Visual Electrophysiology for the Diagnosis of Glaucoma: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the current published literature on the utility of visual electrophysiology testing in the diagnosis of glaucoma. METHODS: Literature searches of the PubMed database were last conducted in August 2025 and restricted to articles published on or after January 1, 2011. The search identified 738 articles that were reviewed in abstract form for relevancy, and 170 were selected for full-text review. After inclusion and exclusion criteria were applied, 37 articles were selected for data abstraction by panel members. A total of 20 studies were selected for inclusion, and the panel methodologist (J.A.R.) assigned each a level of evidence rating. RESULTS: None of these 20 articles were rated level I, 1 article was rated level II, and 19 articles were rated level III. Visual electrophysiology tests, including electroretinography (ERG) and visual evoked potentials (VEP), are objective measures that provide an assessment of visual function. Pattern electroretinography (PERG) may assist the clinician's ability to diagnose early glaucoma before visual field deficits are detected, especially in patients with retinal nerve fiber layer (RNFL) loss as measured by OCT. The photopic negative response (PhNR) of the cone-driven full-field ERG is sensitive to glaucoma damage and has a less strict requirement for lack of media opacity and steady fixation compared with PERG. Visual evoked potentials and multifocal VEP (mfVEP) can discriminate between glaucoma and control eyes, but they are technically challenging to perform, which may limit their adoption for glaucoma diagnosis. CONCLUSIONS: Although significant advances have been made in developing these objective visual electrophysiology tests to discriminate between glaucoma and control eyes, they are not yet recommended in routine clinical evaluation. They may have a role in select scenarios to augment currently accepted structural and functional assessments. Utility is limited because of barriers to widespread clinical implementation, including the lack of consensus on stimulation and analysis protocols with standardized reference ranges. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Duke Scholars

Author Jullia Ann Rosdahl Ophthalmology, Glaucoma