Relationship Between Pattern Electroretinogram, Standard Automated Perimetry, and Optic Nerve Structural Assessments

Abstract

Purpose-To examine the relationship between retinal ganglion cell function measured using pattern electroretinogram optimized for glaucoma screening (PERGLA), retinal nerve fiber layer (RNFL) thickness and optic nerve head topography.Methods-Twenty-nine normal, 28 glaucoma and 37 glaucoma suspect volunteers were enrolled. All participants were age-similar. One randomly selected eye underwent complete eye examination, standard automated perimetry (SAP), scanning laser polarimetry with enhanced corneal compensation (GDxECC), optical coherence tomography (OCT), Heidelberg retina tomograph (HRT) and PERGLA measurements. PERGLA amplitude (microvolt) was converted to decibel for comparison with SAP mean deviation (MD) and pattern standard deviation. The correlation between PERGLA amplitude in dB and the average of sensitivity values for 16 central test locations of SAP were calculated. Analysis of variance, Pearson and Spearman rank correlations, coefficient of variation (CoV) and intraclass correlation coefficients (ICC) were calculated.Results-PERGLA amplitude in glaucomatous eyes was significantly lower than normal eyes (0.47 ± 0.20 vs. 0.70 ± 0.28 μv, p < 0.001) but not glaucoma suspects (0.54 ± 0.21 μv, p = 0.84). PERGLA amplitude was inversely correlated with age (r = −0.31, p = 0.002). PERGLA amplitude (in dB) was associated with the sensitivity values of the SAP central 16 test locations (r = 0.40, p < 0001) across the entire cohort, GDxECC superior RNFL thickness (r = 0.38, p < 0.001) and HRT Moorfields regression analysis classification (rho = −0.34, p = 0.001). The CoV and ICC were 14.5% and 0.89 for PERGLA amplitude, 2.4% and 0.98 for OCT average RNFL, 2.2% and 0.97 for GDxECC TSNIT average and 6.3% and 0.94 for HRT rim area.Conclusion-Retinal ganglion cell function measured using PERGLA is reduced in glaucoma and demostrates modest correlations with central SAP sensitivity values, and structural measures of optic nerve topography and RNFL thickness.

Pattern electroretinogram association with spectral domain-OCT structural measurements in glaucoma

“…The strengths of associations generally were similar to those described previously using TD-OCT, SLP, and CSLO. 9 We found the strongest association between PERG amplitude and GCC thickness (although this association was not significantly stronger than all others), and a much weaker association between PERG amplitude and outer macular thickness (ie, retinal structures presumed not responsible for the PERG response). These results add in vivo anatomical support to the idea that the PERG response is primarily representative of retinal ganglion cell function as opposed to a response of all retinal cells that contribute to visual function (see 29 for a review of the cellular origins of the PERG).…”

“…Previous studies have reported a significant but modest association between PERG amplitude and neuroretinal rim area measured using confocal scanning laser ophthalmoscopy (CSLO) 8,9 (see also 10 ) and RNFL thickness measured using both optical coherence tomography (OCT) 9,[11][12][13] (see also 10,[14][15][16][17] ) and scanning laser polarimetry (SLP). 9 These results suggest that PERG amplitude is at least somewhat representative of ganglion cell count. The generally weak associations reported could be attributable, in part, to the structural measurement chosen to represent ganglion cell count.…”

Comparison of Pattern Electroretinography and Optical Coherence Tomography Parameters in Patients with Primary Open-Angle Glaucoma and Ocular Hypertension

“…Therefore, they concluded that PERG may be more beneficial than RNFL in the ganglion cell evaluation of OHT patients. PERG amplitudes correlate (though weakly) with VF, RNFL and GCC parameters, 33,34 suggesting that PERG and OCT should be evaluated together. 35 …”

Evaluation of visual field parameters in patients with chronic obstructive pulmonary disease

“…Perimetric analysis may show involved areas in the visual field even though the patients' central vision has been preserved. It has been suggested that standard automatic perimetry is a measure of inner retinal ganglion cells (Sehi et al 2009). Although controversy still exists over the role of blueyellow perimetry in detecting early visual field defects, SWAP was reported to be more sensitive than standard achromatic perimetry in demonstrating neuroophthalmologic diseases and glaucoma and may show the functional abnormality earlier than the structural one in the optic nerve head or the retina (Keltner & Johnson 1995;Wild 2001;Heijl 2002).…”