Glaucoma Detection Is Facilitated by Luminance Modulation of the Global Flash Multifocal Electroretinogram

Chu, Patrick H W; Chan, Ho Lung Henry; Brown, Brian

doi:10.1167/iovs.05-0891

Cited by 46 publications

(99 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have shown that IC represents predominantly inner retinal function. [13][14][15] Based on this evidence, emmetropic children with subclinical decreased inner retinal function in the central region may be more likely to subsequently develop myopia.…”

Section: Discussionmentioning

confidence: 97%

Subclinical Decrease in Central Inner Retinal Activity Is Associated With Myopia Development in Children

Choi

et al. 2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

Citation: Li SZ-C, Yu W-Y, Choi K-Y, et al. Subclinical decrease in central inner retinal activity is associated with myopia development in children. Invest Ophthalmol Vis Sci. 2017;58:4399-4406. DOI:10.1167/ iovs.16-21279 PURPOSE. To investigate the characteristics of retinal electrophysiological activity in relation to early myopia development in children.METHODS. Fifty-six children aged 6 to 9 years with emmetropic refractive error (defined as ‡ À0.5 diopter [D] and þ0.5 D) were recruited. Cycloplegic refraction, axial length, and global flash multifocal electroretinogram (MOFO mfERG) at 49% and 96% contrast levels were recorded in all children at their first visit. The refraction and axial length measurements were repeated after 1 year. The amplitudes and implicit times of the direct component (DC) and the induced component (IC) of the MOFO mfERG obtained at the initial visit were analyzed. Correlations between the MOFO mfERG parameters and changes in refractive error and axial length were investigated. RESULTS.The mean spherical equivalent refractive error and axial length of the eyes of the children at the first visit were þ0.19 6 0.33 D and 23.14 6 0.6 mm, respectively. After 1 year, the mean refractive error increased by À0.55 6 0.53 D, whereas axial length increased by 0.37 6 0.22 mm. The changes in refractive error and axial length were significantly correlated with the central IC amplitudes at 49% contrast level measured at the initial visit (q ¼ 0.46, P < 0.001 and q ¼ À0.34, P ¼ 0.01, respectively).CONCLUSIONS. The prospective changes we have shown are believed to derive from central inner retina. These changes appear to precede myopia and could be a potential reference for juvenile myopia development.Keywords: myopia development, multifocal electroretinogram, children vision, inner retina E xcessive eyeball elongation causes myopia. In severe cases, it may result in retinal stretching, thinning, and changes in retinal cell morphology and pathology. Application of the ERG technique has provided ample evidence to confirm that myopia results in impaired retinal function. It has been reported that myopia in adults was associated with decreased nonlinear components of ERG responses, 1 multifocal ERG (mfERG) responses, 2,3 retinal adaptation response, 4 and inner retinal function. [5][6][7] Axial length was shown to be linearly related to ERG amplitudes, 8 first-order kernel, and the first slice of second-order kernel of mfERG responses. 9 The reduction in mfERG responses in myopic adults is believed to be due to the deterioration in retinal function associated with long-standing myopia. However, this explanation cannot be applied to myopic children, and discrepancies of ERG characteristics have been noted between myopic adults and children.2,7 Luu and his colleagues 2 conducted a cross-sectional study of mfERG measurement in 104 children and 31 adults with a range of refractive errors. They found a significant correlation between refractive error and mfERG response in adults, but this correlation ...

show abstract

Section: Discussionmentioning

confidence: 97%

Subclinical Decrease in Central Inner Retinal Activity Is Associated With Myopia Development in Children

Choi

et al. 2017

Invest. Ophthalmol. Vis. Sci.

View full text Add to dashboard Cite

show abstract

“…In glaucoma, amplitudes of the peripheral DC were reduced at mid-luminance difference levels and therefore did not reach saturation level as soon. An adaptive index of the DC showed a good differentiation between healthy subjects and glaucoma patients with an area under the curve (AUC) of 0.986 (sensitivity: 93 %, specificity: 95 %) [13]. The total recording time needed to obtain this data was 6 9 8 min which does not seem feasible in the clinic.…”

Section: Introductionmentioning

confidence: 98%

The 2-global flash mfERG in glaucoma: attempting to increase sensitivity by reducing the focal flash luminance and changing filter settings

et al. 2012

View full text Add to dashboard Cite

Purpose To test a new 2-flash multifocal electroretinogram (mfERG) paradigm in glaucoma using a reduced light intensity of the m-frame flash as opposed to the global flash, as it has been suggested that this may increase the responses induced by the global flash, which has been the part of the mfERG response where most changes have been noted in glaucoma. Methods A mfERG was recorded from one eye of 22 primary open angle glaucoma (POAG) patients [16 normal tension glaucoma (NTG), 6 high tension glaucoma (HTG)] and 20 control subjects. A binary m-sequence (2^13-1, L max 100 cd/m 2 , L min \1 cd/m 2 ), followed by two global flashes (L max 200 cd/m 2 ) at an interval of 26 ms (VERIS 6.0 TM , FMSIII), was used. The stimulus array consisted of 103 hexagons. Retinal signals were amplified (gain = 50 K) and bandpass filtered at 1-300 Hz. For each focal response, the root mean square was calculated. We analyzed 5 larger response averages (central 15°and 4 adjoining quadrants) as well as 8 smaller response averages (central 10°and 7 surrounding response averages of approximately 7°radius each). Three epochs were analyzed: the direct component at 15-45 ms (DC) and the following two components induced by the effects of the preceding focal flash on the response to the global flashes at 45-75 ms (IC-1) and at 75-105 ms (IC-2). Statistical analysis was performed using linear mixed effects models adjusted for age. Results Responses differed significantly between POAG patients and controls in all central response averages. This difference was larger for the central 10°t han for the response average of the central 15°. While these observations held true for all response epochs analyzed, the DC differed least and the IC-1 most when POAG was compared to control. For POAG, the most sensitive differential measure was IC-1 of the central 10°with an area under the ROC curve of 0.78. With a cutoff value of 12.52 nV/deg 2 , 80 % of the POAG patients (100 % HTG, 69 % NTG) were correctly classified as abnormal, while 77 % of the control subjects were correctly classified as normal. When the results of the mfERG were compared to the visual fields, there was a tendency for the mfERG to decrease as the mean defect increased. However, this correlation was only significant in the superior nasal quadrant when the IC-1 of the mfERG was compared to the corresponding area of the visual field. Conclusion When compared to findings from previous studies, reducing the luminance of the m-frame flash in the 2-global flash paradigm did not increase the sensitivity and specificity of the mfERG to detect glaucoma further.

show abstract

“…The global flash paradigm consists of a periodic global flash interleaved with the pseudorandom binary m-sequence multifocal stimulation. This flash sequence produces two components, a direct component (DC) and an induced component (IC); the DC is analogous to a standard mfERG response and reflect certain light adaptation produced by the periodic global flashes [19], while the IC is the change in the response to the global flash produced by the prior local flash, and has been reported to be affected in glaucoma [20][21][22][23]. Naso-temporal response asymmetry across the retina is reported for the IC of the human global flash mfERG, which is a nonlinear response component predominantly from the inner retina [18].…”

Section: Introductionmentioning

confidence: 99%

“…To quantify retinal adaptation, our group derived an index from the DC induced by luminance-modulated global flash mfERG, which is calculated by subtracting the area under the line joining the responses from high (2.12 cd·s/m 2 ) to low (0.62 cd·s/m 2 ) luminance-difference from the area under the luminance-modulated response function fitted with a secondorder best-fit line of the DC responses, which indicates the dependence on the luminance-difference in the luminancemodulated response function [23]. This adaptive index was demonstrated to be sensitive to glaucomatous damage and correlated well with the localized visual field defect in individual patients.…”

Section: Introductionmentioning

confidence: 99%

Luminance-modulated adaptation in the global flash mfERG: a preliminary study of early retinal functional changes in high-risk glaucoma patients

Chu

et al. 2011

Graefes Arch Clin Exp Ophthalmol

Self Cite

View full text Add to dashboard Cite

show abstract

Glaucoma Detection Is Facilitated by Luminance Modulation of the Global Flash Multifocal Electroretinogram

Cited by 46 publications

References 24 publications

Subclinical Decrease in Central Inner Retinal Activity Is Associated With Myopia Development in Children

Subclinical Decrease in Central Inner Retinal Activity Is Associated With Myopia Development in Children

The 2-global flash mfERG in glaucoma: attempting to increase sensitivity by reducing the focal flash luminance and changing filter settings

Luminance-modulated adaptation in the global flash mfERG: a preliminary study of early retinal functional changes in high-risk glaucoma patients

Contact Info

Product

Resources

About