Elsevier

Ophthalmology

Volume 112, Issue 1, January 2005, Pages 10-19
Ophthalmology

Original article
Pattern electroretinogram abnormality and glaucoma

Presented at: American Academy of Ophthalmology Annual Meeting, October, 2002; Orlando, Florida, and American Academy of Ophthalmology Annual Meeting, November, 2003; Anaheim, California.
https://doi.org/10.1016/j.ophtha.2004.07.018Get rights and content

Purpose

To determine the existence of retinal ganglion cell dysfunction and associated risk factors in glaucoma suspects with increased optic disc cupping and normal visual field.

Design

Cross-sectional, observational study.

Participants

Two hundred glaucoma suspect (GS) patients were identified based on optic disc abnormalities (vertical cup-to-disc ratios [C/D]>0.5; vertical C/D asymmetry ≥ 0.2; disc hemorrhages; notching) in association with known glaucoma risk factors (positive family history, African American descent, increased intraocular pressure [IOP]), but normal visual fields. Forty-two patients had early manifest glaucoma (EMG). Sixteen normal black subjects were added to update previous pattern electroretinogram (PERG) normative data and to establish a normal control (NC) group with a racial breakdown comparable with that of the study groups.

Methods

Pattern electroretinograms were recorded simultaneously from both eyes using skin electrodes and automated analysis; visual fields were monitored with standard white-on-white automated perimetry (SAP) central 24-2 program; vertical C/D was evaluated by an independent reader from stereo disc photographs; and univariate and multivariate statistical analysis between PERG and other outcome measures was evaluated.

Main outcome measures

Pattern electroretinogram amplitude (μV), phase (π rad), and interocular asymmetry in amplitude and phase (%); and SAP mean deviation (MD; decibels), vertical C/D, age (years), IOP (mmHg), and race (black vs. nonblack).

Results

The PERG results were abnormal in at least 1 of the outcome measures in 52% of GS patients and 69% of EMG patients. The PERG amplitude was correlated weakly with both MD (P<0.01) and vertical C/D (P = 0.05). The correlation between PERG amplitude and MD and C/D was stronger (P<0.001) for interocular differences rather than absolute measures. Interocular PERG amplitude asymmetry increased with severity of disease (EMG>GS>NC; P<0.01). The PERG amplitude decline with age was steeper in patients with a more negative MD (P<0.01) and in patients with a more negative MD and a larger vertical C/D (P = 0.06). Black race (but not family history) was associated with lower PERG amplitude (P = 0.005) in GS and EMG patients, but not in normal controls (P = 0.44).

Conclusions

The correlation between PERG abnormality and known risk factors for glaucoma indicates that PERG has a predictive potential for the development or progression of the disease, or both.

Section snippets

Patients

Two hundred glaucoma suspect (GS) patients and 42 patients with early manifest glaucoma (EMG) participated in the study. The mean age of the entire group of patients was 57±13 years (median, 57 years). Black patients comprised 52 of the total 242-person population (21%; GS, n = 40; EMG, n = 12). Eligibility was determined through a detailed medical and ocular history and a comprehensive eye examination. Eye examination included best-corrected visual acuity (BCVA), refraction at distance and

Comparison between pattern electroretinogram of patients and control subjects

The PERG amplitude and phase decreased with aging in normal subjects (Fig 2).23 The thick lines represent the regressions of amplitude or phase as a function of age of the NC group, and the thin lines represent the corresponding 95% tolerance limits. Normal controls of black race were not significantly different from nonblacks with respect to PERG amplitude (P = 0.43, analysis of covariance adjusting for age) or PERG phase (P = 0.44). After adjusting for age, the mean PERG amplitude of black

Discussion

We designed this study to determine the prevalence of PERG abnormalities in patients with glaucomatous cupping and normal SAP and to assess the correlation of PERG abnormalities with risk factors for open-angle glaucoma. The goal was to evaluate the predictive potential of the PERG for the early diagnosis of glaucoma. The PERG results were abnormal in at least 1 of the outcome measures (amplitude, phase, interocular asymmetry in amplitude, and phase) in 52% of GS patients and in 69% of EMG

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  • Cited by (0)

    Manuscript no. 240181.

    Supported by The Glaucoma Foundation, New York, New York; Fight for Sight, New York, New York; Research to Prevent Blindness, Inc., New York, New York; and Rotary International, Evanston, Illinois.

    Dr Porciatti has a patent pending application (no. PCT/US03/03155) on the technique for pattern electroretinogram recording.

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