Photopic negative response versus pattern electroretinogram in early glaucoma

Invest Ophthalmol Vis Sci. 2013 Feb 1;54(2):1182-91. doi: 10.1167/iovs.12-11201.


Purpose: Photopic negative response (PhNR) and pattern electroretinogram (PERG) are electrophysiological markers of retinal ganglion cell function; both are reduced in glaucoma. We compared PhNR and PERG in different stages of the disease.

Methods: Eleven eyes with preperimetric glaucoma (glaucomatous optic disc with normal field); 18 with manifest glaucoma; and 26 normals were included. We obtained PhNR (flash strength from 0.1-4 cd·s/m(2)) and steady-state PERG and analyzed PhNR amplitude (baseline to 72 ms trough); PhNR/b-wave ratio; PERG amplitude; and PERG ratio (0.8°/16°).

Results: Identification of PhNR structure was only reliable ≥1 cd·s/m(2) flash strength; amplitude and receiver operating characteristics (ROC) area under curve (AUC) changed little from 1 to 4 cd·s/m(2). Both PhNR and PERG (amplitude and ratio) were reduced in preperimetric and more so in manifest glaucoma. AUCs based on PhNR/PERG amplitudes were not significantly different from chance in preperimetric glaucoma (AUCs 0.61/0.59), but were significant in manifest glaucoma (0.78/0.76); ratios were significant in both glaucoma groups (0.80/0.73 and 0.80/0.79). In spite of that, PhNR ratio and PERG ratio were not significantly correlated (r = 0.22 across all groups); an ROC based on a combination of both reached AUCs of 0.85/0.90 for preperimetric/manifest glaucoma.

Conclusions: Both PhNR and PERG performed similarly to detect glaucoma; for both, ratios performed better than amplitudes. The PhNR has the advantage of not requiring clear optics and refractive correction; the PERG has the advantage of being recorded with natural pupils.

Publication types

  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Diagnostic Techniques, Ophthalmological / standards*
  • Disease Progression
  • Early Diagnosis
  • Electroretinography / methods
  • Electroretinography / standards
  • Female
  • Glaucoma / diagnosis*
  • Glaucoma / physiopathology*
  • Humans
  • Male
  • Middle Aged
  • Ocular Hypertension / diagnosis
  • Ocular Hypertension / physiopathology
  • Photic Stimulation / methods
  • Pupil / physiology
  • ROC Curve
  • Reproducibility of Results
  • Retinal Ganglion Cells / physiology*
  • Sensitivity and Specificity
  • Visual Fields / physiology*