Relationship among Photopic Negative Response, Retinal Nerve Fiber Layer Thickness, and Visual Field between Normal and POAG Eyes

Abstract

Purpose. To determine the relationship among photopic negative response (PhNR) of the electroretinogram (ERG), retinal nerve fiber layer (RNFL) thickness, and the visual field in normal and glaucomatous patients. Methods. Thirty-eight normal volunteers and one hundred twenty-four patients with Primary open-angle glaucoma (POAG) were enrolled in the study. The PhNRs were elicited by white stimuli on a white background and red stimuli on a blue background. The visual field parameters were measured using the standard automated perimetry (SAP). The spectral domain optical coherence tomography (SD-OCT) was used to measure the retinal nerve fiber layer (RNFL) thickness around the optic disc. Results. The PhNR amplitude (W/W, B/R), MD, and mean RNFL thickness in POAG eyes were significantly lower than normal eyes ( P = 0.001). The R value in Normal + Glaucomatous group was higher than that of the only glaucomatous group. The R values of PhNR amplitude (B/R) with MD and RNFL were higher than those of PhNR amplitude (W/W). Significant linear association was found in the relationship between RNFL thickness and PhNR amplitude (B/R) ( R ² = 0.5, P = 0.001). However, significant curve associations were found in the relationship between MD and PhNR amplitude (B/R) and RNFL thickness ( R ² = 0.525, 0.442, P = 0.001). Conclusions. The ganglion cell activity can be more efficiently evaluated with the PhNR elicited with a red than with a broadband stimulus. The linear relationship between the PhNR amplitude and RNFL thickness indicates that inner retinal function declines proportionately with neural loss in glaucomatous eyes. The PhNR and RNFLT are more objective tools to detect glaucomatous damage than visual field.