Foveal Outer Retinal Function in Eyes With Unexplained Visual Symptoms or Acuity Loss | Macular Diseases | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Brodie  SENaidu  EMGoncalves  J Combined amplitude and phase criteria for evaluation of macular electroretinograms.  Ophthalmology. 1992;99522- 530Google ScholarCrossref
Matthews  GPSandberg  MABerson  EL Foveal cone electroretinograms in patients with central visual loss of unexplained etiology.  Arch Ophthalmol. 1992;1101568- 1570Google ScholarCrossref
Miyake  YIchikawa  KShiose  YKawase  K Hereditary macular dystrophy without visible fundus abnormality.  Am J Ophthalmol. 1989;108292- 299Google Scholar
Miyake  YHoriguchi  MTomita  N  et al.  Occult macular dystrophy.  Am J Ophthalmol. 1996;122644- 653Google Scholar
DeLint  PJKeunen  JEELiem  ATAVan Norren  D Scanning laser densitometry in visual loss of unknown origin.  Br J Ophthalmol. 1996;801051- 1054Google ScholarCrossref
Sandberg  MAJacobson  SGBerson  EL Foveal cone electroretinograms in retinitis pigmentosa and juvenile macular degeneration.  Am J Ophthalmol. 1979;88702- 707Google Scholar
Sandberg  MA Objective assessment of retinal function. Albert  DMJakobiec  FAeds. Principles and Practice of Ophthalmology Clinical Practice. Vol 2 Philadelphia, Pa WB Saunders Co1994;1196- 1206Google Scholar
Sandberg  MAHanson  AHBerson  EL Foveal and parafoveal cone electroretinograms in juvenile macular degeneration.  Ophthalmol Paed Gen. 1983;383- 87Google ScholarCrossref
Weiner  AKini  MMGaudio  ARSandberg  MABerson  EL Hydroxychloroquine retinopathy.  Am J Ophthalmol. 1991;112528- 534Google Scholar
Seiple  WHSiegel  IMCarr  REMayron  C Evaluating macular function using the focal ERG.  Invest Ophthalmol Vis Sci. 1986;271123- 1130Google Scholar
Fish  GEBirch  DG The focal electroretinogram in the clinical assessment of macular disease.  Ophthalmology. 1989;96109- 114Google ScholarCrossref
Birch  DGFish  GE Focal cone electroretinograms: aging and macular disease.  Doc Ophthalmol. 1988;69211- 220Google ScholarCrossref
Arden  GBBankes  JLK Foveal electroretinogram as a clinical test.  Br J Ophthalmol. 1966;50740Google ScholarCrossref
Biersdorf  WRDiller  DA Local electroretinogram in macular degeneration.  Am J Ophthalmol. 1969;68296- 303Google Scholar
Fish  GEBirch  DGFuller  DGStraach  R A comparison of visual function tests in eyes with maculopathy.  Ophthalmology. 1986;931177- 1182Google ScholarCrossref
Seiple  WHSiegel  IMCarr  REMayron  C Evaluating macular function using the focal electroretinogram.  Invest Ophthalmol Vis Sci. 1986;271123- 1129Google Scholar
Remulla  JFCGaudio  ARMiller  SSandberg  MA Foveal electroretinograms and choroidal perfusion characteristics in fellow eyes of patients with unilateral neovascular age-related macular degeneration.  Br J Ophthalmol. 1995;79558- 561Google ScholarCrossref
Jacobson  SGSandberg  MAEffron  MHBerson  EL Foveal cone electroretinograms in strabismic amblyopia: comparison with juvenile macular degeneration, macular scars, and optic atrophy.  Trans Ophthalmol Soc U K. 1979;99353- 356Google Scholar
Vaegan  Not AvailableBillson  FA Macular electroretinograms and contrast sensitivity as sensitive detectors of early maculopathy.  Doc Ophthalmol. 1986;63399- 406Google ScholarCrossref
Acosta  PCTrobe  JDShuster  JJKrischer  JP Diagnostic strategies in the management of unexplained visual loss: a cost-benefit analysis.  Med Decis Making. 1981;1125- 144Google ScholarCrossref
Weiner  AChristopoulos  VAGussler  CH  et al.  Foveal cone function in non-proliferative diabetic retinopathy and macular edema.  Invest Ophthalmol Vis Sci. 1997;381443- 1449Google Scholar
Sandberg  MAGaudio  ARMiller  SWeiner  A Iris pigmentation and extent of disease in patients with neovascular age-related macular degeneration.  Invest Ophthalmol Vis Sci. 1994;352734- 2740Google Scholar
Tolentino  MJMiller  SGaudio  ARSandberg  MA Visual field deficits in early age-related macular degeneration.  Vision Res. 1994;34409- 413Google ScholarCrossref
Weiner  ASandberg  MA Normal change in the foveal cone ERG with increasing duration of light exposure.  Invest Ophthalmol Vis Sci. 1991;322842- 2845Google Scholar
Westheimer  G Visual acuity. Moses  RAHart  WMeds. Adler's Physiology of the Eye Clinical Applications St Louis, Mo Mosby–Year Book Inc1987;423Google Scholar
Clinical Sciences
September 1998

Foveal Outer Retinal Function in Eyes With Unexplained Visual Symptoms or Acuity Loss

Author Affiliations

From the Division of Ophthalmology, Saint Luke's Medical Center (Drs Weiner, Schmidt, Patel, Gussler, Kaufman, Kohn, and Weidenthal), and the Department of Neurology, University Hospitals of Cleveland (Dr Remler), Cleveland, Ohio. Dr Remler is now with the Department of Neurology, Froedtert Hospital, Milwaukee, Wis. The authors have no proprietary interest in any equipment used in this study.

Arch Ophthalmol. 1998;116(9):1161-1168. doi:10.1001/archopht.116.9.1161

Objective  To determine whether foveal outer retinal dysfunction is common in eyes with unexplained visual symptoms or acuity loss.

Design  Prospective study.

Participants  Seventy-three eyes of 44 consecutive patients with unexplained visual symptoms or acuity loss, 39 eyes of 39 control subjects, and 12 eyes of 7 patients with known maculopathy.

Intervention  Foveal cone electroretinography (ERG) and letter recognition perimetry.

Main Outcome Measures  Foveal cone ERG data.

Results  Abnormal foveal cone ERG data were recorded in 35 (48%) of 73 eyes (23 [52] of 44 patients). Among these 35 eyes, amplitude was lower than in normal controls (P<.001) and was correlated with visual acuity and the number of letter recognition perimetry errors (P<.05 for both). The latter was higher in eyes with abnormal retinal responses than in symptomatic eyes with normal responses (P<.01). However, initial symptoms, visual acuity, and macular appearance did not differentiate between these 2 groups. Foveal cone ERG test vs retest data showed consistent results.

Conclusion  Foveal outer retinal dysfunction is a common underlying mechanism of previously unexplained visual symptoms or acuity loss. Foveal cone ERG testing should be considered early in the evaluation of eyes with this presentation.