Experiences with the international standard for clinical electroretinography: normative values for clinical practice, interindividual and intraindividual variations and possible extensions.

The international Standard for Clinical Electroretinography requires a minimum of 5 standard response types. In a sample of 20 healthy subjects, the normative values according to this standard were established. Since the distribution of amplitude and implicit time does not follow a Gaussian distribution, we have found the median value and the 1st to 99th percentile or the 5th to 95th percentile useful for determination of abnormality, presented here separately for intraindividual and interindividual variation. To improve quality and reliability, we propose that individual laboratories extend the minimum standard and record the standard responses as parts of a stimulus series of increasing intensity. The normal value of the b/a ratio can easily be established from the maximum response to the Standard for Clinical Electrophysiology standard flash, pointing to abnormalities especially in circulatory disturbances and in degenerative diseases of the retina. The b/a ratio is between 1.5 and 1.7. If flicker responses are recorded at the 1st and 10th minutes after the onset of the rod saturating adaptation light (25 cd/m2), an increase in amplitude can be observed, which in our sample has a relative value of 1.3. A reduced increase in cone response amplitudes during light adaptation might point to abnormality within the rod/cone interaction. Responses from the cone system can be further differentiated by the use of chromatic stimuli. With appropriate filters, short-wavelength cone-sensitive and long-wavelength cone-sensitive responses can be differentiated also in clinical daily practice, which might be helpful for further differentiation of cone disorders. Regular measurements of intraindividual variability can help to improve the quality of electroretinogram recordings. Medians and ranges between the 1st and 99th and the 5th and the 95th percentiles were determined for all recordings for interindividual, as well as for intraindividual variations.