Abstract
Abstract Purpose: Electrophysiological methods enable exact layer by layer diagnosis of the retina and help to answer frequent diagnostic ambiguities between macular and optic nerve diseases. Methods: New multifocal techniques enable topographic representation of the retinal function and can provide accurate diagnosis of macular diseases in early stages. Current trends with emphasis on non‐invasive recording of EOG, ERG, pattern ERG, VEP and multifocal testing, with regards to conventional perimetry, microperimetry and scanning laser ophthalmoscope imaging including autofluorescence of the RPE will be reviewed in representative clinical cases. The importance of standardisation on the performing of all tests according to the recommendations of the International Society for Clinical Electrophysiology of Vision (ISCEV) is emphasised. Results: Global retinal function is well assessed by flash evoked ERGs, but these may be normal in macular disease. PERG and multifocal ERG in combination with autofluorescence imaging may delineate macular diseases in very early stages. In such cases, visual loss may, due to the resulting delay in VEP, erroneously be attributed to optic nerve disease. On the other hand, optic nerve diseases usually do not affect multifocal ERG but can affect PERG, especially its N95 component. Combination of reduced N95 component and delay in VEP is strongly suggestive for optic nerve or ganglion cell disease in which autofluorescence imaging would usually be normal. Conclusions: By judging the cause of visual loss, combination of morphological features by RPE autofluorescence with electrophysiological and psychophysical methods usually leads to correct diagnosis.
Published Version
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