Review highlights potential role of electrophysiology in early glaucoma detection

Visual electrophysiology tests may help detect early glaucoma-related functional changes, but current evidence does not support their routine use in clinical practice, according to a review.

Researchers identified 20 articles for inclusion although evidence was considered low quality, with 19 studies rated as level III evidence and only 1 rated as level II.

Pattern electroretinography (PERG) demonstrated potential for identifying early glaucoma before visual field defects become apparent, particularly in patients with retinal nerve fiber layer loss detected by optical coherence tomography (OCT).

The photopic negative response (PhNR), a component of full-field electroretinography, was also found to be sensitive to glaucomatous damage and may offer practical advantages over PERG because it is less dependent on clear ocular media and stable fixation.

Visual evoked potentials (VEP) and multifocal VEP were able to distinguish glaucoma eyes from healthy controls in reviewed studies. However, the technical complexity of these tests may limit their broader adoption in glaucoma diagnosis.

The authors concluded that while advances in electrophysiologic testing have improved the ability to differentiate glaucoma from normal eyes, these technologies are not currently recommended as part of routine glaucoma evaluation.

Reference

Ou Y, Chopra V, Rosdahl JA, et al. Visual Electrophysiology for the Diagnosis of Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology. 2026;S0161-6420(26)00283-6. doi: 10.1016/j.ophtha.2026.04.014. Epub ahead of print. PMID: 42287272.