OBJECTIVE: The study was designed to analyze the relationship among the three electrophysiological tests and visual fields in primary open angle glaucoma (POAG) in order to find some more sensitive and specific parameters in earlier and early diagnosis of patients with POAG. METHODS: Thirty-six(70 eyes) patients with POAG, 8(12 eyes) glaucoma suspects and 30 (60 eyes) normal subjects underwent pattern electroretinogram (PERG), oscillatory potentials (OPs), pattern visual evoked potentials (PVEP) and Humphery automated perimetry tests respectively. RESULTS: The abnormal rate of PERG was the highest among the three electrophysiological tests in the glaucoma suspects and those of PERG and automated perimetry results were higher than others after early stage. In the correlation analysis of all objects, the amplitude of PERG had negative correlated with IOP and visual indices, but no correlation with C/D and VA. OPs had negative correlated with C/D, and no correlation with visual fields indices, intraocular pressure (IOP) and visual acuity (VA). The latency of PVEP had positive correlation with visual fields indices and C/D, but no correlation with IOP. CONCLUSION: Statistical result showed that different parameters could be selected according to different appearance of POAG. In the earlier stage before visual field defects could be found, PERG would be a more sensitive indicator if IOP were high; once C/D was abnormal, OPs and PVEP would be the better signs even though IOP was normal. PERG and Humphery automated perimetry were very useful indicators after early stage. It was significant in combination of many visual function tests on earlier or early diagnosis of POAG.

Klin Monatsbl Augenheilkd. 2000 Jun;216(6):360-8.
Synopsis of various electrophysiological tests in early glaucoma diagnosis--temporal and spatiotemporal contrast sensitivity, light- and color-contrast pattern-reversal electroretinogram, blue-yellow VEP
Korth MJ, Junemann AM, Horn FK, Bergua A, Cursiefen C, Velten I, Budde WM, Wisse M, Martus P.
Augenklinik mit Poliklinik, Univ. Erlangen-Nurnberg.

BACKGROUND: Of the three glaucoma-defining criteria intraocular pressure, optic-nerve damage, and visual field damage, the latter is a late symptom. Therefore, in order to improve an early sensory diagnosis, new tests are necessary. It is the aim of the present paper to test new sensory methods, to rank them in an order of sensitivity, and to base them on possible pathophysiological mechanisms. PATIENTS AND METHODS: The tests were carried out in subjects of the Erlangen Glaucoma registry: Normals, patients with ocular hypertension, and patients with open-angle glaucoma without or with field defects. The tests are designed to preferentially probe the function of different groups of ganglion cells. Psychophysical methods: Temporal contrast sensitivity in a ganzfeld as "Erlangen flicker test" and spatio-temporal contrast sensitivity to test Magno-cell function. Electrophysiological methods: Pattern-reversal electroretinogram with a luminance-contrast pattern to test Magno-cell function, color-contrast pattern electroretinogram for Parvo-cell function, and blue-on-yellow visual evoked potential to test the "blue-sensitive" pathway. RESULTS: The most sensitive test is the temp.CS, it is significantly reduced in OHT (p < 0.01). The spatio-temp.CS is reduced in perimetric stages (p < 0.01). The BY-VEP is altered in the preperimetric stage (p < 0.01), the PR-ERG in perimetric stages (p < 0.01). The CC-ERG is reduced in even later stages. These results are in agreement with the hypothesis that tests selective for non-redundant neurons are of early diagnostic value. Multivariate analyses increase the early diagnostic value when different functions are tested in combination. CONCLUSIONS: When a particular test is taylored to the the special needs of certain groups of ganglion cells sensory defects can be observed before the occurrence of optic-nerve damage (OHT). The most sensitive psychophysical test is the "Erlangen flicker test" which is a screening test selective for M cells. The most sensitive electrophysiological test is the BY-VEP testing the blue-sensitive ganglion cells.

Zhonghua Yan Ke Za Zhi. 1996 Jul;32(4):267-71.
A study of high-pass resolution perimetry in the early diagnosis of primary open-angle glaucoma
Yu M, Zhou W, Ye T.
Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou.

OBJECTIVE: To evaluate the application of high-pass resolution perimetry (HRP) in detecting the early visual field loss of glaucoma. METHOD: According to the method described by Frisen, we developed HRP in a personal computer. The HRP was used to examine the visual field of 22 normal subjects (44 eyes), 27 cases (41 eyes) of primary open-angle glaucoma (POAG) with abnormal automated visual fields and 10 cases (13 eyes) of early POAG or suspected POAG with normal automated visual fields. RESULTS: The mean resolution threshold in the normal subjects was 3.96+/- 0.55db in the right eyes and 3.98+/- 0.55dB in the left eyes. It is demonstrated that HRP was more sensitive than automated perimetry in detecting the glaucomatous visual field defects, its sensitivity was 93.75% and specificity was 97.7%. The early visual field loss of glaucoma might present increment of the retinal resolution threshold. CONCLUSION: HRP is a relatively sensitive method for the detection of the early visual field loss in POAG, and it can be used extensively.

Am J Ophthalmol. 1997 Mar;123(3):313-9.
The full-field flicker test in early diagnosis of chronic open-angle glaucoma.
Horn FK, Jonas JB, Korth M, Junemann A, Grundler A.
Department of Ophthalmology, Friedrich-Alexander-University Erlangen-Nurnberg, Germany.

PURPOSE: To evaluate whether the full-field flicker test, a psychophysical test employing full-field flickering stimuli to measure temporal contrast sensitivity, can detect glaucomatous optic nerve damage in patients with increased intraocular pressure and glaucomatous optic disk abnormalities but normal visual fields. METHODS: Temporal contrast sensitivity was determined with a sinusoidally flickering light (frequency, 37.1 Hz) of constant mean photopic luminance (10 cd/m2) presented in a full-field bowl of 58-cm diameter. The prospective study included three groups of individuals: the "preperimetric" glaucoma group of 80 patients with increased intraocular pressure, glaucomatous optic disk abnormalities, and normal visual fields; the "perimetric" glaucoma group of 56 glaucomatous patients with increased intraocular pressure and glaucomatous changes of the optic disk and visual field; and the control group of 96 normal subjects. RESULTS: Temporal contrast sensitivity was significantly (P < .001) lower in the two glaucoma groups than in the control group. In the preperimetric glaucoma group, 34% of the patients (27/ 80) were recognized by the full-field flicker test at a specificity of 99%. For all study subjects, temporal contrast sensitivity decreased significantly (P < .001) with decreasing neuroretinal rim area, enlarging peripapillary atrophy, and diminishing retinal nerve fiber layer visibility. CONCLUSIONS: The full-field flicker test can detect glaucomatous optic nerve damage in patients with increased intraocular pressure, glaucomatous optic disk abnormalities, and normal visual fields. Considering its feasibility, simplicity, quick performance, and low costs, the full-field flicker test may be helpful in clinics and in screening examinations as a supplement to glaucoma diagnosis.

Curr Opin Ophthalmol. 1993 Apr;4(2):22-8.
Clinical electrophysiology relevant for early glaucoma diagnosis.
Korth M, Koca M.
University of Erlangen-Nurnberg.

This review reports findings of the recent literature about electrophysiologic techniques that are used in glaucoma diagnosis and research. Included in this review are results obtained by recording electrical responses from the eye (electroretinograms) and from the brain (visual evoked potentials). Studies concerned the electroretinogram evoked by patterned stimuli that originates in the proximal retina and with flash-evoked responses that originate from the proximal retina, such as oscillatory potentials and scotopic threshold responses, from middle layers of the retina (B wave), and from the outer retina (A waves and C waves). Regarding the pattern electroretinogram, the authors agree on its usefulness in the diagnosis of glaucoma. However, the optimal stimulus conditions (temporal and spatial frequency, retinal location, contrast, and color), which component of the response to evaluate, and the value of the pattern electroretinogram in follow-up treatment are debatable. Flash-evoked components of the electroretinogram that have been considered in the past to be of low value in diagnosis of glaucoma now seem to be more important. New developments in visual evoked potentials techniques, such as photostress methods, contrast sensitivity measurements, ramp stimulation, and selective adaptation for isolating blue-cone activity seem to be promising in further increasing the diagnostic value of visual evoked potential measurements.

AJR Am J Roentgenol. 1995 Jan;164(1):181-4.
CT diagnosis of unsuspected traumatic cataracts in patients with complicated eye injuries: significance of attenuation value of the lens.
Boorstein JM, Titelbaum DS, Patel Y, Wong KT, Grossman RI.
Department of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia 19104.

OBJECTIVE. The purpose of this study was to determine whether the CT attenuation value of the lens is helpful in diagnosing acute traumatic cataracts in patients with complicated eye injuries that preclude evaluation by any other means. SUBJECTS AND METHODS. The CT attenuation values of the lenses of 69 patients with acute orbital trauma, including 24 patients with clinically and surgically diagnosed acute traumatic cataracts, were compared with attenuation values of their own contralateral lens and with the attenuation values of the lenses of 103 consecutive asymptomatic control subjects. The study group was composed of consecutive patients with unilateral orbital trauma who were clinically evaluated and referred for CT examination within 48 hr after their initial injury. In all patients, attenuation measurements of the injured lenses were obtained and compared with those of the contralateral lens as an internal control. All surgically diagnosed cataracts were histologically confirmed. RESULTS. The CT attenuation measurement of a lens in any asymptomatic control subject was identical (within the range of the standard deviation) to the measurement of the contralateral lens of that control patient. In patients with orbital injury, the CT attenuation of the patient's cataractous lens was markedly lower than in the contralateral lens (mean density difference, 30 H, p < .0001). This decreased attenuation corresponds to acute cataract formation with increased fluid within the lens. No patient with normal attenuation values of the lens in the traumatized globe (as compared with the contralateral lens) was found to have an acute traumatic cataract or have a cataract develop within a 1-year follow-up period. CONCLUSION. CT may be useful in the examination of patients with acute traumatic cataracts, unsuspected lens injury, opacification of the anterior chamber, or other injuries of the globe with complications that preclude lens evaluation by any other means. This prompt diagnosis may allow timely removal of the lens in appropriate clinical circumstances, preventing damage to the anterior chamber of the globe and other complications of delayed diagnosis and treatment. Further, normal CT findings at the time of trauma suggest that the lens will not undergo acute traumatic cataract formation.