June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Comparison of the Recommended ISCEV and a Modified Analysis Protocol for the PhNR Test.
Author Affiliations & Notes
  • William H Ridder
    Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, United States
  • Jeff Farmer
    Diagnosys, LLC, Massachusetts, United States
  • Footnotes
    Commercial Relationships   William Ridder Abbvie, Code C (Consultant/Contractor), Ionis Pharmaceuticals, Code C (Consultant/Contractor), jCyte, Inc., Code C (Consultant/Contractor); Jeff Farmer Diagnosys, LLC, Code E (Employment)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 770 – F0422. doi:
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      William H Ridder, Jeff Farmer; Comparison of the Recommended ISCEV and a Modified Analysis Protocol for the PhNR Test.. Invest. Ophthalmol. Vis. Sci. 2022;63(7):770 – F0422.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : Several studies have reported that glaucoma patients have abnormal Photopic Negative Response (PhNR) results compared to normal subjects. The International Society for Clinical Electrophysiology of Vision (ISCEV) released an extended protocol standard for PhNR in 2018. The purpose of this study was to compare the standard ISCEV PhNR protocol to a similar protocol modified to enhance the performance of the method in detecting glaucomatous damage.

Methods : Thirty-three subjects were enrolled in this study (12 glaucoma, 10 glaucoma suspects, and 11 control subjects). PhNR tests were conducted with a Diagnosys E3 mobile system (Diagnosys LLC, Lowell, MA) with a monocular ColorBurst stimulator. ISCEV PhNR tests utilized all parameters specified by the ISCEV requirement including 1 cd●s/m2 red flashes on a 10 cd/m2 blue background, 1 Hz stimulation frequency, bandpass filters of 0.3 to 300 Hz, and an average of at least 50 recordings. Modified ISCEV PhNR tests used the same parameters as the ISCEV tests with exceptions of 2 cd●s/m2 red flashes at 1 or 4 Hz stimulation frequency, 5 to 45 Hz bandpass filters and novel, objective sweep selection parameters. All subjects were dilated and PhNRs were conducted with Burian-Allen bipolar electrodes. According to ISCEV standards, the PhNR relative to baseline, a-wave and b-wave response amplitudes and PhNR-baseline/b-wave amplitude ratios were measured. Coefficients of variation and 2-sample t-test were used to assess the data from one randomly chosen eye per subject.

Results : The modified analysis protocol for the PhNR-baseline amplitude resulted in a decrease in the average coefficient of variation for all conditions (Average ISCEV protocol CV = -63% and Modified analysis CV = -41%). The modified analysis resulted in the glaucoma suspects being significantly different from the glaucoma subjects (1 and 4 Hz stimuli with ISCEV analysis p values were 0.083 and 0.838, respectively and with the modified analysis were 0.004 and 0.018, respectively).

Conclusions : The modified analysis protocol resulted in a decrease in within group data variability which resulted in a significant difference between the PhNR-baseline data for the glaucoma subjects and glaucoma suspects. Thus, the modified analysis protocol may result in greater test sensitivity making it a better diagnostic tool.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.


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