‫بسم هللا الرحمن الرحيم‬

Clinical Ocular
Electrophysiology
Interactive Session

Ashraf Saad Galal, M.D

Professor of Ophthalmology
Alexandria University, EGYPT
Electroretinography
( ERG )
Factors affecting ERG

1. Light intensity

2. Spectral sensitivity
Factors affecting ERG

d-
3. Duration wave

4. Temporal frequency
Factors affecting ERG

5. State of light adaptation:

6. Area

7. Perimetric location
Recording Electrodes
 Electrophysiology Apparatus

EPIC 2000
(LKC Technologies)

Primus (Tomey)
Bright Flash ERG
Standard Protocol ERG

Rod Response
Scotopic
24 dB filter
Standard Protocol ERG

Maximal Response
Scotopic
0 dB filter
Bandpass filters:

0.3 – 500 Hz
 Standard Protocol ERG

Oscillatory Potentials
Scotopic
0 dB filter
Bandpass filters:

75 – 500 Hz
Standard Protocol ERG

Cone Response
Photopic
0 dB filter
Standard Protocol ERG

30 Hz Flicker
Response
Photopic
0 dB filter
Standard Protocol ERG
 A.D RP
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Hypovitaminosis A
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 CSNB (Complete)
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Gyrate Atrophy
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Choroideremia
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Cone Dystrophy
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Achromatopsia
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 CRVO
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Retinal Detachment
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Siderosis
Early Late Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
 Quinine Toxicity
Normal

Rod Response

Maximal
Response

OPs

Cone Response

30 Hz Flicker
Response
Pattern ERG
Focal ERG
 Focal ERG

Normal Response

Macular Pathology
Multifocal ERG
Multifocal ERG
Multifocal ERG
Electrooculography
( EOG )
EOG
Electrodes
Visual Evoked Potential (
VEP )
VEP
Electrodes
VEP
&
Age
 VEP
&
Refraction

With Correction No Correction

Visual Acuity
Visual
Pattern
Acuity Reversal
VEP

Sweep
VEP
Optic Neuropathies

Normal
Optic Neuritis
Amblyopia
Rt
Before Occlusion Lt

Rt
After Occlusion Lt
Electrophysiological Testing
1. Confirmation of Neurological or Ophthalmological Disease:
Inherited retinal degenerations - Glaucoma - D.S - Vascular
retinal diseases - Inflammatory retinal diseases.
2. Unexplained Visual Loss: Diminished V.A - Post traumatic -
Night blindness - Abnormal field - Difficult subjective testing -
Hysteria and malingering - Medico-legal claims.
3. Pediatric Neurology: Metabolic, hereditary or neurological
diseases - Non seeing child - Monitoring visual development -
Family history of poor vision.
4. Media Opacities: Cornea - Lens - Vitreous.
Electrophysiological Testing
5. Monitoring Health - Toxicity: Chloroquine - Ethambutol,
Phenothiazines, Tobacco-Alcohol - Vitamin A deficiency -
Desferroxamine, Tamoxifen - Siderosis.
6. Detection of the Diseases or the Carrier States of Inherited
Disorders: R.P - CSNB.
7. Quantitative Assessment of Visual Disease: Uveitis -
Thyrotoxicosis - Preoperative monitoring - Toxicity - Inherited
retinal degenerations - Retinal vascular diseases.
8. Assessment of Retinal and Visual Pathway Function after
Trauma.
9. Research.
Thank you