Effects of medications on the human electroretinogram: A comprehensive review

The electroretinogram (ERG) is a well-established method to investigate retinal function and can often provide critical diagnostic information for underlying retinal disorders. ERG responses rely on the neuronal activity of retinal cells which, like neurons elsewhere, are subject to perturbation by a wide spectrum of neuromodulating substances. These agents have the potential to confound electrophysiologic recordings used to evaluate visual function. We provide a comprehensive literature review of studies that have examined the impact of pharmacologic agents on human electrophysiologic testing of retinal function. This review is focused primarily on full-field ERG data, but also includes a limited number of studies examining effects of medications on pattern ERG and visual evoked potential recordings. The studies reviewed are categorized by medication class and evidence level according to the strength of the supporting data; for example, some included studies have a lower evidence level because they included a small number of subjects or did not use international electrophysiology testing standards. We identified numerous widely-used medications and some recreational substances that have been shown to alter ERG responses, underscoring the need to take a complete medical and medication history for each patient undergoing ERG testing.