Diopsys® ffERG quantifies retinal function improvement in diabetic retinopathy.
A 67-year-old male patient made an appointment with a chief complaint of blurry vision OU. He had a past medical history of diabetes (12 years) and systemic hypertension (7 years). Past ocular history consisted of moderate diabetic retinopathy (5 years) and dry eyes.
|Pupils:||No APD||No APD|
|Fundus Exam:||Intraretinal micro-hemorrhages, Dilated Venous Tree, IRMAs, exudates OU|
|Figures 1-2 Visual Fields Pre-Injections. The Humphrey Visual Field program 10-2 (10 central degrees) shows severe decreased macular sensitivity OU. The central low retinal sensitivity is very symmetric and has progressed rapidly from the previous year.|
|Figures 3-4 OCT Pre-Injections. The OCT OD shows structural disruption in the foveal area, possibly due to old macular edema, and some minor signs of macular edema. The OCT OS shows evident and active macular edema with foveolar cysts. Other intraretinal structural abnormalities can be seen in both eyes due to nonproliferative diabetic retinopathy (NPDR).|
Why Visual Electrophysiology?
Diopsys® ffERG/Multi-Luminance Flicker results provide information that other testing cannot. Visual fields and OCTs evaluate the function and structure of the posterior retina, respectively, while flicker ERG objectively evaluates the function of the entire retina. This evaluation is important to understand the presence of global retinal ischemia and the subsequent risk to develop neovascularization and proliferation.1-4
|Figure 5 ffERG Pre-Injections. Diopsys® ffERG/Multi-Luminance Flicker results show out of range Mag and Phase parameters OU.||Figure 6 ffERG Post-Injections. Diopsys® ffERG/Multi-Luminance Flicker results show in range Mag parameters OU, and borderline/out of range Phase parameters OD/OS.|
Diagnosis and Treatment
The patient was diagnosed with moderate nonproliferative diabetic retinopathy with macular edema (OU). Each eye was subsequently injected with a monthly dose of intra-vitreal injection LUCENTIS® (Ranibizumab 0.3mg).
Impact on Care
The Diopsys® ffERG/Multi-Luminance Flicker test results helped evaluate global retinal function and the impact of intravitreal treatment with anti-VEGF (vascular endothelial growth factor) in eyes with diabetic retinopathy, as demonstrated in the previous clinical trials (e.g. RISE, RIDE5).
The improved flicker ERG and BCVA results showed the injection not only improved the macular edema (structure), but also demonstrated retinal function improvement. Treatment efficacy was confirmed, and the patient was scheduled for a follow-up in 1 month.
1. Bresnick GH, et al. Temporal aspects of the electroretinogram in diabetic retinopathy. Arch Ophthalmol. 1987;105:660-664.
2. Holopigian K, et al. Evidence for photoreceptor changes in patients with diabetic retinopathy. Invest Ophthalmol Vis Sci. 1997;38:2355-65.
3. Kim SH, et al. Electroretinographic evaluation in adult diabetics. Doc Ophthalmol. 1997-1998;94:201-13.
4. Pescosolido N, et al. Role of Electrophysiology in the Early Diagnosis and Follow-Up of Diabetic Retinopathy. J Diabetes Res;2015:319692.
5. Domalpally A, et al. Effects of intravitreal ranibizumab on retinal hard exudate in diabetic macular edema: findings from the RIDE and RISE phase III clinical trials. Ophthalmology. 2015;122:779-86