Elsevier

Ophthalmology

Volume 115, Issue 6, June 2008, Pages 957-963
Ophthalmology

Original article
Reproducibility of Pattern Electroretinogram in Glaucoma Patients with a Range of Severity of Disease with the New Glaucoma Paradigm

Presented in part at: American Academy of Ophthalmology 109th annual meeting, October 2005, Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2007.08.023Get rights and content

Purpose

To determine the reproducibility of the pattern electroretinogram with the new Pattern Electroretinogram for Glaucoma (PERGLA) recording paradigm in glaucoma patients with a range of severity.

Design

Experimental study.

Participants

Fifty-three glaucoma patients were recruited for the study (mean age ± standard deviation [SD], 69±11 years). Their mean deviation (MD) global indices on static automatic perimetry ranged from 2.16 to −31.36 decibels (mean MD, −9.05).

Intervention

All patients had pattern electroretinogram recordings done 5 times by the same operator, on 5 different days with the standardized PERGLA paradigm.

Main Outcome Measures

Pattern electroretinogram amplitude (microvolts), phase (π radians), response variability (coefficient of variation [CV] = SD/mean × 100) of amplitude and phase of 2 partial averages that build up the pattern electroretinogram waveform, interocular asymmetry in amplitude and phase (in terms of the CV generated by the pattern electroretinogram software), signal-to-noise (S/N) ratio, SDs, CV, and intraclass correlation coefficient (ICC). All analyses were done on one eye of each subject, except when interocular asymmetry was studied.

Results

The CVs of intrasession variabilities in amplitude and phase were 12.08% and 2.20%, respectively, and those of intersession variabilities were 20.82% and 4.17%. The pattern electroretinogram produced intersession ICCs in amplitude and phase of 0.791 and 0.765, respectively. These ICCs were significantly higher than the ICCs for pattern electroretinogram interocular asymmetry in amplitude and phase (0.659 [P<0.05] and 0.571 [P<0.05], respectively). On average, the pattern electroretinogram S/N ratio in glaucomatous patients was about 5:1.

Conclusions

The reproducibility of PERGLA in glaucomatous patients is sufficiently good for it to be considered a useful complementary clinical tool. Being more reproducible, direct measures of amplitude and phase should be more useful in monitoring progression than interocular asymmetry comparisons.

Section snippets

Subjects

Fifty-three glaucoma patients were recruited for the study. Their mean age (± standard deviation [SD]) was 69±11 years (median, 71; range, 40–91); 28 were male and 25 female. The study group included 23 Caucasians, 17 Hispanics, 11 African Americans, and 2 Asians. Their mean deviation (MD) on standard automated perimetry ranged from 2.16 to −31.36 decibels (mean MD, 9.05). Each subject had a complete ophthalmologic examination, including visual acuity (VA), slit-lamp examination, IOP

Results

PERGLA produces values for amplitude and phase and, for each, the intrinsic (intratest) variability and interocular differences. We evaluated reproducibility for both intersession test–retest and intrinsic (intratest) of both amplitude and phase in 3 ways: the SD of repeat measurements, CV, and intraclass correlation coefficient (ICC).

Figure 1 shows the intersession test–retest variability of pattern electroretinogram amplitude, expressed in terms of the SD of the results obtained for each

Reproducibility of Pattern Electroretinogram

Several contradictory reports have been published in the past on pattern electroretinogram reproducibility. The large test–retest variability reported in some studies (as high as 100% of coefficient of variation) entertained doubts concerning its clinical usefulness.20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36

Reproducibility is affected by details of the recording techniques, including the nature of the stimuli, as well as electrode sites and types.20, 21, 22, 23, 24, 25,

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    Manuscript no. 2007-58.

    Supported in part by the National Eye Institute, Bethesda, Maryland (research grant no. RO1 EY014957 [VP], core grant no. P30 EY014801); an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York; an unrestricted donation from Zeiss-Meditec-Humphrey, Dublin, California; an unrestricted donation from Allergan, Inc., Irvine, California; an investigator-initiated grant from Pfizer, Inc., New York, New York; and a fellowship scholarship from Laval University.

    All authors except Dr Porciatti have no financial or proprietary interest in any products or devices mentioned in the article. Dr Porciatti developed the Pattern Electroretinogram for Glaucoma paradigm and has a financial interest with Lace Elettronica, Pisa, Italy.

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