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Banijamali SMA, Versek C, Babinski K, Kamarthi S, Green-LaRoche D, Sridhar S. Portable multi-focal visual evoked potential diagnostics for multiple sclerosis/optic neuritis patients. Doc Ophthalmol 2024; 149:23-45. [PMID: 38955958 PMCID: PMC11236877 DOI: 10.1007/s10633-024-09980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Multiple sclerosis (MS) is a neuro-inflammatory disease affecting the central nervous system (CNS), where the immune system targets and damages the protective myelin sheath surrounding nerve fibers, inhibiting axonal signal transmission. Demyelinating optic neuritis (ON), a common MS symptom, involves optic nerve damage. We've developed NeuroVEP, a portable, wireless diagnostic system that delivers visual stimuli through a smartphone in a headset and measures evoked potentials at the visual cortex from the scalp using custom electroencephalography electrodes. METHODS Subject vision is evaluated using a short 2.5-min full-field visual evoked potentials (ffVEP) test, followed by a 12.5-min multifocal VEP (mfVEP) test. The ffVEP evaluates the integrity of the visual pathway by analyzing the P100 component from each eye, while the mfVEP evaluates 36 individual regions of the visual field for abnormalities. Extensive signal processing, feature extraction methods, and machine learning algorithms were explored for analyzing the mfVEPs. Key metrics from patients' ffVEP results were statistically evaluated against data collected from a group of subjects with normal vision. Custom visual stimuli with simulated defects were used to validate the mfVEP results which yielded 91% accuracy of classification. RESULTS 20 subjects, 10 controls and 10 with MS and/or ON were tested with the NeuroVEP device and a standard-of-care (SOC) VEP testing device which delivers only ffVEP stimuli. In 91% of the cases, the ffVEP results agreed between NeuroVEP and SOC device. Where available, the NeuroVEP mfVEP results were in good agreement with Humphrey Automated Perimetry visual field analysis. The lesion locations deduced from the mfVEP data were consistent with Magnetic Resonance Imaging and Optical Coherence Tomography findings. CONCLUSION This pilot study indicates that NeuroVEP has the potential to be a reliable, portable, and objective diagnostic device for electrophysiology and visual field analysis for neuro-visual disorders.
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Affiliation(s)
| | | | - Kristen Babinski
- Department of Neurology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Sagar Kamarthi
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Deborah Green-LaRoche
- Department of Neurology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Srinivas Sridhar
- NeuroFieldz Inc, Newton, MA, USA.
- Department of Physics, Department of Bioengineering and Department of Chemical Engineering, Northeastern University, Boston, MA, 02115, USA.
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Kulyabin M, Zhdanov A, Maier A, Loh L, Estevez JJ, Constable PA. Generating Synthetic Light-Adapted Electroretinogram Waveforms Using Artificial Intelligence to Improve Classification of Retinal Conditions in Under-Represented Populations. J Ophthalmol 2024; 2024:1990419. [PMID: 39045382 PMCID: PMC11265936 DOI: 10.1155/2024/1990419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/27/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Visual electrophysiology is often used clinically to determine the functional changes associated with retinal or neurological conditions. The full-field flash electroretinogram (ERG) assesses the global contribution of the outer and inner retinal layers initiated by the rods and cone pathways depending on the state of retinal adaptation. Within clinical centers, reference normative data are used to compare clinical cases that may be rare or underpowered within a specific demographic. To bolster either the reference dataset or the case dataset, the application of synthetic ERG waveforms may offer benefits to disease classification and case-control studies. In this study and as a proof of concept, artificial intelligence (AI) to generate synthetic signals using generative adversarial networks is deployed to upscale male participants within an ISCEV reference dataset containing 68 participants, with waveforms from the right and left eye. Random forest classifiers further improved classification for sex within the group from a balanced accuracy of 0.72-0.83 with the added synthetic male waveforms. This is the first study to demonstrate the generation of synthetic ERG waveforms to improve machine learning classification modelling with electroretinogram waveforms.
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Affiliation(s)
- Mikhail Kulyabin
- Pattern Recognition LabDepartment of Computer ScienceFriedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Aleksei Zhdanov
- Engineering School of Information TechnologiesTelecommunications and Control SystemsUral Federal University, Yekaterinburg, Russia
| | - Andreas Maier
- Pattern Recognition LabDepartment of Computer ScienceFriedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lynne Loh
- Flinders UniversityCollege of Nursing and Health SciencesCaring Futures Institute, Adelaide, South Australia, Australia
| | - Jose J. Estevez
- Flinders UniversityCollege of Nursing and Health SciencesCaring Futures Institute, Adelaide, South Australia, Australia
| | - Paul A. Constable
- Flinders UniversityCollege of Nursing and Health SciencesCaring Futures Institute, Adelaide, South Australia, Australia
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Cattaneo A, Guandalini A, Peruccio C. Preliminary observations on tear film interferometry performed in horses. J Equine Vet Sci 2024; 133:105002. [PMID: 38218326 DOI: 10.1016/j.jevs.2024.105002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/15/2024]
Abstract
This retrospective study evaluated tear film (TF) interferometry on horses examined in Northern Italy in 2019-2021. The objectives were to evaluate horses affected by keratitis, and to describe TF values in horses with no evidence of ocular disease. All horses received a complete ophthalmic examination and were examined with the Ocular Surface Analyser, Veterinary-setting, prior to eye manipulation, staining and sample collection. Eighteen horses with no evidence of ocular disease were included in the comparison group. Additionally, 46 horses displaying signs of keratitis (neovascularization, corneal opacities, ulceration, epithelial and subepithelial infiltrates) were evaluated. These horses were divided into presumed non-infectious and infectious or presumed infectious keratitis groups (one with proven bacterial origin, and the others with diagnosed or presumptive keratomycosis) with the former including immune-mediated keratitis. From the observations of TF interferometry in the comparison population the authors concluded that for non-invasive break-up time (NIBUT), the estimated preliminary reference interval was 10.4-31.2s, and for tear meniscus height (TMH), it was 0.215-0.457mm. Moreover, within the keratitis population, from an interferometric point of view punctate lesions of the ocular surface were present in all cases of active diagnosed or presumptive subepithelial keratomycosis but not in any of the non-infectious cases, either non-ulcerative or ulcerative. Limitations of the study include a relatively low number of horses examined and the fact that the diagnosis of infectious keratitis was presumptive and based on clinical improvement after treatment in some cases. To the authors' knowledge, this is the first report of TF interferometry performed in horses.
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Affiliation(s)
- A Cattaneo
- Equine Ophthalmic Referrals, Via Endine 29, Albino (Bg) 24021, Italy; Ophthalmology Referrals, Centro Veterinario Specialistico (CVS), Via Sandro Giovannini 51/53, Roma (Rm) 00137, Italy.
| | - A Guandalini
- Ophthalmology Referrals, Centro Veterinario Specialistico (CVS), Via Sandro Giovannini 51/53, Roma (Rm) 00137, Italy
| | - C Peruccio
- Ophthalmology Referrals, Centro Veterinario Torinese (CVT), Lungo Dora Pietro Colletta 147, Torino (To) 10153, Italy
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Shi LF, Hall AJ, Thompson DA. Full-field stimulus threshold testing: a scoping review of current practice. Eye (Lond) 2024; 38:33-53. [PMID: 37443335 PMCID: PMC10764876 DOI: 10.1038/s41433-023-02636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/21/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
The full-field stimulus threshold (FST) is a psychophysical measure of whole-field retinal light sensitivity. It can assess residual visual function in patients with severe retinal disease and is increasingly being adopted as an endpoint in clinical trials. FST applications in routine ophthalmology clinics are also growing, but as yet there is no formalised standard guidance for measuring FST. This scoping review explored current variability in FST conduct and reporting, with an aim to inform further evidence synthesis and consensus guidance. A comprehensive electronic search and review of the literature was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Key source, participant, methodology and outcomes data from 85 included sources were qualitatively and quantitatively compared and summarised. Data from 85 sources highlight how the variability and insufficient reporting of FST methodology, including parameters such as units of flash luminance, colour, duration, test strategy and dark adaptation, can hinder comparison and interpretation of clinical significance across centres. The review also highlights an unmet need for paediatric-specific considerations for test optimisation. Further evidence synthesis, empirical research or structured panel consultation may be required to establish coherent standardised guidance on FST methodology and context or condition dependent modifications. Consistent reporting of core elements, most crucially the flash luminance equivalence to 0 dB reference level is a first step. The development of criteria for quality assurance, calibration and age-appropriate reference data generation may further strengthen rigour of measurement.
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Affiliation(s)
- Linda F Shi
- Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Amanda J Hall
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Dorothy A Thompson
- Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
- UCL Great Ormond Street Institute for Child Health, University College London, London, UK.
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Thompson DA, Mikó-Baráth E, Hardy SE, Jandó G, Shaw M, Hamilton R. ISCEV standard pattern reversal VEP development: paediatric reference limits from 649 healthy subjects. Doc Ophthalmol 2023; 147:147-164. [PMID: 37938426 PMCID: PMC10638119 DOI: 10.1007/s10633-023-09952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/25/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To establish the extent of agreement for ISCEV standard reference pattern reversal VEPs (prVEPs) acquired at three European centres, to determine any effect of sex, and to establish reference intervals from birth to adolescence. METHODS PrVEPs were recorded from healthy reference infants and children, aged 2 weeks to 16 years, from three centres using closely matched but non-identical protocols. Amplitudes and peak times were modelled with orthogonal quadratic and sigmoidal curves, respectively, and two-sided limits, 2.5th and 97.5th centiles, estimated using nonlinear quantile Bayesian regression. Data were compared by centre and by sex using median quantile confidence intervals. The 'critical age', i.e. age at which P100 peak time ceased to shorten, was calculated. RESULTS Data from the three centres were adequately comparable. Sex differences were not clinically meaningful. The pooled data showed rapid drops in P100 peak time which stabilised by 27 and by 34 weeks for large and small check widths, respectively. Post-critical-age reference limits were 87-115 ms and 96-131 ms for large and small check widths, respectively. Amplitudes varied markedly and reference limits for all ages were 5-57 μV and 3.5-56 μV for large and small check widths, respectively. CONCLUSIONS PrVEP reference data could be combined despite some methodology differences within the tolerances of the ISCEV VEP Standard, supporting the clinical benefit of ISCEV Standards. Comparison with historical data is hampered by lack of minimum reporting guidelines. The reference data presented here could be validated or transformed for use elsewhere.
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Affiliation(s)
- Dorothy A Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic, Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
- UCL Great Ormond Street Institute for Child Health, University College London, 30 Guildford Street, London, UK.
| | - Eszter Mikó-Baráth
- Institute of Physiology, Medical School, University of Pécs, Pécs, Hungary
| | - Sharon E Hardy
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gábor Jandó
- Institute of Physiology, Medical School, University of Pécs, Pécs, Hungary
| | - Martin Shaw
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Royal Hospital for Children, Glasgow, UK
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ruth Hamilton
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Royal Hospital for Children, Glasgow, UK
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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The Development of Electroretinographic Oscillatory Potentials in Healthy Young Children. J Clin Med 2022; 11:jcm11195967. [PMID: 36233838 PMCID: PMC9571328 DOI: 10.3390/jcm11195967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to summarize the electroretinographic oscillatory potential (OP) responses in healthy young children recorded by RETeval. METHODS By using the RETeval system, we recorded the implicit times and amplitudes of the OPs (OP1-5), in 132 healthy children aged from 0 to 11 years old. The age, gender, and data of implicit time and amplitude of each child were recorded and analyzed. Correlation analysis was performed between age and implicit time/amplitude. RESULTS No correlation was shown between the implicit times and amplitudes with gender. The implicit times and amplitudes of OP1-5 matured over 10 years of age, with exponential time constants of 1.9, 2.2, 1.8, 1.7, and 1.6 years and 2.1, 2.9, 2.8, 3.0, and 3.2 years, respectively. The majority of the trend occurred within the first 4.6 years. CONCLUSIONS In order to diagnose and evaluate vision-related disorders, the OP response is commonly used. The percentiles and age dependence of OP responses calculated and shown in this study could be regarded as reference data in age-matched pediatric patients.
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Rawicka A, Capasso M, Silvestre P, Giudice C, Juśkiewicz J, Zinno F, D'Anna N. OPHTHALMIC EXAMINATION FINDINGS IN CAPTIVE RING-TAILED LEMURS (Lemur catta, Linnaeus 1758). J Exot Pet Med 2022. [DOI: 10.1053/j.jepm.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Xie X, Feng K, Wang J, Zhang M, Hong J, Zhang H. Comprehensive visual electrophysiological measurements discover crucial changes caused by alcohol addiction in humans: Clinical values in early prevention of alcoholic vision decline. Front Neural Circuits 2022; 16:912883. [PMID: 36034334 PMCID: PMC9403052 DOI: 10.3389/fncir.2022.912883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Alcohol addiction often compromises vision by impairing the visual pathway, particularly the retina and optic nerve. Vision decline in alcoholics consists of a sequential transition from reversible functional deterioration of the visual pathway to irreversible clinical vision degeneration or vision loss. Thus, the control of alcoholic vision decline should focus on prevention before permanent damage occurs. Visual electrophysiology is a promising method for early detection of retinal dysfunction and optic neuropathy, including full-field electroretinography (ffERG) and pattern-reversal visual evoked potential (PR-VEP). So far, however, research studying the electrophysiological characteristics in the preclinical stage of vision decline caused by alcohol addiction is still lacking. Here we conducted a retrospective study with 11 alcoholics and 14 matched control individuals to address this need. We had performed comprehensive visual electrophysiological tests, including ffERG and PR-VEP. We next analyzed all electrophysiological parameters using multivariate statistical analyses and discovered some highly sensitive alterations to alcohol addiction. We found severely reduced amplitudes in scotopic ffERG oscillatory potentials (OPs) in alcohol addicts. These changes indicate the alcohol-induced disturbances of amacrine cells and retinal circulation. In subjects with alcohol addiction, the amplitudes of b-waves diminish significantly in scotopic but not photopic ffERG, implying the impaired function of the retinal rod system and the dysfunction of the inner retina. PR-VEPs elicited by checkerboard stimuli with large 1 degree (°) checks mainly reflect the state of the optic nerve and ganglion cells, and PR-VEPs provoked by small 0.25° checks mainly reflect the function of the macular. We performed both measurements and observed a robust amplitude reduction in all three peaks (N75–P100, P100–N135) and a significant peak time extension in P100. Our research provides an affordable and non-invasive tool to accurately evaluate visual pathway conditions in alcohol addicts and help clinicians take targeted treatment.
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Affiliation(s)
- Xin Xie
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Kang Feng
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Juan Wang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Min Zhang
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Haolin Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
- *Correspondence: Haolin Zhang,
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MERCI: a machine learning approach to identifying hydroxychloroquine retinopathy using mfERG. Doc Ophthalmol 2022; 145:53-63. [PMID: 35732856 DOI: 10.1007/s10633-022-09879-7] [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: 03/03/2021] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Hydroxychloroquine (HCQ) is an anti-inflammatory drug in widespread use for the treatment of systemic auto-immune diseases. Vision loss caused by retinal toxicity is a significant risk associated with long term HCQ therapy. Identifying patients at risk of developing retinal toxicity can help prevent vision loss and improve the quality of life for patients. This paper presents updated reference thresholds and examines the diagnostic accuracy of a machine learning approach for identifying retinal toxicity using the multifocal Electroretinogram (mfERG). METHODS A retrospective study of patients referred for mfERG testing to detect HCQ retinopathy. A consecutive series of all patients referred to Kensington Vision and Research Centre between August 2017 and July 2020 were considered eligible. Eyes suspect for other ocular pathology including widespread retinal disease and advanced macular pathology unrelated to HCQ or with poor quality mfERG recordings were excluded. All patients received mfERG testing and Ocular Coherence Tomography (OCT) imaging. Presence of HCQ retinopathy was based on ring ratio analysis using clinical reference thresholds established at KVRC coupled with structural features observed on OCT, the clinical reference standard. A Support Vector Machine (SVM) using selected features of the mfERG was trained. Accuracy, sensitivity and specificity are reported. RESULTS 1463 eyes of 748 patients were included in the study. SVM model performance was assessed on 293 eyes from 265 patients. 55 eyes from 54 patients were identified as demonstrating HCQ retinopathy based on the clinical reference standard, 50 eyes from 49 patients were identified by the SVM. Our SVM achieves an accuracy of 85.3% with a sensitivity of 90.9% and specificity of 84.0%. CONCLUSIONS Machine learning approaches can be applied to mfERG analysis to identify patients at risk of retinopathy caused by HCQ therapy.
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Zhang T, Lu J, Sun L, Li S, Huang L, Wang Y, Li Z, Cao L, Ding X. Mydriasis-Free Flicker Electroretinograms in 204 Healthy Children Aged 0-18 Years: Reference Data From Two Cohorts. Transl Vis Sci Technol 2021; 10:7. [PMID: 34739038 PMCID: PMC8572514 DOI: 10.1167/tvst.10.13.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this study was to summarize the flicker electroretinogram responses (ERGs) in healthy children using RETeval, a small handheld mydriasis-free full-field flicker ERG system. Methods Flicker ERGs were recorded with the use of the RETeval system in 204 healthy children (aged 18 years and below) from 2 countries, China and the United States. The effects on ERG measurements of the subject's demographics and location were analyzed. Results The implicit times have no correlation with the population (China cohort and US cohort), sex, and refractive error. In contrast, the amplitudes were dependent on demographics. The amplitude differences were small compared to the 95% reference interval; therefore, a single (age-corrected) reference interval can be used in both locations and both sexes. The implicit times and amplitudes mature over the first decade of life with exponential time constants of 2.5 years and 4.1 years, respectively, whereas most of the trend is within the first 6 years (implicit times) and 9 years (amplitudes). Conclusions The age dependence and percentiles obtained in this study could serve as reference data against which the ERG responses from pediatric patients can be compared. Translational Relevance The flicker ERG is one of the standard methods for the assessment and diagnosis of vision-related disorders. This study provides reference data in pediatric subjects, which can then be used to aid in the interpretation of flicker ERG results.
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Affiliation(s)
- Ting Zhang
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinglin Lu
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - You Wang
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zeyu Li
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liming Cao
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Retina Division, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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