Determination of scotopic and photopic conventional visual acuity and hyperacuity.

PURPOSE: Visual acuity (VA) is an important determinant of visual function. Here we establish procedures and recommendations for VA testing extending beyond the classical VA and thus make them available for future studies of visual function in health and disease. Specifically, we provide reference values for photopic and scotopic conventional uncrowded visual acuity (cVA) and Vernier-hyperacuity (hVA) and assess their reproducibility and dependence on contrast polarity. METHODS: For ten observers with normal vision, we determined photopic ("p"; maximal luminance 220 cd/m2) and scotopic ("s"; maximal luminance 0.004 cd/m2; 40 min of dark adaptation) cVA and hVA, for two contrast polarities i.e. black optotypes on white background and vice versa. To assess intersession effects, two sets of measurements were obtained on different days. RESULTS: Compared to pcVA (1.32 decimal VA; - 0.12 ± 0.02 LogMAR), the phVA (14.45 decimal VA; - 1.16 ± 0.04 LogMAR) scaled (in terms of decimal visual acuity) on average with a factor 11.0, the scVA (0.12 decimal VA; 0.91 ± 0.03 LogMAR) with a factor of 0.1, and the shVA (1.47 decimal VA; - 0.17 ± 0.02 LogMAR) with a factor of 1.1. There were neither significant effects of contrast polarity (p > 0.12), nor of session (p > 0.28). CONCLUSIONS: Our approach optimises integrated photopic and scotopic cVA and hVA measurements for general use and thus encourages the integration of these important measures of scotopic visual function in future studies. The absence of strong intersession effects demonstrates that no dedicated training session is needed to obtain scotopic and hVA measurements. The combined measures of scotopic and photopic VAs open a field of applications to study interplay and plasticity of the retinal photoreceptor systems and cortical processing in health and visual disease. As a rule of thumb, hyperacuity is 10× higher both in the photopic and scotopic range than conventional acuity. Thus, scotopic hyperacuity is close to photopic conventional acuity.

Scotopic multifocal visual evoked potentials.

OBJECTIVE: To investigate the scope of scotopic multifocal visual evoked potentials (mfVEPS) for the assessment of scotopic visual fields. METHODS: Pattern-reversal mfVEP for photopic (mfVEPP) and scotopic conditions (mfVEPS; 0.003 cd/m2) were recorded from 36 visual field locations of a circular checkerboard pattern (25° radius) in 9 participants with normal vision. MfVEPP were recorded with a conventional central fixation cross, mfVEPS were recorded (i) with (mfVEPS+) and (ii) without (mfVEPS-) an additional fixation aid. Latency shifts were determined using cross-correlations, mfVEP magnitudes were analysed in an eccentricity dependent manner using signal-to-noise ratios (SNRs). RESULTS: In comparison to mfVEPP, mfVEPS- and mfVEPS+ were delayed by 101 ms and 97 ms, respectively, and had smaller signal-to-noise-ratios. Both mfVEPS were reduced down to noise level in the center and also severely reduced for the most peripheral stimulus eccentricity used. The visual-field-coverage for the paracentral eccentricities of mfVEPS+ and mfVEPS- was 76% and 65% [4°-9°], respectively, and 79% and 66% [9°-16°]. CONCLUSIONS: MfVEPS were delayed compared to mfVEPP and demonstrated the expected central response drop-out typical for scotopic vision. SIGNIFICANCE: MfVEPS may hold promise of an objective, spatially resolved visual field test which motivates testing it in patients with diseases affecting scotopic vision.

Calculation and plotting of retinal nerve fiber paths based on Jansonius et al. 2009/2012 with an R program.

The data presented in this article are related to the research article entitled "Retinal conduction speed analysis reveals different origins of the P50 and N95 components of the (multifocal) pattern electroretinogram" (Bach et al., 2018) [1]. That analysis required the individual length data of the retinal nerve fibers (from ganglion cell body to optic nerve head, depending on the position of the ganglion cell body). Jansonius et al. (2009, 2012) [2,3] mathematically modeled the path morphology of the human retinal nerve fibers. We here present a working implementation with source code (for the free and open-source programming environment "R") of the Jansonius' formulas, including all errata. One file defines Jansonius et al.'s "phi" function. This function allows quantitative modelling of paths (and any measures derived from them) of the retinal nerve fibers. As a working demonstration, a second file contains a graph which plots samples of nerve fibers. The included R code runs in base R without the need of any additional packages.

[Potential of fMRI for the Functional Assessment of the Pathological Visual System]. / Potenzial von fMRT für die Funktionsüberprüfung des pathologischen Sehsystems.

Current developments in functional magnetic resonance imaging (fMRI) of the human visual system have generated a set of powerful approaches that are of great promise for modern ophthalmology. These make it possible to perform an objective spatially resolved test of visual function in patients with strong visual impairment and even to investigate the functional organisation of the visual cortex in the blind. As a consequence, they open a broad field of applications for functional assessment in ophthalmology and provide fundamental insights into the interplay of pathology and plasticity in the human visual system. This is highlighted by current studies investigating patients with acquired or congenital defects of the macula, or with visual pathway abnormalities, extended retinal damage, and complete blindness. Therapeutic approaches targeting the restoration of visual input are expected to benefit from these fMRI applications, either for the estimation of the success rate of a planned retinal therapy or as an objective high-level biomarker for the readout of therapy success.

[Contrast vision-definitions, conversions, and equivalence tables]. / Kontrastsehen ­ Definitionen, Umrechnungen und Äquivalenztabelle.

Human contrast vision and its quantitative assessment are gaining more attention. Publications on this topic can be confusing due to the overabundance of differing definitions and quantification of contrast vision. As a case in point, in Germany, contrast ratios as required for certain driving licenses and the DIN-defined contrast ratio are reciprocal. In this article, the five most important definitions of luminance contrast and contrast vision (Michelson, Weber, contrast ratios, logCS) are presented. We detail the specific domains for them, give formulae to convert between all of them and provide a table with equivalent values. We recommend the unit logCS wherever possible.

Differential effects of optic media opacities on simultaneous multifocal pattern electroretinograms and visual evoked potentials.

OBJECTIVE: To identify potential confounds in the comparison of simultaneously acquired multifocal electroretinograms (mfPERGs) and visual evoked potentials (mfVEPs) to pattern reversal stimulation. METHODS: With VERIS Science 5.1.10X monocular mfPERGs and mfVEPs were recorded simultaneously to optimised pattern-reversal stimulation for a reference condition and two filter conditions, i.e. blur and 8% luminance transmission, in two separate experiments in participants with normal vision. The impact of the filter conditions on mfPERG amplitude (P50 and N95 peaks), mfVEP-magnitude (root-mean-squares and signal-to-noise-ratios), and on the response timing was assessed. RESULTS: Blur reduced mfPERG P50 and N95 amplitudes to 16%, 21%, and mfVEP magnitude to 82%. Decreasing stimulus luminance to 8% reduced only the mfPERG (P50 to 72% and N95 to 74%), but delayed both mfPERG and mfVEP responses by 5.3 and 4.6ms, respectively. CONCLUSIONS: Comparatively minor stimulus manipulations, mimicking optic media opacities, had a differential effect on mfPERGs and mfVEPs magnitudes. SIGNIFICANCE: Simultaneous mfPERG/mfVEP recordings are a promising approach to compare retinal and cortical function, but caution must be exerted in the interpretation of response differences due to incongruent response characteristics.

Case report: practicability of functionally based tractography of the optic radiation during presurgical epilepsy work up.

Pre-operative tractography of the optic radiation (OR) has been advised to assess the risk for postoperative visual field deficit (VFD) in certain candidates for resective epilepsy surgery. Diffusion tensor imaging (DTI) tractography relies on a precise anatomical determination of start and target regions of interest (ROIs), such as the lateral geniculate nucleus (LGN) and the primary visual cortex (V1). The post-chiasmal visual pathway and V1 show considerable inter-individual variability, and in epilepsy patients parenchymatous lesions might further complicate this matter. A functionally based tractography (FBT) seems beneficial for precise OR identification. We assessed practicability of FBT for OR identification in a patient with occipital lobe epilepsy due to a temporo-occipital maldevelopmental tumor. The MRI protocol at 3T included a T1-weighted sagittal 3D scan, a T2-weighted axial 2D scan and a DTI scan using an echo planar spin echo sequence. ROIs for fiber tracking of OR (LGN & V1) were determined with T2*-weighted fMRI-based retinotopic assessment. After DTI pre-processing and fiber tracking, paths with similar properties were combined in clusters for visual presentation and OR localization. Retinotopic phase maps allowed for the identification of V1 and LGN for a precise DTI-based reconstruction of OR, which was distant to the patient's tumor. Location and structure of ORs were comparable in each hemisphere. FBT could thus influence the human research of the extrastriate visual pathway and the risk management of post-operative VFD in epilepsy surgery.

Differential effects of optic media opacities on mfERGs and mfVEPs.

OBJECTIVE: To assess different effects of image degradation that could result from optic media opacities on multifocal retinal (mfERG) and cortical responses (mfVEP). METHODS: Monocular flash-mfERGs and pattern-reversal mfVEPs were recorded. MfERG-P1 amplitudes and implicit times and mfVEP root-mean-square values (RMS) and delays were compared for different filter conditions (none, 8% luminance, 50% luminance, 50% luminance plus blur) in a total of ten participants with normal vision. RESULTS: Reducing stimulus luminance down to 50% and 8% reduced mfERG amplitudes to 86% and 42%, respectively, with no significant effect on mfVEP amplitude. Implicit times were increased for mfERGs by 0.9 ms and 6.0 ms, respectively, and for mfVEPs by 1.0 ms and 6.3 ms, respectively. For '50% luminance plus blur' mfERG amplitudes were significantly reduced centrally and enhanced peripherally and delayed by 1.3 ms. MfVEPs were reduced close to noise level independent of eccentricity. CONCLUSIONS: Degradation of the retinal image is a potential source of discrepancies between mfERGs and mfVEPs. Image blur suppresses the mfVEP at all locations and changes mfERG topography, resulting in a selective loss of central responses. SIGNIFICANCE: Considering optic media opacities is of importance for the correct interpretation of mfERG and mfVEP recordings, particularly in elderly patients.

[Retinotopic mapping of the human visual cortex with functional magnetic resonance imaging - basic principles, current developments and ophthalmological perspectives]. / Retinotope Kartierung des menschlichen visuellen Kortex mit funktioneller Magnetresonanztomografie - Grundlagen, aktuelle Entwicklungen und Perspektiven für die Ophthalmologie.

Since its initial introduction in the mid-1990 s, retinotopic mapping of the human visual cortex, based on functional magnetic resonance imaging (fMRI), has contributed greatly to our understanding of the human visual system. Multiple cortical visual field representations have been demonstrated and thus numerous visual areas identified. The organisation of specific areas has been detailed and the impact of pathophysiologies of the visual system on the cortical organisation uncovered. These results are based on investigations at a magnetic field strength of 3 Tesla or less. In a field-strength comparison between 3 and 7 Tesla, it was demonstrated that retinotopic mapping benefits from a magnetic field strength of 7 Tesla. Specifically, the visual areas can be mapped with high spatial resolution for a detailed analysis of the visual field maps. Applications of fMRI-based retinotopic mapping in ophthalmological research hold promise to further our understanding of plasticity in the human visual cortex. This is highlighted by pioneering studies in patients with macular dysfunction or misrouted optic nerves.

[Abnormal representations in the visual cortex of patients with albinism: diagnostic aid and model for the investigation of the self-organisation of the visual cortex]. / Abnormale Repräsentationen im visuellen Kortex von Albinismus-Patienten : Hilfsmittel bei der Diagnostik und Modell der kortikalen Selbstorganisation.

A characteristic feature of patients with albinism is the misrouting of the optic nerves, which causes the visual cortex to receive an abnormal input. This report details how the detection of misrouting using visual evoked potentials assists the clinical diagnosis of albinism. Further, it shows how the projection abnormality observed in patients with albinism provides a model for investigating the self-organisation of the human visual cortex. This is highlighted by recent findings that were obtained using functional magnetic resonance imaging, visual evoked potentials, and static visual field perimetry.

Abnormal visual projection in a human albino studied with functional magnetic resonance imaging and visual evoked potentials.

The albino visual pathway is abnormal in that many fibres from the temporal retina project to the contralateral visual cortex. The visual projections in a human albino and a control have been investigated with fMRI and VEP during independent visual stimulation of both hemifields. Activity in the occipital cortex in the normal was contralateral to the stimulated visual field, whereas it was contralateral to the stimulated eye in the albino, independent of the stimulated visual field. Thus, the albino visual cortex is activated not only by stimulation in the contralateral visual field, but also by abnormal input representing the ipsilateral visual field. These novel findings help elucidate the nature of albino misrouting.

Directional tuning of human motion adaptation as reflected by the motion VEP.

Motion onset evoked visual potentials are dominated by a negativity (N2) at occipital electrodes and a positivity (P2) at the vertex. The degree of true motion processing reflected by N2 and P2 was estimated from the direction specificity of motion adaptation. Adapting stimuli moved to the right and test stimuli (random dot patterns of 26 degrees diameter; 10% contrast; 10.5 degrees /s velocity) moved in one of eight directions, which differed by 45 degrees. VEPs were recorded from occipito/temporal and central sites in eight subjects. Two adaptation effects were observed for N2 (P<0.01): a global amplitude reduction by 47% and a direction-specific reduction by a further 28%. For P2, only the global effect (54%; P<0.01) was observed. The global adaptation effect could also be induced by pattern reversal and pattern-onset adaptation, i.e. stimuli containing ambiguous or very little motion energy, respectively. We conclude that at least 28% of the N2 amplitude reflects the activity of direction-specific elements, whereas P2 does not at all.

Abnormal retinotopic representations in human visual cortex revealed by fMRI.

The representation of the visual field in early visual areas is retinotopic. The point-to-point relationship on the retina is therefore maintained on the convoluted cortical surface. Functional magnetic resonance imaging (fMRI) has been able to demonstrate the retinotopic representation of the visual field in occipital cortex of normal subjects. Furthermore, visual areas that are retinotopic can be identified on computationally flattened cortical maps on the basis of positions of the vertical and horizontal meridians. Here, we investigate abnormal retinotopic representations in human visual cortex with fMRI. We present three case studies in which patients with visual disorders are investigated. We have tested a subject who only possesses operating rod photoreceptors. We find in this case that the cortex undergoes a remapping whereby regions that would normally represent central field locations now map more peripheral positions in the visual field: In a human albino we also find abnormal visual cortical activity. Monocular stimulation of each hemifield resulted in activations in the hemisphere contralateral to the stimulated eye. This is consistent with abnormal decussation at the optic chiasm in albinism. Finally, we report a case where a lesion to white matter has resulted in a lack of measurable activity in occipital cortex. The activity was absent for a small region of the visual field, which was found to correspond to the subject's field defect. The cases selected have been chosen to demonstrate the power of fMRI in identifying abnormalities in the cortical representations of the visual field in patients with visual dysfunction. Furthermore, the experiments are able to show how the cortex is capable of modifying the visual field representation in response to abnormal input.

Visual motion detection in man is governed by non-retinal mechanisms.

It is generally assumed that there is no sizable proportion of motion detectors in the primate retina. To test this specifically for humans, visual evoked potentials (VEPs) and electroretinograms (ERGs) were recorded simultaneously to visual motion onset (9.3 degrees /s) of an expanding or contracting 'dartboard'. The degree of motion-specific responses in cortex and retina was assessed by testing the direction specificity of motion adaptation with three conditions in a fully balanced paradigm: motion-onset potentials were measured after adaptation to: (1) a stationary pattern; (2) motion in the same direction as the test stimulus; and (3) motion in the opposite direction. Motion-onset responses in the VEP were dominated by the typical N2 at 150 ms, in the ERG by a positivity at 70 ms. Onset of contraction or expansion evoked virtually identical VEP and ERG responses (P>0.5). Motion adaptation produced strong direction-specific effects in the VEP (P<0.05), but not in the ERG (P=0.58): In the adapting and non-adapting direction the VEP (N2) was reduced by 75 and 50% (P<0.001), the ERG by 32 and 26% (P<0.01 and 0.05), respectively. The striking difference of the direction-specificity of motion adaptation between cortex and retina suggests that in humans the vast majority of motion-specific processing occurs beyond the retinal ganglion cells.