The pattern-electroretinogram in glaucoma and ocular hypertension. A cross-sectional and longitudinal study.

The pattern electroretinogram (PERG) is an indicator of retinal ganglion cell function. We studied the PERG in 65 normal eyes, in 52 eyes in early stages of glaucoma, and in 28 ocular hypertensive (OHT) eyes. The PERG was recorded using steady-state high contrast (98%) counterphasing checkerboard patterns at check sizes of 0.8 degrees and 15 degrees at 16 reversals/s and 98% contrast. Stimulation area was 27 degrees x 30 degrees. When compared to normals, in glaucoma eyes PERG amplitudes are reduced to 56 +/- 3.6%, (P < 0.0001) for 0.8 degrees and to 79 +/- 4.0% (P < 0.001) for 15 degrees check sizes. Preferential reduction for the small check size allows classification of patients on an individual basis: using discriminant analysis, normal and glaucoma eyes were classified with a sensitivity of 82.7% and a specificity of 90.8%. Nineteen of 28 OHT eyes were classified as pathological. Eyes with OHT were followed up to test whether the PERG can be used to predict visual field damage. At the repeat visit 5 to 35 months later (mean follow-up 20.2 +/- 8.2 months), in eyes with normal PERGs the average loss in mean sensitivity was -0.61 +/- 0.5 dB, while in eyes with pathological PERGs it was -2.6 +/- 0.7 dB (P = 0.05). Findings suggest that the PERG can be used to discriminate between OHT patients who will develop visual field loss and those who will not. Thus, the PERG may be a test of visual function helpful to decide which OHT patients require treatment before visual field deterioration and optic nerve damage have begun.