CLINICAL AND EXPERIMENTAL EVIDENCE THAT THE PATTERN ELECTRORETINOGRAM (PERG) IS GENERATED IN MORE PROXIMAL RETINAL LAYERS THAN THE FOCAL ELECTRORETINOGRAM (FERG)

Can pattern electroretinography be a relevant diagnostic aid in amblyopia? - A systematic review

INTRODUCTION

Pattern Electroretinography (PERG) is a highly sensitive electrophysiological technique used as an indicator of changes in retinal macular area. Amblyopia seems to result from a cortical visual imbalance but changes at the retinal level may also be present. The purpose of this systematic review was to evaluate if there are any consistent changes described in the scientific literature in PERG responses of amblyopic eyes.

MATERIALS AND METHODS

Searches were conducted in PubMed and Embase databases, using the keywords "Electroretinography" and "Amblyopia", combined with MeSH or Emtree terms "Pattern Electroretinography", "amblyopia", "PERG" and "amblyopia". PERG P50-N95 amplitude and P50 latency were analysed as well as the methodology used.

RESULTS

A total of 234 articles were found and 6 articles were included for review. One of the articles reported results in adults and five of them in children. One of the articles in children reported no changes in either P50-N95 amplitude or P50 latency. All articles that described differences between the amblyopic eye and the normal eye found a decrease in P50-N95 amplitude and/or a delay in P50 latency.

CONCLUSIONS

This review shows promising findings for the use of PERG in amblyopia as an aid in the diagnostic protocol, since this technique may be able to detect an apparent functional impairment of the amblyopic eye.

Electrical activity in visual cortex associated with combined auditory and visual stimulation in temporal sequences known to be associated with a visual illusion

When a subject views a visual stimulus paired with a brief click, a second click occurring approximately 80 ms later produces the hallucination of a second visual stimulus. We have used combinations of visual and sound stimuli to evoke cortical activity and have recorded the associated event-related potentials. We have recorded EPs in a conventional manner, and have calculated from multichannel recordings the Laplacian derivations to determine if the currents were generated in primary visual cortex. Clicks alone do not cause significant activity in V1, but if paired with pattern stimulation, modify the evoked potential. The timing of this extra activity almost certainly excludes "feed back" activation from higher centres, and can most simply be explained if sound-activated thalamo-cortical input can rapidly produce extra activity in 'primed' visual cortex. This finding has general implications for cortical function, for the generation of the hallucination and for 'blindsight'.

Pattern electroretinograms recorded with a skin electrode in pigmentary retinal degeneration

In 24 patients suffering from pigmentary retinal degeneration the electroretinograms to pattern stimulation (PERG) were recorded with a silver-cup electrode placed on the center of the lower eyelid skin referred to an electrode on the earlobe. The results were compared with the responses to flash stimulation (FERG) and pattern visual evoked cortical potentials. None of patients showed normal FERGs. Nineteen of 48 eyes showed subnormal FERGs. The PERG was recorded from those 19 eyes. In the remaining 29 eyes with flat FERG, 8 eyes showed clear PERGs. The peak latency of the first positive component of PERGs was found to be prolonged in these patients. PERGs seemed to be recordable in the patients whose visual acuity and central visual field were relatively well preserved.