Macular electroretinograms and contrast sensitivity as sensitive detectors of early maculopathy

Eighteen patients with early maculopathies of various etiologies were tested with pattern and focal electroretinograms (macular ERGs), with high (400 cd/M2) and moderate (40 cd/M2) stimulus intensities and a four-alternative forced choice (4AFC) contrast sensitivity test in addition to intensive clinical examinations. High spatial frequency contrast sensitivity loss on the 4AFC test was the most striking and consistent feature of all cases. The only eyes not outside normal contrast sensitivity limits were three in which diagnosis was uncertain and the patients had not recognized any problem, including two marginal solar burns. Maculopathy also substantially reduced macular ERG amplitudes. Criterion scores on these tests separated patients from normals more effectively than other noninvasive procedures and only missed one eye detected by contrast sensitivity. Latencies were affected but the delays were of no clinical significance in the individual case. Stimulus intensity was not critical. The results indicate that contrast sensitivity testing and macular ERGs are very reliable indices of central visual dysfunction at a stage when visible macular changes are too subtle for confident diagnosis. Contrast sensitivity has appeal because of its reliability, objectivity, simplicity, and noninvasive nature. It is equally applicable to children and adults. Pattern and focal ERGs can establish that the visual deficit has a retinal origin and can provide the most reliable objective confirmation.