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Biomedical subjects

A E Elsner

Publications and source records attributed to A E Elsner.

At least 37 records · Page 2Linked to original sources
PubMed1996

Characteristics of exudative age-related macular degeneration determined in vivo with confocal and indirect infrared imaging.

PURPOSE: To evaluate the current and future interventions in age-related macular degeneration (AMD), it is essential to delineate the early clinical features associated with later visual loss. The authors describe the retinal pigment epithelium (RPE)/Bruch membrane region in ten patients with advance exudative AMD using current angiographic techniques and a noninvasive method: infrared (IR) imaging with the scanning laser ophthalmoscope. METHODS: Ten patients with exudative AMD, evidence by choroidal neovascularization (CNV), fibrovascular scar formation, pigment epithelial detachment, or serous subretinal fluid,were examined using IR imaging, fluorescein angiography, indocyanine green angiography, and stereoscopic viewing of fundus slides. The authors determined the number and size of drusen and subretinal deposits and the topographic character of the RPE/Bruch membrane area and of CNV. RESULTS: In all patients, IR imaging yielded the greatest number of drusen and subretinal deposits. Sheets of subretinal material, but few lesions consistent with soft drusen, were seen. Infrared imaging provided topographic information of evolving CNV. Choroidal neovascularization appeared as a complex with a dark central core, an enveloping reflective structure which created a halo-like appearance in the plane of focus, and outer retinal/subretinal striae. CONCLUSIONS: Infrared imaging provides a noninvasive, in vivo method to image early changes in the RPE/Bruch membrane. It offers advantages over current imaging techniques by minimizing light scatter through cloudy media and enhancing the ability to image through small pupils, retinal hyperpigmentation, blood, heavy exudation, or subretinal fluid. It provides additional information regarding early CNV, and the character of drusen and subretinal deposits.

Aged↗
PubMed1996

Response of the retina at low temporal frequencies.

We investigated the low-frequency temporal response of the retina by measuring the corneal electroretinogram elicited by flickering lights. A sum of two temporal sine-wave modulations was used to generate difference frequencies between a 36-Hz standard stimulus and a series of low-frequency stimuli. The response of the retina at the difference frequency did not change as the low-frequency component of the stimulus was varied from 0.5 to 4 Hz. We also replicated an earlier study, stimulating the retina with a sum of two sine waves that were varied in average frequency but keeping the difference frequency constant. These data showed no change in the amplitude of the difference frequency as the average stimulus frequency was varied from 8 to almost 40 Hz. Taken together, the two sets of data support the notion that the in vivo early retinal response is low pass and extends without attenuation to frequencies greater than 30 Hz, in contrast to the sensitivity of the visual system measured by psychophysical techniques.

Adaptation, Ocular↗
PubMed1996

Angioscotometry with the scanning laser ophthalmoscope. Comparison of the effect of different wavelengths.

PURPOSE: Angioscotomas are scotomata caused by vessel shadows. Their extent may be influenced by physiological and pharmacologic conditions and disease. In this study, the authors quantified angioscotomas in normal subjects using a fundus perimetry technique with a scanning laser ophthalmoscope. They further investigated the influence of two different wavelengths on scotoma depth. METHODS: For blue-on-yellow perimetry, the authors used two different lasers--an argon laser (lambda = 458 nm) for stimuli and a low background and a HeNE (lambda = 594 nm) for a superimposed yellow background. For red-on-red perimetry, the authors used another HeNe laser (lambda = 633 nm). Fundus illumination was provided by an infrared light. Five healthy subjects were examined. Twenty-one to 24 stimuli (200 msec duration, 0.4 degree x 0.4 degree) were presented at different intensities in randomized order in a 5 degrees x 2.5 degrees retinal test field, directly inferior and adjacent to the disk. RESULTS: The depth of scotomas caused by major vessels varied in all subjects and depended on perimetry condition. To quantify the influence of vessels on sensitivity, the authors analyzed psychometric functions for stimuli projected on the vessels and for those far from the vessels. The authors found a significant difference for targets on the vessel compared to those far, which was more pronounced for the blue-on-yellow condition. CONCLUSIONS: Angioscotomas are detected better with blue targets on a yellow background than with red-on-red perimetry. The greater light absorption by hemoglobin and oxyhemoglobin at short wavelengths compared to longer wavelengths is not compensated for by visual mechanisms.

Adult↗
PubMed1995

Effects of flicker adaptation and temporal gain control on the flicker ERG.

The flicker electroretinogram (ERG) to stimuli varying in temporal frequency and modulation depth was recorded to investigate retinal gain control. With increasing modulation of a sinusoidal flickering stimulus, the flicker ERG shows an amplitude compression and a phase retardation (of the fundamental component) at 16 Hz, an amplitude expansion and a phase advance around 40-48 Hz, and an approximately linear response at 72 Hz. With sum-of-two-sinusoids stimuli, the second stimulus enhances the fundamental response to a 40 or 48 Hz test stimulus at low modulations, and reduces the variation in phase with modulation. This interaction depends primarily on the amplitude of the response to the second stimulus, but not its frequency. With temporally alternating stimuli, a similar but smaller interaction effect is measured. The results suggest that there is an active nonlinear gain control mechanism in the outer retina and this gain control works by adjusting the phase delay of the retinal response. The phase control mechanism is set by the amplitude of the outer retinal response integrated over time.

Adaptation, Ocular↗
PubMed1995

Extinction during time controlled direct retinal stimulation after recovery from right hemispheric stroke.

The temporal variables of extinction in two patients with right hemispheric stroke and two normal controls were studied using a scanning laser ophthalmoscope (SLO). This instrument enabled eye movements to be controlled for by projecting time controlled stimuli directly on to the retina. Both patients had recovered from their stroke (four months and five years) and seemed clinically normal. At 50 ms, patient 1 extinguished one of two stimuli on seven of 40 double simultaneous stimulation (DSS) trials (five left, two right) and patient 2 extinguished the left stimulus on every DSS trial. At 100 ms, patient 1 performed almost perfectly, whereas patient 2 extinguished on 30% of the DSS trials (10 left, two right). At 200 ms, patient 2 performed perfectly. Neither of the controls showed extinction to DSS at any presentation time. Thus detecting DSS was time dependent in the patients but not the normal subjects. These data support the theory that recovery from neglect after right hemispheric damage may be mediated by the left hemisphere.

Adult↗
PubMed1995

Direct measurement of human-cone-photoreceptor alignment.

We have developed an imaging reflectometer to measure cone-photoreceptor alignment. One makes measurements by bleaching the cone photopigment and imaging the distribution of light returning from the retina, which is illuminated from a small source imaged in the plane of the eye's pupil. If the source is near the optimal entry pupil position as determined psychophysically, the distribution of light returning from the retina is peaked, and the magnitude of the peak depends on the location of the source in the pupil of the eye. If the source is far from the optimal entry pupil position, then there is no measurable peak. The location of the peak varies across individuals and coincides with the reported location of best visibility of the measuring light and with previous psychophysical and reflectometric measurements of the Stiles-Crawford peak. The source of this directionality must arise either from the photoreceptors or from behind the photoreceptors because the peak is not present if measurements are made when the cone photopigments have high optical density.

Adult↗
PubMed1995

Digital imaging of central serous retinopathy using infrared illumination.

When used with an infrared laser, scanning laser technology allows imaging of subretinal structures. In the indirect mode (scattered light), drusen, subretinal edema, and other changes in the retinal pigment epithelial complex can easily be visualized as pseudoprominent structures. This study was undertaken to determine the role of infrared imaging in central serous retinopathy. A total of 22 patients affected by acute central serous retinopathy were recruited for the study. All patients underwent fluorescein angiography (488 nm) and infrared imaging (788 nm) using a scanning laser ophthalmoscope (SLO 101; Rodenstock). The confocal mode was used for the fluorescein angiography, but the indirect mode was applied for infrared imaging. In all patients, serous detachment could be visualized by infrared imaging as pseudoprominent, oval-shaped structures. The size was at least one disk diameter and correspondend very well to the clinical appearance. In all patients, late-phase (20 min) fluorescein studies revealed the typical focal leakage with progressive hyperfluorescence. In six patients (27%) the extent of the serous detachment could be seen in a slightly hyperfluorescent rim. Digital image analysis showed that the extent of the serous detachment in the fluorescein angiogram was similar to the size of the thickened structures in the infrared image (r2 = 0.94). This initial study suggests that noninvasive infrared imaging can be a very useful indicator of serous detachment. Further studies regarding the influence of medical or laser treatment must be carried out to prove the clinical relevance.

Acute Disease↗
PubMed1995

Indocyanine green angiography in traumatic choroidal rupture: clinicoangiographic case reports.

Blunt trauma to the eye can cause choroidal ruptures. Often localization is obscured by hemorrhages, edema, and pigmentary changes. The use of indocyanine green (ICG) angiography to supplement fluorescein angiography in visualizing retinal and choroidal tissues was investigated. Three patients with acute traumatic choroidal ruptures received a retinal examination, including fluorescein and ICG angiography study. Choroidal ruptures were well localized in ICG angiograms in both early and late phases. In fluorescein angiograms, the defects were underestimated in early phases and overestimated in the later phases. In one patient with severe traumatic changes, ophthalmoscopy and fluorescein angiography identified all superficial splits, whereas ICG angiography readily detected deeper changes as well. ICG angiography is helpful in diagnosis major and minor ruptures of the choriocapillaris and the choroid, in defining the extent of traumatic ruptures, and in furthering the understanding of the pathology of traumatic ruptures, and in furthering the understanding of the pathology of traumatic tears.

Adolescent↗
PubMed1995

Quantification of cystoid changes in diabetic maculopathy.

PURPOSE: In patients with diabetic macular edema and cysts, quantification of the extent of the cystoid formation has been difficult. This study was performed to introduce reliable measurements of cysts, the quantification of the extent, and its relation to visual acuity. METHODS: Fluorescein angiography generated with a scanning laser ophthalmoscope provided detailed recognition not only of the foveal microvasculature, but also of well-demarcated cystoid formations in the early phases. The sampling area included the central 2.5 degrees of the fovea. Using digital image analysis, two independent observers estimated the area covered by cysts, the number of cysts, and the foveal avascular zone (FAZ). RESULTS: Twenty-three subjects with diabetes and macular cysts were enrolled in the current study. The mean area of the cysts was 0.315 +/- 0.241 mm2 (0.05 mm2 to 0.9 mm2), and the number of cysts ranged from 1 to 7. Both parameters, area of cysts (r2 = 0.61), and number of cysts (r2 = 0.48) showed a significant correlation with visual acuity (P < 0.01), whereas FAZ (0.08 to 0.58 mm2) showed no significant correlation with visual acuity. CONCLUSIONS: Fluorescein angiography allows a reproducible quantification of the extent of macular cysts. The relation of visual acuity to the number of cysts and to the area covered by the cystoid formation is highly significant. Thus, both these measures can provide an objective criterion for the estimation of visual prognosis and an outcome for evaluation therapy techniques.

Adult↗
PubMed1994

Indocyanine green video angiography in patients with age-related maculopathy-related retinal pigment epithelial detachments.

Previous studies have stressed the benefit of laser photocoagulation for patients with age-related macular degeneration (AMD) and well-defined subretinal neovascularization (SRN). However, such lesions account for only 30% of cases with exudative age-related maculopathy. Especially in patients with retinal pigment epithelial detachment (PED), SRN is usually occult. This study was performed to reveal the role of digital indocyanine green (ICG) video angiography in the diagnosis of SRN in patients with PED. A total of 34 patients with AMD-associated retinal PED participated in the current study and underwent fluorescein and ICG angiography using scanning laser ophthalmoscopy. In these patients fluorescein angiography revealed no distinct SRN, whereas in 21 eyes (62%) ICG angiography showed well-demarcated choroidal neovascularization. The present study demonstrates that SRN can be detected in more than 50% of patients with PED by means of ICG video angiography. Therefore, ICG video angiography improves the detection of SRN in patients with AMD-associated PED.

Aged↗
PubMed1993

Mapping cone photopigment optical density.

The distribution of cone photopigment across the retina affects the amount of light captured by cones at each retinal location. Cone photopigment optical density is measured in two ways, with reflectometry and/or with color matching. Color matching measures a higher optical density than does reflectometry. Control experiments confirm that large-field color matches measure photopigment optical density toward their outer edge. There is qualitative agreement as to photopigment distribution from both techniques near the fovea. Beyond 1 deg, color matching indicates little decrease in photopigment with increasing eccentricity, whereas retinal densitometry shows a steep decline in photopigment. The decrease in perifoveal optical density measured with reflectometry is attributed to the decrease in cone coverage from fovea to perifovea as rods and interphotoreceptor spaces increase. Differences among subjects in photopigment distribution near the fovea, measured with both techniques, reflect differences in the specialization of the foveal center for cone length and/or photopigment concentration per cone, which are factors influencing results from both techniques.

Adult↗
PubMed1993

Color matching at high illuminances: photopigment optical density and pupil entry.

Changes in the effective optical density of the cones are sufficient to explain changes in color matches with retinal illuminance and pupil entry. We performed three experiments. In the first experiment, six observers made color matches under both bleached and unbleached conditions to a series of six standard wavelengths. The effects of bleaching could be modeled by a decrease in optical density of the L and M cone photopigments. Slight spectral shifts in the peak wavelengths of the photopigments were required for different observers. In the second experiment we varied retinal illuminance of the color-matching field from 2.4 to 5.4 log Td for a series of long-wavelength primaries. The shape of the color match versus the intensity function was unchanged by the wavelength composition of the matching field. In the third experiment we measured the change in color match with retinal illuminance for different pupil entry positions. At low luminances there was a marked dependence of the color match on pupil entry positions. At high illuminance there was only a small dependence. The half-bleach illuminance values varied as expected from the Stiles-Crawford I effect. We conclude that for wavelengths > 540 nm, changes in color matches with bleaching and pupil entry can be explained by changes in the effective optical density of the cones.

Adult↗
PubMed1992

Analysis of nonlinearities in the flicker ERG.

The electroretinogram (ERG) response to steadily flickering fields shows significant nonlinear components. These nonlinear components have been used to investigate the ERG. We find the following. (1) The fundamental retinal response can be recorded at frequencies greater than 100 Hz and the second and higher harmonic responses have measurable response frequencies as high as 200 Hz. Both the fundamental response component and the second harmonic response component have multiple local maxima as a function of frequency. (2) Measurement of the response of the retina to the sum of two sine waves indicates that there is an early low-pass temporal filter in the retina. This early filter has a cutoff frequency between 40 and 50 Hz. (3) The high frequency nonlinearity is not a compressive nonlinearity.

Electroretinography↗
PubMed1988

Aging and human cone photopigments.

We used a noninvasive technique to investigate changes in photoreceptor function with aging in observers 13-69 years of age. This technique, steady-state color matching, provides estimates of the optical density of cone photopigments, the illuminance that bleaches half of the photopigment, and the ratio of the primaries required at moderate light levels. In normal human retinas, we found that the optical density for a 4-deg field is affected minimally by aging from the second through the seventh decades. The average optical density is 0.27 +/- 0.054. The optical densities of older observers varied more than those of younger observers. The change in optical density with age is nonmonotonic, with slightly lower values for the youngest and oldest observers in our study. The retinal illuminance that bleaches half of the cone photopigment varied little across observers, averaging 4.37 log Td +/- 0.119. The change with age, which averages 0.00018 log Td per year over all observers, also is nonmonotonic. Moderate illuminance color matches did change with age, as expected, with a monotonic decrease with age in the ratio of the long-wavelength primary to the short-wavelength primary required for the color match.

Adolescent↗
PubMed1987

A psychophysical technique for measuring cone photopigment bleaching.

A new, clinically applicable test has been developed to measure the bleaching of the foveal cone photopigments. This noninvasive test is called steady-state color matching. Steady-state color matching is based on the dependence of a color match on the optical density of the cone photopigments. By measuring the color match as a function of retinal illuminance, it is possible to compute the optical density of the cone photopigments at each illuminance. Thus, abnormalities of photopigment bleaching can be detected. This study demonstrates that the technique is readily performed by a clinical population. Patients with central serous retinopathy and retinitis pigmentosa are shown to have low effective optical densities.

Adolescent↗
PubMed1987

Cone photopigment bleaching abnormalities in diabetes.

We have used a color-matching technique to obtain estimates of the optical density of cone photopigments as a function of retinal illuminance in patients with insulin-dependent diabetes mellitus (IDDM). We found that the half-bleach illuminance of some patients is abnormally high. That is, it takes more light to bleach an equivalent amount of photopigment in these patients. Since low illuminance color matches for these patients are normal, this implies that these patients have normal amounts of photopigment, but the photopigment is not bleaching normally. This result clearly points to abnormalities in the outer retina of these diabetic patients. The most likely causes of this abnormality are either decreases in the ability of the cones to absorb light, or an increased rate of regeneration of the cone photopigments.

Adolescent↗