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Sachdeva V, Bhattacharya B, Ganatra S, Kekunnaya R. Subnormal visual acuity after compliant amblyopia therapy: residual/refractory amblyopia or co-existing pathology? - a retrospective analysis. Strabismus 2024; 32:11-22. [PMID: 38311572 DOI: 10.1080/09273972.2023.2294997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Purpose: To assess the prevalence of alternate etiology/co-existing pathology among patients with amblyopia, and to characterize factors contributing to over-diagnosis of amblyopia. Methods: We retrospectively reviewed records of children (from 1 January 2016 to 31 December 2019) who were initially diagnosed as "amblyopia" but later an alternate diagnosis for subnormal vision was established. Patients who had a best corrected visual acuity (BCVA) of ≤20/32 (0.2 logMAR) after compliant amblyopia therapy were divided into 2 groups: those with refractory amblyopia (BCVA improvement from baseline <1 logMAR line) and residual amblyopia (BCVA improvement from baseline >1 logMAR line). Data was collected for presence/absence of amblyogenic risk factors, history, ocular examination, and investigations leading to the final alternate diagnosis. We analyzed the factors that contributed to the initial over-diagnosis of amblyopia using the diagnostic error evaluation and research (DEER) taxonomy tool. Results: During the study period, 508 children with an initial diagnosis of amblyopia met the study criteria. Among these 508 children, 466 were diagnosed to have amblyopia alone, while 26 children (5.1%, median age: 7 years, 17 boys: 9 girls) were revised to have an alternate diagnosis/co-existing pathology. These 26 patients comprised of 2 groups: children referred to us as amblyopia but rediagnosed to have an alternate diagnosis; and a second subset, initially diagnosed by us to have amblyopia, but later found to have alternate diagnosis/co-existing pathology. Subclinical optic neuritis (50%, 13 children), and occult macular dystrophy (OMD) (38.4%, 10 children) were the most frequent alternative diagnoses. Children with ametropic amblyopia (8/26, 30.7%) were most frequently misdiagnosed. Risk factors that led to an initial diagnosis of amblyopia were: high refractive error and heterotropia in 7 patients each (26.9%), anisometropia in 12 (46.1%), and prior pediatric cataract surgery in 4(15.3%). No improvement in BCVA in 21/26 (80.7%) children led to suspicion of co-existing etiology. Other clues were optic disc pallor (11), subnormal color vision (7), history of parental consanguinity in 7, and preceding febrile illness/rhinitis in 1 child. The DEER taxonomy tool suggested that the most common reasons for diagnostic errors were over-emphasis on amblyopia. Conclusion: Our study suggests that 5% of children diagnosed with amblyopia might have co-existing/alternate etiology. Most common co-existing etiologies were subclinical optic neuropathy, and OMD. No improvement in BCVA, subtle history and examination findings prompted further workup. Not considering co-existing etiologies was the most common reason for an initial overdiagnosis of amblyopia.
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Affiliation(s)
- Virender Sachdeva
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam
| | - Bidisha Bhattacharya
- Binocular vision and Neuro Optometry, Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam
| | - Snehal Ganatra
- Child Sight Institute, Nimmagadda Prasad Children's Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, L.V. Prasad Eye Institute, Hyderabad
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Amorim-de-Sousa A, Pauné J, Silva-Leite S, Fernandes P, Gozález-Méijome JM, Queirós A. Changes in Choroidal Thickness and Retinal Activity with a Myopia Control Contact Lens. J Clin Med 2023; 12:jcm12113618. [PMID: 37297813 DOI: 10.3390/jcm12113618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The axial elongation in myopia is associated with some structural and functional retinal changes. The purpose of this study was to investigate the effect of a contact lens (CL) intended for myopia control on the choroidal thickness (ChT) and the retinal electrical response. METHODS Ten myopic eyes (10 subjects, 18-35 years of age) with spherical equivalents from -0.75 to -6.00 diopters (D) were enrolled. The ChT at different eccentricities (3 mm temporal, 1.5 mm temporal, sub-foveal ChT, 1.5 mm nasal, and 3 mm nasal), the photopic 3.0 b-wave of ffERG and the PERG were recorded and compared with two material-matched contact lenses following 30 min of wear: a single-vision CL (SV) and a radial power gradient CL with +1.50 D addition (PG). RESULTS Compared with the SV, the PG increased the ChT at all eccentricities, with statistically significant differences at 3.0 mm temporal (10.30 ± 11.51 µm, p = 0.020), in sub-foveal ChT (17.00 ± 20.01 µm, p = 0.025), and at 1.5 mm nasal (10.70 ± 14.50 µm, p = 0.044). The PG decreased significantly the SV amplitude of the ffERG photopic b-wave (11.80 (30.55) µV, p = 0.047), N35-P50 (0.90 (0.96) µV, p = 0.017), and P50-N95 (0.46 (2.50) µV, p = 0.047). The amplitude of the a-wave was negatively correlated with the ChT at 3.0T (r = -0.606, p = 0.038) and 1.5T (r = -0.748, p = 0.013), and the amplitude of the b-wave showed a negative correlation with the ChT at 1.5T (r = -0.693, p = 0.026). CONCLUSIONS The PG increased the ChT in a similar magnitude observed in previous studies. These CLs attenuated the amplitude of the retinal response, possibly due to the combined effect of the induced peripheral defocus high-order aberrations impacting the central retinal image. The decrease in the response of bipolar and ganglion cells suggests a potential retrograde feedback signaling effect from the inner to outer retinal layers observed in previous studies.
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Affiliation(s)
- Ana Amorim-de-Sousa
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, 4710-057 Braga, Portugal
| | - Jaume Pauné
- Teknon Medical Center, 08022 Barcelona, Spain
- Faculty of Optics and Optometry Polytechnic, University of Catalonia, 08222 Terrassa, Spain
| | - Sara Silva-Leite
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, 4710-057 Braga, Portugal
| | - Paulo Fernandes
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, CF-UM-UP, 4710-057 Braga, Portugal
| | - José Manuel Gozález-Méijome
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, CF-UM-UP, 4710-057 Braga, Portugal
| | - António Queirós
- Clinical and Experimental Optometry Research Lab (CEORLab), School of Science, University of Minho, 4710-057 Braga, Portugal
- Physics Center of Minho and Porto Universities, CF-UM-UP, 4710-057 Braga, Portugal
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Vyas SA, Lakshmanan Y, Chan HHL, Leung TW, Kee CS. Experimentally induced myopia and myopic astigmatism alter retinal electrophysiology in chickens. Sci Rep 2022; 12:21180. [PMID: 36477183 PMCID: PMC9729572 DOI: 10.1038/s41598-022-25075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Myopia (or "short-sightedness") and astigmatism are major causes of visual impairment worldwide. Significant amounts of astigmatism are frequently observed in infants and have been associated with myopia development. Although it is well established that both myopia and astigmatism are associated with ocular structural changes from anterior to posterior segments, very little is known on how these refractive errors alter retinal functions. This study investigated the effects of experimentally induced myopia and myopic-astigmatism on retinal electrophysiology by using an image-guided, multifocal global flash stimulation in chickens, a widely used animal model for refractive error development. Myopia and myopic-astigmatism were experimentally induced, respectively, by wearing spherical (- 10 D, n = 12) and sphero-cylindrical lenses (- 6.00 DS/- 8.00 DCx90: Hyperopic With-The Rule, H-WTR, n = 15; - 6.00 DS/- 8.00 DCx180: Hyperopic Against-The-Rule, H-ATR, n = 11) monocularly for a week (post-hatching day 5 to 12). An aged-matched control group without any lens treatment provided normal data (n = 12). Multifocal electrophysiological results revealed significant regional variation in the amplitude of induced component (IC) (central greater than peripheral; both p < 0.05) in the normal and H-ATR groups, but not in the - 10 D and H-WTR groups. Most importantly, for the first time, our results showed that both H-WTR and H-ATR groups exhibited a significantly longer implicit time of the inner retinal response at the central region when compared to the normal and - 10 D groups, highlighting a significant role of astigmatism in retinal physiology.
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Affiliation(s)
- Sonal Aswin Vyas
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Yamunadevi Lakshmanan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China.,Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Henry Ho-Lung Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China.,Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China.,Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China
| | - Tsz-Wing Leung
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China.,Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China.,Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Chea-Su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, SAR, China. .,Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China. .,Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Stapley V, Anderson RS, Saunders K, Mulholland PJ. Examining the concordance of retinal ganglion cell counts generated using measures of structure and function. Ophthalmic Physiol Opt 2022; 42:1338-1352. [PMID: 36065739 PMCID: PMC9826349 DOI: 10.1111/opo.13041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE There are several indirect methods used to estimate retinal ganglion cell (RGC) count in an individual eye, but there is limited information as to the agreement between these methods. In this work, RGC receptive field (RGC-RF) count underlying a spot stimulus (0.43°, Goldmann III) was calculated and compared using three different methods. METHODS RGC-RF count was calculated at a retinal eccentricity of 2.32 mm for 44 healthy adult participants (aged 18-58 years, refractive error -9.75 DS to +1.75 DS) using: (i) functional measures of achromatic peripheral grating resolution acuity (PGRA), (ii) structural measures of RGC-layer thickness (OCT-model, based on the method outlined by Raza and Hood) and (iii) scaling published histology density data to simulate a global expansion in myopia (Histology-Balloon). RESULTS Whilst average RGC-RF counts from the OCT-model (median 105.3, IQR 99.6-111.0) and the Histology-Balloon model (median 107.5, IQR 97.7-114.6) were similar, PGRA estimates were approximately 65% lower (median 37.7, IQR 33.8-46.0). However, there was poor agreement between all three methods (Bland-Altman 95% limits of agreement; PGRA/OCT: 55.4; PGRA/Histology-Balloon 59.3; OCT/Histology-Balloon: 52.4). High intersubject variability in RGC-RF count was evident using all three methods. CONCLUSIONS The lower PGRA RGC-RF counts may be the result of targeting only a specific subset of functional RGCs, as opposed to the coarser approach of the OCT-model and Histology-Balloon, which include all RGCs, and also likely displaced amacrine cells. In the absence of a 'ground truth', direct measure of RGC-RF count, it is not possible to determine which method is most accurate, and each has limitations. However, what is clear is the poor agreement found between the methods prevents direct comparison of RGC-RF counts between studies utilising different methodologies and highlights the need to utilise the same method in longitudinal work.
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Affiliation(s)
- Victoria Stapley
- Centre for Optometry & Vision Science, Biomedical Sciences Research InstituteUlster UniversityColeraineUK
| | - Roger S. Anderson
- Centre for Optometry & Vision Science, Biomedical Sciences Research InstituteUlster UniversityColeraineUK,National Institute for Health Research (NIHR)Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
| | - Kathryn Saunders
- Centre for Optometry & Vision Science, Biomedical Sciences Research InstituteUlster UniversityColeraineUK
| | - Pádraig J. Mulholland
- Centre for Optometry & Vision Science, Biomedical Sciences Research InstituteUlster UniversityColeraineUK,National Institute for Health Research (NIHR)Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyLondonUK
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Gupta SK, Chakraborty R, Verkicharla PK. Electroretinogram responses in myopia: a review. Doc Ophthalmol 2022; 145:77-95. [PMID: 34787722 PMCID: PMC9470726 DOI: 10.1007/s10633-021-09857-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/11/2021] [Indexed: 11/02/2022]
Abstract
The stretching of a myopic eye is associated with several structural and functional changes in the retina and posterior segment of the eye. Recent research highlights the role of retinal signaling in ocular growth. Evidence from studies conducted on animal models and humans suggests that visual mechanisms regulating refractive development are primarily localized at the retina and that the visual signals from the retinal periphery are also critical for visually guided eye growth. Therefore, it is important to study the structural and functional changes in the retina in relation to refractive errors. This review will specifically focus on electroretinogram (ERG) changes in myopia and their implications in understanding the nature of retinal functioning in myopic eyes. Based on the available literature, we will discuss the fundamentals of retinal neurophysiology in the regulation of vision-dependent ocular growth, findings from various studies that investigated global and localized retinal functions in myopia using various types of ERGs.
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Affiliation(s)
- Satish Kumar Gupta
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India
| | - Ranjay Chakraborty
- Caring Futures Institute, College of Nursing and Health Sciences, Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia
| | - Pavan Kumar Verkicharla
- Myopia Research Lab, Prof. Brien Holden Eye Research Centre, Brien Holden Institute of Optometry and Vision Sciences, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, India.
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Zheng H, Ying X, He X, Qu J, Hou F. Defective Temporal Window of the Foveal Visual Processing in High Myopia. Invest Ophthalmol Vis Sci 2021; 62:11. [PMID: 34236385 PMCID: PMC8267181 DOI: 10.1167/iovs.62.9.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the temporal characteristics of visual processing at the fovea and the periphery in high myopia. Methods Eighteen low (LM, ≤ -0.50 and > -6.00 D) and 18 high myopic (HM, ≤ -6.00 D) participants took part in this study. The contrast thresholds in an orientation discrimination task under various stimulus onset asynchrony (SOA) masking conditions were measured at the fovea and a more peripheral area (7°) for the two groups. An elaborated perceptual template model (ePTM) was fit to the behavioral data for each participant. Results An analysis of variance with three factors (SOA, degree of myopia and eccentricity) was performed on the threshold data. The interaction between SOA and degree of myopia in the fovea was significant (F (4, 128) = 2.66, P = 0.036), suggesting that the masking effect had different temporal patterns between the two groups. The temporal profiles for the two groups were derived based on the ePTM model. The peak and the spread of the temporal window in the fovea were much lower and wider, respectively, in the HM group than that in the LM group (both Ps < 0.05). There was no significant difference in the peripheral temporal window between the two groups. Conclusions High myopia is associated with defective temporal processing in the fovea, captured by a flattened temporal window.
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Affiliation(s)
- Haiyan Zheng
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoxiao Ying
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Jia Qu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fang Hou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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He X, Deng J, Xu X, Wang J, Cheng T, Zhang B, Zhao H, Luan M, Fan Y, Xiong S, Zhu J, Zou H, Xu X. Design and Pilot data of the high myopia registration study: Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM). Acta Ophthalmol 2021; 99:e489-e500. [PMID: 33377612 PMCID: PMC8359463 DOI: 10.1111/aos.14617] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the methodology and pilot data of the Shanghai Child and Adolescent Large-scale Eye Study (SCALE-HM). METHODS This is a population-based, prospective, examiner-masked study with annual follow-up. Patients are 4- to 18-year-olds with high myopia. The participants will fill out questionnaires and then undergo visual acuity, axial length (AL), intraocular pressure, ophthalmologist assessment, microperimetry, cycloplegic refraction, Pentacam, wavefront aberration, fundus, blood and saliva examinations. To describe the pilot data, intergroup differences were assessed with t-tests or analysis of variance and a logistic regression model was used to determine the independent factors associated with peripapillary atrophy (PPA). RESULTS Overall, 134 eyes of 79 participants met the pilot study recruitment criteria. The mean AL and spherical equivalent were 26.91 ± 1.07 mm and -9.40 ± 1.77 D, respectively. Peripapillary atrophy (PPA) (N = 112) and tessellated fundus (N = 67) were the most common fundus changes. The mean AL was significantly longer in PPA (27.08 ± 0.93 mm) than in non-PPA eyes (26.06 ± 1.31 mm; p < 0.001). Axial length (AL) (p = 0.041) was the only independent factor associated with PPA. Axial length (AL) was significantly longer in eyes with diffuse chorioretinal atrophy (N = 11; 28.02 ± 1.31 mm) than without myopic retinal lesions (N = 56; 26.48 ± 0.91 mm, p < 0.001) or with tessellated fundus (N = 67; 27.09 ± 0.97 mm, p = 0.012). The myopic degree was higher in eyes with diffuse chorioretinal atrophy than without myopic retinal lesions (-10.51 ± 2.76 D versus -9.06 ± 1.58 D, p = 0.039). CONCLUSION Peripapillary atrophy and tessellated fundus were common in children and adolescents with high myopia. Results from this prospective study will help to understand the mechanisms, development and prognosis of these changes and can guide early myopia screening.
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Affiliation(s)
- Xiangui He
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Junjie Deng
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Xian Xu
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Jingjing Wang
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Tianyu Cheng
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Bo Zhang
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Huijuan Zhao
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Mengli Luan
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Ying Fan
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Shuyu Xiong
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
| | - Haidong Zou
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
| | - Xun Xu
- Department of Preventative Ophthalmology Shanghai Eye Disease Prevention and Treatment Center Shanghai Eye Hospital Shanghai Children and Adolescents Myopia Prevention and Treatment Technology Center Shanghai China
- Department of Ophthalmology Shanghai General Hospital Shanghai Jiao Tong University National Clinical Research Center for Eye Diseases Shanghai Key Laboratory of Ocular Fundus Diseases Shanghai Engineering Center for Visual Science and Photomedicine Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases Shanghai China
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Amorim-de-Sousa A, Macedo-de-Araújo R, Fernandes P, Queirós A, González-Méijome JM. Multifocal Electroretinogram in Keratoconus Patients without and with Scleral Lenses. Curr Eye Res 2021; 46:1732-1741. [PMID: 33823736 DOI: 10.1080/02713683.2021.1912781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To investigate changes in the multifocal electroretinogram (mfERG) response in eyes with keratoconus when corrected with scleral lenses (SL) compared with the best correction in glasses.Methods: The mfERG responses in 10 eyes with keratoconus were recorded with the best correction using both a trial frame (baseline) and a hexafocon A SL using an electrophysiological diagnostic system. Electrophysiologic measurements were performed with the pupils fully dilated with instillation of 1% phenylephrine. The implicit time (milliseconds), amplitude (nV), and response density (nV/deg2) of the peaks (N1, P1, and N2) were analyzed for the total mfERG response, six rings and four quadrants of the retina, and compared between the two conditions.Results: All eyes had a significant improvement in visual quality with the SL compared with baseline (mean differences, 0.26 ± 0.17 and 0.22 ± 0.13 logarithm of the minimum angle of resolution for high- and low-contrast visual acuity, respectively). The peaks implicit times of the mfERG responses did not show significant differences (p > .05). The P1 amplitude decreased in all the retinal areas with the SL. Only the total retinal response and the nasal quadrants reached significance (p ≤ 0.044). The P1 response density in ring 1 was on average higher with the SL, but not significantly so. The decline in P1 response density from the center to the periphery was more abrupt with the SL, and was more similar to the response density distribution of a typical subject, without a corneal pathology.Conclusions: mfERG did not show any change associated with retinal disease in young patients with keratoconus. Although the improved visual performance was not associated with changes in the mfERG response, the correction of irregular astigmatism with the SL helps exclude the optical effect induced by keratoconus.
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Affiliation(s)
- Ana Amorim-de-Sousa
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - Rute Macedo-de-Araújo
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - Paulo Fernandes
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - António Queirós
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
| | - José M González-Méijome
- Clinical & Experimental Optometry Research Lab (CEORLab), Center of Physics, University of Minho, Braga, Portugal
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9
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Nebbioso M, Lambiase A, Gharbiya M, Bruscolini A, Alisi L, Bonfiglio V. High myopic patients with and without foveoschisis: morphological and functional characteristics. Doc Ophthalmol 2020; 141:227-236. [PMID: 32323040 DOI: 10.1007/s10633-020-09767-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Myopic foveoschisis (MF) is characterized by the splitting of the retinal layers in the fovea of patients with high myopia (HM). MF may progress into foveal detachment or macular hole formation with consequent loss of central vision. The aim of this study is to investigate morphological and functional changes of the macular region in myopic subjects with and without foveoschisis. DESIGN Observational, cross-sectional, comparative study. METHODS Forty-eight patients with HM and 24 healthy controls were evaluated by spectral domain-optical coherence tomography (SD-OCT), multifocal electroretinography (mfERG) and microperimetry (MP-1) tests to assess macular thickness, functionality and sensitivity values, respectively. The results of the diagnostic examinations were compared between three groups: HM patients with MF (N = 24), HM patients without MF (N = 24) and control group (CG) (N = 24). All statistical analyses were performed with STATA 14.0 (Collage Station, Texas, USA). One-way analysis of variance (ANOVA) followed by Tukey's post hoc test was used to analyze differences between groups unless specified; p values < 0.05 were considered as statistically significant. Gender distribution was compared by the Chi square test. RESULTS The statistical analysis with one-way ANOVA followed by Tukey's post hoc test showed a significant increase in macular thickness in HM patients with MF when compared to both HM patients without MF and CG. Morphological changes were associated with functional impairment as demonstrated by the significant decrease in amplitude of the P1 wave and MP-1 sensitivity (p < 0.05), according to the anatomical landmarks. CONCLUSIONS This study showed that the morphological changes observed in the central retina of HM patients with MF are associated with functional alterations. High-tech diagnostic tests such as SD-OCT, mfERG and MP-1 could be useful for management in complications of MF.
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Affiliation(s)
- Marcella Nebbioso
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy.
| | - Magda Gharbiya
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Alice Bruscolini
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Ludovico Alisi
- Department of Sense Organs, Sapienza University of Rome, p. le A. Moro 5, 00185, Rome, Italy
| | - Vincenza Bonfiglio
- Department of Ophthalmology, University of Catania, Via S. Sofia 76, 95100, Catania, Italy
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10
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Read SA, Alonso-Caneiro D, Vincent SJ. Longitudinal changes in macular retinal layer thickness in pediatric populations: Myopic vs non-myopic eyes. PLoS One 2017; 12:e0180462. [PMID: 28662138 PMCID: PMC5491256 DOI: 10.1371/journal.pone.0180462] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/15/2017] [Indexed: 12/14/2022] Open
Abstract
Knowledge of the normal in vivo thickness of the retina, and its individual layers in pediatric populations is important for diagnosing and monitoring retinal disorders, and for understanding the eye’s normal development and the impact of eye growth and refractive error such as myopia (short-sightedness) upon retinal morphology. In this prospective, observational longitudinal study, total retinal thickness (and individual retinal layer thickness) and the changes in retinal morphology occurring over an 18-month period were examined in 101 children with a range of refractive errors. In childhood, the presence of myopia was associated with subtle but statistically significant (p<0.05) changes in the topographical thickness distribution of macular retinal thickness (and retinal layer thickness), characterised by a thinning of the parafoveal retina (and parafoveal or perifoveal thinning in most outer and inner retinal layers). The parafoveal retina was on average 6 μm thinner in myopic children. However, over 18 months, longitudinal changes in retinal thickness and individual layers were of small magnitude (average changes of less than 2 μm over 18 months), indicative of a high degree of stability in retinal morphology in healthy adolescent eyes, despite significant eye growth over this same period of time. This provides the first detailed longitudinal assessment of macula retinal layer morphology in adolescence, and delivers new normative data on expected changes in retinal structure over time and associated with myopia during this period of childhood development.
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Affiliation(s)
- Scott A. Read
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J. Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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11
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Sachidanandam R, Ravi P, Sen P. Effect of axial length on full-field and multifocal electroretinograms. Clin Exp Optom 2017; 100:668-675. [PMID: 28266057 DOI: 10.1111/cxo.12529] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 11/27/2016] [Accepted: 12/01/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim was to investigate the effect of axial length on full-field electroretinogram (ffERG) and multifocal electroretinogram (mfERG) in young Indian subjects. METHODS One hundred subjects (44 male) with refractive errors from +0.50 to -18.00 DS and no myopic retinopathy underwent axial length measurement. ffERG was measured, which included scotopic and photopic responses according to International Society for Clinical Electrophysiology of Vision (ISCEV) guidelines. The mfERG was recorded after correcting for refractive error according to ISCEV standards. The dark-adapted and light-adapted parameters of ffERG and N1, P1 parameters of six rings in mfERG were analysed with axial length, controlled for refractive error. The subjects were divided into seven groups based on axial length. The b/a ratio of dark-adapted and light-adapted 3.0 ffERG and P1/N1 ratio of mfERG amplitudes were analysed for seven groups of axial length. RESULTS The axial length ranged from 21.79 to 30.55 mm. Significant negative correlations were noted for ffERG and mfERG amplitudes, whereas implicit times showed minimal delay with increase in axial length. In ffERG, the scotopic responses were more decreased compared to photopic responses. In mfERG, P1 and N1 amplitudes were significantly decreased in all the rings in all groups and more reduction was noted in the central ring compared to peripheral rings. The P1 amplitudes were more affected as compared to N1 amplitudes. The light-adapted and dark-adapted 3.0 ERG b/a ratio and P1/N1 ratio for seven axial length groups did not show statistically significant difference. The ERG parameters were not significant with refractive error. CONCLUSION This study quantifies the relationship of axial length with ffERG and mfERG parameters in a young Indian population. Although the amplitudes were reduced significantly, the implicit times were not significantly affected. The ERG parameters were more related to axial length than refractive error. Hence, interpretation of ffERG and mfERG parameters needs careful consideration in subjects with increasing axial length.
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Affiliation(s)
- Ramya Sachidanandam
- Department of Optometry, Medical Research Foundation, Chennai, Tamil Nadu, India.,Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Priya Ravi
- Department of Optometry, Medical Research Foundation, Chennai, Tamil Nadu, India.,Elite School of Optometry, Unit of Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Parveen Sen
- Department of Vitreoretina, Medical Research Foundation, Chennai, Tamil Nadu, India
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12
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Song AP, Yu T, Wang JR, Liu W, Sun Y, Ma SX. Multifocal electroretinogram in non-pathological myopic subjects: correlation with optical coherence tomography. Int J Ophthalmol 2016; 9:286-91. [PMID: 26949653 DOI: 10.18240/ijo.2016.02.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 05/13/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the changes of retinal function in non-pathological myopic subjects using multifocal electroretinography (mfERG) and to correlate the data with the central macular thickness obtained using optical coherence tomography (OCT). METHODS One hundred and thirteen subjects (113 eyes) with age range from 18 to 35y were enrolled in the study. The subjects were divided into four groups according to spherical equivalent (SE) and axial length (AL): emmetropia group (EG, n=31; SE: +0.75 to -0.50 D; AL: 22 to 24 mm), low and medium myopia group (LMMG, n=26; SE: >-0.50 to -6.00 D; AL: >24 to 26 mm), high myopia group (HMG, n=34; SE: >-6.00 to -10.00 D; AL: >26 to 28 mm) and super high myopia group (SHMG, n=22; SE: >-10.00 D; AL:>28 mm). The P1 amplitude density, P1 amplitude, and P1 implicit time of the first-order kernel mfERG responses were obtained and grouped into five rings. The central subfield macular thickness (CST) was obtained using macular cube 512×218 scan of Cirrus HD-OCT. RESULTS With the increasing of eccentricity, the first positive peak (P1) amplitude density (P=0.0000, 0.0001, 0.0021 in ring 1-3 respectively) and P1 amplitude (all P=0.0000 in ring 1-5) of each group decreased. With the increasing of myopia, P1 implicit time gradually extended (all P=0.0000 in ring 1-3). The average CST in four diagnostic groups was 241.56±12.72 µm, 244.56±12.19 µm, 254.33±11.61 µm, 261.75±11.83 µm respectively. With the increasing of myopia, CST increased (P<0.001). There was negative relationship between CST and P1 amplitude, P1 amplitude density (r=-0.402, P<0.001; r=-0.261, P=0.003). There was positive relationship between CST and P1 implicit time (r=0.34, P<0.001). CONCLUSION With the increasing of myopia, P1 amplitude density and P1 amplitude of the first-order reaction gradually reduced. This showed potential decline in retinal function in myopia. To some extent it may reflect the functional disorder or depression of the visual cells. The exact mechanism needs further study.
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Affiliation(s)
- Ai-Ping Song
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Tao Yu
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Jian-Rong Wang
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Wei Liu
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Yan Sun
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
| | - Su-Xiang Ma
- Department of Ophthalmology, Second People's Hospital, Jinan 250001, Shandong Province, China
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13
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Abstract
PURPOSE Spectral domain optical coherence tomography (OCT) was used to examine the influence of refractive error (RE) on foveal retinal and choroidal thicknesses and scleral canal width (SCW). The performance of the Cirrus and Bioptigen spectral domain OCT instruments was compared in the same eyes. METHODS Both eyes of 40 healthy human subjects, aged 22 to 38 years, were dilated and imaged, with the Cirrus OCT, using 6-mm five-line rasters collapsed into one line, one centered on the fovea and one bisecting the optic nerve head. Seventy-two of the same eyes were imaged with the Bioptigen OCT, using 6- by 6-mm scans, one centered on the fovea and one on the optic nerve head. Subfoveal retinal and choroidal thicknesses and SCW were measured. Axial lengths (ALs) and REs were obtained using an IOLMaster and a Grand Seiko autorefractor, respectively. RESULTS Only right eyes were included in analyses. Spherical equivalent REs ranged from -12.18 to +8.12 diopters (mean [±SD], -3.44 [±4.06] diopters), and ALs ranged from 20.56 to 29.17 mm (mean [±SD], 24.86 [±1.91] mm). Myopia was associated with relatively thin choroids at the fovea (p < 0.05) but normal retinal thickness. Scleral canal width was significantly correlated with AL as measured with the Bioptigen OCT (p < 0.05). Retinal and choroidal thicknesses recorded with the Bioptigen OCT tended to be smaller than values obtained with the Cirrus OCT (mean difference, 5.63 and 24.76 μm, respectively), whereas the converse was true for the SCW (mean difference, 25.45 μm). CONCLUSIONS The finding that high myopes tend to have a thinner subfoveal choroid is consistent with previous studies. That high myopia was linked to enlarged scleral canals may help to explain the increased risk of glaucoma in myopia. Observed differences obtained with the Cirrus and Bioptigen instruments urge caution in comparing results collected with different instruments.
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14
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Koh V, Tan C, Nah G, Zhao P, Yang A, Lin ST, Wong TY, Saw SM, Chia A. Correlation of structural and electrophysiological changes in the retina of young high myopes. Ophthalmic Physiol Opt 2015; 34:658-66. [PMID: 25331579 DOI: 10.1111/opo.12159] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Despite a high prevalence of myopia among young East Asian adults, there is a lack of data on the myopic retina structure-function relationship in this group. We examined the association between optical coherence tomography (OCT) and electroretinogram (ERG) measurements in highly myopic young Asian adults to provide this information and also determined if OCT can be used as an alternative screening tool to assess retinal function in young myopic adults. METHODS This was a prospective study comprising young adults aged between 18 and 25 years with spherical equivalent refraction of worse than -6.00 D. A comprehensive ophthalmic examination comprising fundus examination and grading, ocular biometry, time-domain OCT (fovea, macular and retinal nerve fibre layer thickness) and ERG (full field and multifocal) were performed for all the eyes. RESULTS A total of 32 eyes (mean spherical equivalent ± standard deviation -10.17 ± 1.51 D, mean age 23.8 ± 1.3 years) were included. None of the eyes showed visible myopic retinopathy and the central retina thickness of all eyes was classified as within the normal range. Full-field ERG amplitude and multifocal ERG P1 amplitudes in the outer rings (R3-R5) were, however, inversely associated with axial length. The multifocal ERG P1 amplitudes were also positively correlated with mean retinal nerve fibre layer thickness in R2, 4, 5 rings and outer macular thickness in R 2-5 rings. CONCLUSION These findings suggest that full field ERG changes may precede fundus and OCT changes in highly myopic young adults. Although there was some correlation between multifocal ERG amplitudes with OCT outer macular and retinal nerve fibre layer thickness, the OCT may not be useful as a retinal function screening tool, being within normal limits in all eyes. Further longitudinal studies are required to determine how the relationship between ERG and OCT will evolve over time.
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Affiliation(s)
- Victor Koh
- Singapore Armed Forces Vision Performance Centre, Military Medicine Institute, Singapore, Singapore; Department of Ophthalmology, National University Hospital, National University Health System, Singapore, Singapore
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15
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Yavas GF, Küsbeci T, Inan UU. Multifocal electroretinography in subjects with age-related macular degeneration. Doc Ophthalmol 2014; 129:167-75. [PMID: 25253559 DOI: 10.1007/s10633-014-9460-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate retinal function objectively in subjects with different stages of age-related macular degeneration (AMD) using multifocal electroretinography (mfERG) and compare it with age-matched control group. METHODS A total of 42 subjects with AMD and 37 age-matched healthy control group aged over 55 years were included in this prospective study. mfERG test was performed to all subjects. Average values in concentric ring analysis in four rings (ring 1, from 0° to 5° of eccentricity relative to fixation; ring 2, from 5° to 10°; ring 3, from 10° to 15°; ring 4, over 15°) and in quadrant analysis (superior nasal quadrant, superior temporal quadrant, inferior nasal quadrant and inferior temporal quadrant) were recorded. Test results were evaluated by one-way ANOVA test and independent samples t test. RESULTS In mfERG concentric ring analysis, N1 amplitude, P1 amplitude and N2 amplitude were found to be lower and N1 implicit time, P1 implicit time and N2 implicit time were found to be delayed in subjects with AMD compared to control group. In quadrant analysis, N1, P1 and N2 amplitude was lower in all quadrants, whereas N1 implicit time was normal and P1 and N2 implicit times were prolonged in subjects with AMD. CONCLUSION mfERG is a useful test in evaluating retinal function in subjects with AMD. AMD affects both photoreceptors and inner retinal function at late stages.
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Affiliation(s)
- Güliz Fatma Yavas
- Department of Ophthalmology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey,
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