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Christina Gerth, MD; David Hauser, MD; Peter B. Delahunt, PhD; Lawrence S. Morse, MD, PhD; John S. Werner, PhD

Arch Ophthalmol. 2003;121:1404-1414.

Objectives  To determine the extent of functional changes in the first-order kernel multifocal electroretinogram (mfERG) responses in patients with large drusen by means of a localized analysis and to determine correlations between mfERG responses and morphologic changes.

Methods  Thirty-one eyes from 20 patients ages 58 to 84 years with large drusen (5 drusen 63 µm diameter) were studied. The mfERGs were recorded with a stimulus of 103 hexagons and a flash intensity of 2.67 candela (cd) · s^-1· m^-2. Each of the 103 single first-order kernel mfERG responses was analyzed and compared with those of age-matched healthy control subjects. Imaging studies, including color stereo fundus photography, red-free fundus photography, and fluorescein angiography, were performed in all patients, and morphologic changes (drusen in red-free fundus photography, staining or window defect in fluorescein angiography) were determined with a digital measurement tool. The mfERG responses were correlated to areas with and without morphologic changes.

Results  Reduced responses were found in 10.0% (scalar products) and 4.0% (response densities) and delayed implicit times in 13.8% (N1), 18.9% (P1), and 23.8% (N2) of all mfERGs. Abnormal mfERG responses extended up to 25° in radius. Significant morphologic-functional relations were detected in only a few patients. Abnormal mfERG variables were present in areas without morphologic changes.

Conclusions  Patients with large drusen exhibit functional changes in the cone-driven pathways evaluated by the mfERG, indexed particularly by implicit times. Morphologically visible changes do not predict retinal function. Large drusen are associated with a more general retinal dysfunction.

From the Department of Ophthalmology and Section of Neurobiology, Physiology, and Behavior, University of California, Davis. Dr Gerth is now with the Department of Ophthalmology, St Franziskus-Hospital, Münster, Germany. The authors have no relevant financial interest in this article.

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