Evaluation of the Electroretinogram Pattern (Diopsys® NOVA System) for the Early Diagnosis of Glaucoma

Glaucoma Clinical Trial

— DIOPSYS  

Official title:

Evaluation of the Electroretinogram Pattern (Diopsys® NOVA System) for the Early Diagnosis of Glaucoma

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03642782
• Other study ID #: DIOPSYS
• Status: Active, not recruiting
• Phase: N/A
• Start date: July 3, 2018
• Est. completion date: December 31, 2023

Study information

• Verified date: April 2023
• Source: Groupe Hospitalier Paris Saint Joseph
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Glaucoma is a common and potentially blinding disease. It is characterized by an optic nerve damage, a visual field defect and elevated intraocular pressure (IOP).

The loss of retinal nerve fibers is accompanied by functional impairment in the territories corresponding to deficits of the visual field. However, this structure-function relationship is not always found initially. These discrepancies are mainly chronological: the structural damage preceding the functional impairment sometimes of several years

Description:

The electroretinogram pattern (ERGP) is an electrophysiological exploration technique that reflects the activity of retinal ganglion cells. It presents itself as an objective field of vision that does not require the active collaboration of the patient. It consists in recording the electrical activity of functional retinal ganglion cells following a light stimulation. Simple (30 minutes maximum), it could improve the detection of early forms of glaucoma. A significant ERGP is also thought to be correlated with peripapillary and macular CNP structural involvement of the ganglionic complex in early forms of glaucoma (MD> -6 dB).

Some results even suggest that ganglion dysfunction could be detected by the ERGP eight years on average before the occurrence of detectable alterations on the RNFL OCT. ERGP is already recognized as a routine examination for monitoring glaucomatous patients (review side in nomenclature and reimbursed by Social Security) but it could therefore be used as a diagnostic tool in very early forms of intraocular hypertonia glaucoma so to objectify signs of preperimetric functional impairment in order to establish a suitable hypotonizing treatment and to improve the prognosis of this disease.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 12
• Est. completion date: December 31, 2023
• Est. primary completion date: July 2, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Man and woman age = 18 years

• Francophone

• Patient with medical insurance

• Refraction: sphere ± 5.0 D and cylinder ± 3.0 D

• Pupillary diameter = 3mm

• Early glaucoma patients :

• Intraocular pressure> 21 mmHg or <21mmHg under treatment

• Thickness of pathological retinal nerve fibers with at least one affected area (OCT)

• At least one reliable visual field (false positives, false negatives and fixation losses = 25%) and no artifacts, with Corrected Pattern Standard Deviation (CPSD) pathological in the 5% and Glaucoma Hemifield Pathological test and an early attack (MD> -6dB)

• Patient at risk for glaucoma with:

• And / or family history of glaucoma

• and / or intraocular pressure> 21 mmHg

• and / or retinal nerve fibers (pathological thickness in at least one area on the OCT)

• and / or reliable visual field (false positives, false negatives and fixation losses = 25%) and without artifact, with pathological Corrected Pattern Standard Deviation (CPSD) in the 5% and Glaucoma Hemifield Pathological Test and an early onset (MD> -6 dB).

Exclusion Criteria:

• Visual acuity below 20/30 (Snellen scale or equivalent on another visual acuity scale)

• Unreliable visual field (false positives, loss of fixation and false negatives> 25%)

• History of intraocular surgery (except uncomplicated cataract surgery)

• Ocular pathology other than associated glaucoma

• Neurological disease affecting the visual field or the optic nerve

• History of macular laser or pan retinal photocoagulation

• Unreliable ERGP pattern

• Offset OCT, unreliable

• Refusal to participate in the study

• Patient under tutorship or curatorship

• Patient deprived of liberty

• Epileptic patient

• Eczema of the eyelids or allergy to one of the components of the electrodes or skin gel allowing the cleaning of the skin before the positioning of the electrodes.

Related Conditions & MeSH terms

• Glaucoma

Intervention

Device:
• Electroretinogram Pattern (Diopsys® NOVA System)
it's an additional examination that extends the duration of the ophthalmological consultation by 30 minutes

Locations

Country	Name	City	State
France	Groupe Hospitalier Paris Saint-Joseph	Paris

Sponsors (1)

Lead Sponsor	Collaborator
Groupe Hospitalier Paris Saint Joseph

Country where clinical trial is conducted

France, 

References & Publications (24)

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Bach M, Unsoeld AS, Philippin H, Staubach F, Maier P, Walter HS, Bomer TG, Funk J. Pattern ERG as an early glaucoma indicator in ocular hypertension: a long-term, prospective study. Invest Ophthalmol Vis Sci. 2006 Nov;47(11):4881-7. doi: 10.1167/iovs.05-0 — View Citation

Banitt MR, Ventura LM, Feuer WJ, Savatovsky E, Luna G, Shif O, Bosse B, Porciatti V. Progressive loss of retinal ganglion cell function precedes structural loss by several years in glaucoma suspects. Invest Ophthalmol Vis Sci. 2013 Mar 28;54(3):2346-52. d — View Citation

Bowd C, Tafreshi A, Vizzeri G, Zangwill LM, Sample PA, Weinreb RN. Repeatability of pattern electroretinogram measurements using a new paradigm optimized for glaucoma detection. J Glaucoma. 2009 Aug;18(6):437-42. doi: 10.1097/IJG.0b013e31818c6f44. — View Citation

Bowd C, Tafreshi A, Zangwill LM, Medeiros FA, Sample PA, Weinreb RN. Pattern electroretinogram association with spectral domain-OCT structural measurements in glaucoma. Eye (Lond). 2011 Feb;25(2):224-32. doi: 10.1038/eye.2010.203. Epub 2010 Dec 24. — View Citation

Bowd C, Vizzeri G, Tafreshi A, Zangwill LM, Sample PA, Weinreb RN. Diagnostic accuracy of pattern electroretinogram optimized for glaucoma detection. Ophthalmology. 2009 Mar;116(3):437-43. doi: 10.1016/j.ophtha.2008.10.026. Epub 2009 Jan 22. — View Citation

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Gordon MO, Beiser JA, Brandt JD, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, Parrish RK 2nd, Wilson MR, Kass MA. The Ocular Hypertension Treatment Study: baseline factors that predict the onset of primary open-angle glaucoma. Arch Ophtha — View Citation

Harwerth RS, Quigley HA. Visual field defects and retinal ganglion cell losses in patients with glaucoma. Arch Ophthalmol. 2006 Jun;124(6):853-9. doi: 10.1001/archopht.124.6.853. — View Citation

Hwang YH, Kim YY, Kim HK, Sohn YH. Ability of cirrus high-definition spectral-domain optical coherence tomography clock-hour, deviation, and thickness maps in detecting photographic retinal nerve fiber layer abnormalities. Ophthalmology. 2013 Jul;120(7):1 — View Citation

Hwang YH, Kim YY. Glaucoma diagnostic ability of quadrant and clock-hour neuroretinal rim assessment using cirrus HD optical coherence tomography. Invest Ophthalmol Vis Sci. 2012 Apr 24;53(4):2226-34. doi: 10.1167/iovs.11-8689. — View Citation

Mafei L, Fiorentini A. Electroretinographic responses to alternating gratings before and after section of the optic nerve. Science. 1981 Feb 27;211(4485):953-5. doi: 10.1126/science.7466369. — View Citation

Mwanza JC, Oakley JD, Budenz DL, Anderson DR; Cirrus Optical Coherence Tomography Normative Database Study Group. Ability of cirrus HD-OCT optic nerve head parameters to discriminate normal from glaucomatous eyes. Ophthalmology. 2011 Feb;118(2):241-8.e1. — View Citation

Na JH, Lee K, Lee JR, Baek S, Yoo SJ, Kook MS. Detection of macular ganglion cell loss in preperimetric glaucoma patients with localized retinal nerve fibre defects by spectral-domain optical coherence tomography. Clin Exp Ophthalmol. 2013 Dec;41(9):870-8 — View Citation

Quigley HA, Dunkelberger GR, Green WR. Retinal ganglion cell atrophy correlated with automated perimetry in human eyes with glaucoma. Am J Ophthalmol. 1989 May 15;107(5):453-64. doi: 10.1016/0002-9394(89)90488-1. — View Citation

Sample PA, Taylor JD, Martinez GA, Lusky M, Weinreb RN. Short-wavelength color visual fields in glaucoma suspects at risk. Am J Ophthalmol. 1993 Feb 15;115(2):225-33. doi: 10.1016/s0002-9394(14)73928-5. — View Citation

Sommer A, Katz J, Quigley HA, Miller NR, Robin AL, Richter RC, Witt KA. Clinically detectable nerve fiber atrophy precedes the onset of glaucomatous field loss. Arch Ophthalmol. 1991 Jan;109(1):77-83. doi: 10.1001/archopht.1991.01080010079037. — View Citation

Tafreshi A, Racette L, Weinreb RN, Sample PA, Zangwill LM, Medeiros FA, Bowd C. Pattern electroretinogram and psychophysical tests of visual function for discriminating between healthy and glaucoma eyes. Am J Ophthalmol. 2010 Mar;149(3):488-95. doi: 10.10 — View Citation

Tan O, Chopra V, Lu AT, Schuman JS, Ishikawa H, Wollstein G, Varma R, Huang D. Detection of macular ganglion cell loss in glaucoma by Fourier-domain optical coherence tomography. Ophthalmology. 2009 Dec;116(12):2305-14.e1-2. doi: 10.1016/j.ophtha.2009.05. — View Citation

Ventura LM, Porciatti V. Restoration of retinal ganglion cell function in early glaucoma after intraocular pressure reduction: a pilot study. Ophthalmology. 2005 Jan;112(1):20-7. doi: 10.1016/j.ophtha.2004.09.002. — View Citation

Ventura LM, Sorokac N, De Los Santos R, Feuer WJ, Porciatti V. The relationship between retinal ganglion cell function and retinal nerve fiber thickness in early glaucoma. Invest Ophthalmol Vis Sci. 2006 Sep;47(9):3904-11. doi: 10.1167/iovs.06-0161. — View Citation

* Note: There are 24 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Correlations between Electroretinogram Pattern, vision field and optical coherence tomography	Electroretinogram Patterny : Magnitude, magnitude D, Magnitude D/Magnitude ratio.	Time of inclusion
Primary	Correlations between Electroretinogram Pattern, vision field and optical coherence	Vision field: mean deviation, corrected pattern standard deviation.	Time of inclusion
Primary	Correlations between Electroretinogram Pattern, vision field and optical coherence	Optical coherence tomography: retinal nerve fiber layer thickness and macular analysis of the ganglionic complex.	Time of inclusion