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Biomedical subjects

G B Arden

Publications and source records attributed to G B Arden.

At least 19 recordsLinked to original sources

The pattern electroretinogram in glaucoma and ocular hypertension.

Thirty one eyes with established glaucoma, 61 high risk ocular hypertensive (OHTs) eyes, 66 medium risk OHT eyes, 58 low risk OHT eyes, and 47 control eyes have been followed for up to 2 years by clinical examination and pattern electroretinography (PERG). The study was 'masked' so electrophysiological and clinical data were kept separate. Criteria have been devised which enable PERG measurements to distinguish all established glaucomatous eyes from all normal controls; these criteria demonstrate abnormalities in some OHT eyes, particularly those at high risk. The PERG abnormality is greatest in eyes with established glaucoma in which the intraocular pressure has been lowered by treatment. The PERG becomes smaller as the degree of clinical abnormality increases. Test-retest variability of the PERG is sufficiently low to ensure that most of those first described as abnormal continue to be so.

Adult

Abnormal dark adaptation kinetics in autosomal dominant sector retinitis pigmentosa due to rod opsin mutation.

The time course of dark adaptation was measured in 10 subjects from three families with autosomal dominant sector retinitis pigmentosa (RP) due to mutations in the first exon of the rod opsin gene. In each subject cone adaptation and the early part of the recovery of rod sensitivity followed the normal time course, but the later phase of rod adaptation was markedly prolonged. The recovery of rod sensitivity is much slower than that reported in any other outer retinal dystrophy. Using a model based upon primate data of rod outer segment length and turnover, we have calculated that the delayed phase of the recovery of rod sensitivity in the RP patients tested following strong light adaptation could be due in part to formation of new disc membrane with its normal concentration of rhodopsin rather than in situ regeneration of photopigment.

Adolescent

Electrode comparison in pattern electroretinography.

In recent years, there has been great interest in recording the pattern electroretinogram (PERG) in glaucomatous and diabetic populations. The Dawson, Trick, and Litzkow thread electrode (DTLTE) and the gold foil electrode (GFE), commonly used for recording PERGs, were compared for variations in amplitude of response, test-retest variability, and patient comfort. Two study centers collected data on a total of 32 normal subjects. The subjects from the London center showed a slight (but not significant) preference for the DTLTE, and the Houston subjects also found the DTLTE to be significantly more comfortable (chi-square = 39, P less than 0.001). In both study groups, the GFE was found to produce a statistically larger amplitude of response than that obtained with the DTLTE. Significant differences were found regardless of the slow (transient, 3.1 Hz; F = 6.24; P = 0.0192) or fast (steady state, 8.3 Hz; F = 18.38; P = 0.0001) stimulus-presentation rate. Larger differences between the two electrodes occurred under steady-state conditions. Although there is no consensus as to the optimum recording conditions to obtain the subtle PERG, it appears the the GFE records larger responses than the DTLTE. However, test-retest data confirmed that the GFE records twice the amplitude of the DTLTE, and it also produced twice the variability (average percent difference over time for GFE, 15%; for DTLTE, 8%).

Adolescent

Nyctalopia with normal rod function: a suppression of cones by rods.

Twenty-nine patients with exaggerated rod-cone interaction are described. All were referred because they appeared to suffer from night blindness. ERG and EOGs were performed but were normal. However, investigation with a modified dark-adaptometry technique showed that in these patients cone flicker thresholds rise considerably more during dark adaptation than is normal, and this is sufficient to explain the symptoms. In one case, the condition appears familial. Many patients report their symptoms begin in early adult life and slowly get worse, but we have no objective evidence of progression.

Adult

Colour contrast sensitivity changes caused by peripheral retinal laser photocoagulation.

Macular phototoxicity is known to occur with laser use, and there is evidence that the wavelength of the light used influences this effect. In this study, a computer based colour contrast sensitivity test was used to assess the immediate macular effects of photocoagulation of peripheral flat retinal holes in otherwise normal retinas, using blue-green (488 and 514 nm), yellow (577 nm), orange (595 nm) or red (647 nm) laser light. The laser aiming beam was not allowed to traverse the macula at any stage during treatment. No protan or deutan axis threshold changes were noted in the 17 patients tested irrespective of the laser wavelength used. Tritan axis sensitivity was significantly reduced one hour after treatment with the blue-green laser, but no tritan axis change was found after treatment with longer wavelength lasers. The effect was no longer present the day after treatment in the subjects tested. The results show that even peripheral retinal treatment with blue-green laser can cause acute macular phototoxicity.

Color Perception

Macular colour contrast sensitivity in ocular hypertension and glaucoma: evidence for two types of defect.

Colour contrast sensitivity (CCS) of a large cohort of glaucomatous patients, ocular hypertensive patients (OH), and normal persons was measured at six-month intervals during a two-year period. The OHs were graded into high, medium, and low risk groups. 69% of glaucomatous patients and 32% of all OHs had CCS thresholds greater than the mean plus 2 SDs of the controls. Satisfactory specificity and sensitivity could not be obtained by adjusting the criterion of threshold. In abnormal eyes, progressive small increases of threshold occurred during the study, but glaucomatous eyes with normal thresholds on the first visit retained normal thresholds in the subsequent visits. Although our system is very sensitive and precise, the proportion of abnormalities detected is no greater than with other techniques. In some glaucomatous patients there is a true preservation of colour vision which does not merely reflect the limitations of the test employed.

Color Perception

Peripheral color contrast. A new screening test for preglaucomatous visual loss.

A new test of peripheral color contrast is described. A high-definition color monitor driven by a personal computer with a graphics interface card displays an annulus subtending 25 degrees at the eye. The color contrast between the annulus and the background can be varied. Forty-five degrees of the annulus is randomly removed in one of four quadrants. Patients are asked to identify the position of the gap while fixating a central spot. The minimum color contrast between annulus and background at which the identification is possible is between 13-16% for the protan, deuteran, and tritan axis in normal subjects. This threshold value changes little with age, refractive error, or pupillary aperture, and test-retest variability is low. Testing one eye takes only 1-2 min. The test was applied to ocular-hypertensive and glaucomatous patients. All patients with glaucoma had thresholds greater than two standard deviations (SD) above the normal mean. In addition, 97% of glaucoma patients had thresholds greater than four SDs, and 95% had thresholds more than five SDs above the normal mean. Most patients with ocular hypertension and clinical signs indicating a low or medium risk of conversion to glaucoma had thresholds under the upper limit of normal. High-risk patients with ocular hypertension fell into two groups. One approximated to normal; the other had elevated thresholds, which in many cases were more than four SDs above the normal mean. The epidemiologic consequences of this test are discussed.

Adult

Temporal and spatial properties of suppressive rod-cone interaction.

Recordings were obtained from rods and horizontal cells of Xenopus, using an eyecup preparation. The enhancement of cone signals produced by rod backgrounds was measured using flickering red spots of varying intensity and diameter, and the experiments were repeated with cone stimuli consisting of alteration of wavelengths of 660 and 605 nm, adjusted for equal effects on rods or cones ("silent substitution"). Rods responded to red flicker with discrete wavelets up to 5 Hz. The characteristics of suppressive rod-cone interaction (SRCI) depend on the precise stimulus parameters. In particular, the reported low-pass attenuation of SRCI is absent with silent substitution. An analysis of the responses to backgrounds in horizontal cells, and the effects of the red light flashes in rods, led to the conclusion that the characteristics of SRCI are determined partially by the fact that "cone" stimuli excite rods and vice versa. This result simplifies the mechanism of SRCI and permits a comparison between the studies of SRCI using electroretinograms and horizontal cells.

Animals

A survey of color discrimination in German ophthalmologists. Changes associated with the use of lasers and operating microscopes.

Color vision tests were performed on 211 German ophthalmologists during their annual meeting at Essen. The subjects also answered detailed questionnaires about their use of lasers and operating microscopes, and their ocular and general health. It was found that 33% of doctors who use lasers or operating microscopes have decreased color discrimination for colors in a tritan color-confusion axis (greater than 2 standard deviations above normal). There is a relationship between number of patients treated and the degree of threshold elevation. Thirty hours of using the operating microscope produces an increase in tritan threshold equivalent to one panretinal photocoagulation.

Adult

[Color vision disturbance in laser operators and patients: comparison of argon and dye lasers].

Color contrast sensitivity was measured in laser operators before and after laser sessions. The tritan threshold was elevated after the sessions in all laser operators who had used argon (blue-green) lasers. No change was observed when lasers with longer wave-lengths were used. Elevation of the tritan threshold to above-normal levels was observed even before laser sessions. The thresholds remained increased even when the laser operator did not use a laser for 3 weeks. Thus, it appears that the damage caused by the argon blue-green laser is cumulative. Elevated tritan thresholds were also observed in patients with peripheral retinal breaks who were treated with an argon (blue-green) laser.

Adolescent

Peripheral contrast sensitivity in glaucoma and ocular hypertension.

Contrast sensitivity has been measured in patients with glaucoma and ocular hypertension, the latter graded into high, medium, and low risk clinical groups. Measurements were made centrally and peripherally at 10 degrees, 15 degrees, 20 degrees, and 25 degrees off-axis at each of the four meridians 45 degrees, 135 degrees, 225 degrees, and 315 degrees. A sine wave grating of 1.9 cycles/degree, reversing at 1 Hz was used. It was displayed on a 100-Hz refresh rate monitor. Normal values were established to compare those from 41 eyes from patients with either primary open angle glaucoma (POAG) with minimal field loss detectable on a Humphrey perimeter, or raised IOP and/or disc changes but no field loss (OH). Those with POAG had normal central contrast sensitivity, but at 20 degrees and 25 degrees eccentricity the values were greater than 2 standard deviations above the normal mean. This was also the case for high risk OH, but not for low risk patients. All the high risk patients except one who had abnormal peripheral contrast sensitivity had possible field defects (threshold elevation at one or more points more than 5 but less than 10 dB above normal mean). Only one of those with normal peripheral contrast sensitivity had such 'suspect points'. The results are assessed in terms of screening of glaucoma suspects.

Contrast Sensitivity

Using argon laser blue light reduces ophthalmologists' color contrast sensitivity. Argon blue and surgeons' vision.

Color contrast sensitivity was measured in laser operators before and after laser use. After argon blue-green laser treatment sessions, sensitivity was reduced for colors lying along a tritan color-confusion line for several hours. This acute effect is due to specular "flash-backs" from the aiming beam off the surface of the contact lens. It is caused only by argon 488-nm light, when the aiming beam intensity is high. In addition, a correlation has been demonstrated between the number of years of laser experience and a chronic reduction in tritan color contrast sensitivity. It is suggested that repeated acute changes caused by the argon lasers may cause cumulative effects and produce a chronic threshold elevation. A simple method of eliminating the acute effect is documented.

Adult

Changes in colour contrast sensitivity associated with operating argon lasers.

A new test of colour vision using computer graphics has been used to obtain quantitative estimates of colour contrast sensitivity in ophthalmologists before and after they have treated patients by argon laser retinal photocoagulation. The colour vision of all subjects is normal when tested with the 100-hue test and HRR (Hardy, Rittler, Rand) plates, but colour contrast sensitivity measured along a tritan colour confusion line is selectively impaired after a treatment session. No such change occurs after a medical session spent examining patients with a fundus camera. In younger ophthalmologists the sensitivity recovers several hours after the treatment session ends, but in some persons there is a prolonged and possibly permanent elevation of threshold.

Adult

Separable evoked retinal and cortical potentials from each major visual pathway: preliminary results.

Single cell experiments in primates show that there are two major parallel pathways named after the lamination in the lateral geniculate nucleus. Each of these systems can be preferentially excited by appropriate stimuli. Here we report that in man the polarity of the evoked potentials both in retina and in cortex depends on which of these pathways is stimulated. The identification of the resulting waveforms is thereby simplified--a matter of practical importance. The fact that at retina and cortex there are characteristic potentials may reflect the different cell biology of the two pathways.

Color Perception

Retinal sensitivity in hereditary retinal degeneration in Abyssinian cats: electrophysiological similarities between man and cat.

The functional and electrophysiological similarities in the changes in the electroretinogram (ERG) of man and cat affected by hereditary retinal degenerative disease were studied. The results of a series of log intensity-amplitude studies in a group of young affected Abyssinian cats were fitted to the Naka-Rushton relationship by means of a mathematical package on the University of London mainframe. The analysis showed that the amplitude of the maximum dark-adapted b-wave was significantly reduced by the end of the period studied but that the value of k, a variable inversely equivalent to retinal sensitivity, was only slightly reduced by the retinal degenerative process. The electrophysiological findings thus are similar to those found in cases of human diffuse dominantly inherited retinitis pigmentosa.

Animals

Monitoring of patients taking canthaxanthin and carotene: an electroretinographic and ophthalmological survey.

1. Patients who have taken canthaxanthin and beta-carotene to avert phototoxicity have been monitored by electroretinographic testing. 2. Patients took the compounds only during the summer months, but were monitored for more than 1 year to determine if seasonal changes in the ERG were visible. 3. The characteristic refractile retinal crystals reduced during the winter. 4. The scotopic b-wave amplitude increased during the winter, whether evoked by red or blue flashes. 5. No other ERG parameter altered. 6. Changes noted in 3 and 4 above are reversible. 7. A dose/ERG-amplitude response relationship was established, but no correlation between blood level or total cumulative dose and b-wave amplitude could be found. 8. It is suggested that the Müller cells concentrate canthaxanthin and this is the mechanism which affects the ERG.

Aged

Leber's hereditary optic atrophy.

Leber described a particular type of hereditary optic atrophy in 1871. The clinical features of all cases since reported are reviewed. There is characteristically acute visual loss, circumpapillary teleangiectatic micropathy, tortuosity of the retinal vessels and oedema in the retinal nerve fibres. 85% of those affected are male, but affected fathers do not transmit the condition to their children. The exact mode of inheritance is still obscure but it is suggested that inheritance may be mitochondrial; enlarged subsarcolemmal mitochondria in LOA patients have been described. Colour vision defects are observed not only in patients, but also in presumed carriers. Electrophysiological investigations demonstrate optic nerve damage, but are not indicative of any particular pathology. It has been reported that in many cases of LOA the severity of the disease is related to tobacco smoking. Increased cyanocobalamin blood levels in patients and increased cyanide blood levels support this hypothesis.

Electroretinography