Electroretinography Can Predict Diabetic Eye Disease Changes

Medical Fundus photo of retinal pathology, diabetic retinopathy
The presentation reviews the capability of electroretinography to predict and evaluate retinal function.

The following article is a part of Ophthalmology Advisor’s conference coverage of the Southeastern Educational Congress of Optometry (SECO) 2021, held in Atlanta and virtually from April 28 to May 2, 2021. The team at Ophthalmology Advisor will be reporting on the presentations offered by these leading experts in optometry and ophthalmology. Check back for more from the SECO 2021 Meeting.


Electroretinography and nutritional supplements represent testing and treatment options, respectively, optometrists can offer patients at risk for diabetic retinopathy (DR), according to a presentation at the Southeastern Educational Congress of Optometry (SECO) meeting, held April 28 to May 2, 2021, in Atlanta. 

According to Nate Lighthizer, OD, associate professor at the Northeastern State University Oklahoma College of Optometry, 1.5 million new cases of diabetes are diagnosed each year in the United States; among these patients, approximately 40% will develop DR — half of whom will not know about the diagnosis until it causes vision problems. 

Because DR is so common in people with diabetes — the rate of cases is roughly 34.5% overall, with 25% occurring 5 years after type 1 diabetes diagnosis and 40% occurring 5 years after type 2 diabetes diagnosis in those taking insulin — testing and treatment strategies are of the utmost importance. 

Electroretinography records the retinal signal in response to high-frequency flash stimuli. Indications for this full-field ERG include diabetes and DR, retinal dystrophies and disease, issues with color vision, visual field, and decreased vision, and testing of retinal function with significant media opacities. 

Flicker ERG can also be used to evaluate retinal function, determine the level of retinal ischemia, and predict and evaluate post-treatment retinal function.2,3 Additionally, when compared with fluorescein angiography, ERG demonstrated a 94% positive predictive value (vs 82% for FA) in predicting prognosis in central retinal vein occlusion. 

Early diagnosis holds multiple benefits, according to Dr Lighthizer; benefits include no longer needing to wait for structural damage to appear to make a diagnosis and the opportunity to prescribe a multicomponent nutritional supplement  for patients with early DR. Data from the Diabetes Visual Function Supplement Study (DiVFuSS,  www.ClinicalTrials.gov Identifier: NCT01646047), published in the British Journal of Ophthalmology in 2015, showed that the DiVFuSS formula “significantly improved visual function, diabetic peripheral neuropathy symptoms, blood lipids, and [high-sensitivity C-reactive protein] in patients with established diabetes, without significantly affecting blood sugar control.”4

Disclosure: The presenter declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

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  1. Lighthizer N. Diabetes mellitus: New testing and treatment for retinopathy. Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. 
  2. Pescosolido N, Barbato A, Stefanucci A, Buomprisco G. Role of electrophysiology in the early diagnosis and follow-up of diabetic retinopathy. J Diabetes Res. 2015;2015:319692. doi:10.1155/2015/3196923.
  3. Tzekov R, Arden GB. The electroretinogram in diabetic retinopathy. Surv Ophthalmol. 1999;44(1):53-60. doi:10.1016/S0039-6257(99)00063-6
  4. Chous AP, Richer SP, Gerson JD, Kowluru RA. The diabetes visual function supplement study (DiVFuSS). Bri J Ophthalmol. 2016;100(2):227-234.