Objective To compare the photopic negative response of the multifocal ERG (mfERGPhNR) and the multifocal pattern electroretinogram (mfPERG) using DTL electrode (EDTL) vs skin electrode (ESKIN) in healthy young and old adults. Methods Ten “Young” [20–27 years] and eight “Old” [60–72 years] participants took part in this study. The electrophysiological responses were recorded binocularly using EDTL and ESKIN. 5-way ANOVAs were applied to investigate the following factors on mfERGPhNR: i) ELECTRODE, ii) DILATATION, iii) AGE, iv) EYE, and v) ECCENTRICITY. For mfPERG, the same factors, except dilatation, were investigated applying 4-way ANOVAs. These were conducted for amplitude and peak time of different components as well as signal-to-noise-ratio (SNR). Results Amplitudes of mfERGPhNR [mfPERG]-based ESKIN recording were reduced to 32–38% [37–38%] compared to EDTL, <InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq1.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="70" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>. This corresponded to SNR reduction to 80% [60%], <InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq1.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="70" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>. ESKIN based responses had shorter peak times, by 0.2–0.5 ms for N1 and P1, <InlineEquation ID="IEq3"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq3.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="62" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.05$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </mrow> </math></EquationSource> </InlineEquation>, [P1: 1.5 ms, <InlineEquation ID="IEq4"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq1.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="70" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>]. Both age groups had comparable amplitudes and SNRs, but Young had shorter peak times, by 1.5–2.2 ms for N1 and P1, <InlineEquation ID="IEq5"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq3.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="62" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.05$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </mrow> </math></EquationSource> </InlineEquation> [3.7–4.2 ms for N1, P1, N2, <InlineEquation ID="IEq6"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq3.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="62" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.05$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </mrow> </math></EquationSource> </InlineEquation>]. Compared to dilated recordings, undilated mfERGPhNR amplitudes were reduced to 47–87%, <InlineEquation ID="IEq7"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq7.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="62" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.01$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.01</mn> </mrow> </math></EquationSource> </InlineEquation>, and peak times were delayed by 2.0–11.8 ms, <InlineEquation ID="IEq8"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="10633_2025_10014_Article_IEq1.gif" Format="GIF" Height="16" Rendition="HTML" Resolution="72" Type="Linedraw" Width="70" /> </InlineMediaObject> <EquationSource Format="TEX">$p < 0.001$</EquationSource> <EquationSource Format="MATHML"><math> <mrow> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </mrow> </math></EquationSource> </InlineEquation>. Conclusions mfPERG & mfERGPhNR traces were similar for EDTL and ESKIN. However, for skin electrodes, amplitudes and SNRs were lower and peak times shorter. ESKIN thus seem to be a viable alternative in patients in whom the use of corneal electrodes is precluded, e.g., children and disabled patients, but at the expense of SNR and with reference to ESKIN normative data.

DTL versus skin electrodes in recording of multifocal pattern electroretinogram and multifocal photopic negative response

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2025年4月9日

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Henrike Marie Nowitzki,
Michael B. Hoffmann,
Khaldoon O. Al-Nosairy

摘要

Objective

To compare the photopic negative response of the multifocal ERG (mfERG_PhNR) and the multifocal pattern electroretinogram (mfPERG) using DTL electrode (E_DTL) vs skin electrode (E_SKIN) in healthy young and old adults.

Methods

Ten “Young” [20–27 years] and eight “Old” [60–72 years] participants took part in this study. The electrophysiological responses were recorded binocularly using E_DTL and E_SKIN. 5-way ANOVAs were applied to investigate the following factors on mfERG_PhNR: i) ELECTRODE, ii) DILATATION, iii) AGE, iv) EYE, and v) ECCENTRICITY. For mfPERG, the same factors, except dilatation, were investigated applying 4-way ANOVAs. These were conducted for amplitude and peak time of different components as well as signal-to-noise-ratio (SNR).

Results

Amplitudes of mfERG_PhNR [mfPERG]-based E_SKIN recording were reduced to 32–38% [37–38%] compared to E_DTL, $p < 0.001$ $p < 0.001$ . This corresponded to SNR reduction to 80% [60%], $p < 0.001$ $p < 0.001$ . E_SKIN based responses had shorter peak times, by 0.2–0.5 ms for N1 and P1, $p < 0.05$ $p < 0.05$ , [P1: 1.5 ms, $p < 0.001$ $p < 0.001$ ]. Both age groups had comparable amplitudes and SNRs, but Young had shorter peak times, by 1.5–2.2 ms for N1 and P1, $p < 0.05$ $p < 0.05$ [3.7–4.2 ms for N1, P1, N2, $p < 0.05$ $p < 0.05$ ]. Compared to dilated recordings, undilated mfERG_PhNR amplitudes were reduced to 47–87%, $p < 0.01$ $p < 0.01$ , and peak times were delayed by 2.0–11.8 ms, $p < 0.001$ $p < 0.001$ .

Conclusions

mfPERG & mfERG_PhNR traces were similar for E_DTL and E_SKIN. However, for skin electrodes, amplitudes and SNRs were lower and peak times shorter. E_SKIN thus seem to be a viable alternative in patients in whom the use of corneal electrodes is precluded, e.g., children and disabled patients, but at the expense of SNR and with reference to E_SKIN normative data.