Evaluation of optic nerve and retinal functions in demyelinating diseases using electrophysiological tests

The aim of this study was to evaluate pattern visual evoked potential (PVEP) and pattern electroretinography (PERG) parameters during the attack-free period in patients with multiple sclerosis (MS) with and without a history of optic neuritis (ON), as well as in individuals with non-MS demyelinating diseases and healthy controls.

This cross-sectional study included 71 patients with demyelinating diseases (95 eyes) and 44 healthy volunteers (88 eyes). This study was prospectively designed to evaluate clinical and electrophysiological data obtained during the routine diagnostic work-up and follow-up in our Neuro-ophthalmology Unit. Patients were classified into three groups: MS with ON (MS + ON), MS without ON (MS-ON), and non-MS demyelinating disorders with ON (non-MS + ON). All participants underwent a comprehensive ophthalmological examination followed by PVEP and PERG testing. Tests were conducted using the Metrovision Monpack system. The peak latencies and amplitudes of the PVEP N75 and P100 waves, as well as the peak latencies and amplitudes of the PERG P50 and N95 waves, were analyzed and compared with control subjects. To account for inter-eye dependency, we employed Generalized Estimating Equations (GEE), specifying a Gaussian family with an identity link function and an exchangeable working correlation structure. Results are reported as median (range) and Mean Differences (MD) with 95% CI.

In the MS + ON group, a significant prolongation of P100 latency along with marked reductions in both P100 and N95 amplitudes was observed (p < 0.001), indicating demyelination accompanied by axonal damage. Additionally, the MS - ON group demonstrated a significant prolongation of P100 latency (p = 0.02) and a reduction in N95 amplitude (p = 0.005), suggestive of subclinical retinal ganglion cell dysfunction in the absence of ON. In the non-MS + ON group, although P100 latency was prolonged (p = 0.01), P100 amplitude was preserved (p = 0.28); however, a significant reduction in N95 amplitude was detected (p = 0.002). Effect sizes were expressed as Mean Differences (MD) with 95% Confidence Intervals (CI) to emphasize clinical magnitude over binary p-values.

In combination with PVEP, PERG enhances neuro-ophthalmological evaluation by revealing optic nerve and retinal ganglion cell involvement across both acute and chronic stages of demyelinating diseases.