclical chemotherapy (Adriamycin, Cyclophosphamide and Dacarbazine). She was referred for haemostatic radiotherapy and her clinic follow-up scheduled.

Biparatopic single-domain antibodies against Axl achieve ultra-high affinity through intramolecular engagement

Overexpression of Axl, a TAM-family receptor tyrosine kinase, plays key roles in the formation, growth, and spread of tumors as well as resistance to targeted therapies and chemotherapies. We identified novel llama V_HHs against human Axl using multiple complementary phage display selection strategies and characterized a subset of high-affinity V_HHs. The V_HHs targeted multiple sites in Ig-like domains 1 and 2 of the Axl extracellular domain, including an immunodominant epitope overlapping the site of Gas6 interaction and two additional non-Gas6 competitive epitopes recognized by murine monoclonal antibodies. Only a subset of V_HHs cross-reacted with cynomolgus monkey Axl and none recognized mouse Axl. As fusions to human IgG1 Fc, V_HH-Fcs bound Axl⁺ tumor cell lines and mertansine-loaded V_HH-Fcs were cytotoxic in vitro against Axl⁺ cells in proportion to their binding affinities. Engineered biparatopic V_HH-V_HH heterodimers bound Axl avidly, and a subset of molecules showed dramatically enhanced association rates indicative of intramolecular binding. These V_HHs may have applications as modular elements of biologic drugs such as antibody-drug conjugates.

Incorporation of a Novel CD16-Specific Single-Domain Antibody into Multispecific Natural Killer Cell Engagers With Potent ADCC

Multispecific antibodies that bridge immune effector and tumor cells have shown promising preclinical and clinical efficacies. Here, we isolated and characterized novel llama single-domain antibodies (sdAbs) against CD16. One sdAb, NRC-sdAb048, bound recombinant human and cynomolgus monkey CD16 ectodomains with equivalent affinity (K_D: 1 nM) but did not recognize murine CD16. Binding was similar for human CD16a expressed on NK cells and CD16b (NA2) expressed on neutrophils but dramatically weaker (K_D: ∼6 μM) for the CD16b (NA1) allotype. The sdAb stained primary human peripheral blood NK cells. Irrespective of fusion orientation and linker length, bispecific sdAb-sdAb and sdAb-scFv dimers (anti-CD16/EGFR, anti-CD16/HER2, and anti-CD16/CD19) retained full binding affinity for each target, coengaged both antigens simultaneously, elicited ADCC against target antigen-expressing tumor cells in a reporter bioassay, and triggered target-specific activation and degranulation of primary NK cells as measured via interferon-γ and CD107a expression. These molecules may have applications in cancer immunotherapy.

Evaluation of a noncanonical Cys40-Cys55 disulfide linkage for stabilization of single-domain antibodies

Incorporation of noncanonical disulfide linkages into single-domain antibodies (sdAbs) has been shown to enhance thermostability and other properties. Here, we evaluated the effects of introducing a novel disulfide linkage formed between Cys residues at IMGT positions 40 and 55 on the melting temperatures (T _m s), reversibility of thermal unfolding, solubility, and antigen-binding affinities of three types of sdAbs (V_H H, V_H , and V_L domains). The Cys40-Cys55 disulfide linkage was tolerated by 9/9 V_H Hs, 12/12 V_H s, and 2/11 V_L s tested and its formation was confirmed by mass spectrometry. Using circular dichroism, we found that the Cys40-Cys55 disulfide linkage increased sdAb T _m by an average of 10.0°C (range: 0-21.8°C). However, enhanced thermostability came at the cost of a partial loss of refolding ability upon thermal denaturation as well as, for some sdAbs, significantly decreased solubility and antigen-binding affinity. Thus, Cys40/Cys55 can be added to the panel of known locations for introducing stabilizing noncanonical disulfide linkages into antibody variable domains, although its effects should be tested empirically for individual sdAbs.

Isolation and characterization of camelid single-domain antibodies against HER2

OBJECTIVE

To isolate and characterize novel high-affinity llama single-domain antibodies against human HER2.

RESULTS

We immunized a llama with human HER2, constructed a phage-displayed VHH library from the lymphocytes of the animal, and isolated six unique HER2-specific VHHs by panning. All six VHHs were unique at the amino acid level and were clonally unrelated, as reflected by their distinct CDR3 lengths. All six VHHs recognized recombinant human HER2 ectodomain with monovalent affinities ranging from 1 to 51 nM, had comparable affinities for cynomolgus monkey HER2, and bound HER2+ SKOV3 cells by flow cytometry. Three of the VHHs recognized recombinant murine HER2 with no loss of affinity compared with human and cynomolgus monkey HER2. The VHHs recognized three major epitopes on HER2 (including one conserved across the human, simian and murine orthologues), all of which were distinct from that of trastuzumab. These VHHs may be useful in the design of modular cancer immunotherapeutics.

A Novel Affinity Tag, ABTAG, and Its Application to the Affinity Screening of Single-Domain Antibodies Selected by Phage Display

ABTAG is a camelid single-domain antibody (sdAb) that binds to bovine serum albumin (BSA) with low picomolar affinity. In surface plasmon resonance (SPR) analyses using BSA surfaces, bound ABTAG can be completely dissociated from the BSA surfaces at low pH, over multiple cycles, without any reduction in the capacity of the BSA surfaces to bind ABTAG. A moderate throughput, SPR-based, antibody screening assay exploiting the unique features of ABTAG is described. Anti-carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) sdAbs were isolated from a phage-displayed sdAb library derived from the heavy chain antibody repertoire of a llama immunized with CEACAM6. Following one or two rounds of panning, enriched clones were expressed as ABTAG fusions in microtiter plate cultures. The sdAb-ABTAG fusions from culture supernatants were captured on BSA surfaces and CEACAM6 antigen was then bound to the captured molecules. The SPR screening method gives a read-out of relative expression levels of the fusion proteins and kinetic and affinity constants for CEACAM6 binding by the captured molecules. The library was also panned and screened by conventional methods and positive clones were subcloned and expressed for SPR analysis. Compared to conventional panning and screening, the SPR-based ABTAG method yielded a considerably higher diversity of binders, some with affinities that were three orders of magnitude higher affinity than those identified by conventional panning.

Rate of EGFR mutation testing for patients with nonsquamous non-small-cell lung cancer with implementation of reflex testing by pathologists

BACKGROUND

Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates.

METHODS

A retrospective observational review of the Web-based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing (with at least 2 years' worth of data, including the pre- and post-implementation period).

RESULTS

The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5-14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post-reflex testing period (p < 0.001).

CONCLUSIONS

Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing.

A texture-processing model of the 'visual sense of number'

It has been suggested that numerosity is an elementary quality of perception, similar to colour. If so (and despite considerable investigation), its mechanism remains unknown. Here, we show that observers require on average a massive difference of approximately 40% to detect a change in the number of objects that vary irrelevantly in blur, contrast and spatial separation, and that some naive observers require even more than this. We suggest that relative numerosity is a type of texture discrimination and that a simple model computing the contrast energy at fine spatial scales in the image can perform at least as well as human observers. Like some human observers, this mechanism finds it harder to discriminate relative numerosity in two patterns with different degrees of blur, but it still outpaces the human. We propose energy discrimination as a benchmark model against which more complex models and new data can be tested.

Histological pattern of thyroid gland neoplasms in Kano, Northern Nigeria

BACKGROUND AND OBJECTIVE

Thyroid gland neoplasms occur globally with geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. There is, however, no published histological study from northwestern Nigeria; hence, the need for this retrospective study to document the pattern in Kano.

MATERIALS AND METHOD

This was a retrospective study of all histologically diagnosed thyroid neoplasms in the Department of Pathology, Aminu Kano Teaching Hospital (AKTH), Kano Nigeria, over a ten year period from 1st January, 2002 to 31st December, 2011.

RESULTS

A total of 522 thyroid specimens (1.5% of all biopsies) were received over the ten year period. Thyroid neoplasms accounted for 157 (30.1%) of all the thyroid specimens, comprising 130 females (82.8%) and 27 males (17.2%) with female to male ratio of 4.8:1. The ages range from 15 to 80 years with a mean age of 35.8 years and peak occurrence in the 4th decade. There were 82 cases (52.2%) of thyroid adenoma (mostly follicular) while thyroid carcinoma accounted for 66 cases (42%). Papillary carcinoma predominated (53%) followed by follicular carcinoma (33.3%) and medullary carcinoma (9.1%). One case each (1.5%) of anaplastic carcinoma, squamous cell carcinoma and metastatic squamous cell carcinoma were seen. All the malignant tumours were epithelial and all except one were primary thyroid malignancy.

CONCLUSION

Thyroid neoplasmis a common thyroid gland lesion in Kano with a striking female preponderance. Thyroid adenoma was the most common benign neoplasm while papillary carcinoma seen a decade earlier in females was the most common malignant thyroid neoplasm. The predominance of papillary carcinoma over follicular carcinoma is a reverse of the finding of an earlier clinicopatholgical study on thyroid gland diseases in Kano.

Childhood rhabdomyosarcoma in Kano, Nigeria: a retrospective analysis of 52 cases

BACKGROUND

Rhabdomyosarcoma is the most common soft tissue sarcoma in children ≤ 15 years of age. There is, however, a paucity of reports on the pattern of its occurrence in Nigeria and other parts of Africa.

OBJECTIVE

The aim of this review is to highlight the age and sex distribution, anatomical location and morphological characteristics of rhabdomyosarcoma among children in Kano, northwestern Nigeria.

PATIENTS AND METHOD

This is a 14 year retrospective study of all cases of rhabdomyosarcomas occurring in children diagnosed at the Pathology Department of Aminu Kano Teaching Hospital, Kano, Nigeria. Clinical data obtained included sex, age, tumour site and histologic subtype.

RESULTS

Fifty two children were seen with a male to female ratio of 1 : 1.3. The ages of these Patients ranged from 4 months to 15 years with a mean (SD) age of 6.99 (4.1) years and peak age frequency in the 0 to 5 years age group. The embryonal variant was the most common histological subtype (69%). The others were alveolar (27%) and pleomorphic (4%) variants. The head and neck was the most affected region (44%) and the most common primary site was the orbit (19.2%).

CONCLUSION

Rhabdomyosarcoma is the most common childhood soft tissue sarcoma in Kano. It occurs in females more frequently than males and the most common histologic subtype is embryonal rhabdomyosarcoma affecting predominantly the orbit.

Necrobiosis lipoidica diabeticorum: necrobiosis lipoidica diabeticorum in a Nigerian from the north. A case report

BACKGROUND

Necrobiosis lipoidica is a rare complication of diabetes mellitus.It is said to occur more often in people with diabetes,a family history of diabetes,tendency to develop diabetes mellitus and those with insulin dependent diabetes.

METHOD

We report an evaluated case of necrobiosis lipoidica diabeticorum residing in the northern part of Nigeria.

RESULT

The patient was treated for 3 weeks in the hospital on admission and was followed up in the general-out-patient department (GOPD) and has been in good health.

AIM AND OBJECTIVE

To bring to the fore of clinicians this dermal complication of diabetes mellitus, the different medical treatments available and the medical treatment employed in our index patient.

CONCLUSION

That necrobiosis lipoidica diabeticorum does exist in our environment and requires a high index of suspicion and scrupplelousness in making the diagnosis and treating the patient.

Developing a methodology for three-dimensional correlation of PET-CT images and whole-mount histopathology in non-small-cell lung cancer

BACKGROUND

Understanding the three-dimensional (3D) volumetric relationship between imaging and functional or histopathologic heterogeneity of tumours is a key concept in the development of image-guided radiotherapy. Our aim was to develop a methodologic framework to enable the reconstruction of resected lung specimens containing non-small-cell lung cancer (NSCLC), to register the result in 3D with diagnostic imaging, and to import the reconstruction into a radiation treatment planning system.

METHODS AND RESULTS

We recruited 12 patients for an investigation of radiology-pathology correlation (RPC) in nsclc. Before resection, imaging by positron emission tomography (PET) or computed tomography (CT) was obtained. Resected specimens were formalin-fixed for 1-24 hours before sectioning at 3-mm to 10-mm intervals. To try to retain the original shape, we embedded the specimens in agar before sectioning. Consecutive sections were laid out for photography and manually adjusted to maintain shape. Following embedding, the tissue blocks underwent whole-mount sectioning (4-mum sections) and staining with hematoxylin and eosin. Large histopathology slides were used to whole-mount entire sections for digitization. The correct sequence was maintained to assist in subsequent reconstruction. Using Photoshop (Adobe Systems Incorporated, San Jose, CA, U.S.A.), contours were placed on the photographic images to represent the external borders of the section and the extent of macroscopic disease. Sections were stacked in sequence and manually oriented in Photoshop. The macroscopic tumour contours were then transferred to MATLAB (The Mathworks, Natick, MA, U.S.A.) and stacked, producing 3D surface renderings of the resected specimen and embedded gross tumour. To evaluate the microscopic extent of disease, customized "tile-based" and commercial confocal panoramic laser scanning (TISSUEscope: Biomedical Photometrics, Waterloo, ON) systems were used to generate digital images of whole-mount histopathology sections. Using the digital whole-mount images and imaging software, we contoured the gross and microscopic extent of disease. Two methods of registering pathology and imaging were used. First, selected pet and ct images were transferred into Photoshop, where they were contoured, stacked, and reconstructed. After importing the pathology and the imaging contours to MATLAB, the contours were reconstructed, manually rotated, and rigidly registered. In the second method, MATLAB tumour renderings were exported to a software platform for manual registration with the original pet and ct images in multiple planes. Data from this software platform were then exported to the Pinnacle radiation treatment planning system in DICOM (Digital Imaging and Communications in Medicine) format.

CONCLUSIONS

There is no one definitive method for 3D volumetric RPC in nsclc. An innovative approach to the 3D reconstruction of resected nsclc specimens incorporates agar embedding of the specimen and whole-mount digital histopathology. The reconstructions can be rigidly and manually registered to imaging modalities such as ct and pet and exported to a radiation treatment planning system.

Assessing homeless population size through the use of emergency and transitional shelter services in 1998: results from the analysis of administrative data from nine US jurisdictions

OBJECTIVES

This study reports findings from the first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period. As such, it provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homeless services over time.

METHODS

Each participating jurisdiction collected data through its homeless services management information systems for persons and families who use emergency shelter and transitional housing. The jurisdictions organized the data by a standardized reporting format. These data form the basis for reporting homeless population size, both in raw numbers and as adjusted for each jurisdiction's overall population size, as well as the rate of turnover and average annual length of stay in emergency shelters and transitional housing.

RESULTS

Individual jurisdictions had annual rates of sheltered homelessness ranging from 0.1% to 2.1% of their overall population, and 1.3% to 10.2% of their poverty population. Annual population size was 2.5 to 10.2 times greater than the point-prevalent population size. Results are broken down for adults and families.

CONCLUSIONS

The prevalence of homelessness varies greatly among the jurisdictions included in this study, and possible factors for this diversity are discussed. Future reports of this nature will furnish similar series of homeless enumerations across a growing number of jurisdictions, thereby providing a basis for exploring the effects of different contextual factors on local prevalence rates of homelessness.

2000 up & comers

They're well on their way to becoming all-stars in the healthcare industry. All age 40 or younger, they've already accomplished much in their careers. Modern Healthcare profiles a dozen managers and executives chosen as this year's team of Up & Comers. As one observer says, "They demonstrate in significant, tangible ways the impact an individual can have on the vision, mission and quality of healthcare services."

Genetic linkage of familial granulomatous inflammatory arthritis, skin rash, and uveitis to chromosome 16

Blau syndrome (MIM 186580), first described in a large, three-generation kindred, is an autosomal, dominantly inherited disease characterized by multiorgan, tissue-specific inflammation. Its clinical phenotype includes granulomatous arthritis, skin rash, and uveitis and probably represents a subtype of a group of clinical entities referred to as "familial granulomatosis." It is the sole human model with recognizably Mendelian inheritance for a variety of multisystem inflammatory diseases affecting a significant percentage of the population. A genomewide search for the Blau susceptibility locus was undertaken after karyotypic analysis revealed no abnormalities. Sixty-two of the 74-member pedigree were genotyped with dinucleotide-repeat markers. Linkage analysis was performed under a dominant model of inheritance with reduced penetrance. The marker D16S298 gave a maximum LOD score of 3.75 at theta = .04, with two-point analysis. LOD scores for flanking markers were consistent and placed the Blau susceptibility locus within the 16p12-q21 interval.

Vision through nuclear and posterior subcapsular cataract

We have developed a new set of tests for evaluation of visual function through media opacities, based on vernier acuity measurements (hyperacuity). In this paper, results of one of these tests, the 'gap test', are compared in patients with posterior subcapsular (PSC) cataract versus nuclear cataract (NC). Patients with PSC cataract often report multiple images or significant 'star burst' effects. We hypothesized the presence of 'multi-prismatic' and/or high frequency spurious resolution phenomena due to PSC cataract characteristic substructure. We were able to minimize these effects by using a pinhole held close to the eye, a large (adapting) background field of white light superimposed on the vernier test targets, a low-pass spatial filter applied to the targets. When the particular problems associated with PSC cataract are not present or are adequately addressed and when patients are matched for visual acuity, the hyperacuity 'gap test' shows less functional effect due to the opacity for PSC cataract than NC in all the cases we have tested. These findings, moreover, indicate that visual acuity provides an insufficient description of the effects of intraocular scattering on image formation. The results emphasize the importance and the necessity of developing models that better clarify the specific effects of different types of ocular media opacities.

The effects of image degradation by cataract on vernier acuity

The resistance of certain types of hyperacuity tasks (eg, vernier acuity) to optical degradation of the retinal image has been demonstrated previously. This suggests that such a task might provide a means of filling the clinical need for a reliable test of retinal function in the presence of cataracts and other ocular opacities. In the present study, we measure several aspects of vernier acuity performance in cataract patients. These data provide an early basis for the development of a vernier acuity test to detect retinal/neural visual loss prior to cataract surgery. We report the results of measurements in 15 cataract patients using a two-dot vernier acuity task with variable separation between the two dots (gap). The data indicate that the shape and mean level of the vernier threshold-versus-gap function co-vary with the functional severity of the opacity as corroborated by Snellen acuity measures. Furthermore, the optical effects of the cataracts we studied are very similar to the effects of degrading the visual stimulus by interposing ground glass for a normal observer. We conclude that the shape of the vernier threshold-versus-gap function is a good indicator of the functional severity of the cataract in patients with otherwise normal vision.

Retinal image noise and vernier acuity

The effects of optically produced "noise" in the retinal luminance distribution of a vernier stimulus are demonstrated in two experiments. In the first, vernier performance with a bright, two-dot target is shown to improve upon the introduction of a luminous background field, relative to performance with a completely dark background. The brighter background probably acts as an adapting field, reducing the visibility of the retinal image "noise". The second experiment demonstrates that, under defocused conditions, introduction of a low-pass spatial filter that removes phase-reversed high spatial frequency components can enhance vernier performance. Thus, high spatial frequency information may interfere with the vernier response when phase information is disturbed by defocus.