RESUMO
Clinical Relevance: Visual function impairment from diabetic retinopathy can have a considerable impact on patient's quality of life. Best-corrected visual acuity (BCVA) is most commonly used to assess visual function and guide clinical trials. However, BCVA is affected late in the disease process, is not affected in early disease, and does not capture some of the visual disturbances described by patients with diabetes. The goal of this report is to evaluate the relationship between diabetic retinal disease (DRD) and visual function parameters to determine which if any of them may be used in a future DRD staging system. Methods: The visual functions working group was 1 of 6 areas of DRD studied as part of the DRD staging system update, a project of the Mary Tyler Moore Vision Initiative. The working group identified 12 variables of possible interest, 7 of which were judged to have sufficient preliminary data to suggest an association with DR to warrant further review: microperimetry, static automated perimetry, electroretinogram (ERG) oscillatory potentials, flicker ERG, low luminance visual acuity (LLVA), contrast sensitivity (CS), and BCVA. The objective field analyzer (OFA) was added after subsequent in-person workshops. Results: Currently, the only visual function test available for immediate use is BCVA; the remaining tests are either promising (within 5 years) or have potential (>5 years) use. Besides BCVA, most visual function tests had a limited role in current clinical care; however, LLVA, CS, flicker ERG, and OFA demonstrated potential for screening and research purposes. Conclusions: Although current visual function tests are promising, future prospective studies involving patients with early and more advanced retinopathy are necessary to determine if these tests can be used clinically or as endpoints for clinical studies. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
RESUMO
Flash electroretinography (fERG) has been used to identify anomalies in retinal cell function in schizophrenia. Several consistent findings have now emerged, but several potentially important parameters have not yet been investigated. In this study, we recorded light- (photopic) and dark-adapted (scotopic) fERG data from 25 schizophrenia patients and 25 healthy control subjects to (1) determine if past key findings on abnormal photoreceptor and bipolar cell signaling could be replicated; (2) for the first time, examine retinal ganglion cell functioning using the photopic negative response of the fERG; (3) also for the first time, determine responsiveness of schizophrenia patients to a flickering stimulus, as an additional method to isolate cone photoreceptor function; and (4) determine if schizophrenia-related changes in the fERG could be detected using a portable hand-held ERG device. In both photopic and scotopic conditions, schizophrenia patients demonstrated weakened photoreceptor and bipolar cell activations that were most pronounced in response to the most intense stimuli. A reduced cone response to a flicker stimulus and attenuation in ganglion cell activity were also observed in the schizophrenia group. In general, groups did not differ in implicit time of retinal cell responses. These findings (1) replicate and extend prior studies demonstrating reduced photoreceptor (both rod and cone) and bipolar cell functioning in schizophrenia; (2) indicate that retinal ganglion function abnormality can also be detected using fERG; and (3) indicate that these anomalies can be detected using a portable testing device, thereby opening up possibilities for more routine administration of ERG testing. (PsycINFO Database Record