30 Hz-flicker mfERG in primary open-angle glaucoma patients : 30 Hz-flicker-mfERG in POAG

Asymmetric Functional Impairment of ON and OFF Retinal Pathways in Glaucoma

Purpose

To investigate ON-pathway versus OFF-pathway dysfunction in glaucoma using handheld electroretinography (ERG) with a temporally modulated sinusoidal flicker stimulus.

Design

Cross-sectional study.

Participants

Fifty-nine participants accounting for 104 eyes, comprised of 19 control eyes, 26 glaucoma suspect eyes, and 59 glaucoma eyes.

Methods

Participants underwent portable ERG testing, which included the photopic flash, photopic flicker, photopic negative response stimulus, ON-OFF stimulus, and a custom-written sinusoidal flicker stimulus that was modulated from 50 to 0.3 Hz.

Main Outcome and Measures

The ERG response amplitudes were measured by the handheld ERG. For the custom-written sinusoidal flicker stimulus, we derived and compared the log10 first harmonic frequency response amplitudes. Patient discomfort and fatigue after ERG testing were rated on a scale from 1 to 5.

Results

Baseline demographics were not significantly different between groups, except for ocular characteristics. Analysis was performed adjusting for participant age, sex, race, and dilation status, and the sinusoidal frequency responses were stratified at 10 Hz because higher frequencies are associated with the OFF-pathway, whereas lower frequencies are associated with the ON-pathway. After stratification, glaucoma eyes showed an adjusted decrease of 32.1% at frequencies of more than 10 Hz (95% confidence interval [CI], -51.8% to -4.1%; P = 0.03). For 10 Hz stimulus frequencies or less, an adjusted 11.5% reduction was found (95% CI, -39.5% to 29.1%; P = 0.50). Glaucoma suspect eyes did show a decreased response, but this was not significant at either frequency range. When comparing handheld ERG with traditional visual field assessments, participants found the handheld ERG to result in much less discomfort and fatigue.

Conclusions

Our finding that glaucoma participants showed greater decreases in ERG response at higher frequencies supports the hypothesis that the OFF-pathway may be more vulnerable in human glaucoma. Using a handheld ERG device with a sinusoidal flicker stimulus may provide an objective assessment of visual function in glaucoma.

Wavelet decomposition analysis in the two-flash multifocal ERG in early glaucoma: a comparison to ganglion cell analysis and visual field

PURPOSE

To further improve analysis of the two-flash multifocal electroretinogram (2F-mfERG) in glaucoma in regard to structure-function analysis, using discrete wavelet transform (DWT) analysis.

METHODS

Sixty subjects [35 controls and 25 primary open-angle glaucoma (POAG)] underwent 2F-mfERG. Responses were analyzed with the DWT. The DWT level that could best separate POAG from controls was compared to the root-mean-square (RMS) calculations previously used in the analysis of the 2F-mfERG. In a subgroup analysis, structure-function correlation was assessed between DWT, optical coherence tomography and automated perimetry (mf103 customized pattern) for the central 15°.

RESULTS

Frequency level 4 of the wavelet variance analysis (144 Hz, WVA-144) was most sensitive (p < 0.003). It correlated positively with RMS but had a better AUC. Positive relations were found between visual field, WVA-144 and GCIPL thickness. The highest predictive factor for glaucoma diagnostic was seen in the GCIPL, but this improved further by adding the mean sensitivity and WVA-144.

CONCLUSIONS

mfERG using WVA analysis improves glaucoma diagnosis, especially when combined with GCIPL and MS.

mfERG_LAB: Software for processing multifocal electroretinography signals

The multifocal electroretinography technique consists of performing sectorized light excitation of the retina and capturing the resulting evoked potential. This provides functional localized information about the state of the retinal neurons. Analysis of multifocal electroretinography signals can be used for diagnosing different types of optic neuropathies (glaucomatous, demyelinating and ischemic ethiology). In order to obtain a reliable diagnosis, it is necessary to apply advanced processing algorithms (morphological, frequency and time-frequency analysis, etc.) to the multifocal electroretinography signal. This paper presents a software application developed in MATLAB(®) (MathWorks Inc., MA) designed to perform advanced multifocal electroretinography signal analysis and classification. This intuitive application, mfERG_LAB, is used to plot the signals, apply various algorithms to them and present the data in an appropriate format. The application's computational power and modular structure make it suitable for use in clinical settings as a powerful and innovative diagnostic tool, as well as in research and teaching settings as a means of assessing new algorithms.