Diagnostic performance of multifocal photopic negative response, pattern electroretinogram and optical coherence tomography in glaucoma

ObjectivesTo optimize stimulation parameters for electroretionographic recordings of the multifocal photopic negative response (mfPhNR) for the detection of glaucoma and to compare the diagnostic accuracy of electrophysiological, structural and functional measures of glaucoma. MethodsIn 24 healthy controls, 10 glaucoma suspects (GLAS) and 16 glaucoma participants (GLAG), mfPhNR for 6 different stimulation rates were assessed to compare their discrimination performance. Subsequently, a cross-modal comparison of the mfPhNR/b-wave ratio was performed with pattern electroretinogram (PERG), and peripapillary retinal nerve fiber layer (pRNFL) thickness. These analyses were based on area under curves (AUC) obtained from receiver-operating-characteristics (ROC) analyses and step-wise regression analyses. ResultsCompared to the other mfPhNR-conditions, the PhNR/b-wave ratio for the fastest stimulation condition had the highest AUC for GLAS(0.84, P = 0.008, 95%CI: 0.71-0.98); the other modalities, i.e., PERG-amplitude and pRNFL had AUCs of 0.77, and 0.74 respectively. pRNFL was the significant predictor for mfPhNR/b-wave ratio [t (48) = 4, P 0.0002]. ConclusionsFast mfPhNR protocols outperform other mf-protocols in the identification of glaucomatous damage especially for GLAS and thus aid the early detection of glaucoma. SignificancemfPhNR recordings might serve as surrogate marker of ganglion cell dysfunction especially in glaucoma suspects.