Why is Zeaxanthin the Most Concentrated Xanthophyll in the Central Fovea?

Diet-based xanthophylls (zeaxanthin and lutein) are conditionally essential polar carotenoids preferentially accreted in high concentrations (1 mM) to the central retina, where they have the capacity to impart unique physiologically significant biophysical biochemical properties implicated in cell function, rescue, and survival. Macular xanthophylls interact with membrane-bound proteins and lipids to absorb/attenuate light energy, modulate oxidative stress and redox balance, and influence signal transduction cascades implicated in the pathophysiology of age-related macular degeneration. There is exclusive transport, sequestration, and appreciable bioamplification of macular xanthophylls from the circulating carotenoid pool to the retina and within the retina to regions required for high-resolution sensory processing. The distribution of diet-based macular xanthophylls and the lutein metabolite meso-zeaxanthin varies considerably by retinal eccentricity. Zeaxanthin concentrations are 2.5-fold higher than lutein in the cone-dense central fovea. This is an ~20-fold increase in the molar ratio relative to eccentric retinal regions with biochemically detectable macular xanthophylls. In this review, we discuss how the differences in the specific properties of lutein and zeaxanthin could help explain the preferential accumulation of zeaxanthin in the most vulnerable region of the macula.

Influence of submacular fluid on recovery of retinal function and structure after successful rhegmatogenous retinal reattachment

Purpose

To determine the influence of residual submacular fluid (SMF) on the recovery of function and structure of the retina after successful rhegmatogenous retinal detachment (RRD) reattachment.

Methods

We reviewed the medical records of all patients who had undergone successful RRD repair by scleral buckling (SB) surgery or by pars plana vitrectomy (PPV) from March 2011 to August 2014. Spectral-domain optical coherence tomographic images of the macular regions were used at 1, 2, 3, 6, 9, and 12 months following the surgery. The best-corrected visual acuities (BCVA) were evaluated at the same times.

Results

The eyes with a macula-off RRD that were treated by SB surgery had a significant higher incidence of residual SMF (52%) than those treated by PPV (6.8%; P <0.001). Nevertheless, the postoperative BCVA was significantly improved in the eyes that had undergone SB surgery (P = 0.007). The postoperative BCVAs were not significantly different between the groups in which the SMF was absorbed (12 eyes) and not absorbed (13 eyes) within 1 month after the SB surgery. The photoreceptor outer segment length and the presence of a foveal bulge were not significantly different between these two groups at 12 months. Multiple regression analyses showed that the presence of a foveal bulge (β = 0.531, P = 0.001) and the duration of the retinal detachment before surgery (β = 0.465, P = 0.002) but not the duration of the SMF were independent factors significantly correlated with the final BCVA.

Conclusions

These results suggest that the postoperative residual SMF does not significantly disrupt the functional and structural recovery of eyes with macula-off RRD treated by SB surgery.

Molecular characterization of foveal versus peripheral human retina by single-cell RNA sequencing

The human retina is a complex tissue responsible for detecting photons of light and converting information from these photons into the neurochemical signals interpreted as vision. Such visual signaling not only requires sophisticated interactions between multiple classes of neurons, but also spatially-dependent molecular specialization of individual cell types. In this study, we performed single-cell RNA sequencing on neural retina isolated from both the fovea and peripheral retina in three human donors. We recovered a total of 8,217 cells, with 3,578 cells originating from the fovea and 4,639 cells originating from the periphery. Expression profiles for all major retinal cell types were compiled, and differential expression analysis was performed between cells of foveal versus peripheral origin. Globally, mRNA for the serum iron binding protein transferrin (TF), which has been associated with age-related macular degeneration pathogenesis, was enriched in peripheral samples. Cone photoreceptor cells were of particular interest and formed two predominant clusters based on gene expression. One cone cluster had 96% of cells originating from foveal samples, while the second cone cluster consisted exclusively of peripherally isolated cells. A total of 148 genes were differentially expressed between cones from the fovea versus periphery. Interestingly, peripheral cones were enriched for the gene encoding Beta-Carotene Oxygenase 2 (BCO2). A relative deficiency of this enzyme may account for the accumulation of carotenoids responsible for yellow pigment deposition within the macula. Overall, this data set provides rich expression profiles of the major human retinal cell types and highlights transcriptomic features that distinguish foveal and peripheral cells.

Investigating the potential of Zernike polynomials to characterise spatial distribution of macular pigment

It has been postulated that particular patterns of macular pigment (MP) distribution may be associated with the risk for eye diseases such as age-related macular degeneration (AMD). This work investigates the potential of Zernike polynomials (ZP) to characterise the level and distribution of MP, and their suitability as a representation for analysis of the effects of age and AMD on MP patterns. As the case study, MP distribution maps computed using an experimental method based on fundus reflectance (MRIA) were obtained for ninety volunteers representing three groups: under-fifty without AMD, fifty and over without AMD, and fifty and over with AMD. ZP with 105 coefficients were fitted to the maps using least-squares optimisation and found to represent MP maps accurately (RMSE<10⁻¹). One-way MANOVA analysis carried out on ZP representations showed that the three subject groups have significantly different means (Wilk’s Lambda 0.125, p<0.0001). Linear discriminant analysis with leave-one-out scheme resulted in accuracy, sensitivity and specificity of classification according to, respectively, disease status regardless of age (81% all); disease status in the age-matched groups (87%, 88%, 86%); age irrespective of disease status (81%, 83%, 73%); and age for subjects without AMD (83%, 88%, 80%). Mean MP distributions computed from ZP coefficients for the three groups showed more elevated and more peaked MP for the healthy under-fifty group; more irregular and more elevated peripheral levels in over-fifty AMD group than in over-fifty non-AMD group; and moderate radial asymmetry in non-AMD over-50 group. The results suggest that ZP coefficients are capable of accurately representing MP in a way that captures certain spatial patterns of its distribution. Using the ZP representation MP maps could be classified according to both age and disease status with accuracy significantly greater than chance, with peak elevation, pattern irregularity and radial asymmetry identified as important features.

An investigation of parafoveal masks with the incremental boundary paradigm

Most of what we know about parafoveal preprocessing during reading is based on the boundary paradigm in combination with parafoveal masks as a presumably neutral baseline condition. Recent evidence questions the neutrality of the baseline condition by showing that parafoveal masks inflict preview costs. Using a novel, incremental boundary paradigm we studied the effect of parafoveal masks. Manipulating the salience of parafoveal previews, we found that increasing salience of the masks resulted in increasingly longer fixation times on target words, but also on pretarget words-suggesting preview costs. We conclude that the hidden preview costs of parafoveal masks in the classical boundary paradigm inflate the processing times for the baseline condition and hence lead to an overestimation of the preview benefit. Thus, the present study questions the validity of some of the conclusions drawn on the basis of the classical boundary paradigm.

Functional architecture of the foveola revealed in the living primate

The primate foveola, with its high cone density and magnified cortical representation, is exquisitely specialized for high-resolution spatial vision. However, uncovering the wiring of retinal circuitry responsible for this performance has been challenging due to the difficulty in recording receptive fields of foveal retinal ganglion cells (RGCs) in vivo. In this study, we use adaptive optics scanning laser ophthalmoscopy (AOSLO) to image the calcium responses of RGCs in the living primate, with a stable, high precision visual stimulus that allowed us to localize the receptive fields of hundreds of foveal ganglion cells. This approach revealed a precisely radial organization of foveal RGCs, despite the many distortions possible during the extended developmental migration of foveal cells. By back projecting the line connecting RGC somas to their receptive fields, we have been able to define the ‘physiological center’ of the foveola, locating the vertical meridian separating left and right hemifields in vivo.

Human L- and M-opsins restore M-cone function in a mouse model for human blue cone monochromacy

Purpose

Blue cone monochromacy (BCM) is an X-linked congenital vision disorder characterized by complete loss or severely reduced L- and M-cone function. Patients with BCM display poor visual acuity, severely impaired color discrimination, myopia, nystagmus, and minimally detectable cone-mediated electroretinogram. Recent studies of patients with BCM with adaptive optics scanning laser ophthalmoscopy (AOSLO) showed that they have a disrupted cone mosaic with reduced numbers of cones in the fovea that is normally dominated by L- and M-cones. The remaining cones in the fovea have significantly shortened outer segments but retain sufficient structural integrity to serve as potential gene therapy targets. In this study, we tested whether exogenously expressed human L- and M-opsins can rescue M-cone function in an M-opsin knockout (Opn1mw-/- ) mouse model for BCM.

Methods

Adeno-associated virus type 5 (AAV5) vectors expressing OPN1LW, OPN1MW, or C-terminal tagged OPN1LW-Myc, or OPN1MW-HA driven by a cone-specific promoter were injected subretinally into one eye of Opn1mw-/- mice, while the contralateral eye served as the uninjected control. Expression of cone pigments was determined with western blotting and their cellular localization identified with immunohistochemistry. M-cone function was analyzed with electroretinogram (ERG). Antibodies against cone phototransduction proteins were used to study cone outer segment (OS) morphology in untreated and treated Opn1mw-/- eyes.

Results

We showed that cones in the dorsal retina of the Opn1mw-/- mouse do not form outer segments, resembling cones that lack outer segments in the human BCM fovea. We further showed that AAV5-mediated expression of either human M- or L-opsin individually or combined promotes regrowth of cone outer segments and rescues M-cone function in the treated Opn1mw-/- dorsal retina.

Conclusions

Exogenously expressed human opsins can regenerate cone outer segments and rescue M-cone function in Opn1mw-/- mice, thus providing a proof-of-concept gene therapy in an animal model of BCM.

High-resolution Imaging in Male Germ Cell-Associated Kinase (MAK)-related Retinal Degeneration

PURPOSE

To describe the characteristics of MAK-related retinal degeneration using optical coherence tomography angiography (OCTA) and adaptive optics scanning laser ophthalmoscopy (AOSLO).

DESIGN

Cross-sectional study.

METHODS

Six patients with rod-cone degeneration and disease-causing mutations in MAK were evaluated with visual acuity, spectral-domain OCT, confocal AOSLO, and OCTA. Foveal avascular zone (FAZ) area, vessel densities, and perfusion densities of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central macula in all 6 patients were compared with 5 normal subjects. Cone spacing was measured in 4 patients from AOSLO images and compared with 37 normal subjects.

RESULTS

Patients ranged from 25 to 81 years of age (mean, 52 years). Visual acuity varied from 20/13 to 20/40+2, except in 1 patient with cystoid macular edema whose vision was 20/60- and 20/70+1. The SCP (P = .012) and DCP (P = .013) vessel density and perfusion density (P =.015 and .013, respectively) were significantly lower in patients compared to normal subjects in the parafoveal region 1.0-3.0 mm from the fovea, but were similar to normal subjects within 1.0 mm of the fovea. The FAZ area was not significantly different from normal (all P ≥ .24). Cone spacing was normal at almost all locations in 2 patients with early disease and increased in 2 patients with advanced disease.

CONCLUSIONS

Although retinal vascular densities are reduced and cone spacing is increased in advanced disease, central foveal structure is maintained until late stages of disease, which may contribute to preservation of foveal vision in eyes with MAK-related retinal degeneration.

Blue cone monochromacy: visual function and efficacy outcome measures for clinical trials

Background

Blue Cone Monochromacy (BCM) is an X-linked retinopathy caused by mutations in the OPN1LW / OPN1MW gene cluster, encoding long (L)- and middle (M)-wavelength sensitive cone opsins. Recent evidence shows sufficient structural integrity of cone photoreceptors in BCM to warrant consideration of a gene therapy approach to the disease. In the present study, the vision in BCM is examined, specifically seeking clinically-feasible outcomes for a future clinical trial.

Methods

BCM patients (n = 25, ages 5–72) were studied with kinetic and static chromatic perimetry, full-field sensitivity testing, and eye movement recordings. Vision at the fovea and parafovea was probed with chromatic microperimetry.

Results

Kinetic fields with a Goldmann size V target were generally full. Short-wavelength (S-) sensitive cone function was normal or near normal in most patients. Light-adapted perimetry results on conventional background lights were abnormally reduced; 600-nm stimuli were seen by rods whereas white stimuli were seen by both rods and S-cones. Under dark-adapted conditions, 500-nm stimuli were seen by rods in both BCM and normals. Spectral sensitivity functions in the superior retina showed retained rod and S-cone functions in BCM under dark-adapted and light-adapted conditions. In the fovea, normal subjects showed L/M-cone mediation using a 650-nm stimulus under dark-adapted conditions, whereas BCM patients had reduced sensitivity driven by rod vision. Full-field red stimuli on bright blue backgrounds were seen by L/M-cones in normal subjects whereas BCM patients had abnormally reduced and rod-mediated sensitivities. Fixation location could vary from fovea to parafovea. Chromatic microperimetry demonstrated a large loss of sensitivity to red stimuli presented on a cyan adapting background at the anatomical fovea and surrounding parafovea.

Conclusions

BCM rods continue to signal vision under conditions normally associated with daylight vision. Localized and retina-wide outcome measures were examined to evaluate possible improvement of L/M-cone-based vision in a clinical trial.

Light distributions on the retina: relevance to macular pigment photoprotection

Light exposure has been implicated in age-related macular degeneration (AMD). This study was designed to measure cumulative light distribution on the retina to determine whether it peaked in the macula. An eye-tracker recorded the subject's field of view and pupil size, and superimposed the gaze position. Fifteen naïve subjects formed a test group; 5 formed a control group. In phase 1, all subjects viewed a sequence of photographic images. In phase 2, the naïve subjects observed a video; in phase 3, they performed computer tasks; in phase 4, the subjects walked around freely. In phase 1, control subjects were instructed to gaze at bright features in the field of view and, in a second test, at dark features. Test group subjects were allowed to gaze freely for all phases. Using the subject's gaze coordinates, we calculated the cumulative light distribution on the retina. As expected for control subjects, cumulative retinal light distributions peaked and dipped in the fovea when they gazed at bright or dark features respectively in the field of view. The light distribution maps obtained from the test group showed a consistent tendency to peak in the macula in phase 3, a variable tendency in phase 4, but little tendency in phases 1 and 2. We conclude that a tendency for light to peak in the macula is a characteristic of some individuals and of certain tasks. In these situations, risk of AMD could be increased but, at the same time, mitigated by the presence of macular carotenoids.

Directional model analysis of the spectral reflection from the fovea and para-fovea

Directional and nondirectional spectral reflection data from 0, 1, 2, 4, and 8 deg eccentricity, and the optic disk, were analyzed from 400 to 950 nm with an existing optical reflection model. The optical model, developed for the fovea, appeared to be also suitable for more eccentric locations. The optical densities of melanin and of the macular pigments zeaxanthin and lutein peaked in the fovea, in correspondence with literature data. The amplitude of the directional component, originating in the cone photoreceptors, had its maximum at 1 deg. The maximum of the directionality (peakedness) occurred at a slightly higher eccentricity.

Diclofenac prevents an early event of macular thickening after cataract surgery in patients with diabetes

PURPOSE

This study compares the effect of topical diclofenac with that of betamethasone against postoperative cystoid macular edema (CME) following cataract surgery in patients with non- and mild nonproliferative diabetic retinopathy.

METHODS

Forty-six (46) consecutive patients with mild nonproliferative- or nondiabetic retinopathy who had bilateral and symmetrical cataracts underwent uncomplicated cataract surgery in both eyes (92 eyes in total). Postoperatively, topical diclofenac was applied 4 times daily for 1 eye, and topical betamethasone 4 times daily for the other eye in each patient. Best corrected logMAR visual acuity (BCVA), averaged foveal thickness (FT) as measured by optical coherence tomography (OCT), and intraocular pressure (IOP) were monitored preoperatively, and also postoperatively at 1 day and 1, 4, and 8 weeks.

RESULTS

VA in both the diclofenac- and betamethasone-treated eyes significantly improved following the cataract surgery; however, no statistical difference of VA was noted between the diclofenac- and betamethasone-treated eyes throughout the observational period (before and after the surgery until 8 weeks postoperatively). FT in both eyes increased after the cataract surgery. FT in the diclofenac-treated eyes did not increase 1 week after surgery, but gradually increased at week 4 and week 8. In contrast, the FT in the betamethasone-treated eyes increased during 1-8 weeks postoperatively. IOP in the diclofenac-treated eyes decreased with time, but IOP in the betamethasone-treated eyes showed no change throughout the observational period.

CONCLUSIONS

Postoperative macular thickening following cataract surgery in patients with non- or mild nonproliferative-diabetic retinopathy cannot be fully suppressed by either topical diclofenac or betamethasone. Nonetheless, diclofenac protected against an early event of postoperative CME and also a decrease of IOP.

Delayed foveal reattachment in scleral buckle surgery for inferior retinal detachment

The study evaluates the prevalence and course of subfoveal serous detachment (SSD) following successful retinal reattachment surgery. SSD was commonly seen in postprimary scleral buckle eyes for inferior rhegmatogenous retinal detachment vs none in the primary pars plana vitrectomy group, irrespective of the break localization.

SUBTHRESHOLD TRANSPUPILLARY THERMOTHERAPY FOR EARLY RESOLUTION OF FOVEAL SUBRETINAL FLUID IN CHOROIDAL METASTASIS

PURPOSE

To report the effectiveness of subthreshold transpupillary thermotherapy (TTT) in the early resolution of subretinal fluid at the fovea in solitary choroidal metastasis.

METHODS

: Three consecutive patients who had adenocarcinoma of the lung with choroidal metastasis and macular subretinal fluid were treated by subthreshold TTT. Tumor response and fluorescein angiographic and visual results were recorded.

RESULTS

Fluorescein angiography revealed solitary choroidal metastasis at the posterior pole with subretinal fluid in all patients. Initial best-corrected visual acuity in Patient 1, a 57-year-old man, was 40/200. Instead of usual high laser intensity, three applications of TTT, 400-mW power, 3-mm size, and 1-minute duration, were performed over the tumor mass. Repeated treatment with the same regimen was performed after 1 week. Visual acuity improved to 20/25 2 months after treatment. Best-corrected visual acuity in Patient 2, a 68-year-old woman, was 10/200 in the right eye before treatment. Visual acuity improved to 80/200 after treatment and remained stable for 14 months. Visual acuity improved from 20/100 to 20/60 in a third patient 2 months after treatment. The disappearance of subretinal fluid over the fovea was noted by fluorescein angiography 2 months after laser treatment and remained stable until the end of follow-up.

CONCLUSION

Improvement of visual acuity and cessation of fluorescein leakage in the tumor showed that subthreshold (i.e., biomicroscopically invisible laser effect) TTT served as an effective treatment modality in the early resolution of macular subretinal fluid in choroidal metastasis. Multiple sessions of subthreshold TTT are safe to apply very close to the macula.

Nutritional manipulation of primate retinas. IV. Effects of n--3 fatty acids, lutein, and zeaxanthin on S-cones and rods in the foveal region

Lutein and zeaxanthin are xanthophylls selectively accumulated by primate retinas that may protect the macula from age-related macular degeneration. In this project, we manipulated n-3 fatty acids, lutein and/or zeaxanthin levels in the diet and studied their possible outcome on S-cone and rod cell density in the foveal region. Rhesus monkeys (7-16 year, n=17) were fed from birth xanthophyll-free semipurified diets with either adequate or low n-3 fatty acids. Five monkeys were supplemented with lutein and six with zeaxanthin for 6-24 months, while six remained xanthophyll-free until sacrifice. Retinas were embedded in methacrylate and serial 2 microm sections were cut along the vertical meridian. Rod nuclei, and immuno-labelled outer segments of S-cones and rods, were reconstructed and counted in an 8 microm strip. The density profiles were compared with data from control monkeys (n=7) fed a standard laboratory diet. S-cone density profiles were symmetrical along the vertical meridian and the densities decreased rapidly with retinal eccentricity. Rod densities were higher in the superior region than the inferior region in most of the control and experimental animals. Unlike the significant effects observed for retinal pigment epithelial cells of these same monkeys (Leung, I.Y-F., Sandstrom, M.M., Zucker, C.L., Neuringer, M., Snodderly, D.M., 2004. Nutritional manipulation of primate retinas. II. Effects of age, n-3 fatty acids, lutein, and zeaxanthin on retinal pigment epithelium. Invest. Ophthalmol. Vis. Sci. 45, 3244-3256), neither xanthophyll supplementation nor low dietary n-3 fatty acids produced consistent effects on S-cone or rod density profiles of the experimental animals. However, monkeys low in n-3 fatty acids had increased variability of S-cone density in the fovea and low density of foveal rod outer segments. The high variability suggests that the photoreceptors of some animals were resistant to the nutritional manipulations, while others may have been affected. Thus, the photoreceptors appear less sensitive than the retinal pigment epithelium to these nutritional manipulations. However, it is possible that more consistent effects would emerge at a later age or after exposure to stressors such as high light levels.

Photopigment optical density of the human foveola and a paradoxical senescent increase outside the fovea

Photopigment optical density (OD) of middle-(M) and long-(L) wavelength-sensitive cones was determined to evaluate the hypothesis that reductions in the amount of photopigment are responsible for age-dependent sensitivity losses of the human cone pathways. Flicker thresholds were measured at the peak and tail of the photoreceptor's absorption spectrum as a function of the intensity of a bleaching background. Photopigment OD was measured at 0 (fovea), 2, 4, and 8 deg in the temporal retina by use of a 0.3-deg-diameter test spot. Seventy-two genetically characterized dichromats were studied so that the L- and M-cones could be analyzed separately. Subjects included 28 protanopes with M- but no L-cones and 44 deuteranopes with L- but no M-cones (all male, age range 12-29 and 55-83 years). Previous methods have not provided estimates of photopigment OD for separate cone classes in the foveola. In this study, it was found that foveolar cones are remarkably efficient, absorbing 78% of the available photons (OD = 0.65). Photopigment OD decreased exponentially with retinal eccentricity independently of age and cone type. Paradoxically, the OD of perifoveal cones increased significantly with age. Over the 70-year age range of our participants, the perifoveal M- and L-cones showed a 14% increase in capacity to absorb photons despite a 30% decrease in visual sensitivity over the same period.

Expression of VEGF and angiopoietins in subfoveal membranes from patients with age-related macular degeneration

PURPOSE

Vascular endothelial growth factor (VEGF) and angiopoietins are key regulators of angiogenesis. The purpose of this study was to measure mRNA levels of these factors and of their receptors in surgically excised subfoveal membranes from patients with age-related macular degeneration (AMD) and to evaluate their relevance as prognostic markers of postsurgical recurrence of choroidal neovascularization (CNV).

DESIGN

Prospective observational case series.

METHODS

setting: Institutional. study population: In a prospective series of 24 patients (aged 51 to 91 years) with classic CNV of AMD diagnosed less than 6 months previously, 24 subfoveal membranes (one eye per patient) were surgically removed and collected. Thirteen patients underwent treatment for recurrence of CNV within 6 months of surgery. main outcome measures: Four 8-mu sections were prepared from each membrane for immunohistochemical determination of vascular density (CD31 immunostaining). The remaining tissue was used for preparation of total RNA. The levels of VEGF-A, VEGF-R1, VEGF-R2, neuropilin-1, angiopoietin-1, angiopoietin-2, Tie-2, and hypoxanthine phosphoribosyltransferase mRNAs were determined by real-time reverse-transcriptase polymerase chain reaction.

RESULTS

Vascular endothelial growth factor, angiopoietin-1, and angiopoietin-2 appeared to be expressed to variable levels in most samples, whereas Tie-2, VEGF-R1, and VEGF-R2 were undetectable. Low levels of VEGF expression correlated with postsurgical recurrence of CNV (P = .07). Angiopoietin-1 and angiopoietin-2 levels did not predict recurrence (P > .1).

CONCLUSION

The results indicate that at the time of surgical excision, subfoveal membranes express angiopoietin-1, VEGF, and, to a lesser degree, angiopoietin-2. Because CNV appears to recur less often in membranes expressing high levels of VEGF, we hypothesize that VEGF acts as a stabilizer of neovessels at this stage of the disease.

Differential distribution of fibroblast growth factor receptors (FGFRs) on foveal cones: FGFR-4 is an early marker of cone photoreceptors

PURPOSE

Relatively little is known of the expression and distribution of FGF receptors (FGFR) in the primate retina. We investigated expression of FGFRs in developing and adult Macaca monkey retina, paying particular attention to the cone rich, macular region.

METHODS

One fetal human retina was used for diagnostic PCR using primers designed for FGFR1, FGFR2, FGFR3, FGFR4, and FGFR like-protein 1 (FGFrl1) and for probe design to FGFR3, FGFR4, and FGFrl1. Rat cDNA was used to synthesize probes for FGFR1 and FGFR2 with 90% and 93% homology to human, respectively. Paraffin sections of retina from macaque fetuses sacrificed at fetal days (Fd) 64, 73, 85, 105, 115, 120, and 165, and postnatal ages 2.5 and 11 years were used to detect FGF receptors by immunohistochemistry and in situ hybridization.

RESULTS

PCR showed each of the FGF receptors are expressed in fetal human retina. In situ hybridization indicated that mRNA for each receptor is expressed in all retinal cell layers during development, but most intensely in the ganglion cell layer (GCL). FGFR2 mRNA is reduced in the adult inner (INL) and outer (ONL) nuclear layers, while FGFrl1 mRNA is virtually absent from the adult ONL. FGFR4 mRNA is particularly intense in fetal and adult cone photoreceptors. Immunoreactivity to FGFR1-FGFR4 was detected in the interphotoreceptor matrix in what appeared to be RPE microvilli associated with developing photoreceptor outer segments, and generally is high in the GCL and low in the INL. Different patterns of FGFR3 and FGFR4 immunoreactivities in the outer plexiform layer (OPL) suggest localization of FGFR3 to horizontal cell processes, with FGFR4 being expressed by both horizontal and bipolar cell processes. FGFR1, FGFR3, and FGFR4 immunoreactivities are present in the inner segments and somata of adult cones. The pedicles of developing and adult cones are FGFR1 and FGFR3 immunoreactive, and the basal, synaptic region is FGFR4 immunoreactive. FGFR4 labels cones almost in their entirety from early in development and is not detected in rods. The fibers of Henle are intensely FGFR4 immunoreactive in adult cones.

CONCLUSIONS

The results show high levels of FGF receptor expression in developing and adult retina. Differential distribution of FGF receptors across developing and adult photoreceptors suggests specific roles for FGF signalling in development and maintenance of photoreceptors, particularly the specialized cones of the fovea.

The relation between visual acuity, fixation stability, and the size and location of foveal hard exudates after photocoagulation for diabetic maculopathy: a 1-year follow-up study

PURPOSE

To study the relation between changes in visual acuity, fixation stability and the retinal area covered by hard exudates 3, 6 and 12 months after laser photocoagulation for diabetic maculopathy.

METHODS

Twenty-four eyes of 24 patients with diabetes mellitus were examined 3, 6 and 12 months after retinal photocoagulation for clinically significant macular oedema. Each examination included visual acuity testing (ETDRS charts), quantification of fixation stability using a scanning laser ophthalmoscope (Rodenstock 101) and fundus photography. The fundus photographs were digitised and the retinal area covered by hard exudates determined by image processing.

RESULTS

The retinal area covered by hard exudates decreased significantly during the first 6 months after treatment ( P=0.05, paired t-test), but increased again between 6 and 12 months after treatment. The visual acuity showed an increase, albeit non-significant, during the first 6 months after treatment followed by a decrease between 6 and 12 months after treatment. Quantification of fixation stability showed that four patients with central exudates fixated at the border of these lesions, and in two of these patients the disappearance of the exudates resulted in increased visual acuity and a change in fixation to the former exudate area.

CONCLUSIONS

The retinal area covered by hard exudates decreases during the first 6 months after central photocoagulation, but increases again between 6 and 12 months after the treatment. Hard exudates covering the foveal region contribute to disturbance of central vision.

Macular pigment and visual acuity in Stargardt macular dystrophy

PURPOSE

To test the hypothesis that macular pigment reflects foveal cone function and possibly the presence of foveal cones in recessive Stargardt macular dystrophy.

METHODS

Sixteen patients (32 eyes) diagnosed to have Stargardt macular dystrophy by clinical criteria were studied with a scanning laser ophthalmoscope (SLO) comparing argon laser blue (488 nm), green (514), helium-neon laser red (633 nm) and infrared diode laser (780 nm) images for the presence or absence of macular pigment in the fovea. Fifteen of the patients were screened for mutations in the ABCR gene. Eyes were graded into three categories: those without foveal macular pigment, those with partial pigment and those with normal amounts of macular pigment. These categories were compared with visual acuity determined by the Snellen chart.

RESULTS

All patients with a visual acuity of 20/200 or worse had no macular pigment in the fovea. All patients with visual acuity of 20/40 or better had a normal amount of macular pigment in the fovea. Patients with partial macular pigment had intermediary acuity values except for two eyes, one with 20/20 and another with 20/200 acuity. Infrared light revealed more retinal abnormalities than blue light at early stages of the disease.

CONCLUSION

Foveal macular pigment is related to foveal cone acuity in Stargardt macular dystrophy and may be a marker for the presence of foveal cones. Infrared light is a sensitive monitor of early Stargardt macular dystrophy.

Optic disc, foveal, and extrafoveal damage due to surgical separation of the vitreous

OBJECTIVE

To evaluate the morphologic outcomes resulting from surgical vitreoretinal separation in young adult primates.

MATERIALS AND METHODS

Vitrectomy and mechanical separation of the vitreous from the internal limiting lamina (ILL) of the posterior retina and surface of the optic disc were performed on 25 young adult cynomolgus monkey eyes in vivo. Lectin histochemical studies were used to evaluate the vitreoretinal interface. Morphologic outcomes were tabulated.

RESULTS

In 11 of 25 eye regions, residual vitreous remained attached to the ILL in some of the regions. Localized ILL breaks or separation of the ILL from the neural retina was noted in 9 eyes. Retinal tissue loss, including avulsion of the ganglion cell, inner plexiform, or inner nuclear layers, was observed in 7 eyes. Avulsion of axon bundles in the optic disc was noted in 9 eyes. Significantly, partial- or full-thickness foveal tears were noted in 11 eyes. Based on the surgeons' intraoperative observations, small superficial optic disc or retinal hemorrhages were observed in 3 of 25 eyes. None of the eyes on which a vitrectomy alone was performed showed ILL damage, or retinal or optic disc tissue loss.

CONCLUSION

Damage may occur to the optic disc, fovea, and extrafoveal retina as a result of surgical separation of the vitreous from the retina in young adult primates.

CLINICAL RELEVANCE

These data support the contention that surgically induced damage at the level of the vitreoretinal interface may help explain the visual field defects noted after surgery to close full-thickness macular holes. These data also support the need for developing additional modalities to assist in vitreous separation, thereby reducing the risk of traumatic complications associated with purely mechanical procedures.

Adult-onset foveomacular pigment epithelial dystrophy: clinicopathologic correlation of three cases

PURPOSE

The authors describe the clinicopathologic features of three patients with adult onset foveomacular pigment epithelial dystrophy (AOFPED).

METHODS

The eyes of three patients were studied ophthalmoscopically and by fluorescein angiography, and obtained postmortem and studied by light and electron microscopy.

RESULTS

Histopathologic study of the three patient's eyes disclosed central loss of the retinal pigment epithelium and photoreceptor cell layer with a moderate number of pigment-containing macrophages present in the subretinal space and outer retina. To either side, the retinal pigment epithelium was distended with much lipofuscin. Basal laminar and basal linear deposits were present throughout the central area. No discontinuities of Bruch membrane were present.

CONCLUSION

The findings in the eyes of three patients with AOFPED included marked aging changes that are similar to those seen in age-related macular degeneration. Pigmented cells with lipofuscin in the subretinal space account for the vitelliform appearance.

ABCR expression in foveal cone photoreceptors and its role in Stargardt macular dystrophy

Mutations in the gene encoding ABCR are responsible for Stargardt macular dystrophy. Here we show by immunofluorescence microscopy and western-blot analysis that ABCR is present in foveal and peripheral cone, as well as rod, photoreceptors. Our results suggest that the loss in central vision experienced by Stargardt patients arises directly from ABCR-mediated foveal cone degeneration.

Corticosteroids as an antiangiogenic agent for histoplasmosis-related subfoveal choroidal neovascularization

The purpose of this study was to evaluate the role of corticosteroids in managing subfoveal choroidal neovascularization (CNV) secondary to the presumed ocular histoplasmosis syndrome. The cases of eighteen patients with histoplasmosis-related subfoveal CNV treated with corticosteroids were reviewed. Ten patients received oral prednisone for 4 to 6 weeks, and eight received a single sub-Tenon's injection of triamcinalone. Visual acuity outcomes were analyzed along with side effect profiles. At two-week follow-up, the prednisone group showed a median improvement in Snellen visual acuity of +2.0 lines, while the triamcinalone group remained essentially stable with a 0.5 line median loss. At treatment end (4 to 6 weeks), both groups showed no significant change in median acuity at 0.0 and -1.0 lines, respectively. Median final vision at 3 months also remained essentially stable at -0.5 lines for each group. Three patients reported anxiety, all of whom were taking prednisone 80 mg daily. Two patients reported increased appetite and weight gain on regimens of prednisone 80 and 100 mg daily. There were no adverse effects reported in the other patients receiving oral prednisone or in any patient receiving sub-Tenon's triamcinalone. The results suggest a beneficial effect of corticosteroids in stabilizing subfoveal CNV secondary to ocular histoplasmosis. In this small series, oral prednisone resulted in a short-term improvement in visual acuity, which stabilized over longer follow-up. The sub-Tenon's triamcinalone group achieved similar final stabilization without the initial improvement. Corticosteroids may be particularly valuable in managing neovascularization in patients who are awaiting interventions currently under development, in preventing recurrence after subfoveal surgery, or in treating non-surgical candidates. Further study is warranted to define the precise role of corticosteroids in this condition.

New surgical approach for removing massive foveal hard exudates in diabetic macular edema

OBJECTIVE

To examine the efficacy of surgical removal of foveal hard exudates in diabetic macular edema and to determine the expression of vascular endothelial growth factor (VEGF) in the excised specimens.

DESIGN

Cohort study.

PARTICIPANTS

Seven eyes of six patients with massive subfoveal hard exudate due to diabetic macular edema were examined. The average age of the patient was 56 years (range, 46-60 years).

INTERVENTION

Pars plana vitrectomy for removal of massive foveal exudates was performed.

MAIN OUTCOME MEASURES

Preoperative and postoperative visual acuity and complications were recorded; immunohistochemical staining for VEGF and other cell markers for macrophage and pigment epithelial cells in excised specimens was performed.

RESULTS

Postoperative best-corrected visual acuity improved by two or more lines of Snellen equivalent in five eyes (71%) (P = 0.0061). VEGF, identified by anticytokeratin and CD68 antibodies, was expressed in pigment epithelial cells and macrophages invading the hard exudates.

CONCLUSION

Surgical removal of foveal hard exudates might be effective in low-vision patients with diabetic maculopathy. VEGF might play a role in the formation and persistence of foveal hard exudates in diabetic macular edema.

Kinetics of foveal cone photopigment in myopia without chorioretinal degeneration

PURPOSE

To study the early changes in the outer retina of myopic eyes, we performed fundus reflection foveal cone densitometry in 45 subjects with normal visual acuity and no chorioretinal degeneration (ages: 18-47 years, refraction; +2.00-(-14.50) diopters).

METHODS

After full bleaching, the density of the photopigment was measured for 7 minutes by using a test spot, 562 nm in wavelength and 1 degrees in diameter, focused on the fovea. We calculated the density difference (DD) and the time constant (TC) of photopigment regeneration.

RESULTS

Although we found no correlation between the DD and the refractive error, there was a significant increase in TC as the refractive error increased (r = 0.50, P < 0.01).

CONCLUSIONS

These findings indicated that the kinetics of cone pigments become abnormal preceding the loss of cone cells or chorioretinal degeneration in high myopia.

Regional expression of disease-related genes in human and monkey retina

PURPOSE

Although specific genes play a role in regional retinal disease, the correlation of regional gene expression in the disease-affected site has not been previously ascertained. Non-human primates are widely used in models of human retinal function and are theorized to have identical (to human) patterns of expression, but no correlation between primate and human regional retinal gene expression has ever been performed. We wanted to evaluate the pattern of regional gene expression for a number of genes whose dysfunctions are known to selectively affect specific regions of the human retina, and to determine whether patterns of regional gene expression in nonhuman primates correlate with the human.

METHODS

Human and rhesus monkey eyes were dissected into retina, retinal pigment epithelium (RPE)/choroid and isolated RPE. Retinal regions were dissected, total RNA was isolated and northern analysis performed. Complementary DNA (cDNA) probes were prepared from genes associated with regional retinal disease. These genes are: rod opsin, the alpha-subunit of rod phosphodiesterase, RDS-peripherin, rod outer membrane (ROM) protein, ornithine aminotransferase (OAT), choroideremia gene product (CHM), tissue specific inhibitor of metalloproteinases-3 (TIMP-3), and red/green photoreceptor pigment protein. We also compared expression of Norrie disease product (NDP), a gene whose mutation is known to globally affect the retina.

RESULTS

Rod-specific mRNA expression is highest in the retinal midperiphery, and cone-specific mRNA levels were highest in total RNA from the cone-dominant fovea. mRNA levels for genes coding for proteins expressed in both rod- and cone photoreceptors (RDS-peripherin and ROM-1) are also highest in total RNA from the retinal midperiphery. Regional mRNA levels of CHM and OAT do not directly correlate with their patterns of disease expression. NDP mRNA expression was equivalent in both fovea and midperipheral retina total RNA. Patterns of gene expression were qualitatively similar for both human and rhesus monkey retina.

CONCLUSIONS

Regional retinal gene expression is an important factor in regional disease. However, for genes not solely expressed by a single photoreceptor subtype, other factors, such as regional metabolic differences, intra- and intercellular interactions, are also likely to be important in predisposing a single retinal region to disease. The pattern of neural retina OAT mRNA expression may have important implications in determining the appropriate tissue approach in gene therapy for gyrate atrophy. Regional retinal gene expression likely plays a significant, but nonexclusive role in the development of regional retinal disease.

Foveal cone photopigment distribution: small alterations associated with macular pigment distribution

PURPOSE

To map the photopigment distribution of central foveal cones in healthy adult subjects before potential onset of age-related macular degeneration. To compare alterations in cone photopigment distribution to those of macular pigment and examine those loci for subretinal changes.

METHODS

Eleven healthy subjects (age range, 31-59 years) underwent reflectometry with a scanning laser ophthalmoscope. The difference in cone photopigment density in the fovea was mapped for the long-wavelength- and middle-wavelength-sensitive cones, using 594-nm light. Macular pigment was mapped with 488-nm and 514-nm light. Subretinal changes were investigated with infrared imaging (830-860 nm).

RESULTS

Most subjects had small alterations in the regularity of their foveal cone photopigment distribution. Alterations were spatially related to macular pigment alterations but not to the presence of subretinal defects. Subjects were classified into three groups according to the type of alterations in the regularity of pigment distributions: central peak of photopigment and macular pigment, small foveal alterations, and broad distribution with missing central peak of photopigment or macular pigment. The resultant groups differed significantly in age, 43, 46, and 59 years, for groups 1, 2, and 3, respectively (P < 0.05).

CONCLUSIONS

Small alterations in the distributions of foveal cone photopigment or macular pigment were found that varied among the subjects. Larger alterations in older subjects may indicate changes in foveal architecture with age, including potential vulnerability of central cones before the onset of clinically significant changes in the retinal pigment epithelium.

Immunostaining with antibodies against protein kinase C isoforms in the fovea of the monkey retina

We reported previously that an antibody to the alpha isoform of protein kinase C (PKC) immunostained rod bipolar cells and bipolar cells that could be blue-cone (B-cone)-specific in postmortem human retina (Kolb et al. (1993) Vis. Neurosci. 10:341-351). In addition, we showed that antibodies to the beta isoform of PKC immunostained cone system bipolar, amacrine, and ganglion cells. Since the fixation of the human material was poor, we were unable to make positive identifications of the specific cell types that were immunoreactive, particularly in the case of PKC-beta antibodies. Thus, herein we have repeated the study on well-fixed monkey foveal retina. PKC-alpha immunoreactivity (IR) was restricted to a single type of cone bipolar cell that contacted only a minority of the cone pedicles at central invaginating contacts of ribbon triads. This bipolar type shares some morphological characteristics of B-cone-specific bipolar cells of primate retina. PKC-beta immunoreactivity was found in cone bipolar cells that made primarily basal contacts with cone pedicles and had axon terminals in sublamina alpha of the inner plexiform layer (IPL). Immunoreactivity also occurred in a type of cone bipolar that made central element contacts and had axon terminals in sublamina b of the IPL. Some ganglion cells, particularly those postsynaptic to flat midget bipolar cells also exhibited PKC-beta-IR. One type of amacrine with an 8 microns diameter cell body showed strong PKC-beta-IR. It was postsynaptic to cone bipolar cells in both sublamina a and b and presynaptic to bipolar axons, other immunoreactive amacrine cells, and ganglion cell dendrites and bodies. The other amacrine cell type showed less strong PKC-beta-IR, large-bodied (12-15 microns cell body diameter), and probably diffuse in branching pattern. The latter interacted with the intensely immunoreactive amacrines, bipolars, and ganglion cells. By comparison to cat and primate retinas where morphology and physiology of many retinal neurons are well documented, we suggest that PKC-beta may be specific to flat midget, flat diffuse, and invaginating diffuse cone bipolar cells and to at least two amacrine cells. Some of these neural types are proposed to be involved in OFF-center cone pathways in the monkey retina.

[Foveal cone densitometry in high myopia]

We performed foveal cone densitometry using a modified fundus camera in 17 eyes of 17 normal subjects (age range, 20 to 47 yr, refractive error, +2.0 to -2.5 D) and 15 eyes of 15 high myopia subjects with normal visual acuity (age range, 18 to 46 yr, refractive error, -9.0 to -14.5 D). After fully bleaching, the density of photopigment was measured for 7 minutes by a test spot of 562 nm in wavelength and 1 degree in diameter, focussed on the fovea. Two-way density and the time constant of pigment regeneration were calculated. No significant difference was found in two-way density between the two groups. The time constant in high myopia (161.6 +/- 36.6 sec), however, was significantly increased (p < 0.01), compared with normals (124.0 +/- 28.7 sec). To study the correlation of psychophysical visual function, we performed a photostress recovery test, which revealed a significant delay of the recovery time in high myopia (p < 0.01). These results suggest that a delay in foveal cone pigment kinetics precedes loss of cone cells or chorioretinal degeneration in high myopia.

Distribution of growth factors in subfoveal neovascular membranes in age-related macular degeneration and presumed ocular histoplasmosis syndrome

PURPOSE

We performed a histopathologic and immunohistologic study to determine the macromolecular and cellular components of subfoveal neovascular membranes removed at the time of submacular surgery.

METHODS

Subfoveal neovascular membranes were surgically removed from ten patients (seven with age-related macular degeneration and three with presumed ocular histoplasmosis syndrome). Tissues obtained were examined by light and electron microscopy to identify structural components. Immunohistochemical staining was then performed with monoclonal antibodies to various growth factors, including transforming growth factor-beta 1, basic fibroblast growth factor, platelet-derived growth factor, and epidermal growth factor, as well as antibodies against procollagen 1 and phosphotyrosine residues.

RESULTS

Most cells in subfoveal neovascular membranes are retinal pigment epithelial cells and cells resembling fibroblasts, with some vascular endothelial cells, lymphocytes, and macrophages. Basic fibroblasts growth factor was found in the extracellular matrix and in endothelial cells. Transforming growth factor-beta 1 was found in endothelial cells, fibroblasts, and retinal pigment epithelial cells. Procollagen 1 was found in protein-synthesizing fibroblasts, and phosphotyrosine residues were detected within fibroblasts, endothelial cells, and retinal pigment epithelial cells.

CONCLUSIONS

Subfoveal neovascular membranes are neovascular complexes composed of retinal pigment epithelial cells, fibroblasts, vascular endothelial cells, and chronic inflammatory cells. Furthermore, transforming growth factor-beta 1 and basic fibroblast growth factor are present within the major cell types, which suggests a possible pathogenic role in the development of the neovascular complex.

[Foveal cone densitometer and changes in foveal cone pigments with aging]

A foveal cone densitometer was built for measuring the kinetics of foveal cone pigments in human eyes. The light from a 500-W xenon lamp was divided into reference, measuring, and bleaching beams, and projected through an optical fiber leading to a modified fundus camera. After the light was projected into the ocular fundus, the reflected light (central 1 degree) was measured by a photomultiplier and the regeneration time and the two-way density were abstracted from the records. The two-way density, which is the decadic logarithm of the measuring-reference beam ratio under bleached conditions divided by the measuring-reference beam ratio under dark conditions, eliminated the artifacts caused by eye movement of blink. Reliable curves were obtained in 45 eyes out of 53 healthy Japanese subjects (age range, 9 to 82 years). The mean +/- standard deviation SD of the two-way density (log) and the time constant (sec) were 0.34 +/- 0.09 and 139.9 +/- 79.3, respectively. The time constant significantly increased with aging.

Morphometric analysis of human retinal pigment epithelium: correlation with age and location

Flat bleached preparations of retinal pigment epithelial (RPE) cells from foveal, temporal posterior pole, and temporal equatorial fundus locations of 20 normal human eyes from donors age ranked from 13 to 96 years were analyzed for density, and 10 were analyzed for area, hexagonality and polymegathism. These factors were related to fundus locations and age. Foveal RPE cells were significantly more dense and more hexagonal in eyes from younger donors. Loss of hexagonality in the fovea, but not elsewhere, was correlated with increasing age. As the eye ages, foveal RPE cells selectively lose unique morphologic characteristics and resemble nonfoveal cells. These morphologic changes resemble other pathologic features of age-related degeneration in their proclivity for the fovea and posterior pole.

Spatial geometry of the dopamine innervation in the avascular area of the human fovea

The dopamine (DA) innervation, labeled by tyrosine hydroxylase immunohistochemistry in a wholemounted human retina, is described in the avascular area of the fovea. Eleven DA neurons give rise to this innervation, among which five are interplexiform cells, so that the DA innervation consists of two plexuses: one is internal and is formed by the dendrites of all of the DA cells, and the other is external and is formed by the scleral processes of the interplexiform cells. Five concentric zones are delineated according to the focal plane in which the internal DA plexus is observed. The central zone 1 contains DA processes crossing in all directions. Zones 2 and 3 do not contain any cell bodies. In zone 3 the internal plexus begins to undergo a concentric arrangement, which is clearly observed in zones 4 and 5. The external DA innervation displays a different appearance in zones 1, 2, and 3, in which it consists of vertically oriented thin processes and terminals penetrating the outer nuclear layer, vs. zones 4 and 5 in which it consists of both the same type and horizontal processes lying in the outer plexiform layer. On the basis of DA-innervation appearance and distribution of labeled and unlabeled cell somata, it was concluded that zones 1, 2, and 3 contained the DA innervation of the foveola. DA processes filtering between photoreceptor cells are particularly well-observed in this region. This anatomical study of the DA innervation in the human fovea leads to a better understanding of the important role of DA in primate central vision and can be used as a reference for an approach of macular pathology.

Retinal densitometry in acute posterior multifocal placoid pigment epitheliopathy

Cone photopigment kinetics were investigated by retinal densitometry in six patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Our goal was to document the course of cone impairment during a period of at least 12 months following the onset of the disease process. During the active stage, we found that the amount of pigment measurable by densitometry (the density difference) was reduced and that the time constant of pigment regeneration was unmeasurable. Following resolution of the fundus lesions, the densitometric parameters gradually improved in eight of ten eyes. In patients who maintained foveal fixation (five eyes), the density difference and the time constant of pigment regeneration improved simultaneously, though with individual differences in time course. Photopigment kinetics returned to normal in all these patients but the density difference remained lower than normal in four of the five eyes. In patients with parafoveal fixation (five eyes), photopigment kinetics were slow, possibly reflecting mixed cone and rod contributions. With time, the density difference improved to a level comparable to that measured in normal observers at a similar retinal location, but the photopigment regeneration time constant remained abnormal or unmeasurable. Recovery was variable, with one eye changing from parafoveal to foveal fixation, and no improvement noted in two eyes with extreme parafoveal fixation. Our findings demonstrate a large interpatient variation associated with APMPPE.

Central sparing in annular macular degeneration

Using fluorescein angiography and monochromatic photography, we measured the size of the central sparing in 45 patients with annular maculopathy (mean +/- S.D., 0.34 +/- 0.15 disk diameter; range, 0.10 to 0.65 disk diameter) and compared it with the size of macular yellow pigment in 40 subjects (mean +/- S.D., 0.31 +/- 0.12 disk diameter; range, 0.1 to 0.5 disk diameter). The close approximation of these values suggested that macular yellow pigment contributed to the annular pattern through a photoprotective mechanism.

Specific binding of peanut agglutinin to foveal and peripheral cone photoreceptors of monkey retina

peanut agglutinin, a lectin with specific affinity for galactose beta-(1----3)-N-acetyl-galactosamine disaccharides, showed binding to the slender cones in the rod-free fovea as well as to the conical cones in the periphery of the monkey (Macaca fuscata) retina, but not to the rods, as revealed by light-microscopic cytochemistry with horseradish-peroxidase-conjugated lectin.

Density of foveal cone pigments at older age

We investigated foveal cone photopigment kinetics by retinal densitometry in 34 eyes of 29 healthy subjects with clear optical media and good visual acuity, ranging in age from 39 to 79 years. Our aim was to assess possible senile disturbances of foveal cones. To assess the effects of ocular straylight, we measured not only in subjects with a clear crystalline lens, but also in pseudophakia and aphakia. In a limited number of subjects color vision was assessed with a Nagel anomaloscope; no systematic changes with age were found. A significant decrease in two-way density and in time constant of regeneration was found to occur only after age 60, with large individual variations. There was no indication that results for subjects with their natural crystalline lens, in aphakia, or in pseudophakia were different. We argue that a reduction in the number of cones with age, rather than an increase in ocular stray light is the most likely explanation of our findings.

Foveal cone pigments and sensitivity in young patients with Usher's syndrome

Psychophysical and reflection retinal densitometric techniques were used to investigate foveal function of three patients (ages 14, 16, and 19 years) with Usher's syndrome who had good central visual acuity and, by ophthalmoscopic examination, normal foveal areas. During dark adaptation foveal sensitivity and its relation to proportion of cone pigment present were normal, but the kinetics of regeneration of the pigments were markedly abnormal. Measurements were made to consider the possibilities that the disorders of regeneration were associated with altered light-catching capacities of the patients' cone pigments, deranged transport of visual cycle substances between the retinal pigment epithelium and photoreceptors, or lingering photoproducts. None of the mechanisms fully accounted for the observed kinetics. The results suggested that abnormal kinetics of regeneration are among the earliest signs of malfunction of the foveal photoreceptor-pigment epithelial complex in some of the retinal degenerative disorders.

Foveal densitometry in central serous choroidopathy

We evaluated foveal cone photopigment kinetics by retinal densitometry in 14 patients (12 men and two women, ranging in age from 30 to 54 years) with central serous choroidopathy. At the initial examinations when 12 of the 14 patients showed active leaks, the measured two-way density of pigment was low and the time-course of regeneration was slow. At later examinations, we found low two-way densities with normal regeneration times in five patients without active leakage. Near normal two-way densities occurred only in three patients who had complete clinical recoveries.