A modified analysis protocol for the PhNR test.

Purpose: Several studies have reported that glaucoma patients have abnormal photopic negative response (PhNR) results compared to reference control subjects. The International Society for Clinical Electrophysiology of Vision (ISCEV) released an extended protocol for PhNR (I-PhNR) in 2018. The purpose of this study was to compare the I-PhNR protocol to a similar protocol modified (M-PhNR) to enhance the performance of the method in detecting glaucomatous damage.

Methods: Thirty subjects were enrolled in this study (12 glaucoma patients, 10 glaucoma suspects, 8 normal controls). PhNR tests were conducted with a Diagnosys E3 mobile system (Diagnosys LLC, Lowell, MA). I-PhNR tests utilized all parameters specified by the ISCEV requirement. M-PhNR tests used the same parameters as the ISCEV tests with the exceptions of a 5-45 Hz bandpass filter and a novel, objective sweep-selection parameter. According to the ISCEV protocol, the PhNR relative to baseline (i.e., BT), a-wave and b-wave response amplitudes and BT/b-wave amplitude ratios were measured. Coefficients of variation, receiver operating characteristic (ROC) curves, and t-tests were used to assess the data from one randomly chosen eye per subject.

Results: The M-PhNR protocol resulted in a decrease in the intra-subject repeat test coefficient of variation and a decrease in the average inter-subject coefficient of variation for the glaucoma subjects. The ROC curves demonstrated an increase in the area under the curve (AUC) for the M-PhNR compared to the I-PhNR protocol. The sensitivity and specificity were also greater for the M-PhNR protocol.

Conclusions: The M-PhNR protocol resulted in a decrease in intra-subject and inter-subject data variability which resulted in a significant increase in the ROC AUC, sensitivity, and specificity for glaucoma. Thus, the M-PhNR protocol shows promise as a better diagnostic tool than the I-PhNR protocol for detecting glaucoma.