Measurement of macular structure-function relationships using spectral domain-optical coherence tomography (SD-OCT) and pattern electroretinograms (PERG)

BACKGROUND: Retinal ganglion cell (RGC) death is a common cause of loss of vision during glaucoma. Pattern electroretinogram (PERG) is an objective measure of the central retinal function that correlates with macular GCL thickness. The aim of this study is to determine possible relationships between the N95 amplitude of pattern electroretinogram (PERG(amp)) and macular ganglion cell/inner plexiform layer thickness (GCIPLT). METHODS AND FINDINGS: This was a retrospective and comparative study including 74 glaucoma patients (44 early stage and 30 advanced stage cases) and 66 normal control subjects. Macular GCIPLT was measured using Cirrus spectral domain-optical coherence tomography. Standard automated perimetry and pattern ERGs were used in all patient examinations. Three types of regression analysis (broken stick, linear regression, and quadratic regression) were used to evaluate possible relationships between PERG(amp) and GCIPLT. Correlations between visual field parameters and GCIPLT were evaluated according to glaucoma severity. The best fit model for the relationship between PERG(amp) and GCIPLT was the linear regression model (r(2) = 0.22; P < 0.001). The best-fit model for the relationship between visual field parameters and GCIPLT was the broken stick model. During early glaucoma, macular GCIPLT was positively correlated with PERG(amp), but not with visual field loss. In advanced glaucoma, macular GCIPLT was positively correlated with both PERG(amp) and visual field loss. CONCLUSIONS: PERG(amp) was significantly correlated with macular GCIPT in early glaucoma patients, while visual field performance showed no correlation with GCIPLT. PERG(amp) can therefore assist clinicians in making an early decision regarding the most suitable treatment plan, especially when GCIPLT is thinning with no change in visual field performance.