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Pattern electroretinogram to detect glaucoma: comparing the PERGLA and the PERG Ratio protocols.

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Summary

Skin electrodes offer a viable alternative for early glaucoma detection using pattern electroretinogram (PERG) protocols, showing comparable efficacy to corneal electrodes with added benefits of no direct eye contact.

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Area of Science:

  • Ophthalmology
  • Neuroscience
  • Biomedical Engineering

Background:

  • Early glaucoma detection is crucial for preventing vision loss.
  • The pattern electroretinogram (PERG) is a diagnostic tool for visual pathway disorders.
  • Existing PERG protocols often use corneal electrodes, which can be uncomfortable.

Purpose of the Study:

  • To compare the efficacy of skin electrodes versus corneal (DTL) electrodes for early glaucoma detection using PERG.
  • To evaluate the performance of the "PERGLA" protocol with skin electrodes against a novel "PERG Ratio" protocol using DTL electrodes.

Main Methods:

  • Two PERG protocols were compared: "PERGLA" (skin electrodes, steady-state reversal gratings) and "PERG Ratio" (DTL electrodes, varying check sizes).
  • 16 glaucoma patients and 13 controls were examined, with simultaneous recording using both electrode types.
  • Glaucoma detection efficacy was assessed using receiver operating characteristics (ROC) analysis.

Main Results:

  • Skin and DTL electrodes demonstrated nearly identical test-retest variability.
  • Skin electrodes yielded lower amplitude (30%) and signal-to-noise ratio (66%) compared to DTL electrodes.
  • The PERG Ratio protocol with DTL electrodes achieved the highest glaucoma detection rate (ROC AUC: 77%).

Conclusions:

  • Skin electrodes are a valid alternative to corneal electrodes for PERG, offering improved patient comfort.
  • While skin electrodes have reduced amplitude and SNR, their diagnostic performance is comparable.
  • The PERG Ratio protocol shows promising results for early glaucoma detection.