1
|
Moroto N, Nakakura S, Tabuchi H, Mochizuki K, Manabe Y, Sakaguchi H. Use of multifocal electroretinograms to determine stage of glaucoma. PLoS One 2023; 18:e0278234. [PMID: 36634040 PMCID: PMC9836278 DOI: 10.1371/journal.pone.0278234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To determine whether multifocal electroretinograms (mfERGs) recorded with natural pupils and skin electrodes can be used to determine the stage of open angle glaucoma (OAG). METHODS Two hundred eighteen eyes of 132 OAG patients and 62 eyes of 62 normal subjects whose best-corrected visual acuity (BCVA) was 0.1 logarithm of the minimum angle of resolution (logMAR) units (20/25) or less were studied. The mean deviations (MDs) obtained by Humphrey Visual Field Analyzer (HFA), optical coherence tomographic (OCT) images, and mfERGs were analyzed. The glaucoma was classified into 4 stages: preperimetric glaucoma (PPG), early stage, moderate stage, and advanced stage glaucoma. The parameters of the mfERGs examined were the amplitudes of the two positive peaks (P1, P2) of the second order kernels in the nasal and temporal fields within the central 15° diameter. RESULTS The mean age of all participants (patients and normals) was 63.8 ± 10.8 years. With the progression of glaucoma, the amplitudes of P1 in the nasal hemifield increased and the amplitudes of P2 decreased. The nasal to temporal ratio (N/T ratio) of the P1 amplitudes and the negative slope of the line between P1 and P2 (P1P2 Slope) in the nasal field were larger at each glaucoma stage except at the PPG stage. Both the N/T amplitude ratio and P1P2 Slope were weakly but significantly correlated with the MD (r = -0.3139, P<0.0001; r = 0.4501, P<0.0001, respectively), and the OCT parameters (all P<0.0001) except the outer layer thickness. CONCLUSIONS Our findings indicate that the amplitudes of P1 and P2 of the second order kernel of the mfERGs in the nasal field of the center region can be good markers for the stages of glaucoma.
Collapse
Affiliation(s)
- Naoya Moroto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
- Ophthalmology, Ogaki Municipal Hospital, Ogaki, Japan
- * E-mail:
| | | | - Hitoshi Tabuchi
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima, Japan
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yusuke Manabe
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|
2
|
Chan HH, Ng Y, Chu PH. Applications of the multifocal electroretinogram in the detection of glaucoma. Clin Exp Optom 2021; 94:247-58. [DOI: 10.1111/j.1444-0938.2010.00571.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Henry Ho‐lung Chan
- Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China. E‐mail:
| | - Yui‐fai Ng
- Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China. E‐mail:
| | - Patrick Ho‐wai Chu
- Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China. E‐mail:
| |
Collapse
|
3
|
de Araújo RB, Oyamada MK, Zacharias LC, Cunha LP, Preti RC, Monteiro MLR. Morphological and Functional Inner and Outer Retinal Layer Abnormalities in Eyes with Permanent Temporal Hemianopia from Chiasmal Compression. Front Neurol 2017; 8:619. [PMID: 29255441 PMCID: PMC5723053 DOI: 10.3389/fneur.2017.00619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/06/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The aims of this study are to compare optical coherence tomography (OCT)-measured macular retinal layers in eyes with permanent temporal hemianopia from chiasmal compression and control eyes; to compare regular and slow-flash multifocal electroretinography (mfERG) in patients and controls; and to assess the correlation between OCT, mfERG, and central visual field (SAP) data. Methods Forty-three eyes of 30 patients with permanent temporal hemianopia due to pituitary tumors who were previously submitted to chiasm decompression and 37 healthy eyes of 19 controls were submitted to macular spectral domain OCT, mfERG, and 10-2 SAP testing. After segmentation, the thickness of the macular retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer, and photoreceptor layer (PRL) was measured. Amplitudes and oscillatory potentials (OPs) were measured on regular and slow-flash mfERG, respectively, and expressed as the mean values per quadrant and hemifield. Results RNFL, GCL, and IPL thickness measurements were significantly reduced in all quadrants, whereas INL, OPL, and PRL thicknesses were significantly increased in the nasal quadrants in patients compared to those in controls. Significant correlations between OCT and 10-2 SAP measurements were positive for the RNFL, GCL, and IPL and negative for the INL, OPL, and PRL. OPs and mfERG N1 amplitudes were significantly reduced in the nasal hemiretina of patients. Significant correlations were found between OP and mfERG amplitudes for inner and outer nasal hemiretina OCT measurements, respectively. Conclusion Patients with permanent temporal hemianopia from previously treated chiasmal compression demonstrated significant thinning of the RNFL, GCL, IPL, and thickening of the INL, OPL, and PRL associated with reduced OP and mfERG N1 amplitudes, suggesting that axonal injury to the inner retina leads to secondary damage to the outer retina in this condition.
Collapse
Affiliation(s)
- Rafael B de Araújo
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maria K Oyamada
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C Zacharias
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Leonardo P Cunha
- Department of Ophtalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Rony C Preti
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mário L R Monteiro
- Laboratory of Investigation in Ophthalmology (LIM 33), Division of Ophthalmology, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
4
|
Saul AB, Still AE. Multifocal Electroretinography in the Presence of Temporal and Spatial Correlations and Eye Movements. Vision (Basel) 2016; 1:E3. [PMID: 31740628 PMCID: PMC6849053 DOI: 10.3390/vision1010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/18/2016] [Accepted: 05/03/2016] [Indexed: 11/21/2022] Open
Abstract
Releasing patients from the fixation task, and permitting them to view natural stimuli such as movies, would provide increased comfort, and potentially additional signs of retinal function, when recording multifocal electroretinograms (mfERGs). Techniques must be developed to handle the difficulties that arise from these alternative stimulation strategies. Multifocal stimuli were presented to volunteer human subjects with and without fixation. Retinocentric analyses were performed to deal with shifts of the stimulus across the retina in the presence of eye movements. Artificial scotomas that moved with the eyes to simulate local retinal defects were presented to assess whether such defects might be detectable in the presence of eye movements. Temporal and spatial correlations in the stimulus can be discounted, permitting retinal kernels to be measured in response to natural stimuli. Responses to temporally natural stimuli tend to have slightly stronger amplitudes because of the presence of low temporal frequencies in these stimuli. The effects of eye movement artifacts can be reduced, permitting similar kernels to be obtained in the absence and presence of eye movements. Convergence to stable kernels took slightly longer in the presence of temporal correlations or eye movements. Artificial scotomas can be localized with these methods. It may be possible to perform multifocal ERG recordings in the clinic using more flexible, natural techniques. However, work is needed to achieve results comparable to those routinely obtained with conventional methods.
Collapse
Affiliation(s)
- Alan B. Saul
- Department of Ophthalmology, and James and Jean Culver Vision Discovery Institute, Augusta University, Augusta, GA 30912, USA
| | | |
Collapse
|
5
|
Hori N, Komori S, Yamada H, Sawada A, Nomura Y, Mochizuki K, Yamamoto T. Assessment of macular function of glaucomatous eyes by multifocal electroretinograms. Doc Ophthalmol 2012; 125:235-47. [DOI: 10.1007/s10633-012-9351-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
|
6
|
Todorova MG, Palmowski-Wolfe AM. MfERG responses to long-duration white stimuli in glaucoma patients. Doc Ophthalmol 2011; 122:87-97. [PMID: 21340609 DOI: 10.1007/s10633-011-9263-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 02/09/2011] [Indexed: 11/28/2022]
Abstract
The intent of our study was to evaluate whether the response to a long-duration white stimulus in the multifocal electroretinogram (mfERG) is sufficiently sensitive to detect early retinal dysfunction in glaucoma. On-off mfERGs were recorded from 15 NTG and 15 HTG patients and compared with 14 control subjects. Recording parameters were the following: LED stimulus screen (RETIscan™), 100-ms stimulus duration, 200-ms stimulus interval, 11-min total recording time, stimulus matrix of 61 elements, frame rate: 70 Hz, Lmax: 180 cd/m(2), Lmin: 0 cd/m(2), and filter setting: 1-200 Hz. The second negative response following stimulus onset (N2-on), as well as following stimulus offset (N2-off), was analyzed as an overall response and in quadrants, as well as in 4 small central and four adjoining peripheral areas per quadrant. The latency of the N2-on was significantly delayed in HTG in all response averages tested, while in NTG this was only seen in the overall response and in the small central response averages (P < 0.05). The most sensitive measure in HTG was the latency of the N2-on of the small peripheral response average of the superior temporal quadrant with an area under the ROC curve of 0.881. For NTG, the most representative measure was the latency of the N2-on of the small central response average of the inferior nasal quadrant with an area under the ROC curve of 0.793. Our results showed that in stimulation with long-duration flashes, the second negative response following the on response, representative of the early PhNR, is affected in glaucoma where N2-on showed a latency delay in POAG patients. The latency delay of the N2-on was more prominent for HTG than for NTG.
Collapse
Affiliation(s)
- Margarita G Todorova
- Department of Ophthalmology, University Hospital Basel, Mittlere Strasse 91, 4031, Basel, Switzerland.
| | | |
Collapse
|
7
|
Effects of luminance combinations on the characteristics of the global flash multifocal electroretinogram (mfERG). Graefes Arch Clin Exp Ophthalmol 2010; 248:1117-25. [PMID: 20306071 DOI: 10.1007/s00417-010-1346-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 02/05/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aims to ascertain the characteristics of the response triggered by the global flash multifocal electroretinogram (MOFO mfERG) under various combinations of global and focal flash luminance, and to determine the optimal conditions for this measurement. METHODS Ten normal subjects with mean age 23.2 yrs (+/- 1.14 yrs) were recruited for the MOFO mfERG measurement. The visual stimulation consisted of four video frames (stimulus frame with 103 scaled hexagonal focal flashes, followed by a dark frame, a global flash and then another dark frame). The focal and global flash intensities were varied independently for four levels (50, 100, 200 and 400 cd/m(2)). The subjects then underwent measurements with sixteen combinations of focal and global flash luminance. The direct component (DC) and induced component (IC) of the MOFO mfERG were grouped into central and peripheral regions for analysis. RESULTS The central and peripheral DC amplitude increased with the focal flash luminance under constant global flash luminance. Moreover, the proportion of the global flash and focal flash intensity was shown to be important to achieve an optimal IC response. When the ratio of global flash luminance to focal flash luminance (g/f ratio) was kept at about 2:1, the central and peripheral IC amplitude reached the peak value, and further increasing the global flash luminance would not enhance the IC response magnitude. The implicit time of both central and peripheral DC generally decreased with the increase of g/f ratio. However, the implicit time of central and peripheral IC increased with the g/f ratio. CONCLUSION The g/f ratio is important in the MOFO mfERG paradigm, since the DC and IC responses change with this ratio. In order to obtain both optimal DC and IC responses, a g/f ratio of 1:1 with focal flash luminance between 100 cd/m(2) and 200 cd/m(2) would be recommended. As the global flash mfERG paradigm is studying the interaction triggered by both flashes, the g/f ratio is a vital parameter for measurement in future studies.
Collapse
|
8
|
Abstract
Achromatic perimetry is the gold standard in glaucoma diagnosis for detecting functional defects from glaucomatous optic neuropathy. Because achromatic perimetry is only able to detect scotomas after loss of up to 30-40% of retinal ganglion cells, early diagnosis using this method is rarely possible. Therefore, a lot of new perimetric procedures have been developed in recent years to detect new scotomas at a very early stage. This review summarizes the theoretical background of retinal ganglion cells in order to better understand the theoretical approaches of new perimetric methods. In addition, the most important commercial perimetric devices currently available are presented.
Collapse
Affiliation(s)
- C Erb
- Abteilung für Augenheilkunde, Schlosspark-Klinik, Berlin, Deutschland.
| | | |
Collapse
|
9
|
Multifocal electroretinography in HIV-positive patients without infectious retinitis. Am J Ophthalmol 2008; 146:579-88. [PMID: 18280451 DOI: 10.1016/j.ajo.2007.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 12/12/2007] [Accepted: 12/14/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate early changes in the central retinal response in human immunodeficiency virus (HIV)-positive patients without infectious retinitis using multifocal electroretinography (mfERG). DESIGN Case control study. METHODS We evaluated three cohorts: HIV-negative controls and two groups of HIV-positive patients separated according to their nadir CD4 counts (>or= 100 cells/mm(3) and < 100 cells/mm(3) for a minimum of six months). mfERG first-order kernels (FOKs) and second-order kernels (SOKs) were analyzed separately by areas of rings, quadrants, and individual hexagons for each cohort. RESULTS Of 103 hexagon locations of FOK results, there were no significant differences in amplitudes of P1 and N1 across the groups (.05 < P < .50), although there was a trend for an overall reduction in the amplitudes. Similarly, latency N1 did not differ (.28 < P < .95). There were significantly delayed latencies of P1 between cohorts across 103 hexagons in both kernels. SOK results also showed significant delay in latencies of P1 and a trend of reduced P1 amplitudes across studied locations among cohorts (.24 < P < .08). CONCLUSIONS The results demonstrate widespread delay in latency in HIV-positive patients, especially in those with prolonged low (below 100 cells/mm(3)) CD4 nadir counts. These findings suggest early diffuse dysfunction of the inner retina results from severe HIV disease even in the HAART era.
Collapse
|
10
|
Lai TYY, Ngai JWS, Lam DSC. Multifocal electroretinography: update on clinical application and future development. EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Palmowski-Wolfe AM, Todorova MG, Orguel S, Flammer J, Brigell M. The ‘two global flash’ mfERG in high and normal tension primary open-angle glaucoma. Doc Ophthalmol 2006; 114:9-19. [PMID: 17160421 DOI: 10.1007/s10633-006-9033-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyse the sensitivity of the '2 global flash' multifocal electroretinogram (mfERG) to detect glaucomatous dysfunction in normal tension (NTG) and high tension primary open angle glaucoma (POAG) patients. METHODS MfERGs were recorded from 20 NTG and 20 POAG patients and compared to those of 20 controls. The mfERG array consisted of 103 hexagons. Each m-sequence step started with a focal flash that could be either dark or light (m-sequence: 2--13, L(max): 200 cd/m(2), L(min): 1 cd/m(2)), followed by two global flashes (L(max): 200 cd/m(2)) at an interval of approximately 26 ms. Focal scalar products (SP) were calculated using focal templates derived from the control recordings (VERIS 4.8). We analyzed 5 response averages (central 7.5 degrees and 4 adjoining quadrants) of the response to the focal flash, the direct component at 10-40 ms (DC) and the following two components induced by the effects of the preceding focal flash on the response to the global flashes at 40-70 ms (IC-1) and at 70-100 ms (IC-2). RESULTS Both NTG and POAG patients differed from controls in the IC-1 response to the superior quadrants, and POAG patients also differed from controls in the centre. The most sensitive parameter was the IC-1 of the superior temporal quadrant with an area under the ROC curve of 0.82 for POAG and 0.79 for NTG. The DC and the IC-2 did not differ significantly between the groups. When all five response averages of the IC-1 were taken into consideration 90% of the NTG patients and 85% of the POAG patients were correctly classified as abnormal while 80% of the control subjects were correctly classified as normal. CONCLUSIONS This stimulus sequence holds promise for the diagnosis of early functional changes in POAG. A new finding is that both NTG, as well as POAG can be differentiated from control subjects.
Collapse
Affiliation(s)
- Anja M Palmowski-Wolfe
- Department of Ophthalmology, University Eye Hospital, Mittlere Strasse 91, 4012, Basel, Switzerland.
| | | | | | | | | |
Collapse
|
12
|
Palmowski-Wolfe AM, Perez MT, Behnke S, Fuss G, Martziniak M, Ruprecht KW. Influence of Dopamine Deficiency in Early Parkinson’s Disease on the Slow Stimulation Multifocal-ERG. Doc Ophthalmol 2006; 112:209-15. [PMID: 16791744 DOI: 10.1007/s10633-006-0008-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE In animal studies intravitreal injection of tetrodotoxin (TTX) results in mfERG waveform changes similar to those observed in glaucoma. As TTX blocks amacrine as well as ganglion cells, there is still a question regarding the underlying cell population responsible for these changes in waveform. In an attempt to assess the contribution of the amacrine cells to these changes, a mfERG was obtained from patients with Parkinson's disease as some amacrine cells are mediated by dopamine, a substance lacking in Parkinson's. METHODS Eight patients with early Parkinson's disease underwent ophthalmologic examination, testing of contrast sensitivity and electrophysiological examination according to ISCEV standard at least 12 h following their last medication with Dopamine. A slow stimulation mfERG was obtained with a stimulus base interval of 53.3 ms and with a stimulus base interval of 106.6 ms. During MF-ERG recordings 103 hexagons stimulated the central 50 deg of the retina simultaneously and independently (m-sequence 2(13), L(max): 200 cd/m(2), approximately 100% contrast). RESULTS Contrast sensitivity and ISCEV standard electrophysiological testing was unremarkable. When the mfERG was analyzed, only four patients had an adequate signal-to-noise ratio to allow further data analysis - one of whom was diagnosed with a multi system atrophy in retrospect. The first order response component was analyzed at a filter setting of 10-300 Hz and at 100-300 Hz (OPs) and compared to mfERGs of a control group. On average, in patients, the amplitude of N1P1 was slightly lower in the central and nasal response averages. When the three OPs at a latency of 72-89 ms were analyzed in the 53.3 ms base interval recording, the most marked difference in amplitude was observed in the superior nasal response average of the first OP. Here a mean amplitude of 1.3 nV/deg(2) in patients compared to a mean amplitude of 1.9 nV/deg(2) in the control group (P: 0.08). DISCUSSION In contrast to our previous findings in NTG, there was a consistent presence of three OPs. Under the stimulus conditions applied, we did not find an influence of dopaminergic amacrine cells on the mfERG in our patients with moderate stages of Parkinsion's. The difficulties in obtaining an adequate signal-to noise ratio due to e.g. muscle artifacts even in Parkinson patients of moderate disease stages render a success of mfERG recording in patients with more advanced stages unlikely. The question of the influence of dopaminergic amacrine cells on the mfERG could possibly be addressed using MPDT in animal research.
Collapse
|