Update on the pattern electroretinogram in glaucoma

Retinal pathway origins of the pattern ERG of the mouse

This study investigated contributions from the retinal On and Off pathways, and the spiking and nonspiking activity of neurons in those pathways to the pattern ERG of the mouse. Light-adapted pattern and ganzfeld ERGs were recorded from anesthetized C57BL/6 mice 3-4 months of age. Recordings were made before and after intravitreal injections of PDA (cis-2,3-piperidine-dicarboxylic acid) to block transmission to hyperpolarizing 2nd order and all 3rd order neurons, TTX (tetrodotoxin) to block Na(+)-dependent spiking, APB (2-amino-4-phosphonobutyric acid) to block synapses between photoreceptors and ON-bipolar cells, and APB + TTX and PDA + TTX cocktails. The pattern stimuli consisted of 0.05 cy/deg gratings reversing in contrast at 1 Hz, presented at various contrasts (50-90%) and a rod saturating mean luminance. For flash ERGs, brief green ganzfeld flashes were presented on a rod-suppressing green background. Recordings were made 39-42 days after unilateral optic nerve crush (ONC) in a subset of animals in which ganglion cell degeneration was subsequently confirmed in retinal sections. Pattern ERGs were similar in waveform for all contrasts, with a positive wave (P1) peak for 90% contrast around 60 ms on average and maximum trough for a negative wave (N2) around 132 ms after each contrast reversal; amplitudes were greatest for 90% contrast which became the standard stimulus. ONC eliminated or nearly eliminated the pattern ERG but did not affect the major waves of the flash ERG. PDA and TTX both delayed P1 and N2 waves of the pattern ERG, and reduced their amplitudes, with effects of PDA on N2 greater than those of TTX. In the flash ERG, PDA reduced a-wave amplitudes, removed OPs but hardly affected b-wave amplitudes. In contrast, TTX reduced b-wave amplitudes substantially, as previously observed in rat. APB removed P1 of the pattern ERG, but left a negative wave of similar timing and amplitude to N2. In the flash ERG, APB removed the b-wave, producing a negative ERG. Addition of TTX to the APB injection removed most of N2 of the pattern ERG, while other waves of the pattern and flash ERG resembled those after APB alone. Addition of TTX to the PDA injection had little effect on the pattern ERG beyond that of PDA alone, but it prolonged the b-wave of the flash ERG. In conclusion, this study confirmed that a selective lesion of ganglion cells will practically eliminate the pattern ERG. The study also showed that P1 of the mouse pattern ERG is dominated by contributions, mainly spiking, from ON pathway neurons, whereas N2 reflects substantial spiking activity from the OFF pathway as well as nonspiking contributions from both pathways.

Adaptive changes of inner retina function in response to sustained pattern stimulation

We have characterized adaptive changes of inner retina function in response to sustained pattern stimulation in 32 normal subjects with an age range 23-77 years by measuring changes of the pattern electroretinogram (PERG) as a function of time. Contrast-reversal stimuli had square-wave profile in space and time, with peak spatial and temporal frequency and high contrast to maximize response amplitude. The PERG signal was sampled over 5min with a resolution of 15s. PERG signals were non-stationary, resulting in either progressive amplitude decline or even enhancement to a plateau, with a time course that could be well described by an exponential function with a time constant of 1-2min. Higher initial amplitudes were generally associated with amplitude decline, and lower initial amplitudes with enhancement. The delta amplitude (plateau minus initial) was a linear function of the initial amplitude. The magnitude of delta decreased with decreasing initial amplitude and inverted its sign for initial amplitudes about 1/3 lower than the maximum initial amplitude measured, but still about 3-4 times larger than the noise. Amplitude decline was generally associated with phase lag, whereas amplitude enhancement was associated with phase advance. Altogether, PERG generators appear to slowly adjust their gain in order to keep their sustained activity at an intermediate level that is rather independent of the level of activity at stimulus onset. This behavior is reminiscent of a buffering mechanism, where glial cells may play a primary role. An energy-budget model of neural-vascular-glial interaction is provided together with an equivalent electrical circuit that accounts for the results.

Diagnostic accuracy of pattern electroretinogram optimized for glaucoma detection

PURPOSE

To assess the ability of the new pattern electroretinogram optimized for glaucoma detection (PERGLA) paradigm to discriminate between healthy individuals and individuals with glaucomatous optic neuropathy (GON).

DESIGN

Cross-sectional study.

PARTICIPANTS

One hundred forty-two eyes of 71 participants (42 healthy and 29 with GON in at least 1 eye) enrolled in the University of California, San Diego, Diagnostic Innovations in Glaucoma Study were studied. Healthy individuals were those recruited as healthy with healthy-appearing optic disc by examination and masked stereoscopic optic disc photograph evaluation. Glaucomatous optic neuropathy was defined based on stereophotograph evaluation.

METHODS

The PERGLA (Glaid Elettronica, Pisa, Italy) recordings were obtained within 6 months of standard automated perimetry (SAP) testing. Dependent variables were PERGLA amplitude, phase, amplitude asymmetry, phase asymmetry, and SAP pattern standard deviation (PSD) and mean deviation (MD).

MAIN OUTCOME MEASURES

Diagnostic accuracy (sensitivity and specificity) of the PERGLA normative database for classifying healthy and glaucomatous individuals was determined. In addition, performance (areas under receiver operating characteristic curves [AUCs]) of PERGLA amplitude and phase for classifying healthy (n=84) and GON (n=50) eyes was determined. Results from both analyses were compared with those from SAP.

RESULTS

Sensitivity and specificity of the PERGLA normative database were 0.76 and 0.59, respectively, compared with 0.83 and 0.77 for SAP. The AUCs for PERGLA amplitude and phase were 0.75 and 0.50 (chance performance), respectively. The AUCs for SAP PSD and MD were 0.83 and 0.78, respectively.

CONCLUSIONS

Pattern electroretinograms recorded using the PERGLA paradigm can discriminate between healthy and glaucoma eyes, although this technique performed no better than SAP at this task. Low specificity of the PERGLA normative database suggests that the distribution of recordings included in the database is not ideal.