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ISCEV extended protocol for the photopic On-Off ERG.

Maja Sustar1, Graham E Holder2,3,4,5, Jan Kremers6

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The photopic On-Off electroretinography (ERG) extends the ISCEV standard for diagnosing retinal disorders. This advanced ERG test helps differentiate On- and Off-system dysfunction in various conditions.

Keywords:
Bipolar cellsClinical standardsElectroretinogram (ERG)Full-field ERGInternational Society of Clinical Electrophysiology of Vision (ISCEV)Long-duration ERGOn–Off ERGRetinal dystrophyRetinopathy

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Area of Science:

  • Ophthalmology
  • Clinical Electrophysiology
  • Retinal Imaging

Background:

  • The International Society for Clinical Electrophysiology of Vision (ISCEV) provides a standard for full-field electroretinography (ERG).
  • The standard ERG protocol may not capture all nuances of retinal function, necessitating extended protocols.
  • Cone-driven On- and Off-system responses are crucial for comprehensive retinal assessment.

Purpose of the Study:

  • To describe an extended ISCEV protocol for photopic On-Off electroretinography (ERG).
  • To outline the clinical applications of photopic On-Off ERG testing.
  • To highlight its utility in diagnosing specific retinal disorders.

Main Methods:

  • Utilizing a light stimulus of 150-200 ms duration.
  • Employing a rod-suppressing background illumination.
  • Eliciting cone-driven On- and Off-system ERG components, including On-response (a-wave, b-wave) and Off-response (d-wave).

Main Results:

  • The photopic On-Off ERG effectively elicits distinct On- and Off-system responses.
  • This extended protocol allows for the assessment of relative On- and Off-system involvement.
  • The d-wave at stimulus offset is a key component of the Off-response.

Conclusions:

  • Photopic On-Off ERG is a valuable extension to the standard ERG protocol.
  • It aids in diagnosing retinal dystrophies and disorders affecting post-phototransduction or post-receptoral pathways.
  • Useful in conditions like congenital stationary night blindness, autoimmune retinopathy, and X-linked retinoschisis.