Kumar Anika, Sanchez Nathan, Kong Alan W, Arnold Benjamin F, Ou Yvonne
School of Medicine, University of California, San Francisco, California.
Department of Ophthalmology, University of California, San Francisco, California.
Ophthalmol Sci. 2025 Feb 13;5(4):100739. doi: 10.1016/j.xops.2025.100739. eCollection 2025 Jul-Aug.
To evaluate the diagnostic performance of a sinusoidal flicker stimulus test at various frequencies using a handheld electroretinography (ERG) device in glaucoma versus control participants.
A cross-sectional study conducted between June 2019 and October 2022 at the University of California, San Francisco.
Participants with glaucoma were recruited from glaucoma clinics if they had a diagnosis of open-angle glaucoma, as demonstrated by optic nerve damage or reproducible visual field defects. Control participants had normal optic nerves and intraocular pressures of ≤21 mmHg and were recruited from optometry clinics.
The RETeval device (LKC Technologies), a handheld ERG recording system, was used to administer a sinusoidal flicker stimulus modulated at 14 frequencies from 1 to 50 Hz, and the first harmonic frequency response amplitudes were collected. Logistic regression models with glaucoma diagnosis as the outcome were trained using data from 67% of participants; models were then tested on the remaining 33%.
Receiver operating characteristic curves demonstrating model performance on the testing set were generated, and area under the receiver operating characteristic curve (AUC) was calculated. The improved DeLong algorithm was used to compare diagnostic performance of the models and differences in performance in dilated versus nondilated eyes.
The study included 117 eyes from 72 participants (18 control, 54 glaucoma; mean age [standard deviation {SD}] = 70.4 [12.2] years; 51.4% female). Among glaucomatous eyes, average (SD) mean deviation was -4.61 (5.55) decibels. In a model assessing the combined effects of amplitude responses across all frequencies, the AUC was 0.57 (95% confidence interval [CI]: 0.37-0.78). However, in a model focusing on frequencies of ≥30 Hz, where the OFF pathway may be more affected, the AUC improved to 0.81 (95% CI: 0.66-0.97). In this higher frequency model, sensitivity was 80% and specificity was 74% at the Youden J cutoff.
These findings provide evidence of the potential use of handheld ERG in diagnosing glaucoma by assessing retinal amplitude responses to sinusoidal flicker stimuli at frequencies between 30 and 50 Hz. This supports the hypothesis that the OFF pathway may be more vulnerable in glaucoma.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
使用手持式视网膜电图（ERG）设备，评估不同频率的正弦闪烁刺激测试在青光眼患者与对照参与者中的诊断性能。
2019年6月至2022年10月在加利福尼亚大学旧金山分校进行的一项横断面研究。
青光眼患者从青光眼诊所招募，若经视神经损伤或可重复的视野缺损证实患有开角型青光眼。对照参与者视神经正常，眼压≤21 mmHg，从验光诊所招募。
使用RETeval设备（LKC Technologies），一种手持式ERG记录系统，给予1至50 Hz的14种频率调制的正弦闪烁刺激，并收集一次谐波频率响应幅度。以青光眼诊断为结果的逻辑回归模型使用67%参与者的数据进行训练；然后在其余33%的参与者上进行测试。
生成显示测试集上模型性能的受试者工作特征曲线，并计算受试者工作特征曲线下面积（AUC）。使用改进的德龙算法比较模型的诊断性能以及散瞳与未散瞳眼睛性能的差异。
该研究纳入了72名参与者的117只眼睛（18名对照，54名青光眼患者；平均年龄[标准差{SD}]=70.4[12.2]岁；51.4%为女性）。在青光眼眼中，平均（SD）平均偏差为-4.61（5.55）分贝。在评估所有频率幅度响应综合效应的模型中，AUC为0.57（95%置信区间[CI]：0.37-0.78）。然而，在关注≥30 Hz频率的模型中，其中OFF通路可能受影响更大，AUC提高到0.81（95%CI：0.66-0.97）。在这个高频模型中，在约登J临界值时，灵敏度为80%，特异性为74%。
这些发现为通过评估视网膜对30至50 Hz频率正弦闪烁刺激的幅度响应，使用手持式ERG诊断青光眼的潜在用途提供了证据。这支持了OFF通路在青光眼中可能更易受损的假设。
专有或商业披露信息可在本文末尾的脚注和披露中找到。
