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

PURPOSE: Carriers of X-linked retinitis pigmentosa (XLRP) frequently show prolonged implicit times of the flicker electroretinogram (ERG). This study tested the hypothesis that a preferential response attenuation within the cone depolarizing (ON) bipolar cell (DBC) pathway is a major contributing factor. METHODS: Light-adapted, full-field ERGs were recorded from 10 XLRP carriers and 12 visually normal control subjects. Fundamental amplitudes and phases of ERG responses to sinusoidally flickering stimuli at temporal frequencies ranging from 8 to 96 Hz were analyzed within the framework of a recent vector summation model of the cone system ERG to test for evidence of a response attenuation within the DBC pathway. In addition, ERG responses to sawtooth flicker were examined for a reduced b- to d-wave amplitude ratio, indicative of ON pathway dysfunction. RESULTS: The carriers' fundamental response phases at 32 Hz correlated significantly with their log ratios of response amplitudes at 32 versus 12 Hz (r = 0.89, P < 0.001) and with their log b- to d-wave amplitude ratios (r = 0.71, P < 0.05), both of which were used as indices of response attenuation within the DBC pathway. A control experiment demonstrated that a reduced sensitivity of cone phototransduction made at most only a minimal contribution to the timing changes in the carriers' flicker ERG responses. CONCLUSIONS: The overall pattern of results indicates that a preferential response attenuation within the DBC pathway is the primary source of timing changes in the flicker ERGs of these carriers of XLRP. These findings illustrate the value of analyzing ERG responses to flickering stimuli at multiple temporal frequencies to evaluate mechanisms of disease action in photoreceptor degenerations.     

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

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

Harmonic analysis of the cone flicker ERG of rabbit

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

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

PURPOSE: Individuals with X-linked retinoschisis (XLRS) show a comparatively greater reduction of the ON response than the OFF response of the electroretinogram (ERG) of the cone system. At high temporal frequencies, they also show a marked attenuation of the flicker ERG that has been attributed to an abnormal cone photoreceptor response. The purpose of this study was to determine whether the high-frequency response attenuation contributes to the abnormal ERG ON response in XLRS. METHODS: Light-adapted ERGs were recorded from three patients with XLRS and from three control subjects, by using rapid-on and rapid-off sawtooth flicker to emphasize ON and OFF responses, respectively, and by using low-pass sawtooth flicker, from which the high temporal frequencies had been removed to mimic the high-frequency attenuation in XLRS. RESULTS: For the control subjects, removing the high stimulus frequencies reduced the amplitude of the b-wave component of the ON response but had little effect on the amplitude of the d-wave component of the OFF response. In the patients with XLRS, the b-wave component of the ON response was already diminished using the full sawtooth stimulus, and removing the higher stimulus frequencies had no further effect. Patients' ERG responses to the 16-Hz stimulus fundamental alone were also abnormal, in that an initial response component normally present in the ERG was absent. CONCLUSIONS: The overall pattern of findings indicates that two factors contribute to the preferential ON-response deficit in XLRS: first, a high-frequency attenuation of the cone photoreceptor response that effectively produces a low-pass stimulus for the postreceptoral pathway and that affects the ON response more than the OFF response and, second, a relatively greater attenuation of the ON- than of the OFF-bipolar cell response that is evident in the aberrant response to the sawtooth fundamental.     

正常人闪烁光视网膜电图和闪烁光视诱发电位的定量分析

目的探讨闪烁光视网膜电图和闪烁光视诱发电位在正常人的变化规律。方法记录51例正常人10Hz闪烁光VEP和30Hz同陈光ERG，使用离散富里叶法分析波形的振幅和相位。结果应按20岁以下组、20～40岁组和40岁以上组对正常入进行记录。10Hz闪烁光VEP基波、二次谐波的振幅，二次谐波的相位，30Hz闪烁光ERG基波的振幅和相位是分析的主要指标。结论闪烁光视网膜电图和闪烁光视诱发电位能进一步分离视锥细胞功能，对视功能进行更好评价。     

Clinical electrophysiology of two rod pathways: normative values and clinical application

BACKGROUND: The scotopic 15-Hz flicker electroretinogram (ERG) has two limbs (slow and fast ERG rod signals), and these have been attributed to two retinal rod pathways (the ON rod bipolar and AII amacrine pathway and the rodcone gap-junction pathway). The aim of this study was to provide normative values of the scotopic 15-Hz flicker ERG, to estimate the inter-individual variability, and to apply this method to a clinical setting. METHODS: Twenty-two normal subjects, one patient with retinitis pigmentosa (RP), and two patients with Stargardt's mascular dystrophy (SMD) participated in the study. The SMD patients were screened for mutations in the 50 exons of the ABCA4 (formerly ABCR) gene. We measured ERG response amplitudes and phases to flicker intensities ranging from -3.37 to -0.57 log scotopic trolands s at a flicker frequency of 15 Hz. RESULTS: The normal scotopic 15-Hz flicker ERG showed a biphasic amplitude pattern with a minimum at about-1.57 log scotopic trolands s, where there was an abrupt phase shift of about 180 deg. The inter-individual variability in ERG amplitude ranged from 47% to 67% for the slow and from 41% to 64% for the fast rod signal. Both the RP patient and the SMD patients (who were compound heterozygotes for mutations in the ABCA4 gene) showed reduced amplitudes for the two rod ERG pathways. CONCLUSION: The inter-individual variability might be explained by anatomical differences between individual retinae. In the RP patient, the amplitude reductions corresponded well with the standard rod ERG. In the SMD patients, however, the scotopic 15-Hz flicker ERG revealed rod dysfunction, whereas the standard rod ERG was within normal limits. The scotopic 15-Hz flicker method may be more sensitive than the standard rod ERG.     

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

Purpose Under certain conditions, the full-field flicker electroretinogram (ERG) of the cone system can show period doubling, such that the shape of the ERG waveform alternates from cycle to cycle. The purpose of this study was to determine the relationship between stimulus temporal frequency and the amplitudes of the spectral components of the ERG that correspond to period doubling. Method ERGs were recorded from 10 visually normal subjects in response to full-field sinusoidal flicker presented at frequencies ranging from 12.5 to 100 Hz. Period doubling was apparent over the stimulus frequency range from 25 to 100 Hz and was quantified in terms of the amplitudes of spectral components of the ERG waveform that corresponded to half the stimulus frequency (f/2) and three and five times that frequency (3f/2 and 5f/2). Results At stimulus frequencies between 30 and 40 Hz, the amplitude of f/2 was significantly lower than either 3f/2 or 5f/2, which themselves did not differ significantly. At stimulus frequencies between 40 and 60 Hz, all three response components were equivalent in amplitude. At stimulus frequencies above 60 Hz, however, the amplitudes of 3f/2 and 5f/2 were reduced significantly compared to f/2. Conclusion There is a frequency-dependent relationship among the spectral components of the flicker ERG that correspond to period doubling. The amplitude of f/2 underestimates the magnitude of period doubling at stimulus frequencies between 30 and 40 Hz, whereas the amplitudes of 3f/2 and 5f/2 underestimate the degree of period doubling at stimulus frequencies above 60 Hz. The explanation for the frequency dependence of these spectral components remains to be resolved.     

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

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

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

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

Effect of contrast on the frequency response of synchronous period doubling

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

Analysis of photoreceptor function and inner retinal activity in juvenile X-linked retinoschisis

Thirteen retinoschisis males with genotyped XLRS1 gene mutations were examined by electroretinogram (ERG) techniques to determine photoreceptor involvement and ON-pathway and OFF-pathway sites of dysfunction. Parameters R(max) and logS determined by fitting the mathematical model of the activation phase of phototransduction to the scotopic and photopic a-wave responses, were not significantly different from normal. However, the XLRS photopic a-wave amplitudes were significantly lower than normal across all intensities, consistent with defective signaling in the OFF pathway. Long flash (150 ms) ON-OFF photopic responses showed reduced b-wave amplitude but normal d-wave amplitude, giving a reduced b/d ratio of <1.32 Hz photopic flicker ERG fundamental frequency responses showed reduced amplitude and delayed phase, consistent with abnormal signaling by both the ON- and OFF-pathway components. These results indicate that the XLRS1 protein appears not to affect photoreceptor function directly for most XLRS males, and that ERG signaling abnormalities occur in both the ON- and OFF-pathway components that originate in the proximal retina.     

Vitamin A Deficiency Modifies the mfERG: A Case Study of Rod Influence on the mfERG

We report an observational case study which showed that the rod pathway may have a significant effect on the multifocal electroretinogram (mfERG). A 68-year-old lady diagnosed with Vitamin A deficiency underwent standard ERG and mfERG. ERG rod and cone function were analysed and the first order mfERG responses were determined. At presentation, there was no demonstrable rod function on ERG testing and normal cone function. mfERG P1 amplitude responses were normal but mfERG P1 latency responses were significantly delayed. Four weeks after initiating treatment with intramuscular Vitamin A, ERG rod function significantly improved. However, cone amplitude was reduced and the 30 Hz flicker latencies decreased. Furthermore, mfERG P1 latency returned to normal and interestingly mfERG P1 amplitude responses showed a significant reduction. These results alter our understanding of the mfERG response by indicating that there is a possible inhibitory influence on mfERG responses from rod pathway systems.     

Flicker electroretinogram in retinitis pigmentosa

Electroretinograms (ERGs) were recorded as a function of flicker frequency from 5 to 50Hz for 14 retinitis pigmentosa (RP) patients, 12 normal subjects and 1 rod monochromat. Data were analyzed by measuring the angular position of the response maximum, i.e. the phase, as a function of pulse-train frequency. Flicker ERGs obtained from the RP patients showed non-linear, frequency-dependent phase shifts when compared to the normal data. These phase shifts were simulated in a normal observer by attenuating the stimulus luminance by 1 log unit. However, the shape of the waveforms recorded from the normal differed markedly from those recorded from the RP patients. The differences, but not the ratios of the times-to-peak of the positive and negative ERG wavelets were longer in the RP patients than in the normal. These data suggest that the temporal anomalies in the RP flicker ERG are most likely due to changes in the amplitudes and time constants of the ERG components, and not simply to a reduced quantum catch or photoreceptor loss.Supported by research and core facility grants from the National Institutes of Health (EY-01791 and EY-01765)     

Isolated mesopic rod and cone electroretinograms realized with a four-primary method

The purpose of this study was to evaluate the feasibility of measuring rod and cone electroretinograms (ERGs) at a single mesopic adaptation level. To accomplish this, a four-primary photostimulator was implemented using a commercially available ERG system (Diagnosys ColorDome) to generate three types of stimuli that temporally modulated rods alone, cones alone, and rods and cones simultaneously. For each stimulus type, ERGs were recorded as a function of temporal frequency (2, 4, 8, or 16 Hz) and mesopic light levels (0.02, 0.16, or 1.26 cd/m²) in normal observers and patients with retinitis pigmentosa (RP) or cone–rod degeneration. The normal observers ERG waveforms showed a clear periodic pattern, mirroring the sinusoidal stimuli. At all light levels, rod responses were always higher than cone responses for temporal frequencies between 2 and 8 Hz, suggesting that rods dominated the responses. Cone responses were minimal at the lowest light level and increased with increases in light level. The amplitude of the response to the combined stimuli was intermediate between that of the isolated cone and the isolated rod stimuli for all light levels. Good receptoral isolation was confirmed by the results showing (1) minimal or no rod ERGs but recordable cone ERGs in the patients and (2) high correlation between the ERG amplitudes obtained from the four-primary method and those from the ISCEV standard clinical protocol in normal observers.     

Slow and fast rod ERG pathways in patients with X-linked complete stationary night blindness carrying mutations in the NYX gene

PURPOSE: To study the slow and fast rod signals of the scotopic 15-Hz flicker ERG in patients carrying mutations in the NYX gene, which has been recently identified as the cause of the complete form of congenital stationary night blindness, CSNB1. METHODS: Twenty eyes of 11 patients with CSNB1 who had nondetectable standard ERG rod b-waves were involved in the study. Scotopic ERG response amplitudes and phases to flicker intensities ranging from -3.37 to -0.57 log scotopic trolands. sec (scot td. sec) were measured at a flicker frequency of 15 Hz. ERG signals to flicker intensities between -3.37 and -1.97 and between -1.17 and -0.57 log scot td. sec were considered to represent primarily the slow and fast rod ERG pathway, respectively. Additionally, standard ERGs were performed. Twenty-two normal volunteers served as control subjects. RESULTS: For the slow rod ERG pathway, all patients exhibited ERG signals that were indistinguishable from noise. Accordingly, there was no systematic phase behavior for the slow rod signals. For the fast rod ERG pathway, the signals were significantly above noise, but they were significantly reduced in amplitude and advanced in phase. CONCLUSIONS: There is evidence that the slow and the fast rod ERG signals can be attributed to the rod bipolar-AII cell pathway and the rod-cone-coupling pathway, respectively. The current study provides evidence to suggest that a defective NYX gene product (nyctalopin) prevents detectable signal transmission through ON rod bipolar cells, but there is a residual transmission through rod-cone gap junctions in CSNB1, possibly through the OFF cone pathway.     

Photopic 30 Hz flicker ERG as a predictor for rubeosis in central retinal vein occlusion

AIMS: To investigate the predictive value of the cone b-wave implicit time in the photopic compared with the scotopic 30 Hz flicker ERG for rubeosis in central retinal vein occlusion. METHODS: 44 patients with a central retinal vein occlusion were examined with full field electroretinogram (ERG). RESULTS: The average implicit time in the photopic 30 Hz flicker ERG in patients who developed rubeosis (n=15) was 38.3 ms. In the patients who did not develop rubeosis (n=29) it was 31.3. The difference is statistically significant (p=0.0000000004). CONCLUSION: The photopic cone b-wave implicit time in the 30 Hz flicker ERG is a good predictor for rubeosis.     

Temporal resolution and temporal transfer properties: gabaergic and cholinergic mechanisms

Temporal resolution is a basic property of the visual system and critically depends upon retinal temporal coding properties which are also of importance for directional coding. Whether the temporal coding properties for directional coding derive form inherent properties or critically depend upon the temporal coding mechanisms is unclear. Here, the influence of acetylcholine and GABA upon photopic temporal coding was investigated in goldfish, using flicker stimuli, in a behavioral and an electrophysiological (ERG) approach. The goldfish temporal resolution ability decreased from more than 90% correct choices at 20 Hz flicker frequency to about 65% at 45 Hz flicker frequency with a flicker fusion frequency of approximately 39 Hz. Blockade of GABAa-receptors reduced the flicker fusion frequency to about 23 Hz, not affecting temporal resolution below 20 Hz flicker frequency. Partial blockade of nicotinic acetylcholine receptors reduced the flicker fusion frequency slightly and lowered the temporal resolution ability in the 25-30 Hz range. Blockade of muscarinic acetylcholine receptors had a smaller effect than the partial blockade of nicotinic acetylcholine receptors. In ERG-recordings, blocking GABAa-receptors increased the a- and b-wave amplitude, induced a delay, an increase and a slow fall-off of the d-wave. Blocking GABAc-receptors had little effect. Blocking GABAa- or GABAa/c-receptors changed the temporal resolution, when expressed as a linear filter, from a 3rd degree filter with resonance to a low order low-pass filter with a low upper limit frequency. The temporal transfer properties were barely changed by blocking either nicotinic or muscarinic acetylcholine receptors, although ERG-components increased in amplitude to varying degrees. The behavioral and electrophysiological data indicate the important role of GABA for temporal processing but little involvement of the cholinergic system. It is proposed that the interaction of the GABAergic amacrine cell network and bipolar cells determines the gain of the retinal temporal coding in the upper frequency range.     

Infliximab exerts a dose-dependent effect on retinal safety in the albino rabbit

Purpose

To study whether the ERG and other clinical findings help to distinguish between advanced hydroxychloroquine (HCQ) retinopathy and pericentral or diffuse retinitis pigmentosa (RP) with similar fundus appearance.

Methods

We conducted a retrospective analysis of patients with advanced HCQ retinopathy (n = 11), pericentral RP (n = 8) and diffuse RP (n = 8). Pericentral RP was defined as having limited fundus damage and relatively normal flicker ERG time-to-peak. Diffuse RP had typical loss of the rod ERG and flicker timing delay. All patients showed reduced amplitude of the ISCEV responses in the full-field electroretinogram (ERG). Aspects of history, visual field results, fundus appearance, fundus autofluorescence and ocular coherence tomography were also compared.

Results

Relative to pericentral RP, patients with HCQ toxicity showed delayed flicker ERG time-to-peak and lower ERG amplitudes, particularly combined rod–cone responses. Relative to diffuse RP, most HCQ toxicity patients had some preserved rod ERG response, and there was no obvious predilection for rod over cone damage. In addition, patients with HCQ toxicity usually lacked markers of long-standing degeneration such as bone spicule figures or severe loss of peripheral field. History of familial disease and long-standing night blindness were specific to RP.

Conclusions

While the early signs of HCQ damage are typically regional in the posterior pole, advanced disease is characteristically diffuse (unlike pericentral RP). This is appropriate for a systemic toxin, as is the finding that rods and cones were both affected in the ERG to a similar degree (unlike genetic rod–cone dystrophies). For patients with severe HCQ exposure and some of our discriminatory findings, and no family history or prior night blindness, HCQ toxicity is a sufficient diagnosis without invoking a second rare disease (Occam’s razor).

     

Association of electroretinogram and morphological findings in branch retinal vein occlusion with macular edema

The objective of this study is to evaluate the relations among electroretinogram parameters (cone a-wave, cone b-wave, and 30-Hz flicker), retinal thickness, and retinal volume in patients with branch retinal vein occlusion (BRVO) and macular edema. We prospectively examined 33 patients (33 eyes) with BRVO and macular edema. The amplitude and implicit time of the a-wave cone, b-wave cone, and 30-Hz flicker were calculated automatically from the ERG. Retinal thickness and volume were measured by optical coherence tomography (OCT) in nine macular subfields. Then, correlations between the ERG parameters and morphological parameters were analyzed. The 30-Hz flicker amplitude was significantly smaller in the eyes with BRVO and macular edema than in the unaffected contralateral eyes. Thirty-hertz flicker and cone b-wave implicit times were significantly longer in the eyes with macular edema than in the unaffected eyes. The implicit time of the cone b-wave was correlated with both retinal thickness and retinal volume in the temporal subfields. Thirty-hertz flicker amplitude was correlated with both retinal thickness and volume in the temporal and superior outer (site of occlusion) subfields, while 30-Hz flicker implicit time was correlated with retinal thickness and volume in the outer temporal subfield. Multiple regression analysis demonstrated that the retinal thickness and volume of the temporal subfields were significant “determinants” of the implicit time for the cone b-wave and 30-Hz flicker, as well as the 30-Hz flicker amplitude. These findings suggest that OCT parameters of the temporal region may reflect postreceptoral cone pathway function in BRVO patients with macular edema.     

Predominant loss of the photopic negative response in central retinal artery occlusion

PURPOSE: To determine how the photopic negative response (PhNR) is affected in central retinal artery occlusion (CRAO). DESIGN: Observational case series. METHODS: Seven patients with unilateral CRAO were included. Full-field scotopic and photopic electroretinograms (ERGs) including the PhNR were recorded. Each ERG amplitude in the affected eye was expressed as a percentage of amplitude of the corresponding wave in the unaffected eye. RESULTS: Mean of the PhNR amplitude was reduced to 12.3 +/- 11.7% of that of unaffected eyes whereas the cone b-wave amplitude was attenuated to only 73.4 +/- 30.4%. This reduction of the PhNR amplitude was more significant than that of other waves including the rod b-wave, maximum a-wave and b-wave, cone a-wave and b-wave, and 30 Hz flicker ERG (P <.005). CONCLUSIONS: The PhNR was severely affected in CRAO despite relative preservation of the cone b-wave, implicating massive loss of ganglion cells and their axons.