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Photopic negative response using a handheld mini-ganzfeld stimulator in healthy adults: normative values, intra- and inter-session variability

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Abstract

Purpose

To determine normative values, intra- and inter-session variability for a range of parameters derived from the photopic negative response (PhNR) using a handheld mini-Ganzfeld stimulator in healthy normal adults.

Methods

Light-adapted flash full-field electroretinograms (ERGs) were recorded from healthy individuals with no visual complaints, visual acuity equal to or better than 0.0 logMAR (20/20 Snellen), and negative family history for visual diseases. ERGs were recorded from both eyes using a DTL® type fiber electrode after dilation of the pupils with instillation of 1 drop of tropicamide eye drops (1%). The full-field PhNR stimulus conditions were produced by a LED-based ColorBurst™ (Diagnosys LLC, Lowell, MA, USA) handheld stimulator. Red flashes of 1, 5 and 7 cd.s/m2 on a blue background of 10 cd/m2 were presented. A-wave, b-wave and PhNR amplitude (determined by both baseline to trough-BT and peak to trough-PT) and peak times were analyzed. Normal limits were determined as 5% percentile for amplitudes and 95% percentile for latencies. Intra- and inter-session variability were assessed with Wilcoxon signed-rank test, intraclass correlation coefficient (ICC) and the coefficient of variability (COV).

Results

Normative limits for PhNR amplitude (µV) using 1, 5 and 7 cd.s./m2 stimuli were, respectively: 20.81; 18.06 and 19.60 for BT and 69.11; 77.98; 76.51 for PT. Peak times (ms) normative limits for 1, 5 and 7 cd.s/m2 intensities were, respectively, 65.98; 78.20 and 77.96. Overall, intra-session variability assessed by coefficients of variation ranged from 1.35 to 10.28%. Inter-session variability disclosed significant intraclass correlation values for all PhNR parameters only for 1 cd.s/m2 stimuli.

Conclusions

The normative values provided by this study are clinically helpful in the diagnosis of inner retinal disorders, especially those affecting retinal ganglion cells such as glaucoma and other optic neuropathies. Further studies, including a larger sample with variable age range would extend the validity of the current results.

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Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), research grant #2018/05869-9 to AB; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Brasília, Brasil) Finance Code 001 to GISB; International Foundation for Optic Nerve Disease (IFOND) to SRS.

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Authors and Affiliations

  1. Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil

    Adriana Berezovsky, Arthur Gustavo Fernandes, Gabriel Izan Santos Botelho, Tatiane Luana Novele Bueno, Nívea Nunes Ferraz, Paula Yuri Sacai & Solange Rios Salomão

  2. Doheny Eye Institute, Los Angeles, California, USA

    Rustum Karanjia & Alfredo Arrigo Sadun

  3. Department of Ophthalmology, David Geffen School of Medicine at UCLA, Doheny Eye Center, Los Angeles, California, USA

    Rustum Karanjia & Alfredo Arrigo Sadun

  4. Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada

    Rustum Karanjia & Stuart Glenn Coupland

  5. Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Rustum Karanjia & Stuart Glenn Coupland

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  1. Adriana Berezovsky
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  2. Rustum Karanjia
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Correspondence to Adriana Berezovsky.

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No Conflicts of Interest: Adriana Berezovsky, Rustum Karanjia, Arthur Gustavo Fernandes, Gabriel Izan Santos Botelho, Tatiane Luana Novele Bueno, Nívea Nunes Ferraz, Paula Yuri Sacai, Alfredo Arrigo Sadun and Solange Rios Salomão certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Potential Conflict of Interest: Stuart G. Coupland functions as a paid consultant to Diagnosys LLC, the equipment manufacturer.

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Berezovsky, A., Karanjia, R., Fernandes, A.G. et al. Photopic negative response using a handheld mini-ganzfeld stimulator in healthy adults: normative values, intra- and inter-session variability. Doc Ophthalmol 142, 153–163 (2021). https://doi.org/10.1007/s10633-020-09784-x

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