Primary Open Angle Glaucoma Diagnosis Using Pattern Electroretinogram Parameters

Abstract

Background

Glaucoma is the most typical cause of permanent blindness. POAG, or primary open angle glaucoma, is the most common type. The pattern electroretinogram (PERG) has become a promising technique for detecting glaucoma early-on. The goal of this study was to assess the ability of PERG to diagnose POAG, especially in early, difficult-to-diagnose cases in comparison with other already established diagnostic methods.

Methods

150 participants (300 eyes) were enrolled in a cross-sectional study at ophthalmology department at Menoufia University Hospital in August 2022 to February 2023. All recruited participants underwent comprehensive ophthalmological and PERG exams. The studied eyes were divided into three groups as 100 normal eyes (Group I), 100 eyes with preperimetric glaucoma (Group II), and 100 eyes with established perimetric glaucoma (Group III).

Results

OCT-RNFL average thickness had a significant positive correlation with P50 latency (r=0.289, p=0.041) or P50 amplitude (r=0.302, p=0.018) and N95 amplitude (r=0.640, p=0.001) among group (II). Also, RNFL thickness had negative correlation with P50 amplitude (r= −0.268, p=0.043) among group (III). RNFL thickness and P50 and N95 amplitude showed highest AUC values in detecting preperimetric glaucomatous eyes vs normal eyes (AUC=0.927, 0.952, 904), and for detecting established perimetric glaucomatous eyes vs normal eyes (AUC=1.00, 0.957, 0.983 respectively) compared with VF MD which showed AUC (0.458 and 0.901 respectively).

Conclusion

Glaucoma patients exhibit PERG alterations (comparable to RNFL thickness changes) so, it could be used as an accurate diagnostic method in POAG. Because PERG alterations occur before visual field abnormalities, it could be relied on as an early diagnostic tool in preperimetric glaucoma. We can use both RNFL thickness assessment by OCT with PERG parameters as complementary tests for accurate diagnosis of preperimetric glaucoma which represents the most difficult diagnostic challenge in glaucoma diagnosis.

Keywords:

• pattern electroretinogram
• preperimetric glaucoma
• primary open angle glaucoma
• RNFL thickness

Abbreviations

PERG, pattern-evoked electroretinogram; POAG, Primary open-angle glaucoma; RGC, retinal ganglion cell; VF, visual field; OCT, optical coherence tomography; VA, visual acuity; IOP, intraocular pressure; SAP, standard automated perimetry; PSD, pattern standard deviation; RNFL, retinal nerve fiber layer; P, Positive response; N, negative response; ERG, electroretinogram.

Data Sharing Statement

All data and materials included in this work are available.

Author Contributions

All authors contributed significantly to the work that was published, whether it be in the ideation, study design, implementation, data collection, analysis, and interpretation, or in all these areas. They also all participated in writing, revising, or critically evaluating the article, gave their final approval for the version that would be published, agreed on the journal to which the article would be submitted, and agreed to be responsible for all aspects of the work.

Disclosure

The authors declare no competing interests in this work.