The Effect of Optical Defocus on the Pattern Electroretinogram in Normal Subjects and Patients With Alzheimer's Disease

The pattern electroretinogram, thought to originate from the spatially sensitive inner retinal layers, was recorded in 16 patients with Alzheimer's disease and 16 age- and gender-matched control subjects under the following two test conditions: (1) optical defocus or inattention, without laser pointer, and (2) optical focus or attention, with laser pointer. By correcting for optical defocus with the laser pointer, control subjects increased their pattern electroretinogram amplitudes by 8% from a mean value of 2.65 μV (standard deviation, 1.12) to 2.87 μV (standard deviation, 0.93), whereas patients with Alzheimer's disease had a 19% increase in pattern electroretinogram amplitude from 2.20 μV (standard deviation, 0.86) to 2.62 μV (standard deviation, 0.64). By controlling for optical defocus, the coefficient of variation (standard deviation/mean) was reduced by 10% (from 42% to 32%) in normal subjects and by 14% (from 39% to 25%) in patients with Alzheimer's disease. A two-way analysis of variance (ANOVA) did not show a significant difference in amplitudes between populations, which indicates that the pattern electroretinogram may not be valuable in establishing an early diagnosis of Alzheimer's disease. In a second study conducted in 20 young, healthy normal subjects, plus lenses were used to defocus the checkerboard stimuli, before recording the pattern electroretinogram. We found that the pattern electroretinogram was extremely sensitive to optical defocusing such that the response amplitude decreased by 13% at 20/25 visual acuity and 19% at 20/30. Reduction of pattern electroretinogram amplitude caused by change in visual acuity is an independent source of artifact. However, any electrophysiologic test that requires the patient to resolve spatial stimuli (for example, pattern electroretinogram or pattern visual-evoked response) is subject to the effect of optical defocus.