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J Glaucoma. 2013 Mar;22(3):219-25. doi: 10.1097/IJG.0b013e318237c89f.

Pattern electroretinogram progression in glaucoma suspects.

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  • 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.



To prospectively monitor progressive changes of retinal ganglion cell function in early glaucoma using the pattern electroretinogram (PERG).


Fifty-nine patients enrolled as glaucoma suspects were observed untreated over an average of 5.7┬▒1.4 years, during which they were tested with PERG (PERGLA paradigm) and standard automated perimetry (SAP) 2 times per year. PERG amplitude and phase were normalized for physiological age-related changes, and linear regressions fitted to the data to calculate progression slopes (signal), slope SE (noise), and corresponding signal-to-noise ratios (SNR=slope├ĚSE). Linear regressions were also used to fit SAP global indices mean deviation (MD) and pattern standard deviation (PSD).


On average, progression slopes of PERG amplitude/phase were skewed toward negative values, their mean being significantly (P<0.01) different from zero. In contrast, mean slopes of SAP-MD and PSD were not significantly different from zero. SNRs were higher for PERG than SAP (P<0.01). A substantial number of eyes displayed significant (P<0.05) progression of PERG amplitude (15% to 20%) or PERG phase (16% to 25%). Fewer eyes displayed significant progression of SAP-MD (0% to 2%) or SAP-PSD (4% to 8%).


The PERG displayed clear longitudinal loss of signal (diminished amplitude, phase delay, or both) in a substantial number of eyes of patients, indicating progressive deterioration of retinal ganglion cell function. Progression of SAP global indices MD and PSD was found in a relatively smaller number of eyes. It remains to be established whether PERG progression has predictive value for developing visual dysfunction.

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