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Update on the Pattern Electroretinogram in Glaucoma

BACH, MICHAEL PhD; HOFFMANN, MICHAEL B. PhD

Optometry and Vision Science: June 2008 - Volume 85 - Issue 6 - p 386-395
doi: 10.1097/OPX.0b013e318177ebf3
Review

Purpose. To review the efficacy of the pattern electroretinogram (PERG) in early diagnosis of glaucoma.

Methods. Stimulation parameters of check size and temporal frequency are considered. Analyses of various peaks (P50, N95, the N95/P50) and Fourier steady-state are considered. The relation to visual field defects is explored.

Results. The PERG is markedly alterated in glaucoma. It shows amplitude reductions in (still) normal areas of the visual field. Optical imaging on the retina needs to be optimal. Higher temporal frequency (>10 reversals/s) improves the sensitivity to detect glaucoma compared with transient stimulation. The ratio between the amplitudes to 0.8° checks and to 16° checks, “PERG ratio,” exploits a check size-specific reduction in early glaucoma and reduces variability. Longitudinal studies suggest that the PERG can indicate incipient glaucoma damage before evidence from the visual field.

Conclusions. The PERG is a demanding electrophysiological technique that can serve as a sensitive biomarker for retinal ganglion cell function. With appropriate paradigms, PERG assists in identifying those patients with elevated interocular pressure in whom glaucoma damage is incipient before visual field changes occur.

Sektion Funktionelle Sehforschung, Universitäts-Augenklinik Freiburg, Germany (MB), and Visual Processing Laboratory, Universitäts-Augenklinik Magdeburg, Germany (MBH)

Received September 27, 2005; accepted October 12, 2007.

© 2008 American Academy of Optometry