Elsevier

Survey of Ophthalmology

Volume 52, Issue 1, January–February 2007, Pages 61-96
Survey of Ophthalmology

Diagnostic and Surgical Techniques
The Clinical Applications of Multifocal Electroretinography: A Systematic Review

https://doi.org/10.1016/j.survophthal.2006.10.005Get rights and content

Abstract

Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40–50° of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

Section snippets

Basics of the Multifocal Electroretinography

Before looking at the clinical applications of mfERG, this section will provide a brief overview on some of the basic concepts of the mfERG. Several review articles have been published on the fundamental and technical aspects of the mfERG and readers can refer to these publications for further references.99, 105, 126, 148

Factors Affecting mfERG in Normal Subjects

As with all other investigations, there is a range of normative values of mfERG parameters due to individual variation. In normal subjects without any retinal pathology, several factors can affect the mfERG responses. Important factors that should be considered in the analysis of mfERG include age, severity of cataract, and the refractive error and axial length status.

Age-related Macular Degeneration

Age-related macular degeneration (AMD) is a common cause of visual impairment in the older population and mfERG has been used to evaluate the extent of retinal dysfunction in AMD patients.14, 54, 56, 57, 72, 91, 110, 122, 151, 152, 167, 172, 228, 248, 258 Patients with early AMD were found to have significant reduction in the foveal P1 amplitude and delay in N1 implicit time compared with normal age-matched controls.167 The extent of mfERG changes is influenced by the severity of AMD as

Stargardt Macular Dystrophy and Fundus Flavimaculatus

Stargardt macular dystrophy (SMD) and fundus flavimaculatus (FF) are hereditary diseases characterized by progressive visual loss in the first or second decades of life with progressive atrophy of the macula. Because the functional loss is initially limited to the macular region, full-field ERG and electro-oculography (EOG) are not useful in detecting early stages of SMD and FF. mfERG has been shown to be useful in documenting foveal dysfunction in patients with these disorders.52, 70, 149, 150

Photodynamic Therapy

Photodynamic therapy (PDT) with verteporfin has been demonstrated by randomized control trials to be effective in the treatment of subfoveal choroidal neovascularization (CNV) due to AMD and pathologic myopia. Several studies have used mfERG to provide an objective assessment of the changes in retinal function after PDT.118, 147, 161, 203, 205, 220, 256 Palmowski et al demonstrated that there were improvements in parafoveal mfERG responses after PDT for CNV due to AMD.220 In another study by

Primary Open-angle Glaucoma

Primary open-angle glaucoma (POAG) is a common cause of visual impairment, and perimetry is the most commonly used method in the diagnosis and monitoring of glaucomatous damage. One of the main limitations of perimetry is the subjective nature of the assessment and therefore false positive and negative results are not uncommon. In view of the ability of mfERG to objectively measure retinal responses topographically, studies have attempted to use mfERG to evaluate the functional changes in

Developments of New Recording Parameters

By altering the mfERG stimulus parameters, researchers can use mfERG to investigate various aspects of retinal electrophysiology at different retinal locations topographically. The use of eight bright frames followed by eight dark frames allowed the measurement of multifocal on- and off-responses.138, 144, 175 Multifocal OP can also be measured by using sf-mfERG with insertion of three dark frames between the multifocal stimuli.11, 12, 13, 79, 317 Responses from ganglion cells and ONHC can also

Conclusions

Since the introduction of mfERG a decade ago, mfERG has been used in a large variety of clinical applications. The main strength of mfERG lies in its ability to provide objective assessment in central retinal function topographically within a reasonable short recording time. Through the analysis of mfERG response amplitudes and implicit times at different retinal locations, localized areas of retinal dysfunction caused by acquired or hereditary diseases can be identified. Application of mfERG

Method of Literature Search

We conducted a search (January 1980–December 2005) of MEDLINE with the PubMed search engine. Search words included multifocal electroretinography, multifocal electroretinogram, multifocal ERG, mERG, mfERG and mf-ERG. We included all original articles and case reports that evaluated the clinical applications of mfERG in various ocular conditions in human. Further references were retrieved from the lists of references provided in individual articles. Publications with duplicated results were

References (329)

  • V.C. Greenstein et al.

    Atypical multifocal ERG responses in patients with diseases affecting the photoreceptors

    Vision Res

    (2004)
  • F. Haq et al.

    Sequential multifocal electroretinogram findings in a case of Purtscher-like retinopathy

    Am J Ophthalmol

    (2002)
  • K.L. Hartley et al.

    Use of the multifocal electroretinogram in the evaluation of a patient with central areolar choroidal dystrophy

    Am J Ophthalmol

    (2002)
  • D.C. Hood et al.

    Identifying inner retinal contributions to the human multifocal ERG

    Vision Res

    (1999)
  • D.C. Hood et al.

    Assessment of local retinal function in patients with retinitis pigmentosa using the multi-focal ERG technique

    Vision Res

    (1998)
  • T. Abe et al.

    Macular degeneration associated with aberrant expansion of trinucleotide repeat of the SCA7 gene in 2 Japanese families

    Arch Ophthalmol

    (2000)
  • A. Abri et al.

    [Multifocal ERG (MERG) examination in the follow-up of AMD patients with subretinal surgery and autologous RPE cell transplantation]

    Spektrum der Augenheilkunde

    (2001)
  • F.B. Aggio et al.

    STRATUSOCT and multifocal ERG in unilateral acute idiopathic maculopathy

    Graefes Arch Clin Exp Ophthalmol

    (2006)
  • J. Albrecht et al.

    The multifocal electroretinogram (mfERG) and cone isolating stimuli: variation in L- and M-cone driven signals across the retina

    J Vis

    (2002)
  • K. Anzai et al.

    [Aging of macular function as seen in multifocal electroretinograms]

    Nippon Ganka Gakkai Zasshi

    (1998)
  • K. Aoyagi et al.

    [Reproducibility and wave analysis of multifocal electroretinography]

    Nippon Ganka Gakkai Zasshi

    (1998)
  • M.A. Bearse et al.

    Retinal function in normal and diabetic eyes mapped with the slow flash multifocal electroretinogram

    Invest Ophthalmol Vis Sci

    (2004)
  • M.A. Bearse et al.

    Local multifocal oscillatory potential abnormalities in diabetes and early diabetic retinopathy

    Invest Ophthalmol Vis Sci

    (2004)
  • M.A. Bearse et al.

    Distribution of oscillatory components in the central retina

    Doc Ophthalmol

    (2000)
  • M.A. Bearse et al.

    Imaging localized retinal dysfunction with the multifocal electroretinogram

    J Opt Soc Am A Opt Image Sci Vis

    (1996)
  • R.S. Behbehani et al.

    Multifocal ERG in ethambutol associated visual loss

    Br J Ophthalmol

    (2005)
  • C. Bellmann et al.

    Potential diagnostic dilemmas using the multifocal electroretinogram in intermittent exotropia

    Br J Ophthalmol

    (2004)
  • C. Bellmann et al.

    Localized retinal electrophysiological and fundus autofluorescence imaging abnormalities in maternal inherited diabetes and deafness

    Invest Ophthalmol Vis Sci

    (2004)
  • D. Besch et al.

    Visual field constriction and electrophysiological changes associated with vigabatrin

    Doc Ophthalmol

    (2002)
  • S. Binder et al.

    Outcome of transplantation of autologous retinal pigment epithelium in age-related macular degeneration: a prospective trial

    Invest Ophthalmol Vis Sci

    (2004)
  • Bock M, Andrassi M, Belitsky L, et al: A comparison of two multifocal ERG systems. Doc Ophthalmol 97:157–78,...
  • M. Bock et al.

    Impact of notch filter use on waveforms of First- and Second-Order-Kernel responses from multifocal ERGs

    Doc Ophthalmol

    (2000)
  • A.C. Browning et al.

    The multifocal electroretinogram in acute macular neuroretinopathy

    Arch Ophthalmol

    (2003)
  • S. Bültmann et al.

    [Follow-up on MEWDS by fundus perimetry and multifocal ERG with the SLO]

    Ophthalmologe

    (2002)
  • S. Bültmann et al.

    Reproducibility of multifocal ERG using the scanning laser ophthalmoscope

    Graefes Arch Clin Exp Ophthalmol

    (2002)
  • S. Cazabon et al.

    Visual loss following removal of intraocular silicone oil

    Br J Ophthalmol

    (2005)
  • H.H. Chan

    Detection of glaucomatous damage using multifocal ERG

    Clin Exp Optom

    (2005)
  • H.H. Chan et al.

    Pilot study of the multifocal electroretinogram in ocular hypertension

    Br J Ophthalmol

    (2000)
  • H.L. Chan et al.

    Variation of multifocal electroretinogram with axial length

    Ophthalmic Physiol Opt

    (2003)
  • H.L. Chan et al.

    The effect of light scattering on multifocal electroretinography

    Ophthalmic Physiol Opt

    (2002)
  • H.L. Chan et al.

    Effect of optical defocus on multifocal ERG responses

    Clin Exp Optom

    (2003)
  • W.M. Chan et al.

    Longitudinal findings of acute macular neuroretinopathy with multifocal electroretinogram and optical coherence tomography

    Clin Experiment Ophthalmol

    (2005)
  • A.V. Chappelow et al.

    Effects of pre-adaptation conditions and ambient room lighting on the multifocal ERG

    Doc Ophthalmol

    (2002)
  • A.V. Chappelow et al.

    Multifocal electroretinogram abnormalities persist following resolution of central serous chorioretinopathy

    Arch Ophthalmol

    (2000)
  • S.P. Chee et al.

    Visual function in Vogt-Koyanagi-Harada patients

    Graefes Arch Clin Exp Ophthalmol

    (2005)
  • C. Chen et al.

    The local cone and rod system function in early age-related macular degeneration

    Doc Ophthalmol

    (2004)
  • C. Chen et al.

    Exploration of multifocal rod electroretinograms recording in human

    Yan Ke Xue Bao

    (2002)
  • C.S. Chen et al.

    Multifocal visual evoked potentials and multifocal electroretinograms in papillorenal syndrome

    Arch Ophthalmol

    (2002)
  • D. Chen et al.

    Transient multifocal electroretinogram dysfunction in multiple evanescent white dot syndrome

    Ophthalmic Surg Lasers

    (2002)
  • J.A. Chisholm et al.

    The impact of fixation on the multifocal electroretinogram

    Doc Ophthalmol

    (2001)

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    The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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