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(Investigative Ophthalmology and Visual Science. 2006;47:4881-4887.)
© 2006 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.05-0875
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Pattern ERG as an Early Glaucoma Indicator in Ocular Hypertension: A Long-Term, Prospective Study

Michael Bach,1 Anke S. Unsoeld,1 Heiko Philippin,1 Flemming Staubach,1 Philip Maier,1 Hans S. Walter,2 Thomas G. Bomer,3 and Jens Funk1

1From the Universitäts-Augenklinik, Freiburg, Germany; 2St.-Vincentius-Krankenhaus, Karlsruhe, Germany; and 3Ophthalmology Practice, Arnsberg, Germany.

PURPOSE. The conversion rate from untreated ocular hypertension (OHT) to glaucoma is only ~1% per year. Discrimination of nonconverters and potential converters would help reserve preventative treatment for those who need it and thus avoid unnecessary side effects and expenditure for those who do not. This prospective study was designed to assess the pattern electroretinogram (PERG) as an early indicator of dysfunction preceding glaucoma.

METHODS. Ninety-five eyes of 54 patients with intraocular pressure ≥25 mm Hg (or ≥23 mm Hg with additional risk factors), normal visual fields, normal optic disc cupping, and visual acuity ≥0.8 were evaluated. Every 6 months during a median follow-up of 8.2 years, the PERG and visual fields were obtained besides other standard diagnostics. PERGs were recorded in steady state mode in response to checkerboard stimuli at 15 reversals/s, and the amplitudes in response to check sizes of 0.8° and 16° as well as the ratio of the amplitude of responses to 0.8° over that to 16° checks were determined.

RESULTS. Glaucomatous visual field defects developed in eight eyes. For the PERG to 0.8° checks and for the PERG ratio, analysis of the receiver-operating characteristic (ROC) yielded steadily increasing ROC areas before conversion (i.e., an increasing ability of the PERG to predict nonconversion or conversion). One year before conversion, the ROC area of the PERG ratio was 0.78; at a threshold of 1.06 this corresponded to a sensitivity of 80% and a specificity of 71%.

CONCLUSIONS. The PERG can help to predict stability or progression to glaucoma in OHT at least 1 year ahead of conversion.




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P. H. W. Chu, H. H. L. Chan, and B. Brown
Luminance-Modulated Adaptation of Global Flash mfERG: Fellow Eye Losses in Asymmetric Glaucoma
Invest. Ophthalmol. Vis. Sci., June 1, 2007; 48(6): 2626 - 2633.
[Abstract] [Full Text] [PDF]


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