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Huchzermeyer C, Lämmer R, Mardin CY, Kruse FE, Kremers J, Horn FK. Pattern electroretinogram, blue-yellow visual evoked potentials and the risk of developing visual field defects in glaucoma suspects: a longitudinal "survival" analysis with a very long follow-up. Graefes Arch Clin Exp Ophthalmol 2024; 262:1607-1618. [PMID: 38183466 PMCID: PMC11031459 DOI: 10.1007/s00417-023-06364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/06/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024] Open
Abstract
PURPOSE Estimating glaucoma suspects' risk for visual field defects helps to avoid under- and over-treatment. In this retrospective, longitudinal cohort study with a very long follow-up, we studied whether pattern electroretinograms (PERG) amplitudes and blue-on-yellow visual evoked potential (BY-VEP) latencies can predict visual field defects. METHODS Participants of the Erlangen Glaucoma Study were examined with PERG and BY-VEP between 9/1991 and 8/2001. Stimuli were created using an optical bench with Maxwellian view and consisted of vertical gratings (0,88 cpd) in a 32° field for both PERG and BY-VEP. Patients were treated according to clinical standards and performed standard automated perimetry (SAP) annually. Retrospectively, patients with normal SAP at baseline were selected. Primary endpoint was conversion to perimetric glaucoma. Predictive value was modeled using Kaplan-Meier analyses and a multivariate cox proportional hazards model with the continuous variables PERG amplitude, BY-VEP peak time and SAP square-root of loss variance (sLV) after stratification for Jonas classification of the optic discs. RESULTS Of 412 patients (288: Jonas 0, 103: I, and 21: II; baseline age: 20-60 years), 65 converted to perimetric glaucoma during follow-up (0.5-23.3 years; median 5.5 years). Optic disc classification was a strong risk factor for conversion (log rank p < 0.0001), and patients with more advanced changes progressed earlier. In the multivariate analysis (log rank p = 0.005), only PERG amplitude remained an independent risk factor after stratification for optic disc morphology (p = 0.021), with a ~ 30% higher risk per μV amplitude decrease. CONCLUSIONS PERG helps to estimate glaucoma suspects' risk for visual field defects.
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Affiliation(s)
- Cord Huchzermeyer
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany.
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany.
| | - Robert Lämmer
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Christian Y Mardin
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Friedrich E Kruse
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Jan Kremers
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Folkert K Horn
- Department of Ophthalmology, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
- Medical Faculty, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
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Rai BB, Sabeti F, Carle CF, Maddess T. Visual Field Tests: A Narrative Review of Different Perimetric Methods. J Clin Med 2024; 13:2458. [PMID: 38730989 PMCID: PMC11084906 DOI: 10.3390/jcm13092458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
Visual field (VF) testing dates back to fifth century B.C. It plays a pivotal role in the diagnosis, management, and prognosis of retinal and neurological diseases. This review summarizes each of the different VF tests and perimetric methods, including the advantages and disadvantages and adherence to the desired standard diagnostic criteria. The review targets beginners and eye care professionals and includes history and evolution, qualitative and quantitative tests, and subjective and objective perimetric methods. VF testing methods have evolved in terms of technique, precision, user-friendliness, and accuracy. Consequently, some earlier perimetric techniques, often still effective, are not used or have been forgotten. Newer technologies may not always be advantageous because of higher costs, and they may not achieve the desired sensitivity and specificity. VF testing is most often used in glaucoma and neurological diseases, but new objective methods that also measure response latencies are emerging for the management of retinal diseases. Given the varied perimetric methods available, clinicians are advised to select appropriate methods to suit their needs and target disease and to decide on applying simple vs. complex tests or between using subjective and objective methods. Newer, rapid, non-contact, objective methods may provide improved patient satisfaction and allow for the testing of children and the infirm.
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Affiliation(s)
- Bhim Bahadur Rai
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
- Faculty of Health, School of Optometry, University of Canberra, Canberra, ACT 2601, Australia
| | - Corinne Frances Carle
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia; (F.S.); (C.F.C.); (T.M.)
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Hermas A, Tsilfidis C, Karanjia R, Miller G, Kantungane AL, El-Salibi A, Kherani IN, Bali S, Coupland S. Sensitivity and specificity of the uniform field electroretinogram in glaucoma detection in comparison to the pattern electroretinogram. Doc Ophthalmol 2024; 148:97-106. [PMID: 38243039 DOI: 10.1007/s10633-023-09960-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/06/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE To determine the ability of the photopic negative response (PhNR) of the uniform field electroretinogram (UF-ERG) to identify early glaucomatous changes in comparison to the checkerboard and bar stimuli of the pattern electroretinogram (PERG). METHODS Forty-nine glaucoma patients were classified into two groups: glaucoma-suspect (23 eyes) and early to moderate glaucoma (30 eyes), based on their clinical examination and the results of standard automated perimetry. Thirty patients (30 eyes) with intraocular pressures (IOP) of 21 mmHg or less, with no history of reported high IOP, were included as controls. PERG and UF-ERG recordings were obtained on a Diagnosys D-341 Attaché-Envoy System. Visual field testing was done only for glaucoma-suspect and glaucoma patients. RESULTS All three tests (PERG bar stimulus, PERG checkerboard stimulus and PhNR) displayed significantly prolonged peak times for glaucoma and glaucoma-suspect patients, with delays ranging from 7.8 to 14.8%, depending on the test. The PERG bar stimulus also showed a significantly lower N95 amplitude for both glaucoma groups (with reductions of 26.0% and 33.0% for glaucoma-suspect and glaucoma groups, respectively). The PERG checkerboard N95 amplitude component had high sensitivity for detecting glaucoma patients but a low specificity (97% and 37%, respectively; AUC = 0.61). Overall, the PhNR peak time showed the highest sensitivity and specificity (77% and 90%, respectively; AUC = 0.87). CONCLUSIONS PERG bar stimuli and the PhNR of the UF-ERG can be used in the clinical setting to detect glaucoma-related changes in glaucoma-suspect and glaucoma patients. However, our data confirm that the PhNR peak time has the best combined sensitivity and specificity.
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Affiliation(s)
- Asma Hermas
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Catherine Tsilfidis
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rustum Karanjia
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Garfield Miller
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Ange-Lynca Kantungane
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | | | - Irfan N Kherani
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada
| | - Shveta Bali
- University of Ottawa Eye Institute, Ottawa, ON, Canada
| | - Stuart Coupland
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Ophthalmology, University of Ottawa, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- University of Ottawa Eye Institute, Ottawa, ON, Canada
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Tirsi A, Gliagias V, Zhu D, Wong B, Gupta R, Park SC, Obstbaum S, Tello C. Correlations between Steady-State Pattern Electroretinogram and Humphrey Visual Field Analyzer Global Indices and Their Associations with Retinal Ganglion Cell Layer-Inner Plexiform Layer Thickness in Glaucoma Suspects. J Ophthalmol 2024; 2024:2443887. [PMID: 38500553 PMCID: PMC10948225 DOI: 10.1155/2024/2443887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose The purpose of this study was to investigate the utility of steady state pattern electroretinogram (ss-PERG) in detecting retinal ganglion cell (RGC) dysfunction in glaucoma suspects (GS) who had normal 24-2 Humphrey Visual Fields (HFA). Materials and Methods This was a prospective cohort study of GS patients who were identified based on optic disc appearance with normal HFAs. Patients received a complete eye examination, standard automated perimetry (SAP), optical coherence tomography (OCT), and ss-PERG measurements. The ss-PERG parameters, Magnitude (Mag), Magnitude D (MagD), and MagD/Mag ratio, were examined, along with their relationships between HFA and OCT measurements. Results Twenty-five patients were included in this study, with a total of 49 eyes. Fifteen eyes had abnormal ss-PERG parameters and when compared to GS eyes with normal ss-PERG parameters, there were significant differences in HFA 24-2, retinal nerve fiber layer (RNFL) thickness, and ganglion cell layer and inner plexiform layer (GCL + IPL) thickness. All ss-PERG parameters were significantly correlated with 24-2 VF mean deviation (MD) and visual field index (VFI), as well as 10-2 VF MD after controlling for age, sex, intraocular pressure, central corneal thickness, and spherical equivalent. When controlled for age, spherical equivalent, and IOP, MagD/Mag ratio significantly contributed to the variance in average GCL + IPL thicknesses, whereas 24-2 VF MD and 10-2 VF MD did not. MagD/Mag ratio also significantly accounted for variance in all macular GCL + IPL sectors, while 10-2 VF MD did not. Conclusions ss-PERG has significant correlations with HFA global indices and was predictive of GCL + IPL thickness in GS patients. Clinical Significance. ss-PERG may serve as a useful functional tool for detecting and measuring RGC dysfunction in GS. It appears to be more sensitive than HFA in the detection of early changes in GCL + IPL thicknesses and may be helpful to use in conjunction with current diagnostic studies to improve the ability of monitoring GS progression.
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Affiliation(s)
- Andrew Tirsi
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, New Hyde Park, NY, USA
| | | | - Daniel Zhu
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - Benny Wong
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - Rohun Gupta
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, New Hyde Park, NY, USA
| | - Sung Chul Park
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, New Hyde Park, NY, USA
| | - Stephen Obstbaum
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, New Hyde Park, NY, USA
| | - Celso Tello
- Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra University/Northwell Health, New Hyde Park, NY, USA
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Ahn EJ, Shin YI, Kim YK, Jeoung JW, Park KH. Hemifield-based analysis of pattern electroretinography in normal subjects and patients with preperimetric glaucoma. Sci Rep 2024; 14:5116. [PMID: 38429373 PMCID: PMC10907379 DOI: 10.1038/s41598-024-55601-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
This prospective cross-sectional study investigated the visual function of preperimetric glaucoma (PPG) patients based on hemifield (HF) pattern electroretinogram (PERG) amplitudes. Thirty-two (32) normal subjects and 33 PPG patients were enrolled in control and PPG groups, respectively. All of the participants had undergone full ophthalmic examinations, including spectral-domain optical coherence tomography (SD-OCT), visual field (VF) examination and pattern electroretinography (PERG). The PERG parameters along with the HF ratios of SD-OCT and PERG were compared between the control and PPG groups. Pairwise Pearson's correlation coefficients and linear regression models were fitted to investigate the correlations. The PERG N95 amplitudes were significantly lower in the PPG group (P < 0.001). The smaller/larger HF N95 amplitude ratio of the PPG group was found to be smaller than that of the control group (0.73 ± 0.20 vs. 0.86 ± 0.12; P = 0.003) and showed positive correlations with affected HF average ganglion cell-inner plexiform layer (GCIPL) thickness (r = 0.377, P = 0.034) and with average GCIPL thickness (r = 0.341, P = 0.005). The smaller/larger HF N95 amplitude ratio did not significantly change with age (β = - 0.005, P = 0.195), whereas the full-field N95 amplitude showed a negative correlation with age (β = - 0.081, P < 0.001). HF analysis of PERG N95 amplitudes might be particularly useful for patients with early glaucoma.
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Affiliation(s)
- Eun Jung Ahn
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Daehakro Seoul Eye Clinic, Seoul, Korea
| | - Young In Shin
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
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Daka Q, Sustar Habjan M, Meglič A, Perovšek D, Atanasovska Velkovska M, Cvenkel B. Retinal Ganglion Cell Function and Perfusion following Intraocular Pressure Reduction with Preservative-Free Latanoprost in Patients with Glaucoma and Ocular Hypertension. J Clin Med 2024; 13:1226. [PMID: 38592025 PMCID: PMC10931696 DOI: 10.3390/jcm13051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Given the global prevalence of glaucoma and the crucial role of intraocular pressure (IOP) reduction in the management of the disease, understanding the immediate effects on retinal structure and function is essential. (2) Methods: This study aimed to assess the effects of preservative-free latanoprost on morphological and functional parameters in treatment-naïve patients with ocular hypertension and open-angle glaucoma. (3) Results: This study showed a significant reduction in IOP by an average of 30.6% after treatment with preservative-free latanoprost. Despite the significant reduction in IOP, no statistically significant changes were observed in the electroretinogram (ERG) nor the optical coherence tomography/angiography (OCT/OCTA) parameters compared to baseline. An exploration of the correlation between IOP changes and various parameters revealed a significant association solely with the macular IPL/INL plexus vessel density (VD) measured with OCTA. (4) Conclusions: This finding suggests a possible association between IOP reduction and changes in the macular microcirculation and provides valuable insights into the differential effects of latanoprost. Acknowledging the study limitations, this study emphasizes the need for larger, longer-term investigations to comprehensively assess the sustained effects of preservative-free latanoprost on both IOP and retinal parameters. In addition, exploring systemic factors and conducting subgroup analyses could improve personalized approaches to glaucoma treatment.
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Affiliation(s)
- Qëndresë Daka
- Department of Pathophysiology, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.S.H.)
| | - Maja Sustar Habjan
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.S.H.)
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.S.H.)
| | - Darko Perovšek
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.S.H.)
| | | | - Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.S.H.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Erb C, Erb C, Kazakov A, Umetalieva M, Weisser B. Influence of Diabetes Mellitus on Glaucoma-Relevant Examination Results in Primary Open-Angle Glaucoma. Klin Monbl Augenheilkd 2024; 241:177-185. [PMID: 37643738 DOI: 10.1055/a-2105-0756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Primary open-angle glaucoma (POAG) is no longer considered an isolated eye pressure-dependent optic neuropathy, but a neurodegenerative disease in which oxidative stress and neuroinflammation are prominent. These processes may be exacerbated by additional systemic diseases. The most common are arterial hypertension, dyslipidemia, and diabetes mellitus. Using diabetes mellitus as an example, it will be shown how far-reaching the influence of such a systemic disease can be on both the functional and the structural diagnostic methods for POAG. This knowledge is essential, since these interferences can lead to misinterpretations of POAG, which can also affect therapeutic decisions.
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Affiliation(s)
- Carl Erb
- Augenklinik am Wittenbergplatz, Berlin, Deutschland
| | | | - Avaz Kazakov
- Department of External Relations and Development, Salymbekov University, Bishkek, Kyrgyzstan
| | - Maana Umetalieva
- Medical Faculty of Medicine, Salymbekov University, Bishkek, Kyrgyzstan
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Feng KM, Tsung TH, Chen YH, Lu DW. The Role of Retinal Ganglion Cell Structure and Function in Glaucoma. Cells 2023; 12:2797. [PMID: 38132117 PMCID: PMC10741833 DOI: 10.3390/cells12242797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Glaucoma, a leading cause of irreversible blindness globally, primarily affects retinal ganglion cells (RGCs). This review dives into the anatomy of RGC subtypes, covering the different underlying theoretical mechanisms that lead to RGC susceptibility in glaucoma, including mechanical, vascular, excitotoxicity, and neurotrophic factor deficiency, as well as oxidative stress and inflammation. Furthermore, we examined numerous imaging methods and functional assessments to gain insight into RGC health. Finally, we investigated the current possible neuroprotective targets for RGCs that could help with future glaucoma research and management.
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Affiliation(s)
| | | | | | - Da-Wen Lu
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (K.M.F.); (T.-H.T.); (Y.-H.C.)
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Gallo Afflitto G, Chou TH, Swaminathan SS, Aiello F, Gedde SJ, Nucci C, Porciatti V. Pattern Electroretinogram in Ocular Hypertension, Glaucoma Suspect and Early Manifest Glaucoma Eyes: A Systematic Review and Meta-analysis. OPHTHALMOLOGY SCIENCE 2023; 3:100322. [PMID: 37334035 PMCID: PMC10272507 DOI: 10.1016/j.xops.2023.100322] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 06/20/2023]
Abstract
Topic To provide standardized confidence limits of the transient pattern electroretinogram (tPERG) P50 and N95 and steady state pattern electroretinogram (ssPERG) amplitudes in normal controls as compared to ocular hypertension (OHT), glaucoma suspect (GS), or early manifest glaucoma (EMG) eyes. Clinical Relevance The identification of standardized confidence limits in the context of pattern electroretinogram (PERG) might overcome the high intrinsic variability of the measure, and it might lead to a more intuitive understanding of the results as well as to an easier comparison of data from multiple tests, sites, and operators. Methods The study protocol was prospectively registered on the International Prospective Register of Systematic Reviews (ID: CRD42022370032). A literature search was conducted on PubMed, Web of Science, and Scopus. Studies comparing PERG raw data in normal control eyes as compared to OHT, GS, or EMG were included. The risk of bias was assessed using the National Institute for Health and Clinical Excellence quality assessment tool. The main outcome was the P50, N95, and ssPERG amplitude difference between the control and the study groups' eyes. The standardized mean difference was calculated as a measure of the effect size for the primary outcome. A subanalysis was conducted based on the type of electrodes adopted for the PERG measurements (invasive vs. noninvasive). Results Of the 4580 eligible papers, only 23 were included (1754 eyes). Statistically significant amplitude differences were found in the P50, N95, and ssPERG amplitudes between normal controls and OHT, GS, and EMG eyes. The highest standardized mean difference values were observed in the ssPERG amplitude in all 3 sets of comparison. The subanalysis did not reveal any statistically significant differences between invasive and noninvasive recording strategies. Conclusions The use of standardized values as the main outcome measures in the context of the PERG data analysis is a valid approach, normalizing several confounding factors which have affected the clinical utility of PERG both for individual patients and in clinical trials. Steady state PERG apparently better discriminates diseased eyes compared to tPERG. The adoption of skin-active electrodes is able to adequately discriminate between healthy and diseased statuses. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Gabriele Gallo Afflitto
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Tsung-Han Chou
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Swarup S. Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Steven J. Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Vittorio Porciatti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Alhagaa AA, Mahmoud Badawi N, Abd Allah El-Morsy O. Primary Open Angle Glaucoma Diagnosis Using Pattern Electroretinogram Parameters. Clin Ophthalmol 2023; 17:3281-3293. [PMID: 37933330 PMCID: PMC10625753 DOI: 10.2147/opth.s424323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Background Glaucoma is the most typical cause of permanent blindness. POAG, or primary open angle glaucoma, is the most common type. The pattern electroretinogram (PERG) has become a promising technique for detecting glaucoma early-on. The goal of this study was to assess the ability of PERG to diagnose POAG, especially in early, difficult-to-diagnose cases in comparison with other already established diagnostic methods. Methods 150 participants (300 eyes) were enrolled in a cross-sectional study at ophthalmology department at Menoufia University Hospital in August 2022 to February 2023. All recruited participants underwent comprehensive ophthalmological and PERG exams. The studied eyes were divided into three groups as 100 normal eyes (Group I), 100 eyes with preperimetric glaucoma (Group II), and 100 eyes with established perimetric glaucoma (Group III). Results OCT-RNFL average thickness had a significant positive correlation with P50 latency (r=0.289, p=0.041) or P50 amplitude (r=0.302, p=0.018) and N95 amplitude (r=0.640, p=0.001) among group (II). Also, RNFL thickness had negative correlation with P50 amplitude (r= -0.268, p=0.043) among group (III). RNFL thickness and P50 and N95 amplitude showed highest AUC values in detecting preperimetric glaucomatous eyes vs normal eyes (AUC=0.927, 0.952, 904), and for detecting established perimetric glaucomatous eyes vs normal eyes (AUC=1.00, 0.957, 0.983 respectively) compared with VF MD which showed AUC (0.458 and 0.901 respectively). Conclusion Glaucoma patients exhibit PERG alterations (comparable to RNFL thickness changes) so, it could be used as an accurate diagnostic method in POAG. Because PERG alterations occur before visual field abnormalities, it could be relied on as an early diagnostic tool in preperimetric glaucoma. We can use both RNFL thickness assessment by OCT with PERG parameters as complementary tests for accurate diagnosis of preperimetric glaucoma which represents the most difficult diagnostic challenge in glaucoma diagnosis.
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Affiliation(s)
- Ahmed A Alhagaa
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, 6132415, Egypt
| | - Nermeen Mahmoud Badawi
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, 6132415, Egypt
| | - Osama Abd Allah El-Morsy
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, 6132415, Egypt
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Predicting Visual Field Progression by Optical Coherence Tomography Angiography and Pattern Electroretinography in Glaucoma. J Glaucoma 2022; 31:881-890. [PMID: 35882039 DOI: 10.1097/ijg.0000000000002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/12/2022] [Indexed: 02/04/2023]
Abstract
PRCIS Reduced P50-N95 amplitude on pattern electroretinography (PERG) and the presence of microvasculature dropout (MvD) on optical coherence tomography angiography (OCT-A) at baseline were significant factors associated with visual field (VF) progression in predominantly normal tension glaucoma (NTG) patients. OBJECTIVE We investigated the baseline demographics and ocular characteristics that predict future progression in glaucoma patients, including PERG and OCT-A parameters. METHODS One Hundred forty eyes with open angle glaucoma that were prospectively enrolled and followed up for at least 3 years, and underwent at least 5 serial VF tests were included. Baseline PERG was performed, and N35, P50, and N95 latencies and amplitudes were obtained. Superficial vessel density at the macula and complete loss of microvasculature within the deep retinal layer of the parapapillary region (MvD) were evaluated from baseline OCT-A images. Eyes with a glaucomatous VF defect in either both hemifields within 24 points of a central 10 degrees of fixation, and with no VF abnormality in the nasal periphery outside 10 degrees of fixation, were considered to have isolated central scotoma. During follow-up, detected disc hemorrhage (DH) was recorded. Parameters associated with VF progression were determined using linear regression analysis of the mean deviation (MD) values, in combination with an event-based analysis using the Glaucoma Progression Analysis (GPA) software from the Humphrey Field Analyzer. "Likely progression" using GPA was considered to have glaucoma progression. RESULTS Of the 140 eyes, 107 (76.4%) were NTG and 57 (40.7%) exhibited glaucoma progression as defined by Humphrey VF GPA. The MD slopes were -0.43±1.11 dB/y in the progressors and 0.59±1.27 dB/y in the nonprogressors ( P <0.001). Glaucoma patients with progression showed frequent MvD on OCT-A, isolated central scotoma, frequent DH, and reduced baseline P50-N95 amplitude compared with patients without progression. Age at diagnosis ( P =0.038) and baseline P50-N95 amplitude ( P =0.019) showed significant associations with the MD slope. The presence of MvD on OCT-A ( P <0.001) and baseline P50-N95 amplitude ( P =0.037) were significantly associated with VF progression on GPA. CONCLUSIONS The presence of MvD and retinal ganglion cell dysfunction by PERG at baseline, DH or central scotoma were significant factors associated with VF progression in predominantly NTG patients. These patients should be monitored more closely.
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Tirsi A, Wong A, Zhu D, Stoffels G, Derr P, Tello MD C. Pattern Electroretinogram Parameters and their Associations with Optical Coherence Tomography in Glaucoma Suspects. J Curr Glaucoma Pract 2022; 16:96-104. [PMID: 36128077 PMCID: PMC9452702 DOI: 10.5005/jp-journals-10078-1365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To investigate whether steady state pattern electroretinogram (ssPERG) could identify retinal ganglion cell (RGC) dysfunction, and to assess the relationship between ssPERG with optical coherence tomography (OCT) measurements in glaucoma suspects (GS). Materials and methods This was a prospective cohort study of GS, identified based on suspicious optic disk appearance and glaucoma risk factors. Complete eye exam, Standard automated perimetry, OCT, and ssPERG were performed. Magnitude (Mag), Magnitude D (MagD), and MagD/Mag ratio were subsequently used in the correlation and linear regression analyses between ssPERG parameters and the RNFL, GCL/IPL, and macular thicknesses measurements. Results Forty-nine eyes of 26 patients were included. Mag and MagD were significantly correlated with the superior, inferior, and average RNFL thicknesses (avRNFLT). All ssPERG parameters were significantly correlated with the average and minimum GCL/IPL thicknesses and the inner macular sector thicknesses. Mag and MagD significantly predicted the superior, inferior, and avRNFLT in the regression analysis. All ssPERG parameters were predictive of GCL/IPL thickness in all sectors as well as the average and minimum GCL/IPL thicknesses. All ssPERG parameters were predictive of all inner macular sector thicknesses and MagD was also predictive of some outer macular sector thicknesses as well. Conclusion ssPERG has significant correlations with and is predictive of RNFL, GCL/IPL, and macular thicknesses in glaucoma suspects. Clinical significance ssPERG may serve as a useful objective functional tool for identifying and following the progression of disease in glaucoma suspects. How to cite this article Tirsi A, Wong A, Zhu D, et al. Pattern Electroretinogram Parameters and their Associations with Optical Coherence Tomography in Glaucoma Suspects. J Curr Glaucoma Pract 2022;16(2):96-104.
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Affiliation(s)
- Andrew Tirsi
- Department of Ophthalmology, Manhattan Eye, Ear, & Throat Hospital, Northwell Health, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Andrew Tirsi, Department of Ophthalmology, Manhattan Eye, Ear, & Throat Hospital, Northwell Health, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States, Phone: 1 (201) 982 4168, e-mail:
| | - Amanda Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Daniel Zhu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
| | - Guillaume Stoffels
- Lennox Hill Hospital/Northwell, Feinstein Institute for Medical Research, New York, United States
| | - Peter Derr
- Diopsys, Inc., Pine Brook, NJ, United States
| | - Celso Tello MD
- Department of Ophthalmology, Manhattan Eye, Ear, & Throat Hospital, Northwell Health, New York, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
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Tirsi A, Orshan D, Wong B, Gliagias V, Tsai J, Obstbaum SA, Tello C. Associations between steady-state pattern electroretinography and estimated retinal ganglion cell count in glaucoma suspects. Doc Ophthalmol 2022; 145:11-25. [PMID: 35377032 PMCID: PMC9259521 DOI: 10.1007/s10633-022-09869-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
Purpose To estimate retinal ganglion cell (RGC) count in glaucoma suspects (GS) and ascertain its relationships with steady-state pattern electroretinography (ssPERG) parameters. Methods In this prospective cross-sectional study, 22 subjects (44 eyes) were recruited at the Manhattan Eye, Ear, and Throat Hospital. Subjects underwent complete eye examinations, optical coherence tomography, standard automated perimetry, and ssPERG testing. Eyes were divided into two groups based upon clinical data: healthy subjects and GS. RGC count was estimated using the combined structure–function index. Results Estimated RGC count, average retinal nerve fiber layer thickness (ARNFLT), and average ganglion cell layer and inner plexiform layer thickness (GCIPLT) were reduced in GS eyes (p ≤ 0.001 for all parameters). Pearson correlations revealed that ssPERG magnitude and magnitudeD correlated with ARNFLT (r ≥ 0.53, p < 0.001), GCIPLT (r > 0.38, p < 0.011), and estimated RGC count (r > 0.46, p < 0.002). Six mediation analyses revealed that estimated RGC count mediated the relationships among ssPERG parameters, ARNFLT, and GCIPLT. Conclusion Steady-state PERG parameters demonstrated linear correlations with estimated RGC count. The associations among ssPERG parameters and structural measures were mediated by estimated RGC count. Supplementary Information The online version contains supplementary material available at 10.1007/s10633-022-09869-9.
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Affiliation(s)
- Andrew Tirsi
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Diopsys Inc., Pine Brook, New York, NJ, USA.
| | - Derek Orshan
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
| | - Benny Wong
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
| | - Vasiliki Gliagias
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
| | - Joby Tsai
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
| | - Stephen A Obstbaum
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
| | - Celso Tello
- Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Diopsys Inc., Pine Brook, New York, NJ, USA
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Porciatti V, Alba DE, Feuer WJ, Davis J, Guy J, Lam BL. The Relationship Between Stage of Leber's Hereditary Optic Neuropathy and Pattern Electroretinogram Latency. Transl Vis Sci Technol 2022; 11:31. [PMID: 35344016 PMCID: PMC8976918 DOI: 10.1167/tvst.11.3.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study was to compare the baseline steady-state pattern electroretinogram (SS-PERG) of patients with G11778A Leber hereditary optic neuropathy (LHON) with different stages of visual acuity (VA) loss before allotopic gene therapy (GT). Methods Patients (n = 28) were enrolled into groups (GT I: chronic bilateral VA ≤35 Early Treatment Diabetic Retinopathy Study [ETDRS]; GT II: acute bilateral VA ≤35 ETDRS; GT III: acute unilateral, VA ≤35 ETDRS, and better eye VA ≥70 ETDRS) and tested with SS-PERG together with 210 age-matched normal controls (NCs). SS-PERG amplitude (nV) and latency (ms) of each eye were averaged for groups GT I, GT II, and NC. Symptomatic eyes (GT III-S) and asymptomatic eyes (GT III-A) of group GT III were included separately and accounted for by using generalized estimating equation (GEE) methods. Results Compared to NC, SS-PERG amplitudes were reduced similarly by approximately 50% (P < 0.001) among all GT groups (NC > GT I, GT II, GT III-S, and GT III-A). SS-PERG latencies were shorter by ≥3.5 ms in all LHON groups and differed by disease stage (G III-A < NC, P = 0.002; GT III-S < GT III-A, P = 0.01; GT II < GT III-S, P = 0.03; GT I < NC, P < 0.001, but not different from other GT groups, all P > 0.1). Conclusions Although SS-PERG amplitude reduction did not distinguish between disease stages, SS-PERG latency shortening occurred in asymptomatic eyes and symptomatic eyes and distinguished between disease stages. Translational Relevance SS-PERG latency shortening is consistent with primary damage of smaller/slower axons and sparing of larger/faster axons and may provide an objective staging of LHON, which may be helpful to determine efficacy in LHON trials.
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Affiliation(s)
- Vittorio Porciatti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diego E Alba
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Janet Davis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John Guy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Structure-function models for estimating retinal ganglion cell count using steady-state pattern electroretinography and optical coherence tomography in glaucoma suspects and preperimetric glaucoma: an electrophysiological pilot study. Doc Ophthalmol 2022; 145:221-235. [PMID: 36161380 PMCID: PMC9653319 DOI: 10.1007/s10633-022-09900-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/28/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To derive and validate structure-function models for estimating retinal ganglion cell (RGC) count using optical coherence tomography (OCT) and steady-state pattern electroretinography (ssPERG) parameters in glaucoma suspects (GS) and preperimetric glaucoma (PPG). METHODS In this prospective cross-sectional study, 25 subjects (50 eyes) were recruited at the Manhattan Eye, Ear, and Throat Hospital. Subjects underwent comprehensive eye examinations, OCT, standard automated perimetry (SAP), and ssPERG testing. Eyes were divided into three groups based on the Global Glaucoma Staging System: healthy (N = 30), GS (N = 10), and PPG (N = 10) eyes. The combined structure-function index (CSFI), which estimates retinal ganglion cell count (eRGCCSFI) from SAP and OCT parameters, was calculated in each study subject. Two prediction formulas were derived using a generalized linear mixed model (GLMM) to predict eRGCCSFI from ssPERG parameters, age, and average retinal nerve fiber layer thickness (ARNFLT) in 30 eyes selected at random (training group). GLMM predicted values were cross-validated with the remaining 20 eyes (validation group). RESULTS The ARNFLT, ssPERG parameters magnitude (Mag) and magnitudeD (MagD), and eRGCCSFI were significantly different among study groups (ANOVA p ≤ 0.001). Pearson correlations demonstrated significant associations among ARNFLT, ssPERG parameters, and eRGCCSFI (r2 ≥ 0.31, p < 0.001). Two GLMMs predicted eRGCCSFI from Mag (eRGCMag) and MagD (eRGCMagD), respectively, with significant equations (F(3,18), F(3,19) ≥ 58.37, R2 = 0.90, p < 0.001). eRGCMag and eRGCMagD in the validation group (R2 = 0.89) correlated with eRGCCSFI similarly to the training group. Multivariate pairwise comparisons revealed that eRGCMag and eRGCMagD distinguished between healthy, GS, and PPG eyes (p ≤ 0.035), whereas independent Mag, MagD, and ARNFLT measures did not distinguish between GS and PPG eyes. CONCLUSION This pilot study offers the first combined structure-function models for estimating RGC count using ssPERG parameters. RGC counts estimated with these models were generalizable, strongly associated with CSFI estimates, and performed better than individual ssPERG and OCT measures in distinguishing healthy, GS, and PPG eyes.
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Lim XH, Nongpiur ME, Najjar RP, Hoang QV, Milea D, Wong CW, Husain R, Htoon HM, Aung T, Perera S, Wong TTL. Steady-State Pattern Electroretinography in Eyes with Glaucoma and High Myopia. Clin Ophthalmol 2021; 15:4455-4465. [PMID: 34819717 PMCID: PMC8607345 DOI: 10.2147/opth.s336903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate features of the steady-state pattern electroretinogram (ssPERG) in subjects with glaucoma (G), high myopia (HM; spherical equivalent ≤-6D) and glaucoma with high myopia (GHM). Patients and Methods Our study included 48 participants divided into 3 groups (G, HM, and GHM) who each underwent monocular ssPERG testing with Diopsys NOVA PERG protocols. The ConStim protocol detects distinct topographic patterns of dysfunction 16° and 24° around the central macula. MagD is the amplitude of the average signal and MagD/Mag ratio indicates the consistency of the response. ssPERG indices were compared between groups and correlated with functional (ie, visual field mean deviation (VFMD)) and structural (ie, average retinal nerve fibre layer (RNFL) thickness; Cirrus optical coherence tomography) features. Results Participants had an average age of 59.4±7.6 years. Mean Humphrey VFMD was -14.22 ± 2.88dB, -2.62 ± 1.18dB and -12.80 ± 2.60dB for G, HM and GHM groups, respectively. Mean RNFL thickness was 63.0 ± 8.20μm, 69.5 ± 15.7μm and 60.6 ± 5.0μm for G, HM and GHM groups, respectively. For the 24° setting, no significant differences were noted for any of the parameters. For the 16° setting, MagD was lower in the GHM group compared to the HM group (0.29µV vs 0.52µV; p = 0.02). Significant differences were noted for the MagD/Mag ratio between HM and G groups (0.58 vs 0.40; p = 0.02) and between HM and GHM groups (0.58 vs 0.35; p = 0.002). There were positive correlations between both MagD 16° and MagD/Mag ratio 16° with VFMD (correlation coefficient [r]=0.37, p = 0.009; and r = 0.44, p = 0.002, respectively) and RNFL (r = 0.43, p = 0.002; and r = 0.48, p = 0.001, respectively). Conclusion MagD/Mag ratio at 16° was significantly lower in glaucomatous eyes (with or without high myopia) compared to those with high myopia without glaucoma, suggesting that glaucoma has a distinct impact on MagD/Mag ratio at 16° irrespective of the presence of myopia.
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Affiliation(s)
| | - Monisha Esther Nongpiur
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, NY, USA
| | - Dan Milea
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Hla Myint Htoon
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tin Aung
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shamira Perera
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tina Tzee Ling Wong
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Friedel EBN, Tebartz van Elst L, Schmelz C, Ebert D, Maier S, Endres D, Runge K, Domschke K, Bubl E, Kornmeier J, Bach M, Heinrich SP, Nickel K. Replication of Reduced Pattern Electroretinogram Amplitudes in Depression With Improved Recording Parameters. Front Med (Lausanne) 2021; 8:732222. [PMID: 34778295 PMCID: PMC8585854 DOI: 10.3389/fmed.2021.732222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The retina has gained increasing attention in non-ophthalmological research in recent years. The pattern electroretinogram (PERG), a method to evaluate retinal ganglion cell function, has been used to identify objective correlates of the essentially subjective state of depression. A reduction in the PERG contrast gain was demonstrated in patients with depression compared to healthy controls with normalization after remission. PERG responses are not only modulated by stimulus contrast, but also by check size and stimulation frequency. Therefore, the rationale was to evaluate potentially more feasible procedures for PERG recordings in daily diagnostics in psychiatry. Methods: Twenty-four participants (12 patients with major depression (MDD) and 12 age- and sex-matched healthy controls) were examined in this pilot study. We investigated PERG amplitudes for two steady-state pattern reversal frequencies (12.5/18.75 rps) and four sizes of a checkerboard stimulus (0.8°, 1.6°, 3.2°, and 16°) to optimize the PERG recordings in MDD patients. Results: Smaller PERG amplitudes in MDD patients were observed for all parameters, whereby the extent of the reduction appeared to be stimulus-specific. The most pronounced decline in the PERG of MDD patients was observed at the higher stimulation frequency and the finest pattern, whilst responses for the largest check size were less affected. Following the PERG ratio protocol for early glaucoma, where similar stimulus dependent modulations have been reported, we calculated PERG ratios (0.8°/16°) for all participants. At the higher frequency (18.75 rps), significantly reduced ratios were observed in MDD patients. Conclusion: The “normalization” of the PERG responses—via building a ratio—appears to be a very promising approach with regard to the development of an objective biomarker of the depressive state, facilitating inter-individual assessments of PERG recordings in patients with psychiatric disorders.
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Affiliation(s)
- Evelyn B N Friedel
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Céline Schmelz
- Pfalzklinikum-Clinic for Psychiatry and Neurology, Klingenmünster, Germany
| | - Dieter Ebert
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kimon Runge
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in Neuromodulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Emanuel Bubl
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Kornmeier
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
| | - Michael Bach
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sven P Heinrich
- Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kathrin Nickel
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Cvenkel B, Sustar M, Perovšek D. Monitoring for glaucoma progression with SAP, electroretinography (PERG and PhNR) and OCT. Doc Ophthalmol 2021; 144:17-30. [PMID: 34652598 PMCID: PMC8882567 DOI: 10.1007/s10633-021-09854-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
Purpose To investigate the value of pattern electroretinography (PERG) and photopic negative response (PhNR) in monitoring glaucoma compared to standard clinical tests (standard automated perimetry (SAP) and clinical optic disc assessment) and structural measurements using spectral-domain OCT. Methods A prospective study included 32 subjects (32 eyes) with ocular hypertension, suspect or early glaucoma monitored for progression with clinical examination, SAP, PERG, PhNR and OCT for at least 4 years. Progression was defined clinically by the documented change of the optic disc and/or significant visual field progression (EyeSuite™ trend analysis). One eye per patient was included in the analysis. Results During the follow-up, 13 eyes (40.6%) showed progression, whereas 19 remained stable. In the progressing group, all parameters showed significant worsening over time, except for the PhNR, whereas in the stable group only the OCT parameters showed a significant decrease at the last visit. The trend of change over time using linear regression was steepest for the OCT parameters. At baseline, only the ganglion cell complex (GCC) and peripapillary retinal nerve fibre (pRNFL) thicknesses significantly discriminated between the stable and progressing eyes with the area under the ROC curve of 0.72 and 0.71, respectively. The inter-session variability for the first two visits in the stable group was lower for OCT (% limits of agreement within ± 17.4% of the mean for pRNFL and ± 3.6% for the GCC thicknesses) than for ERG measures (within ± 35.9% of the mean for PERG N95 and ± 59.9% for PhNR). The coefficient of variation for repeated measurements in the stable group was 11.9% for PERG N95 and 23.6% for the PhNR, while it was considerably lower for all OCT measures (5.6% for pRNFL and 1.7% for GCC thicknesses). Conclusions Although PERG and PhNR are sensitive for early detection of glaucomatous damage, they have limited usefulness in monitoring glaucoma progression in clinical practice, mainly due to high inter-session variability. On the contrary, OCT measures show low inter-session variability and might have a predicting value for early discrimination of progressing cases. Supplementary Information The online version contains supplementary material available at 10.1007/s10633-021-09854-8.
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Affiliation(s)
- Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, Grabloviceva 46, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Maja Sustar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grabloviceva 46, 1000, Ljubljana, Slovenia
| | - Darko Perovšek
- Department of Ophthalmology, University Medical Centre Ljubljana, Grabloviceva 46, 1000, Ljubljana, Slovenia
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Al-Nosairy KO, Hoffmann MB, Bach M. Non-invasive electrophysiology in glaucoma, structure and function-a review. Eye (Lond) 2021; 35:2374-2385. [PMID: 34117381 PMCID: PMC8376952 DOI: 10.1038/s41433-021-01603-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022] Open
Abstract
Glaucoma, its early diagnosis, and monitoring of interventions remain an ongoing challenge. We here review developments in functional assessment and its relation to morphology, evaluating recent insights in electrophysiology in glaucoma and highlighting how glaucoma research and diagnostics benefit from combined approaches of OCT and electrophysiological investigations. After concise overviews of OCT and non-invasive electrophysiology in glaucoma, we evaluate commonalities and complementarities of OCT and electrophysiology for our understanding of glaucoma. As a specific topic, the dynamic range (floor effects) of the various techniques is discussed.
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Affiliation(s)
| | - Michael B Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Michael Bach
- Faculty of Medicine, Eye Center, Medical Center-University of Freiburg, Freiburg im Breisgau, Germany.
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Lauzirika G, Arranz-Marquez E, Garcia-Gonzalez M, Hernández-Verdejo JL, Teus MA. Impact of femtosecond laser-assisted in situ keratomileusis on retinal ganglion cell function. Eur J Ophthalmol 2021; 32:1441-1447. [PMID: 34313139 DOI: 10.1177/11206721211035633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To analyse the effect of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) on the electrical response of retinal ganglion cells using pattern electroretinography (pERG). METHODS This was a longitudinal, prospective, observational pilot study. We included consecutive myopic patients who underwent FS-LASIK to correct up to 6 dioptres of myopia and up to 2 dioptres of astigmatism. Patients with excessive blinking or tearing and those with Snellen uncorrected visual acuity less than 0.9 dec on postop day 1 were excluded. Diopsys NOVA® (Diopsys Inc., NJ) pERG records, using high- and low-contrast patterns, were obtained 16 h and 1 month after FS-LASIK was performed. Magnitude (μV), Magnitude D (μV), Magnitude D/Magnitude ratio and signal-to-noise ratio (dB) were analysed. Wilcoxon test for nonparametric paired data was employed. RESULTS pERG data from 24 eyes were analysed from 24 patients who underwent FS-LASIK. Mean age was 35.79 ± 9.86 years. Mean preoperative refraction was -2.69 ± 7.6 D (spherical) and -0.38 ± 0.40 D (cylinder). Mean surgical time was 56.88 ± 7.6 s. No statistically significant differences were obtained for any of the studied parameters when comparing 16 h with 1 month after FS-LASIK, with the exception of Magnitude with low contrast, which increased from 1.21 ± 0.2 to 1.39 ± 0.29 µV at 16 h and 1 month postoperatively, respectively (p = 0.03). CONCLUSIONS FS-LASIK seems to induce a mild and transitory defect in retinal ganglion cell function. Only a mild decrease was detected in the magnitude value for low-contrast stimuli when pERG was performed 16 h postoperatively, and it returned to normal 1 month after surgery.
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Affiliation(s)
- Gorka Lauzirika
- Department of Ophthalmology, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain.,Novovisión Clinic, Madrid, Spain
| | - Esther Arranz-Marquez
- Department of Ophthalmology, Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain.,Novovisión Clinic, Madrid, Spain
| | | | | | - Miguel A Teus
- Novovisión Clinic, Madrid, Spain.,Department of Ophthalmology, Principe de Asturias University Hospital, Madrid, Spain.,Medicine Faculty, Alcalá University, Alcalá de Henares, Madrid, Spain
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The role of pattern electroretinograms and optical coherence tomography angiography in the diagnosis of normal-tension glaucoma. Sci Rep 2021; 11:12257. [PMID: 34112913 PMCID: PMC8192937 DOI: 10.1038/s41598-021-91813-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/26/2021] [Indexed: 12/28/2022] Open
Abstract
In this study, we investigated the correlation between pattern electroretinogram (PERG) and optical coherence tomography angiography (OCTA) parameters for diagnosis in patients with normal-tension glaucoma (NTG). Forty-nine normal individuals (49 eyes) and 60 patients with NTG (60 eyes) were enrolled. OCTA and PERG parameters, such as macular vessel density (VD) and the amplitude of N35–P50 and P50–N95, were measured. Correlation analyses were performed between the parameters, and the area under the curve (AUC) was used to identify their diagnostic ability for NTG. Macular VD and the amplitude of N35–P50 and P50–N95 showed significant differences between the normal individuals and patients with NTG. Correlation between P50 and N95 amplitude and macular VD was significant in the normal and early glaucoma groups. Macular VD showed a higher AUC value (0.730) than that of P50–N95 amplitude (0.645) in the early glaucoma group. In the moderate to severe glaucoma group, the AUC value of the amplitude of P50–N95 (0.907) was higher than that of macular VD (0.876). The results indicate that PERG and OCTA parameters may identify glaucoma in its early stage, based on the severity of glaucomatous damage in patients with NTG.
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Kong AW, Turner ML, Chan H, Stamper RL, Arnold BF, Della Santina L, Ou Y. Asymmetric Functional Impairment of ON and OFF Retinal Pathways in Glaucoma. OPHTHALMOLOGY SCIENCE 2021; 1:100026. [PMID: 35756578 PMCID: PMC9232180 DOI: 10.1016/j.xops.2021.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022]
Abstract
Purpose To investigate ON-pathway versus OFF-pathway dysfunction in glaucoma using handheld electroretinography (ERG) with a temporally modulated sinusoidal flicker stimulus. Design Cross-sectional study. Participants Fifty-nine participants accounting for 104 eyes, comprised of 19 control eyes, 26 glaucoma suspect eyes, and 59 glaucoma eyes. Methods Participants underwent portable ERG testing, which included the photopic flash, photopic flicker, photopic negative response stimulus, ON-OFF stimulus, and a custom-written sinusoidal flicker stimulus that was modulated from 50 to 0.3 Hz. Main Outcome and Measures The ERG response amplitudes were measured by the handheld ERG. For the custom-written sinusoidal flicker stimulus, we derived and compared the log10 first harmonic frequency response amplitudes. Patient discomfort and fatigue after ERG testing were rated on a scale from 1 to 5. Results Baseline demographics were not significantly different between groups, except for ocular characteristics. Analysis was performed adjusting for participant age, sex, race, and dilation status, and the sinusoidal frequency responses were stratified at 10 Hz because higher frequencies are associated with the OFF-pathway, whereas lower frequencies are associated with the ON-pathway. After stratification, glaucoma eyes showed an adjusted decrease of 32.1% at frequencies of more than 10 Hz (95% confidence interval [CI], -51.8% to -4.1%; P = 0.03). For 10 Hz stimulus frequencies or less, an adjusted 11.5% reduction was found (95% CI, -39.5% to 29.1%; P = 0.50). Glaucoma suspect eyes did show a decreased response, but this was not significant at either frequency range. When comparing handheld ERG with traditional visual field assessments, participants found the handheld ERG to result in much less discomfort and fatigue. Conclusions Our finding that glaucoma participants showed greater decreases in ERG response at higher frequencies supports the hypothesis that the OFF-pathway may be more vulnerable in human glaucoma. Using a handheld ERG device with a sinusoidal flicker stimulus may provide an objective assessment of visual function in glaucoma.
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Affiliation(s)
- Alan W. Kong
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Marcus L. Turner
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Hoover Chan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Robert L. Stamper
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Benjamin F. Arnold
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California
| | - Luca Della Santina
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Ahmed OM, Waisbourd M, Spaeth GL, Katz LJ. Improvement in structure and visual function in patients with glaucoma: the possible key to better treatment? Surv Ophthalmol 2020; 66:644-652. [PMID: 33316283 DOI: 10.1016/j.survophthal.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
Glaucoma is characterized by retinal ganglion cell loss that can lead to permanent visual loss. Current clinical management practice assumes that glaucomatous visual loss is irreversible; however, there is increasing evidence that permanent vision loss and cell death are preceded by reversible functional and structural changes. We propose that these changes should be considered by glaucoma specialists when treating their patients. We discuss the neurobiological basis of this phenomenon and provide clinical evidence of reversibility in both structure and function. Specifically, we review the findings of visual field testing, contrast sensitivity, electroretinography, and imaging of the optic nerve and their correlation with functional changes. We then discuss the clinical value of these observations in helping guide approaches toward the diagnosis and treatment of patients with glaucoma.
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Affiliation(s)
- Osama M Ahmed
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Yale University School of Medicine, New Haven, CT, USA
| | - Michael Waisbourd
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA; Department of Ophthalmology, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - George L Spaeth
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
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Lee T, Seo DR, Kim JY, Choi W, Lee SY, Lee JM, Seong GJ, Kim CY, Bae HW. Relationship between N95 Amplitude of Pattern Electroretinogram and Optical Coherence Tomography Angiography in Open-Angle Glaucoma. J Clin Med 2020; 9:jcm9123854. [PMID: 33260929 PMCID: PMC7759986 DOI: 10.3390/jcm9123854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The pattern electroretinogram (PERG) is useful to detect retinal ganglion cell (RGC) damage in patients with glaucoma. Optical coherence tomography angiography (OCTA) measures retinal vessel density (VD), which is known to be reduced in glaucoma. There may be correlations between parameters of the PERG and OCTA in open-angle glaucoma (OAG). Methods: In total, 95 eyes of 95 OAG patients and 102 eyes of 102 normal controls were included in this study. N35, P50, and N95 latency along with P50 and N95 amplitude were obtained using the PERG. Retinal VD was measured around the peripapillary and macular area according to the ETDRS grid (concentric circles with diameters of 1, 3, and 6 mm), which is named a center (≤1 mm), an inner (1–3 mm), an outer (3–6 mm), and a full (≤6 mm) area. Pearson correlation analysis was done between parameters, and partial correlation analysis was done after adjusting confounding factors. Results: P50 amplitude, N95 amplitude, and VD of most measured areas were significantly lower in the OAG group compared to the normal group. N95 amplitude showed a statistically significant correlation with parameters of optical coherence tomography and visual field, peripapillary outer and full VD, and macular outer and full VD even after adjusting confounding factors. There was no significant correlation between parameters in the normal group. Conclusions: N95 amplitude was associated with structural and functional change including VD reduction in OAG. Microvascular alterations may be associated with dysfunctional changes of RGC recorded by the PERG in OAG.
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Affiliation(s)
- Taekjune Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Du Ri Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Joo Yeon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Wungrak Choi
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Sang Yeop Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
- Department of Ophthalmology, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Korea
| | - Jun Mo Lee
- Siloam Eye Hospital, 181, Deungchon-ro, Gangseo-gu, Seoul 07668, Korea;
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (T.L.); (D.R.S.); (J.Y.K.); (W.C.); (S.Y.L.); (G.J.S.); (C.Y.K.)
- Correspondence: ; Tel.: +82-2-2228-3570
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Al-Nosairy KO, Prabhakaran GT, Pappelis K, Thieme H, Hoffmann MB. Combined Multi-Modal Assessment of Glaucomatous Damage With Electroretinography and Optical Coherence Tomography/Angiography. Transl Vis Sci Technol 2020; 9:7. [PMID: 33200048 PMCID: PMC7645242 DOI: 10.1167/tvst.9.12.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose To compare the diagnostic performance and to evaluate the interrelationship of electroretinographical and structural and vascular measures in glaucoma. Methods For 14 eyes of 14 healthy controls and 15 eyes of 12 patients with glaucoma ranging from preperimetric to advanced stages optical coherence tomography (OCT), OCT-angiography (OCT-A), and electrophysiological measures (multifocal photopic negative response ratio [mfPhNR] and steady-state pattern electroretinography [ssPERG]) were applied to assess changes in retinal structure, microvasculature, and function, respectively. The diagnostic performance was assessed via area-under-curve (AUC) measures obtained from receiver operating characteristics analyses. The interrelation of the different measures was assessed with correlation analyses. Results The mfPhNR, ssPERG amplitude, parafoveal (pfVD) and peripapillary vessel density (pVD), macular ganglion cell inner plexiform layer thickness (mGCIPL) and peripapillary retinal nerve fiber layer thickness (pRNFL) were significantly reduced in glaucoma. The AUC for mfPhNR was highest among diagnostic modalities (AUC: 0.88, 95% confidence interval: 0.75-1.0, P < 0.001), albeit not statistically different from that for macular (mGCIPL: 0.76, 0.58-0.94, P < 0.05; pfVD: 0.81, 0.65-0.97, P < 0.01) or peripapillary imaging (pRNFL: 0.85, 0.70-1.0, P < 0.01; pVD: 0.82, 0.68-0.97, P < 0.01). Combined functional/vascular measures yielded the highest AUC (mfPhNR-pfVD: 0.94, 0.85-1.0, P < 0.001). The functional/structural measure correlation (mfPhNR-mGCIPL correlation coefficient [rs]: 0.58, P = 0.001; mfPhNR-pRNFL rs: 0.66, P < 0.001) was stronger than the functional-vascular correlation (mfPhNR-pfVD rs: 0.29, P = 0.13; mfPhNR-pVD rs: 0.54, P = 0.003). Conclusions The combination of ERG measures and OCT-A improved diagnostic performance and enhanced understanding of pathophysiology in glaucoma. Translational Relevance Multimodal assessment of glaucoma damage improves diagnostics and monitoring of disease progression.
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Affiliation(s)
| | | | - Konstantinos Pappelis
- Department of Ophthalmology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Hagen Thieme
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michael B. Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
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Kong AW, Della Santina L, Ou Y. Probing ON and OFF Retinal Pathways in Glaucoma Using Electroretinography. Transl Vis Sci Technol 2020; 9:14. [PMID: 33117606 PMCID: PMC7571283 DOI: 10.1167/tvst.9.11.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
Glaucoma is a progressive neurodegenerative disease involving damage and eventually death of retinal ganglion cells (RGCs) that comprise the optic nerve. This review summarizes current understanding of specific RGC type vulnerability in glaucoma and how electroretinography (ERG) may provide an objective measure of these functional perturbations. There is building evidence to suggest that ON RGCs, which respond to light increments, may be more resilient to elevated intraocular pressure and glaucoma, whereas OFF RGCs, which respond to light decrements, may be more susceptible. ERG experiments in nonhuman primates and mice have also shown that the ON- and OFF-pathways can be separated using a variety of techniques such as pattern ERG and the photopic negative response. Another ERG paradigm of interest to separate the ON and OFF responses is a flicker stimulus at varying temporal frequencies. Response to lower temporal frequencies is associated with the ON-pathway, and ERG response to higher frequencies is associated with the OFF-pathway. In mice, experimental glaucoma models have shown greater decreases in ERG response at higher frequencies, suggesting that the OFF-pathway is more susceptible. We also summarize current clinical ERG protocols used for glaucoma and discuss innovations for developing new types of stimuli that can further separate the ON- and OFF-pathways. Applying these novel paradigms that distinguish ON- and OFF-pathways may ultimately improve glaucoma diagnostics and monitoring of glaucoma progression.
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Affiliation(s)
- Alan W Kong
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Luca Della Santina
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
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Al-Nosairy KO, Thieme H, Hoffmann MB. Diagnostic performance of multifocal photopic negative response, pattern electroretinogram and optical coherence tomography in glaucoma. Exp Eye Res 2020; 200:108242. [PMID: 32926894 DOI: 10.1016/j.exer.2020.108242] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/31/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Abstract
The photopic negative response of the electroretinogram reflects retinal ganglion cell function and consequently aids diagnosis of optic nerve diseases including glaucoma. In this study, we assessed the efficacy of stimulation parameters for electroretinographic recordings of the multifocal photopic negative response (mfPhNR) for the detection of glaucoma and compared the diagnostic accuracy of electrophysiological, structural and functional measures of glaucoma. We compared the diagnostic performance of the mfPhNR for 6 different stimulation rates in a cohort of 24 controls, 10 glaucoma suspects (GLAS ) and 16 glaucoma participants (GLAG). A cross-modal comparison of the mfPhNR/b wave ratio was performed with the pattern electroretinogram (PERG), and the peripapillary retinal nerve fiber layer (pRNFL) thickness. These analyses were based on area under curves (AUC) obtained from receiver-operating-characteristics (ROC) and step-wise regression analyses. We found that compared to the other mfPhNR-conditions, the PhNR/b-wave ratio for the fastest stimulation condition had the highest AUC for GLAS (0.84, P = 0.008, 95%CI: 0.71- 0.98), while the other modalities, i.e., PERG-amplitude and pRNFL had AUCs of 0.78 (P= 0.039), and 0.74 (P < 0.05), respectively. For GLAG , the respective AUCs were 0.78 (P= 0.004), 0.85 (P< 0.001) and 0.87 (P< 0.001). pRNFL was the significant predictor for both mfPhNR/b-wave ratio [t (48) = 4, P = 0.0002] and for PERG amplitude [t (48) = 3.4, P = 0.001]. In conclusion, fast mfPhNR protocols outperform other multifocal PhNR protocols in the identification of glaucomatous damage especially for GLAS and thus aid the early detection of glaucoma, indicating its value as a surrogate marker of early stage ganglion cell dysfunction.
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Affiliation(s)
| | - Hagen Thieme
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
| | - Michael B Hoffmann
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany.
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Prencipe M, Perossini T, Brancoli G, Perossini M. The photopic negative response (PhNR): measurement approaches and utility in glaucoma. Int Ophthalmol 2020; 40:3565-3576. [PMID: 32737731 PMCID: PMC7669808 DOI: 10.1007/s10792-020-01515-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
Purpose Visual electrophysiological testing continues to generate interest among glaucoma experts because of its potential help in clarifying disease pathophysiology and promoting early detection of glaucomatous damage. The photopic negative response (PhNR) is a slow negative component of the full-field electroretinogram that has been shown to provide specific information about retinal ganglion cells (RGCs) activity. The purpose of this article is to review the literature to explore the currently available measurement methods and the utility of PhNR in glaucoma diagnostic process. Methods We gathered publications related to the origins, types of stimuli used, measurements methods and applications of the PhNR of ERG in animal models and humans through a search of the literature cited in PubMed. Search terms were: “PhNR”, “photopic negative response”, “glaucoma”, “glaucomatous optic neuropathy”, “ERG”, “electroretinogram”. Results The most reliable PhNR measurements are obtained using a red stimulus on a blue background, without requiring refractive correction, fixation monitoring, or ocular media transparency. Given its direct correlation with RGCs response, the PhNR measured as baseline-to-trough (BT) represents the most reliable parameter of evaluation. Glaucoma patients with evident perimetric defects show pathologic PhNR values. Even though the PhNR is promising in detecting early RGCs impairment, distinguishing between healthy subjects and suspect patients at risk of developing glaucomatous damage still remains challenging. Conclusion The PhNR is a useful additional tool to explore disorders that affect the innermost retina, including glaucoma and other forms of optic neuropathy. In particular, comparing reports of the standard examinations (optic disc assessment, OCT RNFL measurement, standard automated perimetry) with the results of electrophysiological tests may be helpful in solving clinical diagnostic and management dilemmas. On the one hand, the PhNR of the ERG can examine the parvocellular pathways; on the other hand, the steady-state pattern ERG optimized for glaucoma screening (PERGLA) can explore the magnocellular pathways. This could give ophthalmologists a useful feedback to identify early RGCs alterations suggestive of glaucoma, stratify the risk and potentially monitor disease progression.
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Affiliation(s)
- Matteo Prencipe
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy.
| | - Tommaso Perossini
- Studio Oculistico Associato Mario and Tommaso Perossini, Livorno, Italy
| | | | - Mario Perossini
- Studio Oculistico Associato Mario and Tommaso Perossini, Livorno, Italy
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Jung KI, Jeon S, Shin DY, Lee J, Park CK. Pattern Electroretinograms in Preperimetric and Perimetric Glaucoma. Am J Ophthalmol 2020; 215:118-126. [PMID: 32087144 DOI: 10.1016/j.ajo.2020.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether visual function can be graded in detail using pattern electroretinogram (PERG) in preperimetric to perimetric glaucoma. DESIGN Cross-sectional observational study. METHODS Twenty-six normal subjects, 113 preperimetric glaucoma patients (which included glaucoma suspect patients), and 52 early perimetric glaucoma patients with a mean deviation (MD) >-10 dB were included. Structural and functional measurements were performed using spectral-domain optical coherence tomography and a commercial ERG stimulator, respectively. RESULTS The average retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness were thinnest in the perimetric group, followed by the preperimetric group and the control group (P < .001). PERG N95 amplitude was the largest in the control group, followed by the preperimetric group and the perimetric group (P < .001). Among the preperimetric glaucoma patients, presence of the RNFL defect was associated with lower PERG N95 amplitude (P = .013). The N95 amplitude showed a significant relationship with average RNFL thickness (r = 0.336, P < .001) and GCIPL thickness (r = 0.376, P < .001). In the preperimetric group with the RNFL defect, the N95 amplitude showed larger areas under the receiver operating characteristic curve (0.779) than the MD (0.533, P = .005). CONCLUSIONS PERG N95 amplitudes decreased from the control to preperimetric glaucoma group and were reduced more in perimetric glaucoma. The functional assessment for detecting early glaucomatous damage could be complemented by PERG N95 amplitude. Usefulness of PERG parameters except N95 amplitude seemed to be limited in a clinical setting because of relatively low diagnostic performance in preperimetric glaucoma.
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Long-term PERG monitoring of untreated and treated glaucoma suspects. Doc Ophthalmol 2020; 141:149-156. [PMID: 32152920 DOI: 10.1007/s10633-020-09760-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate long-term structural and functional progression of untreated and treated glaucoma suspects (UGS and TGS). METHODS Retrospective analysis of serial steady-state pattern electroretinogram (PERG), mean retinal nerve fiber layer thickness (RNFLT), and standard automated perimetry mean deviation (SAP-MD) in UGS (N = 20) and TGS (N = 18). Outcome measures were the rates of change (linear regression slopes) of PERG amplitude, PERG phase, mean RNFLT, and SAP-MD over 9.8 ± 1.3 years (15.6 ± 4.2 visits). RESULTS The number of patients with significant (P < 0.05) progression slopes for PERG amplitude, PERG phase, RNFLT, and SAP-MD was, respectively, UGS: 5, 0, 4, 2; TGS: 8, 2, 6, 5. In UGS, outcome measures were not correlated with each other. In TGS, both PERG amplitude and RNFLT were significantly (P < 0.05) correlated with SAP-MD (R ≥ 0.58), while PERG amplitude and RNFLT were not correlated with each other (R = 0.43, P = 0.064). The rate of change of SAP-MD was predicted (P < 0.05) by a linear combination of RNFLT slope and PERG amplitude slope. CONCLUSIONS Results substantiate and extend previous results showing that steady-state PERG amplitude progressively decreased over time in a proportion of glaucoma suspects, with relatively steeper slope in TGS compared to UGS. RNFLT progression also had a steeper slope in TGS compared to UGS; however, progressions of PERG amplitude and RNFLT were not significantly correlated. Both PERG progression and RNFLT progression independently contribute to prediction of visual field progression.
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Yang L, Tang X. Bilateral asymmetry improved accuracy when assessing glaucomatous vision-related quality of life impairment. Medicine (Baltimore) 2019; 98:e17924. [PMID: 31702674 PMCID: PMC6855665 DOI: 10.1097/md.0000000000017924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bilateral asymmetry has been used in optical coherence tomography tests to find early damage to the optic nerve. However, limited studies have quantitatively evaluated bilateral asymmetry in electrophysiological disorders in patients with glaucoma. The aim of the study was to evaluate bilateral asymmetry in pattern visual evoked potentials (PVEPs) and conventional clinical markers as well as its potential use in detecting glaucomatous impairment. After investigating 60 glaucomatous patients (120 eyes) and 65 age and sex-matched normal control subjects (130 eyes) using uni- and multivariable analysis, we found that vision-related quality of life (VRQOL) impairment was significantly associated with larger bilateral asymmetry index (BAI) of clinical markers. Rasch-calibrated National Eye Institute Visual Function Questionnaire-25 scores were significantly associated with the BAI in PVEPs latency in 15 minutes check size (β = -0.478, 95% confidence interval [CI], -0.708 to -0.248, P < .001) and the BAI in visual field mean deviation (β = -0.249, 95% CI, -0.454 to -0.044, P = .018) according to multivariable analysis. Bilateral asymmetry in objective and subjective functional measurements was quantitatively associated with glaucomatous VRQOL impairment. This finding may help bridge the gap in understanding between patients and clinicians, and increase awareness of how glaucomatous neuropathic progression may interfere with patients' daily life.
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Affiliation(s)
- Li Yang
- Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University
- Tianjin Key Laboratory of Ophthalmology and Visual Science
- Tianjin Eye Institute, Tianjin, China
| | - Xin Tang
- Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University
- Tianjin Key Laboratory of Ophthalmology and Visual Science
- Tianjin Eye Institute, Tianjin, China
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Elgohary AM, Elbedewy HA, Saad HA, Eid TM. Pattern electroretinogram changes in patients with primary open-angle glaucoma in correlation with visual field and optical coherence tomography changes. Eur J Ophthalmol 2019; 30:1362-1369. [PMID: 31496271 DOI: 10.1177/1120672119872606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To study the pattern electroretinogram changes in primary open-angle glaucoma patients in correlation with visual field changes and optical coherence tomography measurements of retinal nerve fiber layer thickness in the peripapillary region in an attempt to evaluate the clinical value of pattern electroretinogram as an objective test of functional deficit in glaucoma. PATIENTS AND METHODS The study included 81 eyes of 81 participants: 50 primary open-angle glaucoma patients, 16 primary open-angle glaucoma suspects, and 15 controls. All subjects underwent visual field testing using 24-2 Humphrey standard automated perimetry, peripapillary retinal nerve fiber layer average thickness using the 3.4-mm circular scan of the Heidelberg OCT spectralis and pattern electroretinogram using CSO RetiMax device in accordance with the International Society for Clinical Electrophysiology of Vision guidelines. RESULTS We had three main groups: normal, glaucoma suspect, and primary open-angle glaucoma patients, and the last group included three subgroups: mild, moderate, and severe. There was significant difference in the visual field mean deviation, peripapillary retinal nerve fiber layer average thickness, and most pattern electroretinogram measured parameters between the three main groups and in between primary open-angle glaucoma subgroups. There was significant positive correlation between visual field mean deviation and the peripapillary retinal nerve fiber layer average thickness, P50 amplitude, and P50-N95 amplitude (p < 0.001, p = 0.018, and p < 0.001, respectively). Significant negative correlation was also found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p < 0.001). Significant positive correlation was found between retinal nerve fiber layer average thickness and P50-N95 amplitude (p = 0.001). Significant negative correlation was found between peripapillary retinal nerve fiber layer average thickness and N95 amplitude (p = 0.001) and significant positive correlation of retinal nerve fiber layer average thickness with P50-N95 amplitude (p = 0.017) in primary open-angle glaucoma patients. CONCLUSION Peripapillary retinal nerve fiber layer average thickness shows significant negative correlation with pattern electroretinogram N95 amplitude and a significant positive correlation with P50-N95 amplitude. In combination with optical coherence tomography, pattern electroretinogram can be used to objectively assess functional loss in glaucoma.
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Affiliation(s)
- Asmaa M Elgohary
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hazem A Elbedewy
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hisham A Saad
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek M Eid
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Abstract
PURPOSE To evaluate the ability of macular and multifocal (mf) pattern electroretinogram (PERG) to differentiate preperimetric glaucoma (PG) and glaucoma with hemifield loss (GHL) from controls, to compare the discrimination ability of PERG and fourier-domain optical coherence tomography (FD-OCT), and to assess the relationship between measurements. PATIENTS AND METHODS Standard automated perimetry, steady-state and transient PERG and mfPERG measurements were obtained from PG (n=14, 24 eyes), GHL (n=5, 7 eyes), and controls (n=19, 22 eyes). Circumpapillary retinal nerve fiber layer (cpRNFL), full-thickness macula, and segmented macular layer thicknesses on FD-OCT were investigated. Measurements were compared using mixed effects linear models. The relationships between measurements and the diagnostic performance of each technology were assessed. RESULTS Compared with controls, average P50 peak time transient PERG responses were reduced in PG and GHL, whereas average latency and amplitude steady-state and mfPERG responses were abnormal only in GHL. cpRNFL and macular thickness measurements in PG and GHL differed significantly from controls. A significant relationship was found between PERG and most FD-OCT or SAP parameters. Partial least squares discriminant analysis revealed that OCT parameters, along with mfPERG and transient PERG parameters had similar ability to discriminate PG and GHL from healthy controls. CONCLUSIONS PERG and OCT parameters may be abnormal, with significant correlations between measurements, in PG eyes. Both technologies may be useful for detection of early glaucoma.
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Shamsher E, Davis BM, Yap TE, Guo L, Cordeiro MF. Neuroprotection in glaucoma: old concepts, new ideas. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1604222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Ehtesham Shamsher
- Department of Visual Neuroscience, University College London Institute of Ophthalmology, London, UK
| | - Benjamin M. Davis
- Department of Visual Neuroscience, University College London Institute of Ophthalmology, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London
| | - Timothy E. Yap
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Li Guo
- Department of Visual Neuroscience, University College London Institute of Ophthalmology, London, UK
| | - Maria Francesca Cordeiro
- Department of Visual Neuroscience, University College London Institute of Ophthalmology, London, UK
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London
- The Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
Purpose of review Currently, the clinical evaluation of neuro-ophthalmologic diseases are mainly focused on identifying stages where structural or functional damage occur. Recognition of retinal ganglion cell (RGC) functional patterns as well as monitoring RGC dysfunction can be performed using steady-state pattern electroretinogram (PERG). The analysis of the amplitude and latency shift aid on providing information on early damage or monitoring of the RGC, allowing for prompt clinical intervention and management modification, potentially changing the natural history of the disease. The purpose of this article is to review the latest findings in PERG, in early manifest glaucoma, non arteritic ischemic optic neuropathy, multiple sclerosis with unilateral recovered optic neuritis and its fellow eyes. Recent Findings The steady-state PERG responses provide new and early specific information in neuro-ophthalmic diseases affecting the inner retina. Summary Steady state PERG presents specific amplitude and latency outcomes based on the neuro-ophthalmic disease affecting the inner retina, allowing early recognition of changes at the level of RGC and the degree of RGC dysfunction. In addition, PERG alterations may be induced in healthy subjects as well as susceptible eyes using different stress tests such as head down tilting or water drinking tests.
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Hassankarimi H, Noori SMR, Jafarzadehpour E, Yazdani S, Radinmehr F. Analysis of pattern electroretinogram signals of early primary open-angle glaucoma in discrete wavelet transform coefficients domain. Int Ophthalmol 2019; 39:2373-2383. [PMID: 30725244 DOI: 10.1007/s10792-019-01077-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate discrete wavelet transform coefficients and identify descriptors of pattern electroretinogram (PERG) waveforms in order to determine PERG characteristics for optimizing the diagnosis of early primary open-angle glaucoma (POAG). METHODS Pattern electroretinogram was performed in 30 normal eyes and 30 eyes with primary open-angle glaucoma according to the ISCEV protocol. The check size was 0.8° and 16°, and the color was black/white in both groups. The results were analyzed in time domain (TD) and discrete wavelet transform (DWT) using the MATLAB software. The mean value, standard deviation, and relative energy of level 6 and 7 detail coefficients (d6, d7) and level 7 approximation coefficients (a7) of Daubechies 4 (db4), Daubechies 8 (db8), Symlet 5 (sym5), Symlet 7 (sym7), and Coiflet 5 (coif5) wavelets were calculated. In all the mentioned wavelets, DWT descriptors were extracted. Signals were reconstructed by inverse DWT. All data obtained by TD and DWT analyses were compared between the two groups. RESULTS In both check sizes, a significant attenuation of N95 amplitude was seen in the patient group. The relative energy of a7 of db8 increased significantly in the POAG group in the 0.8° check size. In larger check stimuli, the relative energy of d7 of coif5 decreased significantly and the standard deviation of d7 of sym7 increased markedly in glaucomatous patients (P < 0.05). In small stimuli, N95 descriptor (7N) of db8 had the highest value and showed a significant increase as compared to the POAG group. In the 16° check size, there was no significant difference. A strong correlation was seen between reconstructed signals and originals (r = 0.99). CONCLUSION The DWT can quantify PERG responses more accurately. In agreement with TD and wavelet coefficients domain results, 7N of db8 decomposition can be used as a good indicator for early detection of POAG.
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Affiliation(s)
- Homa Hassankarimi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Noori
- Departments of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Jafarzadehpour
- Department of Optometry, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran. .,Department of Optometry, Faculty of Rehabilitation, Iran University of Medical Sciences, Shahnazary St., Mohseni Sq., Mirdamad Blvd., Tehran, Iran.
| | - Shahin Yazdani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Radinmehr
- Department of Optometry, School of Rehabilitation Science, Iran University of Medical Sciences, Tehran, Iran
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Tanna AP. The Challenge of Detecting Glaucoma Progression. Ophthalmology 2018; 124:S49-S50. [PMID: 29157361 DOI: 10.1016/j.ophtha.2017.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022] Open
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Kurysheva NI, Maslova EV, Zolnikova IV, Fomin AV, Lagutin MB. A comparative study of structural, functional and circulatory parameters in glaucoma diagnostics. PLoS One 2018; 13:e0201599. [PMID: 30138396 PMCID: PMC6107119 DOI: 10.1371/journal.pone.0201599] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the diagnostic accuracy of structural parameters, vessel density (VD) measured by optical coherence tomography angiography (OCTA), and electrophysiological testing in diagnosis of primary open-angle glaucoma (POAG). METHODS 35 healthy participants and 90 POAG subjects underwent the measurement of whole image en face (wi) VD in the disc/peripapillary region and macula, the retinal nerve fiber layer (RNFL), and the average thickness of ganglion cell complex (GCC), pattern electroretinograms and pattern visual evoked potentials. The area under the receiver operating characteristic curve (AUC) was assessed for each parameter to differentiate early POAG from healthy eyes and between the POAG stages. RESULTS To distinguish early POAG from healthy eyes, the parameters with the highest AUC were detected: P50 amplitude of transient pattern electroretinogram, 1° (AUC 0.93, p = 0.002), P1 component of steady-state pattern electroretinogram (AUC 0.92, p = 0.003), P100 amplitude of pattern visual evoked potential, 1° (AUC 0.84, p = 0.013), wiVD macula superficial (AUC 0.80, p = 0.001), wiVD Disc (AUC 0.74, p = 0.016), GCC (AUC 0.74, p = 0.016) and to distinguish early POAG from the moderate to severe POAG: inferotemporal peripapillary VD (AUC 0.94, p < 0.0001) and focal loss volume of GCC (AUC 0.92, p < 0, 001). CONCLUSIONS Our results demonstrate the importance of measuring the microcirculation parameters in the macular area along with PERGs and PVEPs for the early detection of glaucoma. VD in the inferotemporal sector of the peripapillary retina and focal loss volume of the GCC are important for monitoring of the disease. The inclusion of OCTA, PERGs and PVEPs in glaucoma diagnostics may improve its early detection and monitoring.
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Affiliation(s)
- Natalia Ivanovna Kurysheva
- Consultative-Diagnostic Department of Ophthalmology Center of the Federal Medical and Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Ophthalmological Department of the Institute of Improvement of Professional Skill of FMBA, Moscow, Russian Federation
- * E-mail:
| | - Ekaterina Vladimirovna Maslova
- Consultative-Diagnostic Department of Ophthalmology Center of the Federal Medical and Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, Ophthalmological Department of the Institute of Improvement of Professional Skill of FMBA, Moscow, Russian Federation
| | | | - Alexey Valentinovich Fomin
- National Research Institute of Eye Diseases, Russian Academy of Medical Sciences, Moscow, Russian Federation
| | - Mikhail Borisovich Lagutin
- Lomonosov Moscow State University, Faculty of Mechanics and Mathematics, Department of Mathematical Statistics and Stochastic Processes, Moscow, Russian Federation
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Fry LE, Fahy E, Chrysostomou V, Hui F, Tang J, van Wijngaarden P, Petrou S, Crowston JG. The coma in glaucoma: Retinal ganglion cell dysfunction and recovery. Prog Retin Eye Res 2018; 65:77-92. [DOI: 10.1016/j.preteyeres.2018.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/18/2018] [Accepted: 04/03/2018] [Indexed: 01/07/2023]
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Electrophysiology of Olfactory and Optic Nerve in Outpatient and Intraoperative Settings. J Clin Neurophysiol 2018; 35:3-10. [PMID: 29300714 DOI: 10.1097/wnp.0000000000000416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evoked potentials are time-locked electrophysiologic potentials recorded in response to standardized stimuli using scalp electrodes. These responses provide good temporal resolution and have been used in various clinical and intraoperative settings. Olfactory evoked potentials (OEPs) may be used as an adjunct tool in identifying patients of Parkinson disease and Alzheimer dementia. In clinical practice, visual evoked potentials (VEPs) are particularly useful in identifying subclinical cases of optic neuritis and in treatment surveillance. In recent times, pattern electroretinograms and photopic negative response have been gaining attention in identifying glaucoma suspects. During surgical manipulation, there is a risk of damage to optic or olfactory nerve. Intraoperative neurophysiologic monitoring can provide information regarding the integrity of olfactory or visual pathway. OEPs and VEPs, however, show high degree of variability and are not reliable tools because the responses are extremely susceptible to volatile anesthetic agents. Newer techniques that could possibly circumvent these drawbacks have been developed but are not used extensively. In this article, we briefly review the available techniques to obtain OEPs and VEPs, diagnostic applications, the utility of intraoperative monitoring, the limitations of the current techniques, and the future directions for research.
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Kim SI, Park HYL, Park CK. Comparison of the Variability of Standard Automated Perimetry between Preperimetric Glaucoma Patients and Normal Controls. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Hae-Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Camp AS, Weinreb RN. Will Perimetry Be Performed to Monitor Glaucoma in 2025? Ophthalmology 2017; 124:S71-S75. [PMID: 28865878 DOI: 10.1016/j.ophtha.2017.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/04/2017] [Accepted: 04/07/2017] [Indexed: 10/18/2022] Open
Abstract
Visual field testing has played an essential role in the diagnosis and management of glaucoma for more than a century. Methods to examine the visual field have been refined from early kinetic perimetry to current standard automated perimetry (SAP). Clinicians now use SAP for the diagnosis and management of glaucoma throughout the world. Various testing paradigms and analytic methods have been developed to simplify the diagnosis of glaucoma and the interpretation of progression. Moreover, strategies have been implemented to improve patient experience with visual field testing and to increase reliability. Objective functional tests, such as electroretinography, provide an alternative to subjective visual field testing but are not yet ready for widespread adoption. Standard automated perimetry is being adapted and improved constantly. New devices may allow patients to complete visual field tests at home, which could relieve patients and clinicians from in-office testing and allow for more frequent examinations. Glaucoma detection and progression analysis also are incorporating progressively more information and will be improved as deep learning strategies are applied. Finally, perimetric and structural testing likely will become more closely intertwined as testing platforms and progression analysis incorporate both of these measures. Visual field testing will continue to have an important role in the diagnosis and management of glaucoma.
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Affiliation(s)
- Andrew S Camp
- Hamilton Glaucoma Center, Shiley Eye Institute and Department of Ophthalmology, University of California-San Diego, La Jolla, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute and Department of Ophthalmology, University of California-San Diego, La Jolla, California.
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Amarasekera DC, Resende AF, Waisbourd M, Puri S, Moster MR, Hark LA, Katz LJ, Fudemberg SJ, Mantravadi AV. Steady-state pattern electroretinogram and short-duration transient visual evoked potentials in glaucomatous and healthy eyes. Clin Exp Ophthalmol 2017; 46:54-61. [PMID: 28600806 DOI: 10.1111/ceo.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE This study evaluates two rapid electrophysiological glaucoma diagnostic tests that may add a functional perspective to glaucoma diagnosis. BACKGROUND This study aimed to determine the ability of two office-based electrophysiological diagnostic tests, steady-state pattern electroretinogram and short-duration transient visual evoked potentials, to discern between glaucomatous and healthy eyes. DESIGN This is a cross-sectional study in a hospital setting. PARTICIPANTS Forty-one patients with glaucoma and 41 healthy volunteers participated in the study. METHODS Steady-state pattern electroretinogram and short-duration transient visual evoked potential testing was conducted in glaucomatous and healthy eyes. A 64-bar-size stimulus with both a low-contrast and high-contrast setting was used to compare steady-state pattern electroretinogram parameters in both groups. A low-contrast and high-contrast checkerboard stimulus was used to measure short-duration transient visual evoked potential parameters in both groups. MAIN OUTCOME MEASURES Steady-state pattern electroretinogram parameters compared were MagnitudeD, MagnitudeD/Magnitude ratio, and the signal-to-noise ratio. Short-duration transient visual evoked potential parameters compared were amplitude and latency. RESULTS MagnitudeD was significantly lower in glaucoma patients when using a low-contrast (P = 0.001) and high-contrast (P < 0.001) 64-bar-size steady-state pattern electroretinogram stimulus. MagnitudeD/Magnitude ratio and SNR were significantly lower in the glaucoma group when using a high-contrast 64-bar-size stimulus (P < 0.001 and P = 0.010, respectively). Short-duration transient visual evoked potential amplitude and latency were not significantly different between the two groups. CONCLUSIONS AND RELEVANCE Steady-state pattern electroretinogram was effectively able to discern between glaucomatous and healthy eyes. Steady-state pattern electroretinogram may thus have a role as a clinically useful electrophysiological diagnostic tool.
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Affiliation(s)
| | - Arthur F Resende
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Sanjeev Puri
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - L Jay Katz
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
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Cvenkel B, Sustar M, Perovšek D. Ganglion cell loss in early glaucoma, as assessed by photopic negative response, pattern electroretinogram, and spectral-domain optical coherence tomography. Doc Ophthalmol 2017; 135:17-28. [DOI: 10.1007/s10633-017-9595-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Monsalve P, Triolo G, Toft-Nielsen J, Bohorquez J, Henderson AD, Delgado R, Miskiel E, Ozdamar O, Feuer WJ, Porciatti V. Next Generation PERG Method: Expanding the Response Dynamic Range and Capturing Response Adaptation. Transl Vis Sci Technol 2017; 6:5. [PMID: 28553559 PMCID: PMC5444497 DOI: 10.1167/tvst.6.3.5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/27/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare a new method for steady-state pattern electroretinogram (PERGx) with a validated method (PERGLA) in normal controls and in patients with optic neuropathy. Methods PERGx and PERGLA were recorded in a mixed population (n = 33, 66 eyes) of younger controls (C1; n = 10, age 38 ± 8.3 years), older controls (C2; n = 11, 57.9 ± 8.09 years), patients with early manifest glaucoma (G; n = 7, 65.7 ±11.6 years), and patients with nonarteritic ischemic optic neuropathy (N; n = 5, mean age 59.4 ± 8.6 years). The PERGx stimulus was a black-white horizontal grating generated on a 14 × 14 cm LED display (1.6 cycles/deg, 15.63 reversals/s, 98% contrast, 800 cd/m2 mean luminance, 25° field). PERGx signal and noise were averaged over 1024 epochs (∼2 minutes) and Fourier analyzed to retrieve amplitude and phase. Partial averages (16 successive samples of 64 epochs each) were also analyzed to quantify progressive changes over recording time (adaptation). Results PERGLA and PERGx amplitudes and latencies were correlated (Amplitude R2 = 0.59, Latency R2 = 0.39, both P < 0.0001) and were similarly altered in disease. Compared to PERGLA, however, PERGx had shorter (16 ms) latency, higher (1.39×) amplitude, lower (0.37×) noise, and higher (4.2×) signal-to-noise ratio. PERGx displayed marked amplitude adaptation in C1 and C2 groups and no significant adaptation in G and N groups. Conclusions The PERGx high signal-to-noise ratio may allow meaningful recording in advanced stages of optic nerve disorders. In addition, it quantifies response adaptation, which may be selectively altered in glaucoma and optic neuropathy. Translational Relevance A new PERG method with increased dynamic range allows recording of retinal ganglion cell function in advanced stages of optic nerve disorders. It also quantifies the response decline during the test, an autoregulatory adaptation to metabolic challenge that decreases with age and presence of disease.
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Affiliation(s)
- Pedro Monsalve
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Giacinto Triolo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Jorge Bohorquez
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | | | | | | | - Ozcan Ozdamar
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - William J Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Vittorio Porciatti
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Porciatti V, Ventura LM. The PERG as a Tool for Early Detection and Monitoring of Glaucoma. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0128-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Comparing three different modes of electroretinography in experimental glaucoma: diagnostic performance and correlation to structure. Doc Ophthalmol 2017; 134:111-128. [PMID: 28243926 DOI: 10.1007/s10633-017-9578-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare diagnostic performance and structure-function correlations of multifocal electroretinogram (mfERG), full-field flash ERG (ff-ERG) photopic negative response (PhNR) and transient pattern-reversal ERG (PERG) in a non-human primate (NHP) model of experimental glaucoma (EG). METHODS At baseline and after induction of chronic unilateral IOP elevation, 43 NHP had alternating weekly recordings of retinal nerve fiber layer thickness (RNFLT) by spectral domain OCT (Spectralis) and retinal function by mfERG (7F slow-sequence stimulus, VERIS), ff-ERG (red 0.42 log cd-s/m2 flashes on blue 30 scotopic cd/m2 background, LKC UTAS-E3000), and PERG (0.8° checks, 99% contrast, 100 cd/m2 mean, 5 reversals/s, VERIS). All NHP were followed at least until HRT-confirmed optic nerve head posterior deformation, most to later stages. mfERG responses were filtered into low- and high-frequency components (LFC, HFC, >75 Hz). Peak-to-trough amplitudes of LFC features (N1, P1, N2) and HFC RMS amplitudes were measured and ratios calculated for HFC:P1 and N2:P1. ff-ERG parameters included A-wave (at 10 ms), B-wave (trough-to-peak) and PhNR (baseline-to-trough) amplitudes as well as PhNR:B-wave ratio. PERG parameters included P50 and N95 amplitudes as well as N95:P50 ratio and N95 slope. Diagnostic performance of retinal function parameters was compared using the area under the receiver operating characteristic curve (A-ROC) to discriminate between EG and control eyes. Correlations to RNFLT were compared using Steiger's test. RESULTS Study duration was 15 ± 8 months. At final follow-up, structural damage in EG eyes measured by RNFLT ranged from 9% above baseline (BL) to 58% below BL; 29/43 EG eyes (67%) and 0/43 of the fellow control eyes exhibited significant (>7%) loss of RNFLT from BL. Using raw parameter values, the largest A-ROC findings for mfERG were: HFC (0.82) and HFC:P1 (0.90); for ff-ERG: PhNR (0.90) and PhNR:B-wave (0.88) and for PERG: P50 (0.64) and N95 (0.61). A-ROC increased when data were expressed as % change from BL, but the pattern of results persisted. At 95% specificity, the diagnostic sensitivity of mfERG HFC:P1 ratio was best, followed by PhNR and PERG. The correlation to RNFLT was stronger for mfERG HFC (R = 0.65) than for PhNR (R = 0.59) or PERG N95 (R = 0.36), (p = 0.20, p = 0.0006, respectively). The PhNR flagged a few EG eyes at the final time point that had not been flagged by mfERG HFC or PERG. CONCLUSIONS Diagnostic performance and structure-function correlation were strongest for mfERG HFC as compared with ff-ERG PhNR or PERG in NHP EG.
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Tiryaki Demir S, Oba ME, Erdoğan ET, Odabaşı M, Dirim AB, Demir M, Can E, Kara O, Yekta Şendül S. Comparison of Pattern Electroretinography and Optical Coherence Tomography Parameters in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension. Turk J Ophthalmol 2016; 45:229-234. [PMID: 27800239 PMCID: PMC5082259 DOI: 10.4274/tjo.39260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/15/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To investigate the correlation of visual field (VF), pattern electroretinography (PERG) and Fourier domain optical coherence tomography (FD-OCT) results in patients with ocular hypertension (OHT) and early primary open-angle glaucoma (POAG). Materials and Methods: The study included 72 eyes of 37 patients with early POAG, 76 eyes of 38 patients with OHT, and 60 eyes of 30 controls. All subjects underwent full ophthalmologic examination, VF assessment with 24-2 Humphrey standard automated perimetry (Swedish Interactive Thresholding Algorithm (SITA)-Standard), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness measurement with FD-OCT, and PERG P50 and N95 wave latency and amplitude measurements with electroretinography (Nihon Kohden). Results: With the exception of the nasal quadrant, all GCC parameters and RNFL results were significantly lower in the POAG group compared to the OHT and control groups. There was no statistically significant difference between the OHT and control group. PERG amplitudes were lower in the POAG and OHT groups than in the control group. Reduction in N95 amplitude was greater than that of P50 amplitude. No difference was detected in PERG latencies among groups. GCC was significantly correlated with VF and RNFL in the POAG group. Conclusion: Significant thinning of the GCC and RNFL occurs in addition to VF pathologies in patients with early POAG, and these examinations should be concomitantly evaluated. During diagnostic assessment of patients with early POAG, GCC and RNFL analysis by FD-OCT are highly effective. GCC is as reliable as RNLF in the early diagnosis of glaucoma and there is a highly significant correlation between them. Dysfunction of ganglion cells in patients with OHT may be detected earlier using PERG amplitude analysis.
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Affiliation(s)
- Semra Tiryaki Demir
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Mehmet Ersin Oba
- Kafkas University Faculty of Medicine, Department of Ophthalmology, Kars, Turkey
| | - Ezgi Tuna Erdoğan
- İstanbul University İstanbul Faculty of Medicine, Department of Physiology, İstanbul, Turkey
| | - Mahmut Odabaşı
- Medipol University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Ayşe Burcu Dirim
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Mehmet Demir
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Efe Can
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Orhan Kara
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
| | - Selam Yekta Şendül
- Şişli Etfal Training and Research Hospital, Clinic of Ophthalmology, İstanbul, Turkey
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Abstract
The early detection of glaucoma is imperative in order to preserve functional vision. Structural and functional methods are utilized to detect and monitor glaucomatous damage and the vision loss it causes. The relationship between these detection measures is complex and differs between individuals, especially in early glaucoma. Using both measures together is advised in order to ensure the highest probability of glaucoma detection, and new testing methods are continuously developed with the goals of earlier disease detection and improvement of disease monitoring. The purpose of this review is to explore the relationship between structural and functional glaucoma detection and discuss important technological advances for early glaucoma detection.
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Affiliation(s)
- Katie A. Lucy
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
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de Moraes CG, Liebmann JM, Medeiros FA, Weinreb RN. Management of advanced glaucoma: Characterization and monitoring. Surv Ophthalmol 2016; 61:597-615. [PMID: 27018149 DOI: 10.1016/j.survophthal.2016.03.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/16/2016] [Accepted: 03/17/2016] [Indexed: 01/27/2023]
Abstract
Recent advances in glaucoma diagnosis focus on diagnosing the disease in early stages. Despite the importance of such efforts, a meaningful proportion of patients present in advanced stages. The cost for treatment and monitoring of advanced glaucoma often exceeds that with earlier disease, not to mention the significant effect of visual impairment on quality of life. Moreover, structural and functional tests used to monitor changes encounter technical limitations in advanced cases that can delay detection of true progression. New technologies and methods to analyze longitudinal data may prove helpful for monitoring patients with advanced glaucoma and reduce the burdens of the disease.
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Affiliation(s)
- C Gustavo de Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA.
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York, USA
| | - Felipe A Medeiros
- Shiley Eye Institute, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Shiley Eye Institute, Hamilton Glaucoma Center and Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
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