ELECTRO-DIAGNOSTIC

TESTS
(ERG, EOG, VER)
Dr. Ankit M. Punjabi
DOMS (final year)
Dept. of Ophthalmology, KIMS Hospital
Bangalore, Karnataka, INDIA
Email: drankitalways@gmail.com

ERG
Electric potential generated by retina in
response to stimulation of light.
First recorded by Frithiof Holmgren (1865)
In humans by Dewar (1877)
Extensive work thereafter by Riggs (1941)

ERG waves (a, b, c)

a is negative wave. Amplitude is from
baseline to trough & implicit time is from
onset of stimulus to trough of a wave
b is large positive wave. Amplitude is
trough of a to peak of b & implicit time is
from onset of stimulus to peak of b
c is lower amplitude, prolonged +ve wave
less imp

ERG

ERG
a originphotoreceptors
b originMullers cells + bipolar cells.
Mainly from Mullers in response to
increase (ECF) K+ in bipolars
c origin RPE
Oscillatory potentials (small wavelets on
ascending limb of b) from amacrine cells

Physiologic basis of ERG

a wave
- Light falling Hyperpolarisation
- Outer portion of photoreceptor positive
- Inner portion - negative
- Blue dim flash - Rod ERG
- Bright red light - Cone ERG

Physiologic basis of ERG

b wave- Muller cells modified astrocytes
- No synaptic junction
- Respond to potassium concentration
- Change in membreane potential
- Cells provide b wave from rods and cones
- Oscillatory potential

Physiologic basis of ERG

C wave
- RPE in response to rod signals only
- Direct contact of rod cells with RPE

Amplitude

Implicit time

Recording protocol
1.

Full mydriasis

2.

30 min dark adaptation

3.

Rod response / scotopic blue/dim white

4.

Max. combined response / scotopic white

5.

Oscillatory potentials

6.

10 min of light adaptation

7.

Single flash cone response / photopic white flash

8.

30 Hz flicker

ERG recording
Electrodes active, reference, ground
Ganzfeld bowl stimulator
Signal averager
Amplifier
Display monitor
Printer

Factors influencing ERG

1. Stimulus
- a wave increase in size
- b wave reaches maximum
- Shortening of latency of peaks
. Flickering light cone response only

Factors influencing ERG

2. Recording equipment 3. Dark adaptation
- ERG increases in size
- b wave becomes slower

4. Age and sex

- small ERG within hr of birth , declines in adults
- Larger in females than males

Cone Rod ERG

In light adaptation 6-8 million cones tested
In dark- additional 125 million rods contribute
In dark adaptation initial 6-8 min majority of
response is from cones
Orange-red stimulus cone + rod response
White flicker at 30 Hz with intensity constant
only cones respond. As the freq increases b
amplitude decreases

Separation of cone & rod ERG

For clinically useful information
Cone ERG flickering stimulus 30-70
Hz (rods upto 50 Hz)
Rod ERG in dark adaptation / blue light

ERG recording
1. Normal Waveforms Rod response /
scotopic blue / dim white are usually
smoother, dome shaped. Initial ve a wave is
not seen & is hidden by b. Longer implicit
time. Only rods contribute

ERG recording
2. Max combined response / scotopic
white flash / mesopic response is a
deep a wave with tall b. Longer
implicit, larger amplitudes. Both rods &
cones contribute

ERG recording
3. Oscillatory potentials
4. Single flash cone response / photopic
white flash small a & b waves.
Waveforms are more peaked with shorter
implicit & smaller amplitude. Cone function
5. 30 Hz flicker multiple peaked waveforms.
Cone function
4

Clinical Applications
1. Diagnosis and prognosis of retinal
disorders
a. Retinitis pigmentosa
b. Diabetic retinopathy
c. Retinal detachment
d. Vascular occlusions of retina
e. Toxic and deficiency status

Clinical Applications
2.To assess retinal function when fundus
examination is not possible
- Corneal opacities
- Dense cataract
- Vitreous haemorrhage

EOG

EOG
Measurement of resting potential of eye
Which exist between cornea and back of
the retina during fully light adapted and
Fully dark adapted conditions.

EOG
First discovered by Du Bois-Raymond (1849)
Riggs (1954) & Francois worked extensively
Arden & Fojas discovered importance of ratio
Records overall mass response only.

EOG recording

Dilate (>3 mm)

Skin electrodes near both canthi of BE

Ground electrode at forehead.

Lighted room

3 fixation lights 15o apart (dim, red)

Looks left & right with 30o excursion at

rate of 1520 rotations per minute .

EOG recording

EOG recording
Base line. Keep lights on for 5 min
Turn off the lights. Record for 15 min in dark
adapted state
Turn on the lights. Record for 15 min in light
adapted state
Recordings sampled at 1 min intervals
Response decreases progressively during
dark adaptation

EOG
Potentials decrease progressively reaching
lowest value called dark trough in 8-12 min
Light insensitive part of EOG
Switch on record in light adapted state
Progressive increase in potential, peak is
called light peak in 69 min
Light sensitive part of EOG

EOG

Ardens ratio
Light peak / dark trough X 100
>180%

Normal

165180%

Borderline

<165%

Subnormal

Difference of >10% in BE is significant

Good pt cooperation is required

2 components of EOG
A) Light sensitive [ Light peak ]
- Contributed by rods and cones
B) Light insensitive [ Dark trough ]
- Contributed by RPE , Photoreceptors
inner nuclear layer

EOG
Indications
1. Best dystrophy markedly reduced
with Arden ratio is less than 120%
2. Butterfly pattern dystrophy
3. Chloroquine toxicity
4. Stargardts dystrophy

Visually
Evoked
Potential
(Response)
VEP / VER

Visual evoked potential

Gross electrical signal generated at visual cortex in
response to visual stimuli
Impulses carried to visual cortex via visual pathway
Recorded by EEG
It is the only objective technique to assess
clinical and functional state of visual syst.beyond
retinal ganglion cells.

Types of VEP
1. Pattern VEP (checker-board
patterns on TV monitor)
2. Flash VEP (diffuse flash light for
uncooperative subjects)

VEP
Un-dilated pupils. Sit 1 meter from monitor
Electrodes in midline at forehead, vertex &
occipital lobes
2-3 different checker sizes are shown
Recording is done

VEP
Normal waveform
Pattern VEP has initial ve (N1)
+ve(P1)second ve (N2) wave
Positive wave 70 100 ms
Negative wave 100 130 ms
Positive wave - 150 200 ms
Flash VEP is complex. 2 positive & 2
negatives.

VEP Indications
a) Un-explained visual loss
b) Optic neuritis
c) Multiple sclerosis
d) Compressive ON lesions
e) Cortical blindness
f) Amblyopia
g) Glaucoma

No one can drive you crazy

unless

you give them the keys