Electroretinography (ERG) has emerged as a transformative tool in optometric practice, enabling eye care professionals to assess retinal function with unprecedented accuracy. In a recent podcast episode, Dr. Chris Lievens and Dr. Timothy Earley delved into the evolving role of ERG in managing chronic eye diseases, particularly diabetic retinopathy. This article explores the insights shared during their conversation, focusing on the practical applications of ERG, its impact on patient care, and its future potential in optometry.

Electroretinography (ERG) is a diagnostic test that measures the electrical responses of various cell types in the retina, including photoreceptors, inner retinal cells, and ganglion cells. ERG serves as a functional assessment, akin to an EKG for the eyes, providing critical information about retinal health that structural imaging alone cannot reveal.

This ability to assess retinal function makes ERG particularly valuable in monitoring diseases like diabetic retinopathy, macular degeneration, and other chronic conditions that can impact vision.

Traditionally, ERG was confined to research settings due to the complexity of the equipment and testing protocols. However, advancements have led to the development of more practical, handheld ERG devices that integrate seamlessly into everyday optometric practice.

Dr. Earley highlighted how these newer devices simplify the testing process:

1. Monitoring Diabetic Retinopathy
ERG’s ability to generate a Diabetic Retinopathy (DR) score allows optometrists to track disease progression objectively. A DR score combines data from signal strength, speed, and pupil response, offering a quantifiable metric to assess the likelihood of needing retinal interventions.

2. Detecting Functional Deficits in AMD (Age-Related Macular Degeneration)
While structural imaging focuses on visible changes, ERG can detect functional deficits in the retina that precede visible damage. This makes it an invaluable tool for early intervention in conditions like AMD.

3. Beyond Diabetes and AMD: Emerging Uses

A common misconception is that ERG and Optical Coherence Tomography (OCT) are redundant. While OCT excels in assessing structural changes, ERG provides a functional assessment, allowing optometrists to correlate structure with function.

The combination of OCT and ERG enables a comprehensive evaluation, particularly in chronic diseases like diabetic retinopathy and AMD, where structure-function disparity is common.

1. Expanding Protocols:
Current research is exploring the adaptation of ERG protocols for other retinal diseases and systemic conditions impacting ocular health.

2. Enhancing Accessibility:
The development of user-friendly, handheld ERG devices is democratizing access to advanced retinal diagnostics for smaller practices.

3. Standardization and Training:
As ERG becomes more integrated into routine care, standardizing protocols and ensuring adequate training for optometric technicians will be crucial.

4. Insurance and Reimbursement:
ERG testing is reimbursable under multiple CPT codes, making it a financially viable addition to practice. However, ongoing advocacy is needed to expand insurance coverage for newer protocols.