Electroretinography Measures the Electrical Responses of Various Cell Types in the Retina

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    Electroretinography measures the electrical responses of various cell types in theretina,including thephotoreceptors(rodsandcones), inner retinal cells (bipolarandamacrinecells),and theganglion cells.Electrodesare usually placed on thecorneaand the skin near theeye,although it is possible to record the ERG from skin electrodes. During a recording, the patient'seyes are exposed to standardizedstimuliand the resulting signal is displayed showing the time

    course of the signal's amplitude (voltage). Signals are very small, and typically are measured inmicrovolts or nanovolts. The ERG is composed of electrical potentials contributed by differentcell types within the retina, and the stimulus conditions (flash or pattern stimulus, whether abackground light is present, and the colors of the stimulus and background) can elicit strongerresponse from certain components.

    http://webvision.med.utah.edu/book/electrophysiology/the-electroretinogram-clinical-applications/

    If a flash ERG is performed on a dark-adapted eye, the response is primarily from therodsystem. Flash ERGs performed on a light adapted eye will reflect the activity of thecone system.Sufficiently bright flashes will elicit ERGs containing an a-wave (initial negative deflection)followed by a b-wave (positive deflection). The leading edge of the a-wave is produced by thephotoreceptors, while the remainder of the wave is produced by a mixture of cells includingphotoreceptors,bipolar,amacrine, and Muller cells orMuller glia.

    [1]The pattern ERG, evoked by

    an alternating checkerboard stimulus, primarily reflects activity of retinal ganglion cells.

    Clinically used mainly byophthalmologistsand optometrists, the electroretinogram (ERG) isused for the diagnosis of various retinal diseases.

    [2]

    Inherited retinal degenerations in which the ERG can be useful include:

    Retinitis pigmentosaand related hereditary degenerations Retinitis punctata albescens Leber's congenital amaurosis Choroideremia Gyrate atrophy of the retina and choroid Goldman-Favre syndrome Congenital stationary night blindness- normal a-wave indicates normalphotoreceptors;

    absent b-wave indicates abnormality in thebipolar cellregion. X-linked juvenileretinoschisis Achromatopsia Cone dystrophy Disorders mimicking retinitis pigmentosa Usher Syndrome

    Other ocular disorders in which the standard ERG provides useful information include:

    Diabetic retinopathy

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    Other ischemic retinopathies includingcentral retinal vein occlusion(CRVO), branchvein occlusion (BVO), and sickle cell retinopathy

    Toxic retinopathies, including those caused byPlaquenilandVigabatrin. The ERG is alsoused to monitor retinal toxicity in many drug trials.

    Autoimmune retinopathies such as Cancer Associated Retinopathy (CAR), MelanomaAssociated Retinopathy (MAR), and Acute Zonal Occult Outer Retinopathy (AZOOR)

    Retinal detachment Assessment of retinal function after trauma, especially in vitreous hemorrhage and other

    conditions where the fundus cannot be visualized.

    The ERG is also used extensively in eye research, as it provides information about the functionof the retina that is not otherwise available.

    Other ERG tests, such as thePhotopic Negative Response(PhNR) andpattern ERG(PERG) maybe useful in assessing retinal ganglion cell function in diseases likeglaucoma.

    ThemultifocalERG is used to record separate responses for different retinal locations.

    The international body concerned with the clinical use and standardization of the ERG, EOG,and VEP is the International Society for the Clinical Electrophysiology of Vision[3]

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    What is electroretinography?

    Electroretinography (ERG) is an eye test used to detect abnormal function of theretina(the light-detecting portion of the eye). Specifically, in this test, the light-sensitive cells of the eye, the rodsand cones, and their connectingganglioncells in the retina are examined. During the test, anelectrode is placed on thecornea(at the front of the eye) to measure the electrical responses tolight of the cells that sense light in the retina at the back of the eye. These cells are called therods and cones.

    How is an ERG done?

    The patient assumes a comfortable position (lying down or sitting up). Usually the patient's eyesare dilated beforehand with standard dilating eye drops. Anesthetic drops are then placed in theeyes, causing them to become numb. The eyelids are then propped open with a speculum, and anelectrode is gently placed on each eye with a device very similar to a contact lens. An additionalelectrode is placed on the skin to provide a ground for the very faint electrical signals producedby the retina.

    During an ERG recording session, the patient watches a standardized light stimulus, and theresulting signal is interpreted in terms of its amplitude (voltage) and time course. This test caneven be performed in cooperative children, as well as sedated or anesthetized infants. The visualstimuli include flashes, called a flash ERG, and reversing checkerboard patterns, known as apattern ERG.

    What do the electrodes do?

    The electrodes measure the electrical activity of the retina in response to light. The informationthat comes from each electrode is transmitted to a monitor where it is displayed as two types ofwaves, labeled the A waves and B waves.

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    How are eletroretinography readings made?

    Readings during eletroretinography are usually taken first in normal room light. The lights arethen dimmed for 20 minutes, and readings are again taken while a white light is shined into theeyes. The final readings are taken as a bright flash is directed toward the eyes.

    Why is an ERG done?

    An ERG is useful in evaluating both inherited (hereditary) and acquired disorders of the retina.An ERG can also be useful in determining if retinal surgery or other types of ocular surgery suchascataractextraction might be useful.

    What diseases is my doctor looking for with an ERG? There are a number of conditions, mostly ocular in nature, in which the ERG

    may provide useful information. The diagnoses most commonly suspectedwhen ordering an ERG are predominantly conditions of the retina, including:

    retinitis pigmentosa,

    retinitis punctata albescens,

    retinitis pigmentosa sine pigmentoo ,

    related hereditary retinal degenerations,

    disorders that mimic retinitis pigmentosa,

    Leber's congenital amaurosis,

    choroideremia,

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    gyrate atrophy of the choroid,

    gyrate atrophy of the retina,

    Goldman-Favre syndrome,

    congenital stationary night blindness,

    X-linked juvenile retinoschisis,

    achromatopsia,

    cone dystrophies, and

    Does the test hurt?

    The test is painless. However, the electrode that rests on the eye may feel a little like an eyelashhas lodged in the eye. This sensation may persist up to several hours following completion of theERG.

    What are the risks of an ERG?

    There are no risks specifically associated with an ERG. Some patients experience mild oculardiscomfort during or after the procedure. Rarely, a corneal abrasion may occur, which is readilytreated with early detection. If you believe you have irritation or a corneal abrasion following anERG, you should call your eye doctor or the doctor who ordered your ERG.

    How long does the ERG take?

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    The ERG takes about an hour or less.

    How about after the test?

    One should not rub the eyes for an hour after an ERG (or any test in which the cornea has been

    anesthetized), lest one injure the cornea.

    How much does an ERG cost?

    Generally speaking, an ERG will be billed by your doctor or your hospital back to yourinsurance company. The same vagaries that haunt the billing process for most complex cases canundoubtedly affect collections for ERG. Any claim can lead to some reimbursement rejectionsby insurance or difficulties for patients tasked with handling their own billing matters. The costfor an ERG performed on a Medicare patient is about $150. Medicaid reimbursement may belower.

    http://webvision.med.utah.edu/book/electrophysiology/the-electroretinogram-clinical-applications/

    ERG (electroretinography) electrodes

    UniMed supplies DTL thread electrodes, which are easy to use and comfortable for the subject.DTL electrodes are made with a conductive thread that is laid along the lower eyelid, in contactwith the tear film and cornea. We supply the thread on a card for users to make their ownelectrodes, or as ready made single-use electrodes. All of our DTL electrodes are CE-compliantand FDA approved.

    DTL Thread card winding

    The ER04 card provides 100 inches (254cm) of DTL thread, sufficient for approximately 30electrodes. The connection to the recording equipment is made using the mini-grabber and cable.

    Use self-adhesive tape to

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    fix the thread into the corner of the eye, and to tape the mini-grabber to the side of the face.

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    Ready-made DTL electrodes

    These are available in unsterilised single-electrode packs, complete with self-adhesive tabs, or insterile packs of 2 electrodes. Note that the non-sterileelectrodes require cable ER51 to connect to the recording equipment, whilst the sterile typerequires cable ER12/TP.

    Gold foil ERG electrodes

    Recently added to our range. Conductive gold foil on Mylar backing with touchproof connector.

    Single-use only.

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    ERG-jet electrode

    Another recent addition to our range of ERG electrodes. Contact lens electrode with aconductive gold ring on the inner surface. Supplied in a sterile blister pack and suitable forhuman and veterinary clinical use. Single-use item.

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    Electrooculography (EOG/E.O.G.) is a technique for measuring theresting potentialof theretina. The resulting signal is called the electrooculogram. The main applications are inophthalmologicaldiagnosisand in recordingeye movements. Unlike theelectroretinogram, theEOG does not represent the response to individual visual stimuli.

    Eye movement measurements: Usually, pairs of electrodes are placed either above and below theeye or to the left and right of the eye. If the eye is moved from the center position towards oneelectrode, this electrode "sees" the positive side of the retina and the opposite electrode "sees"

    the negative side of the retina. Consequently, a potential difference occurs between theelectrodes. Assuming that the resting potential is constant, the recorded potential is a measure forthe eye position.

    Principle

    The eye acts as a dipole in which the anterior pole is positive and the posterior pole is negative.1. Left gaze: the cornea approaches the electrode near the outer canthus of the left eye, resulting

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    in a positive-going change in the potential difference recorded from it. 2. Right gaze: the corneaapproaches the electrode near the inner canthus of the left eye, resulting in a positive-goingchange in the potential difference recorded from it (A, an AC/DC amplifier).

    [edit] Ophthalmological diagnosis

    The EOG is used to assess the function of the pigment epithelium. Duringdark adaptation, theresting potential decreases slightly and reaches a minimum ("dark trough") after several minutes.When the light is switched on, a substantial increase of the resting potential occurs ("light peak"),which drops off after a few minutes when the retina adapts to the light. The ratio of the voltages(i.e. light peakdivided by dark trough) is known as theArden ratio. In practice, the measurementis similar to the eye movement recordings (see above). The patient is asked to switch the eyeposition repeatedly between two points (usually to the left and right of the center). Since thesepositions are constant, a change in the recorded potential originates from a change in the restingpotential.

    Application in Entertainment

    Electrooculography was used byRobert ZemeckisandJerome Chen, the visual effectssupervisor in the movieBeowulf, to enhance theperformance captureby correctly animating theeye movements of the actors. The result was an improvement over the technique used for thefilmThe Polar Express.

    Electrooculography was used in theNeural Impulse Actuator, a product of the now defunctcompanyOCZ Technology. This device helps gamers to increase their playing speed.

    http://www.hindawi.com/journals/cin/2010/135629/

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    EOGs have been used to help gamers improve their playing speed.