Workflows for the Photopic Negative Response and the Baby Vision Test

Visual electrophysiological tests are noninvasive, objective tools widely used in clinical ophthalmology. However, two promising modalities, the photopic negative response (PhNR), which assesses inner retinal and retinal ganglion cell function, and the dynamic target-based Baby Vision Test, remain underutilized in clinical practice despite their ability to provide valuable objective functional data. Limited adoption is primarily due to procedural variability, numerous confounding factors, and challenges in result interpretation. To address these barriers, clear and standardized operational protocols are essential for maximizing their diagnostic potential. Here, a standardized 6E workflow is proposed, encompassing Environment, Equipment, Examinee, Electrode, Examination, and Exit, designed to improve the clinical feasibility and implementation of these tests. In a retrospective analysis, implementation of the 6E protocol significantly increased the proportion of infants who successfully completed testing. Specifically, the PhNR test success rate increased from 61.54% to 86.45% (p < 0.05), while the average duration of the Baby Vision Test decreased from 17.44 ± 9.89 min to 13.28 ± 9.24 min (p < 0.05). These findings demonstrate that the 6E workflow enhances the clinical utility and efficiency of PhNR and Baby Vision testing, supporting their broader application in the diagnosis and management of glaucoma and pediatric visual disorders.