Sensitivity and specificity of the uniform field electroretinogram in glaucoma detection in comparison to the pattern electroretinogram.

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.

Comparison of the uniform-field electroretinogram and the pattern electroretinogram to checkerboard and bar gratings.

PURPOSE: To compare the electroretinal response associated with the uniform-field electroretinogram (UF-ERG) to that of the pattern electroretinogram (PERG) to checkerboard and bar-grating stimuli. METHODS: UF-ERG and PERG to bars and checkerboard were recorded for 18 visually normal subjects (36 eyes) of mean age 45 years (range 20-75). UF-ERG was recorded to the increment and decrement of a 200-ms duration luminance modulation. Luminance onset and offset UF-ERG responses were averaged to produce a simulation of the PERG response. The mean amplitude and implicit time for the P50 and N95 potentials of actual and simulated PERG responses were recorded for each eye in the cohort. RESULTS: The simulated PERG waveform resulting from arithmetic averaging of the UF-ERG to luminance increment and decrement was characterized by prominent positive and negative components resembling those of the P50 and N95 PERG potentials. Implicit timing of the P50 potential was lengthened in the actual PERG to bars and checks relative to that of the simulation (P < 0.05, P < 0.001). Amplitude of the N95 potential was greater in the PERG to bars than in the PERG to checks (P < 0.05) or the simulated PERG (P < 0.001). The amplitude and implicit timing of all waveform components were significantly correlated between the actual and simulated PERG. CONCLUSIONS: The UF-ERG to light onset and offset can be reliably recorded in human subjects. The extent to which the simulated PERG recapitulates the actual PERG response is better with checkerboard rather than bar-grating stimuli.