Corneal metabolism
1. o Cornea requires energy for normal metabolic activities as well as for maintaining transparency and dehydration o Energy is generated by the breakdown of glucose in the form of ATP o Most actively metabolizing layer are epithelium and endothelium o Sources of nutrients : o Oxygen : mainly from atmosphere through tear film , with minor amount supplied by the aqueous and limbal vasculature o Glucose , amino acid, vitamins and other nutrients supplied to cornea by aqueous humor o Glucose also derived from glycogen stores in corneal epithelium o Epithelium consumes O2 10 times faster then stroma
2. o Three process or pathways – o Pentose shunt (Hexose monophosphate shunt) –occurs both in hypoxic and normoxic condition o Glycolysis (Embden meyerhof pathway) –anaerobic process , glucose / glycogen converted to pyruvate yeilding 2 ATPs o TCA or krebs or citric acid cycle- aerobic condition pyruvate is oxidized to yield 36 ATP, water, CO2.
3. o In normal conditions all the glucose consumed by the cornea o Glucose mostly come from aqueous humor o The rate of glucose consumption by the whole cornea is approx. 100 microgram/hr/cm2. o 1 mol. of glucose will be converted to the pyruvic acid and produced 2 molecules lactic acid and 2 mol. of ATP o In the krebs cycle, 1 mol. of glucose will utilize the pyruvic acid and O2 to produced 36 mol. ATP o Epithelium and endothelium will consume the oxygen
4. o The pentose phosphate pathway is used to metabolize five carbon sugars; one ATP and 2 NADH molecules are produced from oxidation of one glucose molecule o Produced intermediates for nucleic acid synthesis and some amino acids o This process will happen in hypoxic or normoxic condition o The purpose of glucose metabolism through the pentose shunt is the production of NADPH
Corneal metabolism
1. o Cornea requires energy for normal metabolic activities as well as for maintaining transparency and dehydration o Energy is generated by the breakdown of glucose in the form of ATP o Most actively metabolizing layer are epithelium and endothelium o Sources of nutrients : o Oxygen : mainly from atmosphere through tear film , with minor amount supplied by the aqueous and limbal vasculature o Glucose , amino acid, vitamins and other nutrients supplied to cornea by aqueous humor o Glucose also derived from glycogen stores in corneal epithelium o Epithelium consumes O2 10 times faster then stroma
2. o Three process or pathways – o Pentose shunt (Hexose monophosphate shunt) –occurs both in hypoxic and normoxic condition o Glycolysis (Embden meyerhof pathway) –anaerobic process , glucose / glycogen converted to pyruvate yeilding 2 ATPs o TCA or krebs or citric acid cycle- aerobic condition pyruvate is oxidized to yield 36 ATP, water, CO2.
3. o In normal conditions all the glucose consumed by the cornea o Glucose mostly come from aqueous humor o The rate of glucose consumption by the whole cornea is approx. 100 microgram/hr/cm2. o 1 mol. of glucose will be converted to the pyruvic acid and produced 2 molecules lactic acid and 2 mol. of ATP o In the krebs cycle, 1 mol. of glucose will utilize the pyruvic acid and O2 to produced 36 mol. ATP o Epithelium and endothelium will consume the oxygen
4. o The pentose phosphate pathway is used to metabolize five carbon sugars; one ATP and 2 NADH molecules are produced from oxidation of one glucose molecule o Produced intermediates for nucleic acid synthesis and some amino acids o This process will happen in hypoxic or normoxic condition o The purpose of glucose metabolism through the pentose shunt is the production of NADPH
you will get information and knowledge about different dyes, their uses in the diagnosis of ocular diseases in detail.
different dyes are as follows: Fluorescein, Rose Bengal, ICG, Lissamine Green, and Trypan Blue.
Direct Download Link ❤❤https://healthkura.com/eye-ppt/28/❤❤
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anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
you will get information and knowledge about different dyes, their uses in the diagnosis of ocular diseases in detail.
different dyes are as follows: Fluorescein, Rose Bengal, ICG, Lissamine Green, and Trypan Blue.
Direct Download Link ❤❤https://healthkura.com/eye-ppt/28/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com/eye-ppt/❤❤❤
anatomy of optic nerve and its blood supply and clinical corelation
Presentation Layout: optic nerve anatomy
Embryology of optic nerve
Introduction
Parts of optic nerve
Blood supply
Clinical significance
For Further Reading
Wolff’s Anatomy of the eye and orbit by Bron, Tripathi and Tripathi
Anatomy and Physiology of eye by A.K. Khurana 2nd edition
Comprehensive Ophthalmology by A.K. Khurana 5th edition
AAO- Fundamentals & Principles of Ophthalmology : sec 2
Walsh and Hoyt’s Clinical Ophthalmology
Internet
Vitamins are organic nutrients that are required in small quantities for a variety of biochemical functions and which generally cannot be synthesized in the body and must be supplied by the diet.
Covers the over view of Rhodopsin its functions, Four level structure of Rhodopsin, The diseases caused by mutations in the gene, visual signaling( Introduction to GPCR also Included)
email- malhotrapurvi24@gmail.com
Retinal Pigment epithelial cells perform a multitude of functions to protect the retina and maintain normal vision. Any kind of RPE malfunction leads to a variety of ocular diseases.
This PPT explains the various functions performed by RPE to maintain normal vision.
It is a slide to teach students in universities about the basics of vitamin A, its benefits, metabolism, clinical indication, and also general information.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
7. A. RETINAL PIGMENT EPITHELIUM
(RPE)
Single layer cuboidal epithelium.
4-6 million RPE cells per eye.
Photoreceptors : RPE ratio = 45 : 1
Essential for support and viability of photoreceptor cell
7
9. RETINAL
METABOLISM
Source of energy :
1. Carbohydrate, Lipid, Amino acid, Minerals and
Oxygen
Primary source is glucose metabolism
Supplied from blood stream (capillaries in the choroid
and via central retinal artery).
Under normal physiological conditions the retina has
a high rate of anaerobic glycolysis.
Oxygen consumption is high in photoreceptors.
Obtain energy mostly by oxidative phosphorylation
Muller cells store glycogen, providing a ready source
for glucose.
9
10. PHYSIOLOGIC ROLE OF RPE
Functions:
1. Visual pigment regeneration
2. Phagocytosis of the shed photoreceptors outer segments
discs
3. Maintenance of the outer blood- retinal barrier
4. Absorption of light (reduction of scatter)
5. Regeneration and repair after injury
10
Contd…
11. 6. Retinal adhesion
7. Active transport of materials into and out of the RPE
Functions contd…
11
12. 1. VISUAL PIGMENT REGENERATION
Regeneration of visual pigment (rhodopsin) involves both photoreceptor and
RPE.
Role of RPE:
- 2nd highest vit A containing structure
- Uptake, storage, mobilization of vit A for use in visual cycle
Generates 11- Cis- retinaldehyde used in formation of rhodopsin.
Role of photoreceptor:
Synthesize opsin {uses 11- Cis –retinaldehyde in the generation of rhodopsin}
12
13. In photoreceptor cell, rhodopsin is photolyzed
and undergoes a cis- to- trans isomerization :
All – trans –
retinaldehyde
All – trans – retinol
Returned to RPE in
presence of IRBP
Retinyl esters11- cis – retinol11- cis - retinal
Retinol
dehydrogenase
Lecithine retinol
acyltransferase
Isomero -
hydrolase
dehydrogenase
Released and
converted to
When needed
for regeneration
of rhodopsin
Returned to
photorecepto
r with IRBP
Interphotoreceptor retinoid binding protein
13
15. 2. PHAGOCYTOSIS OF PHOTORECEPTOR OUTER-
SEGMENT DISCS
Distal tip of disc arrives to RPE and
are phagocytosed.
Encapsulated in phagosome.
Fuses with lysosome and are digested.
15
16. Each photoreceptor cell sheds approximately 100 outer-segment
discs per day.
Each RPE cell digests more than 4000 discs daily.
The shedding event follows a circadian rhythm:
rods :-- within 2 hours of light onset;
cones :-- at onset of darkness.
16
17. Applied
Age related macular degeneration
Drusens:
• Failure of the RPE to clear the waste material
that gets accumulated between basal lamina
of RPE & inner collagenous layer of Bruch’s
17
18. 3. TRANSPORT, BARRIER AND
METABOLISM:
• RPE controls volume & composition of fluid in subretinal
space through transport of ions, fluid & metabolites
• Asymmetrical distribution of ion channel in apical and basal
membrane - vectorial transport.
• Tight junction - barrier for free diffusion.
18
19. Transport channels:
Active transport of (K+, Ca++, Na+ , CI-, and HCO)
-Na+ secreted from RPE to the subretinal space.
- K+ from subretinal space to RPE.
Na+K+-ATPase pump is present at the apical side
[K+ conductance].
Na+K+2CL co-transport.
High carbonic anhydrase activity ---- associated with
both the apical and basal sides of the cell
19
20. Applied
• The trans-RPE potential is the basis for the Electro-oculogram(EOG),
which is the most common electrophysiologic test for evaluating the RPE.
Reflects the activity of RPE and photoreceptors.
An eye blinded by pathology infront of photoreceptor layer will have
normal EOG.
• Mutation in these ion channel produce degenerative disease of retina.
20
21. 4. PIGMENTATION
• Melanin and lipofuscin
• Abundant in apical and mid portion of cytoplasm.
• Melanin: absorption of scattered light; scavenging of the free radicals
21
22. Applied
• Oculocutaneous albinism [OCA]
:complete lack of melanin pigment in
skin , hair and eyes (Ocular albinism:
only in eyes)
• In old age, melanin granule is
autodigested by lysosomes so fundus
in old age is less pigmented
22
23. Stargardt’s disease / Fundus
Flavimaculatus
Most common macular dystrophy
Characterised by accumulation of
lipofuschin within RPE
NON-SPECIFIC MOTTLING
SNAIL SLIME APPEARANCE
BEATEN BRONZE APPEARANCE GEOGRAPHIC ATROPHY
23
24. 5. RETINAL ADHESION:
• Is maintained by :
i. Interdigitation of outer segment and RPE microvilli.
ii. Active transport of subretinal fluid via RPE to
choriocapillaries.
iii. Binding properties of interphotoreceptor matrix.
iv. Passive hydrostatic forces.
v. Internal tamponade action of vitreous
24
Mechanical force
outside subretinal
space:
Fluid pressure
Vitreous adhesion
Forces in the subretinal
space:
RPE pump
Mechanical
interdigitation
Inter photoreceptor
matrix
25. APPLIED
Retinal detachment: detachment of neurosensory retina with RPE.
i. Rhegmatogenous: due to full thickness defect in neural retina permitting fluid
to subetinal space.
ii. Tractional : due to pulling of neural layer by traction by contracting
vitreoretinal membrane.
iii. Exudative : subretinal fluid accumulation from choroidal vessels or neural
layer vessels.
25
26. 6. REPAIR AND REGENERATION
• Although of neural origin the RPE can be the pluripotent tissues
• Capable of local repair and cell migration
• After a focal laser burn, for example, the RPE cells that surround the burn
begin to divide, and cells fill the defect to form a new blood-retinal barrier
within 1–2 weeks
26
28. Visual perception:
Is the sensation which results from stimulation of retina with light.
4 types :
i. Light sense: awareness of light -- rods
ii. Form sense: ability to discriminate between shape of objects --- cones.
iii. Contrast sense: ability to perceive slight change in luminance between
regions which are not separated by distinct border.
iv. Colour sense: ability to discriminate between colour of different
wavelength.
28
29. PHOTOCHEMISTRY OF VISION
• Light falling upon the retina absorbed by photosensitive
pigments in rods and cones initiate photochemical change
initiate electrical change. In this way the process of vision begins.
• Photochemistry of vision includes:
a) Vitamin A
b) Visual pigments
c) Light induced changes
29
30. Vitamin A to Visual Pigments Dietary vitamin A:
carotenes and
retinol
Transport in intestinal
lymphatics
Storage of
vitamin A in
liver as Retinol
Production of
retinol-
binding
protein
(carrier
protein)
Transport of retinol-protein
complex
Formation of
Rhodopsin
used in night
vision
Maintenance of
healthy corneal
and
conjunctival
epithelial cells
30
31. Vitamin A – Rhodopsin formation
• In retina, retinol attached to specific
receptor present on basal surface of
RPE
• Inside RPE , no change in vit A and
passes unchanged to outersegment of
photoreceptor.
31
32. • There, retinol is oxidized to retinene
• Combines to opsin to form rhodopsin
Visual pigments
Rhodopsin/
Scotopsin
Iodopsin/
Photopsin
32
33. RHODOPSIN
Present in disc of outer rod segment
Opsin + retinal
Mol. wt: 40,000
Sensitive to light: 493-505nm
Absorbs primarily yellow wavelength of
light, transmits violet and red, so also called
visual purple
33
34. PHOTOPSIN
Different from Rhodopsin (opsin part)
Respond to specific wavelength of light giving
rise to colour vision.
3 types :
a. blue sensitive : 435 nm
b. green sensitive :535nm
c. red sensitive : 580nm
Cynolabe
Chlorolabe
Erythrolabe
34
35. 2. Light induced changes:
Photochemical changes occuring in rods and cones.
In outer segment of rods:
1. Rhodopsin bleaching
2. Rhodopsin regeneration
3. Visual cycle
35
36. RHODOPSIN BLEACHING AND REGENERATION
Rhodopsin bleaching
• Separation of all- trans retinal (formed from
isomerization of 11 – cis –retinal) and opsin
is called photodecomposition, and the
rhodopsin is said to be bleached by the
action of light – within photoreceptors.
• Presence of light
BLEACHING
REGENERATION
36
37. Rhodopsin regeneration
All – trans retinal
Enters chromophore pool in photoreceptor
outer segment and RPE cells
Isomerized to 11– cis – retinal
Binds to opsin to form rhodopsin
Independent of light
This whole process is called rhodopsin
regeneration
37
38. VISUAL CYCLE
• This equilibrium between the
photodecomposition and regeneration
of visual pigments Visual Cycle
38
39. • Similar to those of rhodopsin.
• But nearly total rods bleaching occurs before the significant bleaching of
cones.
Light induced changes in the cones
39
40. PHYSIOLOGY OF VISION
• Mechanisms:
1. Initiation of vision [transduction]
2. Transmission of visual sensation
3. Visual perception
Light falling on retina absorbed by photosensitive pigments of rods and
cones initial photochemical changes occur initiate electrical change
transmit the message through ganglion cell along the fibers of optic
nerve > optic tract visual cortex.
40
41. Phototransduction
• The process of translation of the information
content of a light stimulus into electrical signals.
• Occurs in the photoreceptors
Photons captured Hyperpolarization
Release of
Neurotransmitter
41
42. RODS PHOTOTRANSDUCTION
Rhodopsin absorbs light
11-cis bond of retinal is broken
Opsin molecule undergo
conformational changes
Activated state: Meta –
rhodopsin II.
Starts a reaction that controls the inflow
of cations into rods outer segments 42
44. • Metarhodopsin, an activated rhodopsin
activates transducin
• Activated transducin(bound to GTP) –
activates phosphodiesterase(PDE) – catalyses
conversion of cGMP to GMP cGMP
decreases within the photoreceptors.
• Produce electrical response(receptor
potential): marks the beginning of nerve
impulse.
44
45. In normal condition (no
light)
• Inner segment of photoreceptor pumps Na+ from inside
to outside, creating negative potential inside.
• Na+ moves into outer segment, through open channels
and pass into inner segment, and is extruded by Na+ /K+
ATPase pumps.
• Na+ channel kept open by cGMP.
45
46. Contd…
• Na+ moving into outer segment and exiting the
inner segment: dark current.
• Photoreceptor is depolarized (membrane potential:
−40 mV) release glutamate from synaptic
terminal starting the neural signals for vision.
46
47. When light strikes
• Light activates visual pigment, decrease concentration
of cGMP close the Na+ channels reduction of dark
current hyperpolarizes photoreceptor (membrane
potential: -75mV)
• Local graded potential
• Stops glutamate release from synaptic terminal leading to
depolarization of Cone - On center bipolar cells and
hyperpolarization of Cone off center bipolar cell.
47
48. APPLIED
ROD SPECIFIC GENE DEFECT
i. Rhodopsin :
- Autosomal dominant retinitis pigmentosa
- Autosomal recessive retinitis pigmentosa (ARRP)
- Stationary form of nactylopia
ii. Rod transducin:
-Nougaret disease (AD stationary nactylopia)
iii. Rod cGMP phosphodiesterase: ARRP
iv. Rod cGMP –gated channel : ARRP
v. Guanylate cyclase : Leber congenital amaurosis.
48
50. CONE PHOTOTRANSDUCTION
• Resembles that of rods.
• Cone phototransduction is comparativly insensitive but faster and capable
of adapting enormously to the ambient level of illumination.
• Acquity increases with increased illumination.
50
51. • Rods and cones differ in their degrees of convergence onto ganglion
cells.
• Convergence makes rod system a better light detector, but reduces its
spatial resolution.
• Near one to-one mapping within cone system maximizes
discrimination of fine detail, visual acuity.
51
52. CONE SPECIFIC GENE DEFECT :
i. Cone cGMP gated channel : achromatopsia
cone - monochromatism
rod – monochromatism
iii. L or M cone opsins : red/green color deficiency.
52
53. Anomalous trichromatic colour
vision
• Protanomalous- defective red
colour appreciation.
• Deuteranomalous – defective
green colour
• Tritanomalous – defective blue
colour
NORMAL
RED- GREEN DEFECT BLUE DEFECT
53
54. Dichromatism
Dichromatic color vision
• Protanopia- absence of red sensitive
cone pigment
• Deuteranopia – absence of green
sensitive cone pigment
• Tritanopia – absence of blue
sensitive cone pigment
54
55. PROCESSING AND TRANSMISSION OF
VISUAL IMPULSE IN RETINA
• Receptor potential generated in photoreceptors
• Transmitted by electronic conduction to cells of retina
i.e. horizontal cell, bipolar cell, amacrine cell and
ganglion cells.
• From axons of ganglion cell to optic nerve.
• Ganglion cells transmit visual signal by means of action
potential. 55
57. i. Bipolar Cells
• 1st order neuron of visual pathway.
• Dendrites synapse with rod spherules and cone pedicles in OPL
• Axons synapse with dendrites of ganglion cells and amacrine cells in
IPL.
• Separate bipolars for rods and cones.
• At least two types of cone
bipolars:
1. ON – bipolars
2. OFF - bipolars 57
58. • Bipolars cells with ionotropic receptors, respond to glutamate with
depolarization: OFF bipolars
• Bipolar cells with metabotropic receptors, respond to glutamate with
hyperpolarization: ON bipolars.
OFF Bipolar
• Depolarizes in
dark
• Hyperpolarize
in light
On Bipolar
• Depolarizes in
light
• Hyperpolarize
in dark
58
59. ii. Horizontal cells :
• Transmits signals horizontally in OPL from rods
and cones to bipolar cells.
• Main function :
To enhance visual contrast by causing lateral
inhibitions.
59
60. • Are antagonistic interneurons, inhibit photoreceptors by
releasing GABA.
• Glutamate from cones and rod goes to horizontal cells
and then releases GABA back into rods and cones.
• Provide inhibitory feedback to photoreceptors and
inhibitory feed forward to bipolars
60
61. iii. Amacrine cell:
Receive information at synapse of bipolar cell
axon and ganglion cell dendrites.
Cone amacrines mediate antagonistic
interaction among on- bipolar , off- bipolar
and ganglion cell.
Rod amacrine receive input of rod bipolar and
deliver to on and off bipolar ganglion cell.
61
62. • Thus, rod signals undergo additional
synaptic delay.
• Amacrine cells help in temporal
summation and in initial analysis of visual
signals before leaving retina.
62
63. iv. Muller cells
Non-neural, glial cells.
Extends from inner segment of photoreceptor to ILM.
Functions:
1. Plays a supportive role.
2. Buffers ionic concentration in extracelluular space [K+].
3. Forms ELM and seals subretinal space.
4. Glycogen metabolism.
5. Maintains clarity of vitreous via phagocytosis.
6. Neurotransmitter uptake and conversion.
63
64. APPLIED
• Activation of muller cell in neuronal degeneration in retina.
• Increase growth factor secretion
• Long lasting gliosis may lead to subretinal fibrosis following RD
and ERM formation leading to RD.
64
65. GANGLION CELL LAYER
• 1.12 to 2.22 million ganglion cells
• 2nd order neuron of visual pathway
• The electrical response of bipolar cells after
modification by amacrine cells is transmitted to
the ganglion cells which in turn transmits their
signal by means of action potential to brain.
• Two types:
1. On - center cells : excited by the light in the
center of their receptive field.
2. Off – center cells : inhibited.
65
66. Other subgroups of retinal ganglion cells:
Tonic cells driven by L or M cones :
- foveal; for high visual acquity
Tonic cells driven by S cones :
- extrafoveal; For color contrast
Phasic cell:
- Concentrated in fovea; Faster conducting than
ganglion cells
Important in movement detection.
66
67. W- ganglion cells :
- 40%, small
- Receive most of excitation impulse from
rods
- Essential for scotopic vision
X- ganglion cells :
- 55%, medium size
- Responsible for color vision
Y- ganglion cells :
- 5%, largest
- Responds to rapid movement or change
in light intensity
67
68. Non–neural cells of retina
• Macroglia (astrocytes, oligodendroglia, schwann cells)
• Microglia
• These cells provide:
respond to retinal cell injury
regulate the ionic & chemical composition of extracellular
milieu
participate in blood- retina barrier
form the myelination of optic nerve
guide neuronal migration during development & exchange
metabolites with neurons 68
69. Neuro transmitters in the retina
Different synaptic neurotransmitters found in the retina:
I. Glutamate: excitatory transmitter, released by rods and cones at their
synapse with bipolar
II. GABA, glycine, dopamine, acetylcholine, indolamine : inhibitory
neurotransmitters produced by Amacrine cells and Horizontal cells
69
70. iii. Cholinesterase : found in processes of Muller, horizontal,
amacrine and ganglion cells.
In human retina, only true acetylcholinesterase has been found,
acetylcholine ---dominant synaptic neurotransmitter.
iv. Carbonic anhydrase– isolated from cones and RPE but not rods,
70
71. VISUAL ADAPTATION
• It involves:
I. dark adaptation
II. light adaptation
DARK ADAPTATION:
The ability of the visual system, both rod and cone mechanism to
recover sensitivity following exposure to light
The recovery is faster in cone but the sensitivity is greatest in rods
The time taken to see in dim illumination is called dark adaptation
time 71
72. Mechanism of dark adaptation
It is based on the changes in visual pigments
When the person remains in darkness for a long
time the retinaldehyde & opsins in rods & cones are
converted back into light sensitive pigments.
Vit A is reconverted back into retinal to give
additional light sensitive pigments, the final limit
being determined by the amount of opsins in rods
& cones
72
73. LIGHT ADAPTATION
• The process by which retina adapts itself to bright light is called light
adaptation
• Quick & occurs over a period of 5 mins
MECHANISM:
When a person remains in bright light, large proportion of
photochemicals in both rods & cones is reduced to retinal & opsins,
much of the retinal of both rods & cones is converted into Vit A.
73
74. Photopic and Scotopic vision
• Dim light detection by rods
• In scotopic vision, the light-sensitive retina allows detection of objects at low levels
of illumination. Its ability to recognize fine detail is poor and color vision is absent;
objects are seen in shades of gray
• Bright light cone activity predominates
• Bright illumination is necessary for the sharp visual
acuity and color discrimination of photopic vision.
74
75. ELECTRORETINOGRAM :
• Is the record of action potential produced by retina when stimulated by light
of adequate intensity.
75
‘a’ wave is
negative wave,
arises from
photoreceptors
‘b’ wave is positive
wave, arises from
Muller cells
‘c’ wave is prolonged
positive wave, arises
from RPE
Light passes through most of the retinal layers
Reaches and stimulates the photoreceptor outer segment discs
The neural flow then proceeds back through the retinal elements in the opposite direction of the incident light
Between outer vascular choriocapillaries and inner photoreceptor cells.
Long microvillus on their apical surface—interdigitate with outer segments of photoreceptor
45:1-- This constancy has physiological relevance, in that each RPE cell is metabolically responsible for providing support functions to multiple overlying receptors.
The retina can switch from glycolysis to oxidative metabolism depending on need,
Retina is sensitive to any fall in CHO concentration within its tissue, it can tolerate a fall in concn as low as 30mg/100ml without any disturbance of activity but any lower thant this concn the vision will suffer
Retina is one of the highest Oxygen consuming tissue in the body
Besides it also helps in the synthesis of different growth factors
Aldehyde and alcohol forms of vit A are membranolytic Reitnyl esters are are not lytic to cell membranes
esterified via fatty acids like palmitic acid or stearic and oleic acids.
Radioactive protein synthesized in inner segment of photoreceptor and transported to outer segment, incorporate into new disc (9-11days.)
APPLIED ::: Defects in the phagocytic functions of RPE leads to the degeneration of the photoreceptors
Absorption improves optical quality
Iris is diaphanous and translucent(tyr neg) giving rise to a pink-eyed appearance; iris is blue or darkbrown (tyr pos)
Fundus lack pigment(tyr-neg) and hypopigmeted (tyr pos) and shows choroidal vessels, foveal hypoplasia, no foveal pit
Fleck
3rd bulls eye maculopathy
Neural retina remains rather firmly attached to the RPE.
Hydrostatic force is from vitreous to the choroid>> rpe is firm>> outward push of fluid keeps retina attached
Resulting in the accumulation of subretinal fluid in the potential space between the NSR and RPE
In degenerative disease like RETINITIS PIGMENTOSA, rpe cells migrate into the injured neural retina and sometimes comes to rest around vessels to contribute to characteristic bony spicules
Retinol is oxidized to retinene by the enzyme retinene reductase
Rhodopsin is membrane bound glycolipid
One of the serpentine receptors coupled to Gprotein
Insoluble in water
The photopigment in rods is arranged in the disc membranes and its protein is rhodopsin
In cones the photopigment is located throughout the continuous plasma membrane whose deep infoldings form the cone discs
Light falling upon the retina is absorbed by photosensitive pigments in rods and cones and initiates photochemical changes that in turn initiate the electrical changes and thus the process of vision sets in.
Thus the bleaching of the retinal photopigments occurs under the influence of light, whereas the regeneration process is independent of light, proceeding equally in light and darkness.
The amount of rhodopsin in the rods herefore varies inversely with the incident light
Under the constant light stimulation, a steady state must exist under which the rate at which the photochemicals are bleached is equal to the rate at which they are regenerated
Ionic balance is maintained by Na-K –ATPase pump in inner segment & Na\K-Ca exchanger in outer segment
The photoreceptor potential is different from the receptor potential (in other sensory receptors) in that the excitation of photoreceptors causes increased negativity of membrane potential >> hyperpolarization , rather than decreased negativity (depolarization)
Also eye is unique in that the receptor potential of photoreceptors is a local graded potential>> doesn’t propagate and follow all or none rule
Classic triad comprise of bony-spicule retinal pigmentation, arteriolar attenuation and waxy disc pallor
LCA is the commonest geneticlally defined cause of visual impairment in children >> oculodigital syndrome
Cone: characterized by presence of only one primary colour and thus the person is truly colour blind
Without cones, one loses ability to read and see colors and can be legally blind.
The ability to perceive one of the three primary colours is completely absent
When a minute spot of light strikes the retina, the central most area is excited but the area around is inhibited. Thus instead of the excitatory signal spreading widely in th retina because of spreading dendritic andaxonal tree in th plexiform layers, transmission through horizontal cells puts stop to this by providing lateral inhibition in th surrounding layers
Besides we have parvo cellular and magno cellular ganglion cells
And monosynaptic and polysynaptic ganglion cells