Global Flash Multifocal Electroretinogram Research Articles

Enhancement of the Inner Foveal Response of Young Adults with Extended-Depth-of-Focus Contact Lens for Myopia Management.

Myopia management contact lenses have been shown to successfully decrease the rate of eye elongation in children by changing the peripheral refractive profile of the retina. Despite the efforts of the scientific community, the retinal response mechanism to defocus is still unknown. The purpose of this study was to evaluate the local electrophysiological response of the retina with a myopia control contact lens (CL) compared to a single-vision CL of the same material. The retinal electrical activity and peripheral refraction of 16 eyes (16 subjects, 27.5 ± 5.7 years, 13 females and 3 males) with myopia between -0.75 D and -6.00 D (astigmatism < 1.00 D) were assessed with two CLs (Filcon 5B): a single-vision (SV) CL and an extended-depth-of-focus (EDOF) CL used for myopia management. The peripheral refraction was assessed with an open-field WAM-5500 auto-refractometer/keratometer in four meridians separated by 45° at 2.50 m distance. The global-flash multifocal electroretinogram (gf-mfERG) was recorded with the Reti-port/scan21 (Roland Consult) using a stimulus of 61 hexagons. The implicit time (in milliseconds) and response density (RD, in nV/deg2) of the direct (DC) and induced (IC) components were used for comparison between lenses in physiological pupil conditions. Although the EDOF decreased both the HCVA and the LCVA (one and two lines, respectively; p < 0.003), it still allowed a good VA. The EDOF lens induced a myopic shift in most retinal areas, with a higher and statistically significant effect on the nasal retina. No differences in the implicit times of the DC and IC components were observed between SV and EDOF. Compared with the SV, the EDOF lens showed a higher RD in the IC component in the foveal region (p = 0.032). In the remaining retinal areas, the EDOF evoked lower, non-statistically significant RD in both the DC and IC components. The EDOF myopia control CL enhanced the response of the inner layers of the fovea. This might suggest that, besides other mechanisms potentially involved, the central foveal retinal activity might be involved in the mechanism of myopia control with these lenses.

Electrophysiological response of myopic young adults with a novel ophthalmic lens for the control of myopia progression

Aims/Purpose: To evaluate the changes in the electrophysiological response of the retina induced by a novel perifocal ophthalmic lens designed for myopia control.Methods: This experimental cross‐sectional study, evaluated eleven myopic participants (24.9 ± 4.5 years) with refractive errors lower than 6.00 D (spherical equivalent of −2.40 ± 1.32 D in the right eye and − 2.24 ± 1.56 D in the left eye). Refraction, best‐corrected visual acuity, and axial length were obtained at baseline. The global flash multifocal electroretinogram (gf‐mfERG) was assessed for the sensorial dominant eye with the RETI‐port/scan21 (Roland Consult, Wiesbaden, Germany). The gf‐mfERG recordings were performed with a stimulus array pattern of 61‐scaled hexagons displayed on a 19‐inch RGB monitor at a 33 cm distance (optically corrected). The retina was divided into three groups ‐ the fovea (that included concentric ring 1), the parafovea (rings 2 and 3) and the peripheral retina (rings 4 and 5). The peak‐time (in milliseconds, ms), the amplitude (in nano‐volts, nV) and the mean response density (nV/deg2) of the direct and implicit components (DC and IC, respectively) were analysed and compared between control (monofocal contact lenses) and test conditions (perifocal lenses). These lenses have an add power of +2.50 D on the temporal side, and + 2.00 D on the nasal side, intended to change the peripheral refraction.Results: No differences were found in the DC and IC peak time between the control and test measurements, for the fovea, parafovea and peripheral retina. The mean response density of the DC was higher with the perifocal lens for the perifovea (p‐value = 0.033) and for the peripheral retina (p‐value = 0.026). For the IC, the mean response density was also higher with the perifocal lens, only for the parafovea (p‐value = 0.003).Conclusions: Perifocal lenses for myopia control upregulate the parafoveal and peripheral retinal electrical activity.

Dual-focus contact lenses for myopia control modify central retinal electrophysiology in humans.

Dual-focus contact lenses create two focal planes, one providing a clear retinal image while the other imposes myopic defocus on the retina to slow myopia progression. This study used global-flash multifocal electroretinogram (gmfERG) response amplitudes to compare central versus peripheral retinal responses under dual-focus conditions and to assess the optimal degree of myopic defocus compared with a single-vision control lens. Twenty participants each underwent three gmfERG trials, wearing a spectacle correction over dual-focus contact lenses with plano central power and peripheral secondary focal powers of either +2.00D, +4.00D or a plano single-vision lens. We compared amplitudes and latencies of the gmfERG direct and induced components (DC and IC) within participants, between the three different contact lens powers and at different retinal eccentricities (gmfERG ring). We observed significant differences in the gmfERG responses between the single-vision and dual-focus contact lenses. Overall, DC amplitudes peaked between zero and +2.00D secondary power, while IC amplitudes were maximal between +2.00D and +4.00D. Compared with the single-vision control, the greatest increase in DC and IC amplitudes while wearing dual-focus lenses occurred within the central 10° of the retina. There was no interaction effect between gmfERG ring (eccentricity) and secondary power, and no difference in the latency of the gmfERG responses between different powers. We found that dual-focus contact lenses with a +2.00D secondary power are close to that expected to induce the greatest increase in gmfERG responses relative to a single-vision lens. Dual-focus lenses produced the highest DC and IC response amplitudes relative to a single-vision lens in the central 10° of the retina. This suggests that dual-focus contact lenses slow myopia progression by modifying central rather than peripheral retinal activity.

The effect of simultaneous dual-focus integration on the global flash multifocal electroretinogram in the human eye.

To investigate the effect of simultaneous dual-focus (DF) on retinal activities measured by global flash multifocal electroretinogram (mfERG). Thirty adults were recruited for mfERG measurement under three conditions: in-focus (i.e., no defocus), +2.50D DF and +7.50D DF, administered using single vision contact lenses and DF lenses. The direct component (DC) and the induced component (IC) of the mfERG were pooled into central macular (0-8°), para-macular (8-18°) and peri-macular (18-30°) regions, and then compared across the three conditions using two-way, repeated measures ANOVA. Simultaneous DF had a significant effect on the IC amplitude, which was significantly stronger under +7.50 D DF (p<0.01) than for the in-focus condition, which was mostly derived from the central and para-macular regions. No significant effect was observed for the +2.50 D DF condition. Under the effect of relatively strong simultaneous DF integration, the retina showed an enhanced retinal response, which originated from the inner retina. Compared with the peri-macular region, central and para-macular responses appeared to be enhanced.

Global-flash mfERG responses to local differences in spherical and astigmatic defocus across the human retina.

Emmetropisation is essentially a visually guided, within-eye process. We investigated differences in global-flash multifocal electroretinogram (gmfERG) responses to naturally occurring differences in spherical and astigmatic defocus across the retina, which might provide a basis for guiding eye growth. Experiment 1: The gmfERG responses (direct, DC, and induced, IC, amplitudes and latencies) recorded simultaneously from six retinal areas (15° eccentricity, spaced at 60°, areas 3.2°2 ) were correlated with the uncorrected retinal defocus measured at the six corresponding retinal locations in 20 adults with foveal refractive errors (-4.75 to +1.25D). No correcting lenses were used to avoid introduction of lens-induced aberrations and magnification. Experiment 2 investigated the effect of superimposing astigmatic defocus (+2.00/-4.00D Jackson Cross Cylinder presented at four orientations) on gmfERG responses. Experiment 1: DC and IC response amplitudes were greater in retinal regions naturally exposed to more hyperopic spherical defocus (DC: rho=0.26, p=0.005; IC: rho=0.29, p=0.001), but response latencies were unaffected by sign or magnitude of spherical defocus (DC: p=0.34; IC: p=0.40). Response amplitudes and latencies were unaffected by astigmatic defocus. Experiment 2: Rotating the JCC axis to four different orientations had no effect on the gmfERG responses (DC amplitude, p=0.39; DC latency, p=0.10; IC amplitude, p=0.51; IC latency, p=0.64). The gmfERG responses from discrete retinal areas varied with the sign and magnitude of local spherical defocus, but we found no evidence that retinal responses were affected by astigmatic defocus. Therefore, local astigmatism is unlikely to provide cues for controlling eye growth, whereas differences in response to spherical defocus between different retinal regions could potentially provide cues for controlling eye growth in emmetropisation.

The Effect of Atropine on Human Global Flash mfERG Responses to Retinal Defocus.

To investigate the action of atropine on global flash multifocal electroretinogram (gmfERG) responses to retinal defocus. gmfERG recordings were made monocularly in 19 healthy adults under three lens-imposed defocus conditions (2 diopters myopic, 2 diopters hyperopic, and no defocus) before and 24 hours after instillation of 1 drop of 0.1% atropine. Signals reflecting activity from the outer and inner retina (direct [DC] and induced [IC] components respectively) were analyzed. Responses were grouped into either a central (0°-6°) or peripheral (6°-24°) retinal zone. The gmfERG responses were compared relative to the no defocus, no atropine condition. Within the central zone, atropine had no effect on the amplitudes and peak times of DC or IC responses to defocus. For IC responses in the peripheral zone, there was a significant interaction effect of atropine and defocus (F2,36 = 6.050, P = 0.011) with greater post-atropine amplitudes under myopic defocus (mean increase = 15.5%, 95% confidence interval [CI] = 5.6%-25.4%, P = 0.004). Atropine also had a significant main effect of increasing IC peak times (F1,18 = 9.722, P = 0.006). For DC responses, atropine had a significant main effect of increasing DC amplitudes (F1,18 = 7.821, P = 0.012) and peak times (F1,18 = 15.406, P = 0.001) regardless of sign of defocus. Our results imply that atropine acts in the inner layers of the peripheral retina to affect neuronal responses to myopic defocus, raising the possibility that atropine may potentiate the effects of myopic defocus in inhibiting eye growth.

Neuropeptide Y treatment induces retinal vasoconstriction and causes functional and histological retinal damage in a porcine ischaemia model.

To investigate the effects of intravitreal neuropeptide Y (NPY) treatment following acute retinal ischaemia in an invivo porcine model. In addition, we evaluated the vasoconstrictive potential of NPY on porcine retinal arteries exvivo. Twelve pigs underwent induced retinal ischaemia by elevated intraocular pressure clamping the ocular perfusion pressure at 5mmHg for 2hr followed by intravitreal injection of NPY or vehicle. After 4weeks, retinas were evaluated functionally by standard and global-flash multifocal electroretinogram (mfERG) and histologically by thickness of retinal layers and number of ganglion cells. Additionally, the vasoconstrictive effects of NPY and its involved receptors were tested using wire myographs and NPY receptor antagonists on porcine retinal arteries. Intravitreal injection of NPY after induced ischaemia caused a significant reduction in the mean induced component (IC) amplitude ratio (treated/normal eye) compared to vehicle-treated eyes. This reduction was accompanied by histological damage, where NPY treatment reduced the mean thickness of inner retinal layers and number of ganglion cells. In retinal arteries, NPY-induced vasoconstriction to a plateau of approximately 65% of potassium-induced constriction. This effect appeared to be mediated via Y1 and Y2, but not Y5. In seeming contrast to previous invitro studies, intravitreal NPY treatment caused functional and histological damage compared to vehicle after a retinal ischaemic insult. Furthermore, we showed for the first time that NPY induces Y1- and Y2- but not Y5-mediated vasoconstriction in retinal arteries. This constriction could explain the worsening invivo effect induced by NPY treatment following an ischaemic insult and suggests that future studies on exploring the neuroprotective effects of NPY might focus on other receptors than Y1 and Y2.

Subclinical Decrease in Central Inner Retinal Activity Is Associated With Myopia Development in Children.

To investigate the characteristics of retinal electrophysiological activity in relation to early myopia development in children. Fifty-six children aged 6 to 9 years with emmetropic refractive error (defined as ≥ -0.5 diopter [D] and ≤ +0.5 D) were recruited. Cycloplegic refraction, axial length, and global flash multifocal electroretinogram (MOFO mfERG) at 49% and 96% contrast levels were recorded in all children at their first visit. The refraction and axial length measurements were repeated after 1 year. The amplitudes and implicit times of the direct component (DC) and the induced component (IC) of the MOFO mfERG obtained at the initial visit were analyzed. Correlations between the MOFO mfERG parameters and changes in refractive error and axial length were investigated. The mean spherical equivalent refractive error and axial length of the eyes of the children at the first visit were +0.19 ± 0.33 D and 23.14 ± 0.6 mm, respectively. After 1 year, the mean refractive error increased by -0.55 ± 0.53 D, whereas axial length increased by 0.37 ± 0.22 mm. The changes in refractive error and axial length were significantly correlated with the central IC amplitudes at 49% contrast level measured at the initial visit (ρ = 0.46, P < 0.001 and ρ = -0.34, P = 0.01, respectively). The prospective changes we have shown are believed to derive from central inner retina. These changes appear to precede myopia and could be a potential reference for juvenile myopia development.

Human electroretinal responses to grating patterns and defocus changes by global flash multifocal electroretinogram.

The electrical response of the retina was examined as a function of retinal region, using stimuli of various spatial frequencies in the first experiment. In the second experiment, the regional response of the retina to defocus at high and low spatial frequencies was investigated. Twenty three subjects were recruited for global flash multifocal electroretinogram (mfERG) in experiment 1. Black and white gratings (printed on plastic transparent sheets) of four spatial frequencies (SF), 0.24, 1.2, 2.4 and 4.8 cycle per degree were presented in front of the mfERG stimulation. The amplitudes and implicit times of the direct (DC) and induced (IC) components of mfERG responses were pooled into six concentric rings for analysis. There was low amplitude DC at low SF, which increased with increasing SF, and which decreased with increasing eccentricity. The IC was high in amplitude at all SF and reduced in amplitude with increasing eccentricity. Our findings suggested that outer and inner retina had different characteristics in processing spatial details. In experiment 2, Twenty-three young adults were recruited for mfERG measurement. The retinal electrical responses for low (0.24cpd) and high (4.8cpd) SF under fully corrected conditions of short-term negative defocus (-2D) and short term positive defocus (+2D) conditions were measured. There was a sign-dependent response to defocus in the DC response, mainly in peripheral regions. The sign dependent response at low SF was more obvious than that at high SF, and was located more peripherally. The IC response showed no clear trends for either defocus condition. The human retina seems to have a decoding system for optical defocus, which was tuned for low spatial frequency, and was located in the retinal near periphery.

Local Relationship between Global-Flash Multifocal Electroretinogram Optic Nerve Head Components and Visual Field Defects in Patients with Glaucoma

Purpose. To investigate the local relationship between quantified global-flash multifocal electroretinogram (mfERG) optic nerve head component (ONHC) and visual field defects in patients with glaucoma. Methods. Thirty-nine patients with glaucoma and 30 normal controls were enrolled. The ONHC amplitude was measured from the baseline to the peak of the second positive deflection of the induced component. The ONHC amplitude was normalized by dividing ONHC amplitude by the average of seven largest ONHC amplitudes. The ONHC amplitude ratio map and ONHC deficiency map were constructed. The local relationship between the ONHC measurements and visual field defects was evaluated by calculating the overlap between the ONHC deficiency maps and visual field defect plots. Results. The mean ONHC amplitude measurements of patients with glaucoma (6.01 ± 1.91 nV/deg2) were significantly lower than those of the normal controls (10.29 ± 0.94 nV/deg2) (P < 0.001). The average overlap between the ONHC deficiency map and visual field defect plot was 71.4%. The highest overlap (75.0%) was between the ONHC ratios less than 0.5 and the total deviations less than 5%. Conclusions. The ONHC amplitude was reduced in patients with glaucoma compared to that in normal controls. Loss of the ONHC amplitude from the global-flash mfERG showed a high local agreement with visual field defects in patients with glaucoma.

Myopia Progression in Children Is Linked with Reduced Foveal mfERG Response

To study the changes in retinal electrophysiology in children during myopia progression during a 1-year period. Twenty-six children aged from 9 to 13 years were recruited for the global flash multifocal electroretinogram (mfERG) measured at 49% and 96% contrast, in two visits 1 year apart. The amplitudes and implicit times of both direct component (DC) and induced component (IC) measured at these two visits were analyzed and compared. Pearson's correlation was used to study the association between the changes of mfERG response and myopia progression during the test period. Myopia increased by -0.48 ± 0.32 diopter (D) (P < 0.001) during the year, with 24 of 26 children becoming more myopic (range = 0.00 to ∼ -1.38 D); axial length increased by 0.25 ± 0.11 mm (P < 0.001) during the year. The increased myopia was highly correlated with increase in axial length (r = -0.70; P < 0.001). The central DC and IC amplitudes at 49% contrast reduced significantly as myopia progressed and the paracentral implicit times of these two components were reduced considerably. However, the high-contrast responses were virtually unaffected. Our findings suggested that the inner retinal functions in the central retina, with some involvement of the paracentral region, were decreased as myopia progressed in children.

Global flash multifocal electroretinogram: early detection of local functional changes and its correlations with optical coherence tomography and visual field tests in diabetic eyes

To investigate the correlations of the global flash multifocal electroretinogram (MOFO mfERG) with common clinical visual assessments--Humphrey perimetry and Stratus circumpapillary retinal nerve fiber layer (RNFL) thickness measurement in type II diabetic patients. Forty-two diabetic patients participated in the study: Ten were free from diabetic retinopathy (DR), while the remainder suffered from mild to moderate nonproliferative diabetic retinopathy. Fourteen age-matched controls were recruited for comparison. MOFO mfERG measurements were made under high- and low-contrast conditions. Humphrey central 30-2 perimetry and Stratus OCT circumpapillary RNFL thickness measurements were also performed. Correlations between local values of implicit time and amplitude of the mfERG components [direct component (DC) and induced component (IC)], and perimetric sensitivity and RNFL thickness were evaluated by mapping the localized responses for the three subject groups. MOFO mfERG was superior to perimetry and RNFL assessments in showing differences between the diabetic groups (with and without DR) and the controls. All the MOFO mfERG amplitudes (except IC amplitude at high contrast) correlated better with perimetry findings (Pearson's r ranged from 0.23 to 0.36, p < 0.01) than did the mfERG implicit time at both high and low contrasts across all subject groups. No consistent correlation was found between the mfERG and RNFL assessments for any group or contrast conditions. The responses of the local MOFO mfERG correlated with local perimetric sensitivity but not with RNFL thickness. Early functional changes in the diabetic retina seem to occur before morphological changes in the RNFL.

Early local functional changes in the human diabetic retina: a global flash multifocal electroretinogram study

To investigate early functional changes of local retinal defects in type II diabetic patients using the global flash multifocal electroretinogram (MOFO mfERG). Thirty-eight diabetic patients and 14 age-matched controls were recruited. Nine of the diabetics were free from diabetic retinopathy (DR), while the remainder had mild to moderate non-proliferative diabetic retinopathy. The MOFO mfERG was performed at high (98%) and low (46%) contrast levels. MfERG responses were grouped into 35 regions for comparison with DR classification at those locations. Z-scores of the regional mfERG responses were compared across different types of DR defects. The mfERG waveform consisted of the direct component (DC) and the induced component (IC). Local reduction in DC and IC amplitudes were found in diabetic patients with and without DR. With increasing severity of retinopathy, there was a further deterioration in amplitude of both components. Under MOFO mfERG paradigm, amplitude was a useful screening parameter. The MOFO mfERG can help in detecting early functional anomalies before the appearance of visible signs, and may assist in monitoring further functional deterioration in diabetic patients.

Sign-dependent changes in retinal electrical activity with positive and negative defocus in the human eye

The purpose of this study was to investigate the effect of optical defocus on changes of electrical response as a function of retinal region. Twenty-three subjects (aged 19–25 year) with normal ocular health were recruited for global flash multifocal electroretinogram (mfERG) recordings under control (fully corrected) condition, and short-term positive defocus (+2D and +4D) and negative defocus (−2D and −4D) conditions. The amplitudes and implicit times of direct (DC) and induced (IC) components of mfERG responses were pooled into six concentric rings for analyses. The mfERG responses demonstrated more significant changes in amplitude in paracentral retinal regions than in the central regions under defocused conditions. The paracentral DC amplitude showed a significant reduction under negative defocus conditions. In contrast, the paracentral IC amplitude showed a significant increment under positive defocus conditions. Interestingly, the central IC response showed significant reduction in amplitude only to negative defocus, while increasing its amplitude to positive defocus. However, the DC and IC implicit times were virtually unaffected under defocused conditions. Our findings suggest that human retina is able to differentiate defocused signals and to identify positive and negative defocus. It shows that paracentral retina reacts more vigorously to optical defocus than does central retina.

Luminance-modulated adaptation in the global flash mfERG: a preliminary study of early retinal functional changes in high-risk glaucoma patients

To investigate the association of the luminance-modulation global flash multifocal electroretinogram (mfERG) and other clinical assessments of vision in subsets of subjects at high risk of developing glaucomatous damage. Eighteen subjects (28 eyes) with asymmetric glaucoma and ocular hypertension were measured in this longitudinal study of visual field, OCT, and multifocal electroretinogram (mfERG). Five ophthalmic examinations were scheduled, once every 12months over a 4-year period. The mfERG was assessed using a luminance-modulated global flash stimulation paradigm. The adaptive index which we have reported previously was calculated. There was a significant thinning of the peripapillary retinal nerve fiber layer over the course of the study for eyes with ocular hypertension, or for fellow eyes with asymmetric glaucoma which initially had an abnormal adaptive index; such eyes showed a thinning rate of -3.59 and -3.69μm/year, respectively. However, no significant thinning was found for eyes which initially had a normal adaptive index. Two subjects were shown to have glaucomatous damage, confirmed by abnormal thinning of the retinal nerve fiber layer and visual field loss respectively at the last visit. However, these patients had shown an abnormal adaptive index in the mfERG measurement at the first visit. The adaptive index calculated from the measurement of luminance-modulated global flash mfERG is useful for predicting progression of signs related to glaucoma, especially in high-risk groups. The abnormal adaptive index reflects the change in fast-adaptive mechanisms in the retina and indicates the risk of developing glaucoma.

Loss of the Low-Frequency Component of the Global-Flash Multifocal Electroretinogram in Primate Eyes with Experimental Glaucoma

To study relationships between glaucoma-sensitive components identified with frequency-domain analysis of global-flash multifocal electroretinogram (mfERG), regional retinal nerve fiber layer thickness (RNFLT), and local visual field sensitivity (VS). Eleven macaque monkeys, including four controls and seven with unilateral laser-induced trabecular meshwork scarification and ocular hypertension, were observed with optical coherence tomography (OCT), full-field light-adapted flash ERG, 103-hexagon global-flash mfERG (MFOFO), and static perimetry. The effects of experimental glaucoma on mfERG were assessed in the frequency domain. Relations between root mean square (RMS) amplitude of a glaucoma-sensitive frequency range and peripapillary RNFLT (standard 12° OCT circular scan), and between RMS amplitude and VS were studied. Experimental glaucoma led to a dramatic and consistent power loss in the low-frequency (<25 Hz) band of mfERG. The RMS of this low-frequency component (LFC) correlated significantly with the regional RNFLT. The r(2) of linear fits was 0.39 (P < 0.001) for cross-sectional group data and 0.60 after correction for intersubject variability. The r(2) of linear fits for longitudinal data from individual animals was as high as 0.78 (P < 0.001). Local LFC RMS amplitude also correlated significantly with interpolated VS for hexagons. The r(2) for exponential fits of hexagon LFC RMS amplitudes (inner three rings) versus VS (dB) was 0.29 to 0.52 (P < 0.001) for the group and up to 0.95 in individuals. The significant correlations between regional measures of global-flash mfERG, RNFLT, and VS suggest that LFC RMS amplitude provides a useful index for objective quantification of local RGC function and monitoring of early changes in glaucoma.

Forward and backward adaptive effects in global flash multifocal electroretinogram stimulation

Purpose: The present study investigated retinal adaptive responses in concert with the modulation of forward and backward adaptation induced by periodic global flashes using the global flash multifocal electroretinogram (mfERG).Methods: Six normal subjects were recruited for global flash mfERG measurements, which consisted of 103 scaled hexagonal elements followed by a global flash frame. In experiments I and II, with constant luminance maintained in both local and global flash frames, the number of dark frames was independently varied and these frames were either inserted prior to or following the global flash frame to investigate the forward or backward adaptive effect of the global flash on the mfERG. In experiment III, the number of dark frames was fixed but the luminance of the global flash frame was varied with constant luminance of the focal flash. This was used to demonstrate that the adaptive effect related not to time but to variation of luminance.Results: All the central, para‐central and peripheral direct component amplitudes were found to be significantly influenced by variation of the number of dark frames (p < 0.01). Reducing the forward adaptive effect of the global flash enhanced the direct component response and it became steady after five dark frames were inserted following the global flash. Reducing the backward adaptive effect of the global flash also enhanced the direct component response but it started reducing after four dark frames were inserted prior to the global flash frame. These changes were different with luminance modulation of the global flash intensity with fixed dark frames, while the direct component amplitude grew approximately linearly with decreasing mean luminance of the global flash stimulation.Conclusion: The retina plays a major role in visual adaptation. Both forward and backward adaptive effects of the global flash on the direct component have been illustrated in this study. The results show that the forward and backward adaptive phenomena in the global flash mfERG are different and demonstrate that backward adaptation is found at the retinal level.

Myopia Progression in Children is Associated with Regional Changes in Retinal Function: A Multifocal Electroretinogram Study

Introduction:To determine if retinal function is associated with myopia progression in children over a one-year period.Methods:Twenty-two children (mean = 11±1 years) were recruited in this study. Refraction and global flash multifocal electroretinogram measurements were performed at 49% and 96% contrasts at the initial visit and after 1 year. The amplitudes and implicit times of direct (DC) and induced components (IC) of the mfERG responses were pooled into five concentric rings for analysis. Pearson's correlation (r) was performed to determine if myopia progression was correlated with the changes in these mfERG's parameters.Results:The mean myopia progression was −0.45±0.34D (range = plano∼−1.38). At 49% contrast, the IC implicit times from rings 2 to 5 (r = −0.57∼−0.65, p < 0.01), and the DC implicit time at ring 3 (r = 0.55, p < 0.01), were significantly delayed with myopia progression. At 96% contrast, only the IC implicit time within ring 1 was delayed (r = −0.60, p < 0.01). In contrast, neither DC nor IC amplitudes at both contrasts were affected (r = −0.11∼0.28, all p > 0.05).Conclusions:Myopia progression in children delayed IC implicit time at 49% contrast predominantly at the paracentral retina. These results support our previous findings (Ho et al., 2011) that the effect of myopia development on retinal function is regional dependent.

Multifocal ERG wavelet packet decomposition applied to glaucoma diagnosis

BackgroundGlaucoma is the second-leading cause of blindness worldwide and early diagnosis is essential to its treatment. Current clinical methods based on multifocal electroretinography (mfERG) essentially involve measurement of amplitudes and latencies and assume standard signal morphology. This paper presents a new method based on wavelet packet analysis of global-flash multifocal electroretinogram signals.MethodsThis study comprised twenty-five patients diagnosed with OAG and twenty-five control subjects. Their mfERG recordings data were used to develop the algorithm method based on wavelet packet analysis. By reconstructing the third wavelet packet contained in the fourth decomposition level (ADAA4) of the mfERG recording, it is possible to obtain a signal from which to extract a marker in the 60-80 ms time interval.ResultsThe marker found comprises oscillatory potentials with a negative-slope basal line in the case of glaucomatous recordings and a positive-slope basal line in the case of normal signals. Application of the optimal threshold calculated in the validation cases showed that the technique proposed achieved a sensitivity of 0.81 and validation specificity of 0.73.ConclusionsThis new method based on mfERG analysis may be reliable enough to detect functional deficits that are not apparent using current automated perimetry tests. As new stimulation and analysis protocols develop, mfERG has the potential to become a useful tool in early detection of glaucoma-related functional deficits.

Impairment of retinal adaptive circuitry in the myopic eye

Previous studies have proposed that the inner retina is affected in myopes. This study aimed to investigate the changes in adaptive circuitry of the inner retina in myopia, using the global flash multifocal electroretinogram (global flash mfERG) with different levels of contrast (luminance modulation). Fifty-four myopes had global flash mfERG recorded with different contrasts. The direct component (DC) and the induced component (IC) of the mfERG response were pooled into six regions for analysis. The response amplitudes and implicit times at different contrasts were also analysed. Results showed that myopes had significant reduction in the paracentral DC amplitude for the 29% and 49% contrasts and in the paracentral IC amplitude at all contrasts measured. The peripheral IC amplitude for the 49% contrast was also reduced. No significant change was found in implicit time for either DC or IC response. Refractive error explained about 14% of the variance in DC and 16% of the variance in IC amplitude respectively; axial length could not account for additional variance in either paracentral DC or IC amplitudes in the hierarchical regression models used. We concluded that the paracentral retinal region in myopes showed signs of impaired retinal adaptation, suggesting a functional loss at the inner retinal layer. In addition, functions attributed to the outer retinal layer showed only small changes due to myopia.