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International Medical Scientific Journal       Issue-2 

10.5281/zenodo.5517016 

97 

    



Art of Medicine           Volume-1 

International Medical Scientific Journal       Issue-2 

10.5281/zenodo.5517016 

98 

 

Art of Medicine International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly. 

Internet address: http://artofmedicineimsj.us 
E-mail: info@artofmedicineimsj.us 

11931 Barlow Pl Philadelphia, PA 19116, USA +1 (929) 266-0862 

 

 
 

  



Art of Medicine           Volume-1 

International Medical Scientific Journal       Issue-2 

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99 

THE VALUE OF PERIMETRIC AND ELECTROPHYSIOLOGICAL 

DIAGNOSTIC CRITERIA IN EARLY PRIMARY OPEN-ANGLE 

GLAUCOMA 

Yusupov Azamat Farkhadovich, M.D, Director of the State Institution 

"Republican Specialized Scientific and Practical Medical Center of Eye 

Microsurgery", Tashkent, 100173, Uzbekistan,  eye-сenter@inboх.ru 
 Karimova Muyassar Khamitovna, M.D, Professor, Deputy Director for 

Scientific Work of the State Institution "Republican Specialized Scientific and 

Practical Medical Center for Eye Microsurgery mkarimova2004@mail.ru Tashkent, 

100173, Uzbekistan 
 Zakirkhodjaeva Mastona Azizkhodzhayevna, Basic doctoral student, 

ophthalmologist, State Institution "Republican Specialized Scientific and Practical 

Medical Center of Eye Microsurgery", mastonaz@bk.ru Tashkent, 100173, 
Uzbekistan 

Abdushukurova Asal Azamat kizi, clinical resident of the State Institution 

"Republican Specialized Scientific and Practical Medical Center of Eye 

Microsurgery", yusupovaasal0917@mail.ru Tashkent, 100173 ,Uzbekistan 
 

Abstract  

The purpose of the study to study and analyze electrophysiological indicators 

in the early diagnosis of primary open-angle glaucoma. 

Material and research methods. Studies of electrophysiological characteristics 
were carried out in RSSPMCEM under photopic conditions on a Neuro-ERG device 

from Neurosoft company using chess receptive fields of 0.75 arc minutes in black 

and white and blue-yellow versions. Clinical static perimetry was performed in the 
RSSPMCEM on a TOMEY AP-3000 (Automated Perimeter) device with the ability 

to conduct threshold and color-opposing methods for studying the central field of 

view. 

Results. When analyzing the main functional perimetric indices and the nature 
of the topography and depth of defects in the central field of view (MD, PSD, CPSD), 

a significant change in the light sensitivity thresholds of the blue-yellow perimetry 

relative to the standard research method was noted. 
Conclusion. The complex use of ERG and static perimetry makes it possible to 

reveal the presence of changes in the visual system at the early preclinical stages of 

the development of glaucomatous optic neuropathy. 

Keywords: oscillator potentials, glaucomatous optic neuropathy, blue cone 
ERG, retinal ganglion cells.  

 

Introduction. At this time, the problem of early diagnosis of glaucoma, as well 
as the peculiarities of changes in certain types of ERG at the early stages of the 

development of glaucomatous optic neuropathy remain very relevant [1, 10, 11, 12, 

13, 14]. It is well known that standard static threshold perimetry reveals functional 

defects in the visual field with the death of 30% of retinal ganglion cells. On the other 
hand, standard types of ERG are insensitive and nonspecific in the development of 

mailto:eye-сenter@inboх.ru
mailto:mastonaz@bk.ru
mailto:yusupovaasal0917@mail.ru
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glaucomatous primary lesions [2, 6, 7, 19]. In the early preclinical diagnosis of 

glaucomatous neuropathy, a special position is occupied by disorders in the blue-
conical system of the visual analyzer [3, 8, 9, 20]. Blue cones are distinguished by the 

presence of large receptive fields, pronounced color opposition to yellow, and 

localization in the paramacular region 7–10 ° from the center of fixation. In this 

regard, we used a complex of electrophysiological recording methods, in particular, 
electroretinography (ERG) for a short-wave stimulus [4, 5, 15, 16, 17, 18]. 

Material and research methods  

At the Republican Specialized Scientific and Practical Medical Center of Eye 

Microsurgery, 42 patients (84 eyes) were examined with a diagnosis of suspected 
glaucoma. The visual acuity of patients with ametropia correction was 0.9–1.0. 

Refractive errors did not exceed 3.0 diopters; concomitant disorders of the visual 

analyzer were not  detected. At the time of diagnosis, none of the examined patients 
received local drug antihypertensive therapy. The average age of the patients was 

50.5 ± 2.5 years. The comparison group consisted of 20 people without changes in 

visual functions of the corresponding sex and age. Electrophysiological and 

perimetric methods were used: blue-yellow threshold static perimetry, color-opposing 
blue-yellow electroretinography for examining the visual organ to assess the 

functional state of the visual system with standard methods for examining the organ 

of vision. 
Clinical static perimetry was performed in the RSSPMCEM on a TOMEY AP-

3000 (Automated Perimeter) device with the ability to conduct threshold and color-

opposing methods for studying the central field of view. The stimulus parameters 

corresponded to Goldman 3 standards, the background brightness was 31.5 asB, the 
program for early glaucoma diagnosis was 30-2 threshold (SAP), 30-2 blue-yellow 

(SWAP). The stimuli are presented on a white or yellow background using 

appropriate light filters in the form of blue-yellow or white-and-white (standard) 
perimetry. The results of the conducted perimetric studies were analyzed using 

statistical package data: MD, MS, PSD. 

Studies of electrophysiological characteristics were carried out in RSSPMCEM 

under photopic conditions on a Neuro-ERG device from Neurosoft company using 
chess receptive fields of 0.75 arc minutes in black and white and blue-yellow 

versions. The results of standard and color-opposing perimetry research methods, as 

well as electrophysiological indicators were processed using the applied package of 
research methods Statistica 6.0. 

 Research results 

 When analyzing the main functional perimetric indices and the nature of the 

topography and depth of defects in the central field of view (MD, PSD, CPSD), a 
significant change in the light sensitivity thresholds of the blue-yellow perimetry 

relative to the standard research method was noted. The data are shown in Table 1.                                                                                                                                                            

Table 1. 
  



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Comparative analysis of perimetric parameters in patients with suspected 

glaucoma 

 Control group Clinical group 

Perimetric indices SAP SWAP SAP SWAP 

MD, db 0,75 ± 0,25* 0,93 ± 0,5 –1,57 ± 0,45 *  –1,75 ± 

0,75 

MS, db 21 ± 1,5  25 ± 2,75 18 ± 2,5 22 ± 3,5 

PSD, db 2,37 ± 0,75 3,25 ± 1,5* 3,37 ± 1,5 5,75 ± 2,5* 

 

 These indicators in patients with suspected glaucoma were two times higher 

than those in the control group, which indicates a higher sensitivity of the SWAP 
technique in the early diagnosis of glaucoma. The topography of visual field defects 

during SWAP perimetry did not differ from that with standard, however, the depth of 

defects was significantly higher with SWAP perimetry. 

When conducting electrophysiological studies, the criteria were selected that are most 
similar in damage to the S-cone system of the retina: PERG, oscillatory potentials, 

blue-cone electroretinography (S-CON ERG). The data are shown in Table 2.                                                                                                                                                        

Table 2. 
Comparative analysis of electrophysiological parameters in patients with 

suspected glaucoma. 

Pattern-ERG complex 

N95 

Black and white 

chess stimulus 

Blue and 

yellow chess 

stimulus 

 

Black and 

white chess 
stimulus 

Blue and 

yellow 

chess 
stimulus 

Amplitude, μV 5 ± 0,75   5,28 ± 0,45* 4,75 ± 1,25 3,78 ± 1,75 

Latency, ms 95 ± 2,5*  97 ± 2,5* 112 ± 3,0* 117 ± 3,8* 

Oscillatory Potential 
Index 

9,75 ± 1,75    10,73 ± 1,85* 14,4 ± 1,85 17,2 ± 2,5* 

D-wave amplitude, 
mV blue-conical ERG 

- 34 ± 0,75* - 28 ± 1,25* 

 

In the study of the color channels of the retina in patients with suspected 

glaucoma in the blue-yellow variant to a stimulus of 0.75 arc minutes according to 

PERG data, a change in the culmination time of the N95 complex to 117 ± 3.8 ms, as 
well as a change in the amplitude to 5 ± 2.3 mB. In patients of the "suspected 

glaucoma" group, the PERG data for a black-and-white checkerboard pattern of 0.75 

also differed from normal values and amounted to 112 ± 3.0 ms and 6.5 ± 2 mA in 
terms of culmination time and amplitude, respectively. In the control group, the value 

of the culmination time and amplitude of the N95 complex was 95 ± 2.5 ms and 5.5 ± 

0.75 mA. The results obtained, presented in table 1, indicate a greater sensitivity of 

blue-yellow PERG relative to the standard technique of glaucomatous lesions of 
retinal ganglion cells in early diagnosis (POAG). When studying the index of 

oscillatory potentials for a white stimulus in patients of the "suspected glaucoma" 



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group, it was 14.4 ± 1.85 mV, and for a blue stimulus - 17.2 ± 2.5 mV. In the control 

group, the OP index was 9.75 ± 1.75 mV for the white stimulus and 10.73 ± 1.85 mV 
for the blue stimulus, respectively.  

The data reflect the presence of overexcitation processes at the level of the inner 

layers of the retina at the preclinical stages of development of glaucomatous optic 

neuropathy. The variant of the study of OP neither blue stimulus showed significantly 
more sensitive results with respect to oscillatory potentials to a white stimulus, which 

suggests the presence of its better informative value in the diagnosis of primary open-

angle glaucoma. 

During studies of the blue-cone ERG (S-CON ERG), the amplitude of the D-
wave generation was 28 ± 1.25 mV in the group of patients with suspected glaucoma 

and was characterized by a decrease in the amplitude of the off-blue cone response. 

In the control group, the above S-CON ERG index was 34 ± 0.75 mV. An increase in 
the latency and a decrease in the amplitudes of the D wave in the S-CON ERG in 

patients with suspected glaucoma relative to the control group indicates the likelihood 

of damage to the off-short-wave channels at the level of retinal ganglion cells during 

the development of excitotoxic glaucoma reactions. 
Сonclusions 

1. Indicators MD.MS.PSD in patients with suspected glaucoma were 2 times 

higher than those in healthy subjects during SWAP perimetry, which makes it 
possible to use it for early diagnosis of ischemic changes in the retina in glaucoma. 

2. Oscillatory potentials (OP) to a blue stimulus are significantly more sensitive, 

relative to (OP) to a white stimulus, which is informative in the diagnosis of POAG. 

3. The complex use of ERG and static perimetry makes it possible to reveal the 
presence of changes in the visual system at the early preclinical stages of the 

development of glaucomatous optic neuropathy. 

  



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