Electrodiagnosis of Retinal Disease

Abstract

Considering the expansion of diagnostic means for retinal diseases over the last couple of years, e.g. by the advent of imaging techniques, the application of retinal electrophysiology has been increasingly narrowed. In this book Yozo Miyake succeeds—from a very personal point of view—in presenting a broad range of possible applications of retinal electrodiagnostics. At the same time, he combines the underlying disease mechanisms with their impact on the electroretinogram. The stated purpose of the book is to summarize the author’s lifetime experience of clinical electrophysiology of retinal diseases that he and his co-workers studied in detail. It does not claim to be a complete reference book for retinal electrophysiology. The original hardback textbook comprises four independent chapters on principles and methods, hereditary retinal and allied diseases, acquired retinal and acquired macular diseases. Each chapter is extensively illustrated; of the 258 figures, about half are high quality fundus photographs including some fluorescein angiograms, and the other half consist of example traces for the different diseases. The index is comprehensive; references are current up to 2004, with some citations from 2005. Of the various electrophysiological techniques, the book’s focus is on full-field ERG and focal macular ERG. Multifocal ERGs (mfERGs) are shown when they add information to the focal macular ERG, or to demonstrate features that are not intuitive, such as normal first order but reduced second order kernels in complete CSNB. For some diseases (retinitis pigmentosa, macular hole, MEWDS), the trace arrays are not included, only the 3D topography is displayed. The first chapter “Principles and Methods” provides a thorough user-friendly introduction to retinal electrophysiology, with emphasis on full-field ERG and focal macular ERG. It will appeal to readers not yet familiar with the techniques in establishing a basis for the following chapters, and to the advanced electrophysiologist for a quick review of the most important principles. Miyake combines a detailed description of the methods with diverting explanations of the underlying mechanisms that generate electroretinographic responses. In addition to standard full-field ERGs he includes subchapters on the intensity response function, a special LED contact lens electrode that was developed by his group and its applications, S-cone ERGs and—preparing for the extensive chapter on congenital stationary night blindness—on and off responses. Focal macular ERGs are introduced in great detail, as this method was also developed by Miyake. It is not used routinely today, yet the reader can learn important principles for other techniques such as the influence of stray light on responses, and it provides the necessary background knowledge to follow the clinical part of the book. The chapter concludes with short introductions to mfERGs, EOG and OCT. The chapter “Hereditary retinal and allied diseases” is the central part of the book and presents 21 different retinal dystrophies, with focus on generalized dystrophies, e.g. retinitis pigmentosa, Bietti crystalline dystrophy, gyrate atrophy and enhanced S-cone syndrome. The main focus is on congenital stationary night blindness with its various types and on X-linked retinoschisis. There is also a subchapter on occult macular dystrophy, as the author was the first to define this disease. Prior to the electrophysiological characterization, a detailed account on the sympGraefes Arch Clin Exp Ophthalmol (2008) 246:1793–1794 DOI 10.1007/s00417-007-0734-y