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Steady-state PERG adaptation: a conspicuous component of response variability with clinical significance

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Abstract

Purpose

To investigate within-test variability of the steady-state PERG (SS-PERG).

Methods

SS-PERGs were recorded in response to black–white horizontal gratings (1.6 cycles/deg, 98% contrast, 15.63 reversals/s, LED display, 25 deg square field, 800 cd/sqm mean luminance) using skin electrodes. PERG and noise (± reference) signals were averaged over 1024 epochs (~ 2.2 min) and Fourier analyzed to retrieve SS-PERG amplitude and phase. SS-PERGs were split into 16 partial averages (samples) of 64 epochs each, and corresponding amplitudes and phases combined in polar coordinates to assess their dispersion (within-test variability). To assess time-dependent variability, samples were clustered in four successive time segments of ~ 33 s each. Amplitude adaptation was defined as amplitude difference between initial and final clusters, and PERG phase adaptation as the corresponding phase difference. To determine the dynamic range of SS-PERG adaptation, recording was performed in normal controls of different age (n = 32) and patients with different severity of optic nerve dysfunction (early manifest glaucoma, EMG, n = 7; non-arteritic ischemic optic neuropathy, NAION, n = 5).

Results

Amplitude adaptation was largest in younger controls (amplitude adaptation ÷ noise, SNR = 9.5, 95% CI 13.1, 5.9) and progressively decreased with increasing age (older subjects, SNR = 5.5, 95% CI 9.2, 1.8) and presence of disease (EMG: SNR = 2.4, 95% CI 3.5, 1.4; NAION: SNR = 1.9, 95% CI 6.5,-2.2). In 11 young subjects, amplitude adaptation was repeatable (test–retest in two sessions a week apart; intraclass correlation coefficient = 0.59). Phase adaptation was not significantly different from zero in all groups.

Conclusions

SS-PERG adaptation accounts for a sizeable portion of the within-test variability. As it has robust SNR, sufficient test–retest variability, and is altered in disease, it may have physiological and clinical significance. This study suggests that SS-PERG protocols should include adaptation in addition to SS-PERG amplitude and phase/latency.

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Funding

NIH-NEI RO1 EY019077 (VP), NIH center grant P30-EY014801 (VP), unrestricted grant to Bascom Palmer Eye Institute from Research to Prevent Blindness, Inc., provided support in the form of salary for Vittorio Porciatti, Maja Kostic (RO1 EY019077, RPB) and infrastructure (P30-EY014801). The sponsor had no role in the design or conduct of the study.

Author information

Authors and Affiliations

  1. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA

    P. Monsalve, S. Ren, L. Vazquez, M. Kostic, P. Gordon, W. J. Feuer & V. Porciatti

  2. Head and Neck Department, IRCCS St. Raffaele Hospital, Milan, Italy

    G. Triolo

  3. Johns Hopkins Wilmer Eye Institute, Columbia, MD, USA

    A. D. Henderson

Authors
  1. P. Monsalve
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  2. S. Ren
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  3. G. Triolo
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  4. L. Vazquez
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  5. A. D. Henderson
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  6. M. Kostic
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  7. P. Gordon
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  8. W. J. Feuer
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  9. V. Porciatti
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Corresponding author

Correspondence to V. Porciatti.

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Conflict of interest

All authors 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.

Statement of human rights

The study followed the tenets of the Declaration of Helsinki and was approved by the Institutional Review Board of the University of Miami.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed written consent was obtained from all subjects after the nature of the test and possible risks were explained in detail.

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Monsalve, P., Ren, S., Triolo, G. et al. Steady-state PERG adaptation: a conspicuous component of response variability with clinical significance. Doc Ophthalmol 136, 157–164 (2018). https://doi.org/10.1007/s10633-018-9633-2

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  • DOI: https://doi.org/10.1007/s10633-018-9633-2

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