title: Retinal dysfunction and refractive errors: an electrophysiological study of children.
abstract: OBJECTIVE
  To evaluate the relation between refractive error and electrophysiological retinal abnormalities in children referred for investigation of reduced vision.
  
  
  METHODS
  The study group comprised 123 consecutive patients referred over a 14 month period from the paediatric service of Moorfields Eye Hospital for electrophysiological investigation of reduced vision. Subjects were divided into five refractive categories according to their spectacle correction: high myopia (< or = -6D), low myopia (>-6D and < or = -0.75D), emmetropia (>-0.75 and <1.5D), low hyperopia (> or = 1.5 and <6D), and high hyperopia (> or = 6D). Patients with a specific diagnosis at the time of electrophysiological testing were excluded. Only the first member of any one family was included if more than one sibling had been tested. All tests were performed to incorporate ISCEV standards, using gold foil corneal electrodes where possible. In younger patients skin electrodes and an abbreviated protocol were employed.
  
  
  RESULTS
  The mean age of patients was 7.1 years with an overall incidence of abnormal electrophysiological findings of 29.3%. The incidence of abnormality was higher in high ametropes (13/25, 52%) compared to the other groups (23/98, 23.5%). This difference was statistically significant (chi2 test, p = 0.005). There was also a significant association between high astigmatism (>1.5D) and ERG abnormalities (18/35 with high astigmatism v 20/88 without, chi2 test, p = 0.002). There was no significant variation in frequency of abnormalities between low myopes, emmetropes, and low hyperopes. The rate of abnormalities was very similar in both high myopes (8/15) and high hyperopes (5/10).
  
  
  CONCLUSIONS
  High ametropia and astigmatism in children being investigated for poor vision are associated with a higher rate of retinal electrophysiological abnormalities. An increased rate of refractive errors in the presence of retinal pathology is consistent with the hypothesis that the retina is involved in the process of emmetropisation. Electrophysiological testing should be considered in cases of high ametropia in childhood to rule out associated retinal pathology.
authors.affiliation: Department of Ophthalmology, The Children's University Hospital, Temple Street, Dublin D1, Ireland. ian@flitcroft.com
authors.forename: D I
authors.initials: DI
authors.lastname: Flitcroft
authors.forename: G G W
authors.initials: GG
authors.lastname: Adams
authors.forename: A G
authors.initials: AG
authors.lastname: Robson
authors.forename: G E
authors.initials: GE
authors.lastname: Holder
mesh_terms: D000293:Adolescent; D001251:Astigmatism / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004596:Electroretinography / Q000379:methods; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology; D008297:Male; D009216:Myopia / Q000209:etiology; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000209:etiology*; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012737:Sex Factors; D015354:Vision, Low / Q000209:etiology*