Biomedical subjects

W Seiple

Publications and source records attributed to W Seiple.

At least 19 recordsLinked to original sources

PubMed2001

Retinal pigment epithelial dysfunction in patients with pigment dispersion syndrome: implications for the theory of pathogenesis.

OBJECTIVE: To test the hypothesis that the retinal pigment epithelial/photoreceptor complex is affected in patients with pigment dispersion syndrome and/or in patients with pigmentary glaucoma. METHODS: Electro-oculograms were recorded from patients with pigment dispersion syndrome, pigmentary glaucoma, ocular hypertension, and primary open-angle glaucoma and from control subjects. Electro-oculograms were recorded during 15 minutes of dark adaptation followed by 15 minutes of light adaptation. For each subject, dark-trough amplitudes, dark-trough latencies, light-peak amplitudes, light-peak latencies, and ratios of the light-peak amplitude to the dark-trough amplitude (Arden ratios) were calculated. RESULTS: A 1-way analysis of variance of the Arden ratios indicated significant differences among the groups of subjects. Results of a post hoc Newman-Keuls test revealed that the mean Arden ratios of patients with pigment dispersion syndrome and patients with pigmentary glaucoma were significantly lower than the mean ratios of the controls, the patients with primary open-angle glaucoma, and those with ocular hypertension. CONCLUSIONS: The results provide support for the hypothesis that the integrity of the retinal pigment epithelial/photoreceptor complex is affected in patients with pigment dispersion syndrome and in those with pigmentary glaucoma. Congenital and/or structural abnormalities of the retinal pigment epithelial/photoreceptor complex should be considered when models of the etiology of pigment dispersion syndrome are proposed.

Adult↗

PubMed2001

Perceived and actual performance of daily tasks: relationship to visual function tests in individuals with retinitis pigmentosa.

PURPOSE: To investigate the functioning in daily task performance of individuals with retinitis pigmentosa (RP). Goals were (1) to quantify the relationships among clinical tests of vision, self-reports, and evaluations of actual task performance to predict difficulty in these tasks; and (2) to validate self-report questionnaire data about daily task performance with observations and measurements of actual task performance conducted by a certified low-vision specialist. DESIGN: A cross-sectional study and survey. PARTICIPANTS: Sixty-two individuals with RP (mean age, 37 years) participated in the study. METHODS: We obtained data about task performance from subjects' reports about their daily performance as assessed by a 53-item questionnaire and from a specialist's rating about actual ability on a 64-item battery of tasks, including ones similar to those assessed with the questionnaire. MAIN OUTCOME MEASURES: Clinical measures of vision included visual acuity, visual fields using Goldmann perimetry, letter contrast sensitivity, and cone and rod electroretinogram (ERG) function. The questionnaire and functional tasks were clustered into three categories: "reading," "mobility," and "peripheral detection." RESULTS: Self-report was correlated significantly with actual task performance. Task performance was correlated significantly with clinical test performance. Moderate or worse difficulty in performance was observed only for visual acuity worse than 20/40; log contrast sensitivity less than 1.4; a visual field area smaller than 2000 deg(2) (area equivalent to a 50-degree diameter of visual field to the Goldmann II-4-e target); and ERG amplitudes less than 10 microvolts for 32-Hz light-adapted white flicker. CONCLUSIONS: Despite the significant correlations, there remains variability in task performance that is unaccounted for in some individuals with low levels of clinical test performance. The assessment of actual task performance validated the use of self-reports in individuals with RP.

Activities of Daily Living↗

PubMed2001

Duration thresholds for target detection and identification in the peripheral visual field.

PURPOSE: In the current study, we measured threshold duration required to perform the tasks of letter identification, letter detection, grating orientation discrimination, and symmetry detection of targets presented as a function of retinal eccentricity. METHODS: Targets were presented in the nasal visual field on the horizontal meridian at eccentricities ranging from 0 degree to 22 degrees. Threshold duration was calculated using a modified staircase procedure. RESULTS: We found that for the task of letter identification, the rate of duration sensitivity loss was independent of the letter size. In contrast, for the tasks of letter detection, grating discrimination, and symmetry detection, the rate of loss was greater for smaller targets than for larger targets. CONCLUSION: At equivalent target sizes, letter identification always demonstrated the steepest decline in duration sensitivity with increasing eccentricity. This might be the case if the final stages of the identification process are rate limiting. It was hoped that by quantifying duration sensitivity of the peripheral retina, more appropriate temporal stimuli could be used in rehabilitation programs that train reading using eccentric preferred retina loci in patients with advanced macular disease.

Adult↗

PubMed2001

Local cone and rod system function in patients with retinitis pigmentosa.

PURPOSE: To compare local cone and rod system function in patients with retinitis pigmentosa (RP) using electrophysiological and psychophysical techniques. METHODS: Cone-mediated multifocal electroretinograms (M-ERGs), cone system threshold visual fields, rod-mediated M-ERGs, and rod system threshold visual fields were measured in seven patients with RP. RESULTS: All the patients had normal cone system visual field thresholds and normal cone-mediated M-ERG implicit times within the central 5 degrees. Both cone-mediated responses were abnormal at some peripheral retinal locations. There were significant correlations among cone system amplitude, timing, and visual field loss. All the patients had some retinal areas where the rod-mediated M-ERG amplitudes were not measurable. In areas where they were measurable, these rod-mediated M-ERG responses were often within normal limits for amplitude and timing. In contrast to the cone system data, there were no significant relationships between rod-mediated M-ERG measures and rod system threshold elevations. The cone and rod system psychophysical thresholds showed regional correspondence; the amplitude-scale and time-scale measures of the M-ERG did not. CONCLUSIONS: The results indicate that there was better local correspondence between psychophysical and electrophysiological measures in the cone system than in the rod system in patients with RP. In addition, the psychophysical measures of cone and rod system function showed better correspondence than did the electrophysiological measures.

Adult↗

PubMed2001

Variable tinted spectacle lenses: a comparison of aesthetics and visual preference.

PURPOSE: To determine the correlation between the aesthetics of lens tints preferred for cosmesis and lens tints preferred for viewing. METHODS: Thirty-five subjects (mean age: 25; 49% male, 51% female) with no significant ocular pathology participated in the study. Median visual acuity was 20/20. Color vision testing was performed on each subject using Ishihara plates, and those with abnormal scores were excluded from the study. Subjects were shown nine pre-selected tinted lenses (50% transmittance) of variable wavelengths. These lenses were mounted on two separate color backgrounds, one white and the other approximating their skin tone. Subjects were asked to choose from each background which tinted lens they would most prefer to wear and which lens they would least prefer to wear. The subjects were then shown a series of eight pictures (four nature photographs and four paintings) with different dominant wavelengths. Subjects were asked to grade the aesthetic effect of a clear lens and each of the nine tinted lenses on the appearance of the pictures. Chromaticity coordinates were calculated for each lens and picture. RESULTS: The blue lens was the most frequently chosen preferred lens to wear, followed by green, purple, and gray. The least preferred lenses were yellow, brown, and pink. For viewing the nature photographs, the clear lens was preferred over any of the tinted lenses. For viewing the paintings, the purple lens was most preferred. The yellow lens was least preferred for both photographs and paintings. CONCLUSIONS: Younger individuals with no significant ocular pathology preferred viewing both nature photographs and paintings through tinted lenses that did not, or only slightly, altered the chromaticity of the image. Whereas a clear lens was favored over the tinted lenses for viewing the photographs, some tinted lenses (purple and pink) were preferred for viewing paintings. There was no correlation between the most favored lens tint chosen based purely on cosmesis and the most favored lens tint based on viewing preference. However, the least preferred lens tint for cosmesis and viewing was yellow.

Adult↗

PubMed2000

Electrophysiologic assessment of photoreceptor function in patients with primary open-angle glaucoma.

PURPOSE: Electroretinograms to high-intensity flashes were obtained to determine the extent of rod and cone photoreceptor and postreceptor dysfunction in patients with primary open-angle glaucoma. METHODS: Full-field flash electroretinograms were obtained using brief high-intensity flashes. Dark-adapted (rod-dominated) and light-adapted (cone-dominated) electroretinogram responses were recorded to a "white" light as a function of flash intensity. The a-wave data were fitted with a model based on photopigment transduction to obtain values for the parameters of log Rmax (the maximum response) and log S (sensitivity). Oscillatory potentials were measured to the cone-dominated high-intensity flashes. Standard clinical 30 Hz flicker electroretinogram responses were recorded using a Grass photostimulator. RESULTS: Analysis of rod and cone a-wave data showed that log Rmax and log S values were within the normal range in nearly all of the patients. For some patients, oscillatory potentials were delayed beyond the normal range. CONCLUSION: Our results provide little evidence for widespread photoreceptor abnormalities in primary open-angle glaucoma.

Adult↗

PubMed2000

The nature and extent of retinal dysfunction associated with diabetic macular edema.

PURPOSE: To evaluate the nature and extent of retinal dysfunction in the macular and surrounding areas that occurs in patients with diabetes with clinically significant macular edema (CSME). METHODS: Eleven patients were evaluated before focal laser treatment. Multifocal electroretinogram (ERG) and full-field ERG techniques were used to assess the effects of diabetic retinopathy and CSME on macular, paramacular, and peripheral retinal function. A modified visual field technique was used to obtain local threshold fields. The relationship between local sensitivity changes and local ERG changes was determined. RESULTS: Local ERG responses were significantly delayed and decreased in amplitude, and timing changes were observed in a larger area of the retina than amplitude changes. Visual field deficits were similarly widespread with marked sensitivity losses occurring in retinal areas with normal ERG amplitudes and in areas that appeared to be free of fundus abnormalities. Despite this similarity and the finding that retinal areas with elevated thresholds have timing delays, timing delays were not good predictors of the degree of threshold elevation. CONCLUSIONS: The results demonstrate the widespread nature of timing deficits and visual field deficits that are associated with CSME.

Adult↗

PubMed2000

Retinal function in diabetic macular edema after focal laser photocoagulation.

PURPOSE: To assess the effects of focal photocoagulation on retinal function in the macular and perimacular areas in patients with diabetes who have clinically significant macular edema. METHODS: Eleven patients were assessed after focal laser treatment. Multifocal electroretinogram (ERG) and full-field ERG techniques were used to evaluate the effects of treatment on macular, paramacular, and peripheral retinal function. A modified visual field technique was used to obtain local threshold fields. The posttreatment results were compared with pretreatment results. Changes in local ERG response amplitudes and implicit times were calculated for each patient and presented as difference fields. The changes in local ERG responses were compared with the changes in local field sensitivity. RESULTS: After treatment, the results of the psychophysical tests suggested little or no change in visual function, but changes in retinal function were observed with the multifocal ERG technique. Local ERG responses showed increases in implicit time and decreases in amplitude, compared with pretreatment values. Timing was affected more than amplitude. CONCLUSIONS: The results suggest that focal treatment produces changes in retinal function, and these changes are not restricted to the treated macular area.

Adult↗

PubMed1999

Identifying inner retinal contributions to the human multifocal ERG.

Contributions to the multifocal electroretinogram (ERG) from the inner retina (i.e. ganglion and amacrine cells) were identified by recording from monkeys before and after intravitreal injections of n-methyl DL aspartate (NMDLA) and/or tetrodotoxin (TTX). Components similar in waveform to those removed by the drugs were identified in the human multifocal ERG if the stimulus contrast was set at 50% rather than the typically employed 100% contrast. These components were found to be missing or diminished in the records from some patients with glaucoma and diabetes, diseases which affect the inner retina.

Adult↗

PubMed1998

Assessment of local retinal function in patients with retinitis pigmentosa using the multi-focal ERG technique.

To assess local retinal function in patients with retinitis pigmentosa (RP), multi-focal ERGs and local thresholds (static visual fields) were obtained on eight RP patients with visual acuities of 20/25 or better. All eight patients showed multi-focal responses with normal timing within the central 5 deg. However, there were few responses with normal timing in the areas outside the central 7.5 deg, except in the case of the only patient with a 30 Hz full-field response with normal timing. Since full-field ERGs are dominated by responses from the periphery, this finding supplies a foundation for the commonly observed delays in the full-field cone ERGs of patients with RP. With respect to amplitude, only two patients showed multi-focal responses with near normal amplitudes anywhere in the field. The loss of amplitude at any point was not a good predictor of visual sensitivity in the Humphrey visual field. On the other hand, all areas with normal timing had near normal sensitivity. Timing changes appear to be an early indication of local retinal damage to the cone system. Nearly all areas with sensitivity losses greater than 0.5 log unit, and some areas with near normal sensitivity, showed significantly delayed multi-focal ERGs. Finally areas with extreme sensitivity loss show multi-focal responses with a wide range of amplitudes and implicit times across patients, suggesting different mechanisms of disease action in different patients.

Adult↗

PubMed1998

Use of bioptic amorphic lenses to expand the visual field in patients with peripheral loss.

PURPOSE: To test the effectiveness of a bioptic form of a peripheral vision-enhancement lens in patients with retinitis pigmentosa (RP), choroideremia, and Usher's syndrome Type II. METHODS: Fifteen patients with peripheral visual field loss were trained in the use of the amorphic lenses for driving and other everyday activities for a 3-month period. A cross-over study design was used, where one group of eight patients received training during the first 3 months of the 6-month study, and another group of seven patients received training during the second 3 months. All patients were administered a battery of clinical, psychophysical, functional, mobility, and driving assessment tests at the beginning of the study, at 3 months, and at 6 months. The assessment tests were coded according to the primary visual skill involved in the task. These visual skills included: recognition, peripheral detection, scanning, tracking, visual memory, and mobility. RESULTS: After training, the patients showed improvement in all visual skills categories on the assessment tests, with overall improvement of 37%. There was no significant difference in the levels of improvement between the two groups. Those with smaller visual field extents showed significantly greater improvement on peripheral detection and scanning tasks. Those patients trained during the first 3 months of the study maintained their skills when tested at the 6-month point. CONCLUSION: Patients with peripheral vision loss may benefit from a rehabilitation program which combines low vision training with amorphic lenses in a bioptic configuration.

Adult↗

PubMed1998

Multifocal rod electroretinograms.

PURPOSE: To assess the feasibility of obtaining reliable multifocal rod electroretinograms (ERGS) and to compare them to full-field ERGs. METHODS: Multifocal rod ERGs were recorded using a stimulus array of 61 hexagons. The minimum number of dark, blank frames between flashes was varied from 0 (a minimum of 13.3 msec between flashes) to 21 (a minimum of 293 msec between flashes). Full-field ERGs were obtained using trains of flashes designed to simulate the multifocal sequences. Flashes were blue (W47B), except in a few cases in which red (W26) was used to check for cone intrusion. Flash intensities varied from -1 to 1.7 log scot td-s. RESULTS: Dark-adapted, multifocal ERGs to blue flashes had a small, early component followed by a larger, late component. The early component showed little change in amplitude with increasing intensity. Comparisons with the full-field ERGs indicated that the early component was the focal response. The larger, late component was the response to stray light, and it can be suppressed with the addition of a surround. The focal response was from a relatively circumscribed retinal region. This is shown by comparing the multifocal rod responses from a patient with retinitis pigmentosa to her behaviorally measured rod visual field. CONCLUSIONS: By choosing conditions (namely, flashes of moderate intensity with a surround) to minimize the effects of stray light, multifocal rod ERGs can be recorded with sufficient localization to be clinically useful. However, the signal-to-noise ratio of these multifocal rod ERGs was poorer than for multifocal cone responses for comparable recording periods because of the need for blank frames and the slower recovery of the rods to successive presentations.

Adult↗

PubMed1997

Electroretinographic and psychophysical findings during early and late stages of human immunodeficiency virus infection and cytomegalovirus retinitis.

PURPOSE: The authors examined electrophysiologic and psychophysical measures of retinal function in patients infected with human immunodeficiency virus (HIV) at different stages of infection, including patients with cytomegalovirus retinitis (CMVR). METHODS: All patients had complete ophthalmologic examinations. Rod-mediated psychophysical thresholds were measured using a modified two-color dark-adapted perimetry technique. Rod-dominated full field flash electroretinograms (ERGs) were obtained as a function of flash intensity, followed by cone-dominated ERGs. The 26 patients infected with HIV (26 eyes) were categorized into three groups. Six patients were infected with HIV but had not progressed to acquired immunodeficiency syndrome (AIDS), and 14 had AIDS. Six patients had CMVR with less than 10% of the retina involved. The data were compared with results from age-similar control subjects. RESULTS: Psychophysical thresholds as a function of retinal eccentricity were elevated for each of the three stages of HIV infection. The group of patients with CMVR had the greatest amount of threshold elevation and threshold elevation increased with retinal eccentricity. In addition, all three patient groups had abnormal electroretinographic findings. Patients with CMVR were affected more severely on all measures than were the other HIV-infected groups. CONCLUSIONS: Results reveal that a diffuse functional retinal pathology exists in eyes with the funduscopic appearance of localized peripheral CMVR. Additionally, patients infected with HIV, including those without cotton wool spots, may have abnormal retinal function.

Adult↗

PubMed1997

Relative effects of aging and age-related macular degeneration on peripheral visual function.

The purpose of this study was to determine the extent of peripheral visual deficits in patients with early age-related macular degeneration (ARMD) using electrophysiological and psychophysical techniques. Dark-adaptation curves, electro-oculograms (EOGs), and electroretinograms (ERGs) were obtained from patients with early ARMD and from normally sighted control subjects. The control subjects' data were used to calculate age-dependent 95% confidence intervals for each measure of visual function. For the control subjects, performance on all our measures of visual function decreased with age. For the patients with early ARMD, the cone system absolute thresholds, EOG ratios, and cone-dominated ERG amplitudes and implicit times were within the range of normal age-related changes. Rod system absolute thresholds, cone-rod break times, and rod-dominated electroretinographic measures were abnormal in some patients. These results suggest that when the effects of aging are taken into account, some patients classified as early ARMD may not show significant changes in peripheral retinal function with standard clinical tests.

Aged↗

PubMed1997

Evidence for photoreceptor changes in patients with diabetic retinopathy.

PURPOSE: To determine whether the rod and cone photoreceptors are affected in patients with diabetic retinopathy. METHODS: Twelve patients with diabetes and varying levels of retinopathy and nine age-similar control observers participated in this study. Two-color (500 versus 650 nm) dark-adapted thresholds were measured as a function of retinal eccentricity. Full-field flash electroretinograms were obtained using brief, high-intensity flashes. Dark-adapted rod-isolated (Wratten 47B filter) and light-adapted cone-isolated (Wratten 26 filter) electroretinographic responses were measured as a function of flash intensity. The a-wave data were fitted with a model based on photopigment transduction to obtain values for the parameters of Rmax (the maximal response) and log S (sensitivity). Standard clinical 30-Hz flicker electroretinographic responses were also measured. RESULTS: Psychophysically measured dark-adapted thresholds were elevated primarily at eccentricities of 5 degrees and 10 degrees from the fovea. Analysis of rod and cone a-wave data showed that Rmax was normal in most of the patients, but log S was reduced. Analysis of b-wave and oscillatory potential parameters showed rod and cone postreceptoral abnormalities, including changes in the rod-isolated semisaturation constant (log k), cone-mediated 30-Hz flicker, and cone-isolated oscillatory potentials. The electrophysiological results were not significantly correlated with blood glucose or glycosylated hemoglobin level. CONCLUSIONS: The results provide evidence for rod and cone receptoral and postreceptoral deficits in patients with diabetic retinopathy. The photoreceptor changes are primarily in the log S (sensitivity) parameter and are attributed to transduction abnormalities.

Adult↗

PubMed1996

Age-related functional field losses are not eccentricity dependent.

Previous studies have found an increase in peripheral target localization errors in normally sighted older adults. These results have been interpreted as indicative of a constriction of the "useful field of view". In the present study, we parametrically manipulated masking, distractors and stimulus luminance and examined the relationships between peripheral target localization and age. We found that backward masking and/or flashed distractors increased error rates. This decrement in performance was larger for more peripherally located targets and largest for the older subjects at all stimulus locations. Stimulus luminance (either 2 or 78 cd/m2) had no effect on peripheral localization performance at any age. We also demonstrated that all subjects, regardless of age, had higher localization error rates to more peripherally located targets. In older subjects, error rates increased equally at all eccentricities; that is, there was an eccentricity independent increase in the number of target localization errors as a function of age. This finding does not support the interpretation of a selective constriction of the functional visual field in older subjects.

Adult↗

PubMed1996

Rates of change differ among measures of visual function in patients with retinitis pigmentosa.

PURPOSE: To assess changes in measures of visual function in patients with retinitis pigmentosa (RP) over time. METHODS: Patients with RP and visual acuity of 20/40 or better and central visual fields of 10 degrees or larger were enrolled in a 9-year prospective study. The following measures of visual function were obtained annually over the follow-up period: visual acuity, Goldmann visual fields (V4e target), focal electroretinograms, and hue discrimination. RESULTS: Over the follow-up period, the averaged group data showed changes in all measures of visual function. The smallest amount of change occurred for visual acuity and hue discrimination, and the greatest amount of change occurred for visual field area. Examination of individual patient data over the follow-up period indicated that the rates of change varied among patients and that losses in function for one measure did not correlate well with losses on other measures. CONCLUSIONS: These results stress that although visual function deteriorated over time for this group of patients with RP, there were differences among our measures of visual function. Measures that primarily assess central retinal function change relatively slowly compared with measures that assess more peripheral retinal function.

Adult↗

PubMed1996

Outer-retina locus of increased flicker sensitivity of the peripheral retina.

We tested alternative hypotheses concerning the locus of enhanced flicker sensitivity observed in response to stimuli presented to the peripheral retina. The first hypothesis attributes increased temporal frequency sensitivity to ganglion cell and higher-order neural processing, whereas the second hypothesis states that the locus of these temporal effects is at the cone photoreceptors. To test these alternative hypotheses we measured retinal electrophysiological and psychophysical temporal modulation thresholds. We found that sensitivity for temporal frequencies < 30 Hz did not vary as a function of retinal location for either the focal electroretinogram (ERG) or the psychophysical measure. However, for both measures, sensitivity for temporal frequencies > or = 30 Hz was greater in the peripheral retina than in the central retina. In addition, critical flicker frequency for the central retina was linear as a function of retinal illuminance for both the psychophysical and the electrophysiological measures. For the peripheral retina the slopes of critical flicker frequency versus log illuminance functions were steeper than the central slopes for both threshold measures. Eccentrically measured focal ERG and psychophysical critical flicker frequency values showed a relative saturation, deviating from the linear slope above 3.5 log Td. The findings of similar focal ERG and psychophysical temporal sensitivity changes with eccentricity support an outer retinal origin of this phenomenon.

Adaptation, Ocular↗