Purpose

To compare the diagnostic accuracy of the photopic negative response (PhNR) elicited by red-blue (RB) and white-white (WW) stimuli, for detection of retinal ganglion cell (RGC) dysfunction in a heterogeneous clinical cohort.

Methods

Adults referred for electrophysiological investigations were recruited consecutively for this single-centre, prospective, paired diagnostic accuracy study. PhNRs were recorded to red flashes (1.5 cd·s·m⁻²) on a blue background (10 cd·m⁻²) and to white flashes on a white background (the latter being the ISCEV standard LA 3 stimulus). PhNR results were compared with a reference test battery assessing RGC/optic nerve structure and function including optical coherence tomography (OCT) retinal nerve fibre layer thickness and mean RGC volume measurements, fundus photography, pattern electroretinography and visual evoked potentials. Primary outcome measures were differences in sensitivity and specificity of the two PhNR methods.

Results

Two hundred and forty-three participants were initially enrolled, with 200 (median age 54; range 18–95; female 65%) meeting inclusion criteria. Sensitivity was 53% (95% confidence intervals [CI] 39% to 68%) and 62% (95% CI 48% to 76%), for WW and RB PhNRs, respectively. Specificity was 80% (95% CI 74% to 86%) and 78% (95% CI 72% to 85%), respectively. There was a statistically significant difference between sensitivities (p = 0.046) but not specificities (p = 0.08) of the two methods. Receiver operator characteristic (ROC) area under the curve (AUC) values were 0.73 for WW and 0.74 for RB PhNRs.

Conclusion

PhNRs to red flashes on a blue background may be more sensitive than white-on-white stimuli, but there is no significant difference between specificities. This study highlights the value and potential convenience of using white-on-white stimuli, already used widely for routine ERG assessment.

中文翻译：

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临床异质人群中宽带和彩色刺激引起的明视阴性反应的诊断准确性

目的

比较红蓝 (RB) 和白白 (WW) 刺激引起的明视阴性反应 (PhNR) 的诊断准确性，以检测异质临床队列中的视网膜神经节细胞 (RGC) 功能障碍。

方法

这项单中心、前瞻性、配对诊断准确性研究连续招募了接受电生理学检查的成年人。 PhNR被记录为蓝色背景(10cd·m ^{-2 )上的红色闪光(1.5cd·s·m -2} )和白色背景上的白色闪光(后者是ISCEV标准LA 3刺激)。 PhNR 结果与评估 RGC/视神经结构和功能的参考测试电池进行比较，包括光学相干断层扫描 (OCT) 视网膜神经纤维层厚度和平均 RGC 体积测量、眼底摄影、图形视网膜电图和视觉诱发电位。主要结果指标是两种 PhNR 方法的敏感性和特异性的差异。

结果

最初招募了 243 名参与者，其中 200 名（中位年龄 54 岁；范围 18-95 岁；女性 65%）符合纳入标准。 WW 和 RB PhNR 的灵敏度分别为 53%（95% 置信区间 [CI] 39% 至 68%）和 62%（95% CI 48% 至 76%）。特异性分别为 80%（95% CI 74% 至 86%）和 78%（95% CI 72% 至 85%）。 两种方法的敏感性（ p = 0.046）之间存在统计学显着差异， 但特异性（p = 0.08）没有显着差异。 WW 的受试者工作特征 (ROC) 曲线下面积 (AUC) 值为 0.73，RB PhNR 的受试者操作特征 (ROC) 值为 0.74。

结论

PhNR 对蓝色背景上的红色闪光可能比白色刺激更敏感，但特异性之间没有显着差异。这项研究强调了使用白对白刺激的价值和潜在便利性，该刺激已广泛用于常规 ERG 评估。