Analysis of the slope between P50 and N95 waves of the large field pattern electroretinogram as an additional indicator of ganglion cell dysfunction

Aim Dysfunction of the retinal ganglion cells (RGC) can be detected by the pattern electroretinogram (PERG) as a reduction of the N95 amplitude, a decrease of the ratio between N95 and P50 amplitude and/or a shortening of P50 peak time. Additionally, the slope from the top of the P50 towards the N95 (P50–N95 slope) is less steep than in control subjects. The aim of the study was to quantitatively evaluate this slope in large field PERGs in controls and patients with RGC dysfunction due to optic neuropathy. Subjects and methods Large field (21.6°X27.8°) PERGs and optical coherence tomography (OCT) data from 30 eyes of the 30 patients with different types of clinically confirmed optic neuropathies, and with P50 amplitudes within normal limits and abnormal PERG N95 were retrospectively analysed and compared to 30 healthy eyes of 30 control subjects. The P50-N95 slope was analysed with a linear regression from 50 to 80 ms after the stimulus reversal. Results The patients with optic neuropathy exhibited a significant reduction of the N95 amplitude ( p < 0.001) and N95/P50 ratio ( p < 0.001), the P50 peak time was mildly shorter ( p = 0.03). The P50–N95 slope was significantly less steep in eyes with optic neuropathies (− 0.089 ± 0.029 vs. − 0.220 ± 0.041, p < 0.001). Thickness of temporal RNFL and the P50–N95 slope appeared to be the most sensitive and specific parameters for detecting RGC dysfunction (AUC = 1.0). Conclusions The slope between the P50 and N95 waves of a large field PERG is considerably less steep in patients with RGC dysfunction and could thus be an efficient biomarker, particularly in the diagnosis of early or borderline cases.