Abstract
PurposeTo determine if a novel analysis method will increase the diagnostic value of the multifocal electroretinogram (mfERG) in diagnosing early-stage multiple sclerosis (MS).MethodsWe studied the mfERG signals of OD (Oculus Dexter) eyes of fifteen patients diagnosed with early-stage MS (in all cases < 12 months) and without a history of optic neuritis (ON) (F:M = 11:4), and those of six controls (F:M = 3:3). We obtained values of amplitude and latency of N1 and P1 waves, and a method to assess normalized root-mean-square error (FNRMSE) between model signals and mfERG recordings was used. Responses of each eye were analysed at a global level, and by rings, quadrants and hemispheres. AUC (area under the ROC curve) is used as discriminant factor.ResultsThe standard method of analysis obtains further discrimination between controls and MS in ring R3 (AUC = 0.82), analysing N1 waves amplitudes. In all of the retina analysis regions, FNRMSE value shows a greater discriminating power than the standard method. The highest AUC value (AUC = 0.91) was in the superior temporal quadrant.ConclusionBy analysing mfERG recordings and contrasting them with those of healthy controls it is possible to detect early-stage MS in patients without a previous history of ON.
Highlights
The multifocal electroretinogram technique obtains objective and qualitative measurements regarding the functioning of the retina excited with different types of visual stimuli, and was developed for the simultaneous detection of the electrical activity from specific sectors of the retina [1]
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Amplitudes AN1 and AP1 have a maximum value in R1 and progressively decrease to the exterior due to the existence of a maximum concentration of cones in the fovea that decreases towards the periphery [12]
Summary
The multifocal electroretinogram (mfERG) technique obtains objective and qualitative measurements regarding the functioning of the retina excited with different types of visual stimuli, and was developed for the simultaneous detection of the electrical activity from specific sectors of the retina [1]. A major advantage of the mfERG technique is that it reveals bipolar cell functionality (mainly) and photoreceptor contribution, as well as the spatial distribution of the aforementioned sensitivity [2]. In the ISCEV standard stimulus array is scaled to elicit comparable response amplitudes from each stimulus sector, resulting in larger hexagons with increasing eccentricity [3]. It is possible to obtain an individualized response in each sector through the correlation between the continuous signal registered in the electrodes and the m-sequence
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