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. 2018 Sep 13;7(5):6.
doi: 10.1167/tvst.7.5.6. eCollection 2018 Sep.

Pattern Electroretinogram Detects Localized Glaucoma Defects

Tommaso Salgarello  1 , Andrea Giudiceandrea  1   2 , Luigi Calandriello  1   2 , Dario Marangoni  1   2 , Alberto Colotto  2 , Aldo Caporossi  1   2 , Benedetto Falsini  1   2
Affiliations

Pattern Electroretinogram Detects Localized Glaucoma Defects

Tommaso Salgarello et al. Transl Vis Sci Technol. .

Abstract

Purpose: We evaluated the clinical ability of pattern electroretinogram (PERG) to detect functional losses in the affected hemifield of open-angle glaucoma patients with localized perimetric defects.

Methods: Hemifield (horizontally-defined) steady-state PERGs (h-PERGs) were recorded in response to 1.7 c/deg alternating gratings from 32 eyes of 29 glaucomatous patients with a perimetric, focal one-hemifield defect, 10 eyes of 10 glaucomatous patients with a diffuse perimetric defect, and 18 eyes of 18 age-matched normal subjects. Standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT) for retinal nerve fiber layer (RNFL) thickness also were performed. h-PERG amplitudes and ratios, calculated corresponding hemifield perimetric deviations, as well as hemiretina RNFL thicknesses were analyzed.

Results: h-PERG amplitudes, perimetric deviations, and RNFL thicknesses showed losses (P < 0.001) when comparing affected with unaffected hemifields of localized glaucomatous eyes. No differences were found in h-PERG amplitudes between hemifields of normal or diffuse glaucomatous eyes. h-PERG amplitude ratios (affected/unaffected hemifield) in localized glaucoma were lower (P < 0.001) than the ratios from normal or diffuse glaucomatous eyes. The areas under the receiver operating characteristic curves for h-PERG amplitude ratios, comparing localized-defect glaucomatous eyes with normal or diffuse glaucomatous eyes, were 0.93 and 0.91, respectively.

Conclusions: h-PERG assessment showed good diagnostic accuracy to confirm localized glaucomatous defects detected perimetrically. This test may be particularly useful in cognitively impaired patients or young/nonverbal patients unable to provide reliable visual fields.

Translational relevance: h-PERG provides a sensitive objective measure to confirm focal losses detected with SAP and/or RNFL thickness analysis.

Keywords: electroretinogram; glaucoma; hemifield; hemiretina; localized defect.

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Figures

Figure 1
Figure 1
Typical h-PERG recording in the clinical setting, by stimulating the upper hemifield. The subject fixates at a mark placed midway of the two hemifields.
Figure 2
Figure 2
Steady-state h-PERG waveforms and clinical findings obtained in a patient with primary open-angle glaucoma and a superonasal arcuate scotoma (#25 in Table 1). (A) PERG responses from the upper (top) and lower (bottom) hemifields. (B) Automated visual field (total deviation plot from the perimetric 30-2 SITA-standard test). (C) RNFL analysis (thickness deviation map by OCT optic disc cube 200 × 200). Calibration bars of h-PERG tracings are shown in the bottom left corner.
Figure 3
Figure 3
Box plots of h-PERG amplitude ratios calculated from (A) upper and lower hemifields of normal subjects, (B) affected (Aff) and unaffected (Unaff) hemifield of localized glaucoma patients, and (C) upper and lower hemifields of diffuse glaucoma patients. Each box shows 75th, 50th, and 25th percentiles. Error bars show 95th and 5th percentiles. Asterisks show 99th and 1st percentiles.
Figure 4
Figure 4
ROC curves calculated for h-PERG amplitude ratios from (A) affected to unaffected hemifields of localized glaucoma patients and upper to lower hemifields of normal subjects (AUC ± SE, 0.91 ± 0.04) and from (B) affected to unaffected hemifields of localized glaucoma patients and upper to lower hemifields of diffuse glaucoma patients (AUC ± SE, 0.93 ± 0.04).
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