RE-PERG, a new procedure for electrophysiologic diagnosis of glaucoma that may improve PERG specificity

Abstract

PurposeA significant variability of the second harmonic (2ndH) phase of steady-state pattern electroretinogram (SS-PERG) in intrasession retest has been recently described in glaucoma patients (GP), which has not been found in healthy subjects. To evaluate the reliability of phase variability in retest (a procedure called RE-PERG or REPERG) in the presence of cataract, which is known to affect standard PERG, we tested this procedure in GP, normal controls (NC), and cataract patients (CP).MethodsThe procedure was performed on 50 GP, 35 NC, and 27 CP. All subjects were examined with RE-PERG and SS-PERG and also with spectral domain optical coherence tomography and standard automated perimetry. Standard deviation of phase and amplitude value of 2ndH were correlated by means of one-way analysis of variance and Pearson correlation, with the mean deviation and pattern standard deviation assessed by standard automated perimetry and retinal nerve fiber layer and the ganglion cell complex thickness assessed by spectral domain optical coherence tomography. Receiver operating characteristics were calculated in cohort populations with and without cataract.ResultsStandard deviation of phase of 2ndH was significantly higher in GP with respect to NC (P<0.001) and CP (P<0.001), and it correlated with retinal nerve fiber layer (r=−0.5, P<0.001) and ganglion cell complex (r=−0.6, P<0.001) defects in GP. Receiver operating characteristic evaluation showed higher specificity of RE-PERG (86.4%; area under the curve 0.93) with respect to SS-PERG (54.5%; area under the curve 0.68) in CP.ConclusionRE-PERG may improve the specificity of SS-PERG in clinical practice in the discrimination of GP.

<p>RE-PERG, a new paradigm for glaucoma diagnosis, in myopic eyes</p>

“…General demographics of the whole sample are reported in Table 1. Those of GP and NC patients have been reported previously 12,13. Those of MY group patients are reported in Table 2.…”

“…The groups GP and normal controls (NC) were the same used in previously published studies 12,13. As for MY group, from January 1 to 31 2017, 19 consecutive non-glaucomatous MY were enrolled in the study.…”

“…Spectral-Domain OCT, standard automated perimetry, and pattern electroretinogram examination procedures were the same used in previously published studies 12,13…”

“…In a first study12 we showed that the variability of early glaucoma patients was greater than the physiological one present in healthy individuals; in addition, it was also correlated with markers of disease severity such as retinal thickness and visual field indices. Subsequently, we showed that RE-PERG findings are not influenced by optic media opacities such as cataract 13. Aim of this study was to evaluate the reliability of RE-PERG in non-glaucomatous patients (GP) with myopic fundus alterations.…”

RE-PERG in early-onset Alzheimer’s disease: A double-blind, electrophysiological pilot study

“…Phase variability was shown to be very low in healthy controls but the standard deviation of the phase is higher in glaucoma patients. [ 56 ] Moreover, unlike the amplitude, phase variability is not influenced by optical media opacities and myopia. [ 57 , 58 ] Second-level imaging-based tests for the diagnosis of AD and VD are often expensive and not always available, especially in rural hospitals, such that diagnostic tools based on biomarkers able to distinguish among the various types of dementia are needed.…”