Update on the pattern electroretinogram in glaucoma.
OBJECTIVE
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 degrees checks and to 16 degrees 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.
Bach
Michael
M
Sektion Funktionelle Sehforschung, Universitäts-Augenklinik Freiburg, Germany. michael.bach@uni-freiburg.de
Hoffmann
Michael B
MB
D018450:Disease Progression; D004594:Electrophysiology; D004596:Electroretinography / Q000592:standards; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D011237:Predictive Value of Tests; D012165:Retinal Ganglion Cells / Q000502:physiology; D014785:Vision, Ocular / Q000502:physiology