Selective Automated Perimetry Under Photopic, Mesopic, and Scotopic Conditions: Detection Mechanisms and Testing Strategies.

PURPOSE: Automated scotopic, mesopic, and photopic perimetry are likely to be important paradigms in the assessment of emerging treatments of retinal diseases, yet our knowledge of the photoreceptor mechanisms detecting targets under these conditions remains largely dependent on simian data. We therefore aimed to establish the photoreceptor/postreceptoral mechanisms detecting perimetric targets in humans under photopic, mesopic, and scotopic conditions and to make recommendations for suitable clinical testing strategies for selective perimetry. METHODS: Perimetric sensitivities within 30° of fixation were determined for eight wavelengths (410, 440, 480, 520, 560, 600, 640, and 680 nm) under scotopic, mesopic (1.3 cd.m-2) and photopic (10 cd.m-2) conditions. Data were fitted with vector combinations of rod, S-cone, nonopponent M+L-cone mechanism, and opponent M- versus L-cone mechanism templates. RESULTS: Scotopicperimetric sensitivity was determined by rods peripherally and by a combination of rods and cones at, and immediately around, fixation. Mesopic perimetric sensitivity was mediated by M+L-cones and S-cones centrally and by M+L-cones and rods more peripherally. Photopic perimetric sensitivity was determined by an opponent M- versus L-cone, a nonopponent M+L-cone, and an S-cone mechanism centrally and by a combination of an S-cone and an M+L-cone mechanism peripherally. CONCLUSIONS: Under scotopic conditions, a 480-nm stimulus provides adequate isolation (≥28 dB) of the rod mechanism. Several mechanisms contribute to mesopic sensitivity: this redundancy in detection may cause both insensitivity to broadband white targets and ambiguity in determining which mechanism is being probed with short-wavelength stimuli. M- and L-cone-derived mechanisms are well isolated at 10 cd.m-2: these may be selectively probed by a stimulus at 640 nm (≥ 20 dB isolation). TRANSLATION RELEVANCE: In human observers, multiple mechanisms contribute to the detection of Goldmann size III and size V perimetric targets under scotopic, mesopic, and photopic conditions. The relative contribution of these mechanisms appears to differ from those found previously for macaques. Our results furthermore suggest that caution must be exercised when using microperimetric techniques, which are typically conducted under mesopic conditions and which are likely to be important in the assessment of emerging treatments for retinal disease. This is because mesopic background conditions maximize the redundancy of target detection. Furthermore, our results demonstrate that spectral manipulation of the stimulus alone cannot be used to reliably separate rod from cone responses under these conditions.