PurposeTo further improve analysis of the two-flash multifocal electroretinogram (2F-mfERG) in glaucoma in regard to structure–function analysis, using discrete wavelet transform (DWT) analysis.MethodsSixty subjects [35 controls and 25 primary open-angle glaucoma (POAG)] underwent 2F-mfERG. Responses were analyzed with the DWT. The DWT level that could best separate POAG from controls was compared to the root-mean-square (RMS) calculations previously used in the analysis of the 2F-mfERG. In a subgroup analysis, structure–function correlation was assessed between DWT, optical coherence tomography and automated perimetry (mf103 customized pattern) for the central 15°.ResultsFrequency level 4 of the wavelet variance analysis (144 Hz, WVA-144) was most sensitive (p < 0.003). It correlated positively with RMS but had a better AUC. Positive relations were found between visual field, WVA-144 and GCIPL thickness. The highest predictive factor for glaucoma diagnostic was seen in the GCIPL, but this improved further by adding the mean sensitivity and WVA-144.ConclusionsmfERG using WVA analysis improves glaucoma diagnosis, especially when combined with GCIPL and MS.

In our study, mfERG showed a statistically significant correlation with perimetric sensitivity measured in linear units and with structural macular changes detected with time-domain OCT.

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NCT01265628.

PurposeTo improve structure-function analysis in primary open-angle glaucoma (POAG) by including the two-global flash multifocal electroretinogram (2F–mfERG) and macular ganglion cell layer segmentation.MethodsTwenty-five glaucoma patients (six pre-perimetric (PPG), 19 POAG) and 16 controls underwent 2F–mfERG, optical coherence tomography (OCT), and standard automated perimetry (SAP). For 2F–mfERG, the root mean square was calculated for the focal flash response at 15–45 ms (DC) and the global flash responses at 45–75 ms (IC1) and 75–105 ms (IC2). For OCT, macular total thickness (mT) and ganglion cell-inner plexiform layer (GCIPL) thickness were analysed. Values from the central 10° and 15° of 2F-mfERG were compared to the corresponding areas from OCT and visual field.ResultsBoth PPG and POAG had significantly lower mfERG responses in the central 10° and 15° than the control group. Of the glaucoma patients, 30.7% (three PPG, five POAG) showed central mfERG and GCIPL reduction without a SAP defect in the central 15 degrees. Four patients had a central SAP defect associated with a reduced GCIPL without any detectable dysfunction on mfERG. MfERG DC and IC2 were larger with increased mT (p ≤ 0.02), but GCIPL only related positively to IC2 (p = 0.027). SAP sensitivity also increased with thicker mT but not with GCIPL (p < 0.03 and p = 0.35). DC, IC2, and GCIPL could best differentiate glaucoma from control (AUC values: 0.897, 0.903, and 0.905).ConclusionsStructure function analysis in glaucoma can be improved when the GCIPL thickness as well as the 2F–mfERG is included as these measures complement information obtained by SAP.