How ERG Supports the OWNS Mission

By Dorothy Hitchmoth, OD

I recognized early on that having electroretinography (ERG) in my practice would help me embody the OWNS mission to “bring worldwide evidence-based nutrition and wellness strategies to healthcare providers, scientists, and the public to help change the course of vision loss and poor health.” ERG has long been considered a valuable tool in caring for patients who have diabetes. However, the move to portable, handheld ERGs has it made it a practical staple in a growing number of optometric practices. In my practice, we use ERG for early detection of diabetic retinopathy (DR) as well as for monitoring disease progression. Furthermore, it helps me have conversations with my patients about diet, exercise, supplements and metabolic control.


Structure + Function with the RETeval

Structural imaging reveals the anatomy of the retinal tissue, ERG objectively evaluates retinal function. While both functional and structural assessments have their benefits, functional changes generally appear well before structural changes and are often accompanied by symptoms such as blur, glare, photopsia and scintillations. In studies comparing the ability of ERG and structural imaging to evaluate sight-threatening DR, ERG outperformed traditional imaging by predicting which patients would likely need subsequent medical intervention (Al-Otaibi 2017, Brigell 2020).  Importantly, interpreting results is easy—a score of 23.4 or higher indicates an 11-fold increase in the likelihood that the patient will require medical intervention within three years (Brigell 2020).  

The RETeval® ERG device by LKC Technologies is the only FDA-cleared, portable, battery-operated, non-mydriatic ERG testing instrument on the market in the U.S. It has skin rather than corneal electrodes, adjusts for pupil size in real time and doesn’t require dilation. In my opinion, it is one of the easiest-to-use instruments in the optometrist’s toolkit because it’s portable, efficient, tech-friendly and enhances confidence when caring for patients who have diabetes and are at-risk for diabetic retinopathy (DR).

The Five Pillars of DR Management

When deciding how to approach the care of a DR patient, I refer to the Modern Fundamentals of Diabetic Retinopathy Management in Optometry, a consensus document released in 2023 by a diabetic retinopathy task force. The guidelines are as follows:

  1. DETECT: Approach diabetic retinopathy as a chronic progressive disease. Being a chronic progressive disease implies that you can detect it before it becomes advanced disease. This can be achieved using both structural and functional testing.
  2. GRADE: Grade diabetic retinopathy at the time of diagnosis and at each subsequent visit. Chart structural retinal damage and quantify retinal cell function.
  3. ASSESS RISK: To assess risk of progression, monitor diabetic retinopathy patients over time using both structural and objective functional measures.
  4. MANAGE: Utilize multi-disciplinary resources to manage all diabetic retinopathy patients, regardless of disease severity.
  5. SUPPORT: Provide comprehensive patient education and strategies to help prevent disease progression.

Currently, these guidelines are open for public comment within the optometric community. I invite my colleagues to take advantage of this opportunity to voice your opinion and feedback on specific elements of these guidelines. You can do so by accessing the survey here. Ensuring that the OWNS network priorities are reflected in these guidelines cannot be overstated, particularly given their strong focus on working with patients, offering support, and making appropriate nutritional recommendations.

 

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References:

Al-Otaibi H, Al-Otaibi MD, Khandekar R, et al. Validity, usefulness and cost of RETeval system for diabetic retinopathy screening. Transl Vis Sci Technol. 2017;6(3):3. doi:10.1167/tvst.6.3.3

Brigell MG, Chiang B, Maa AY, Davis CQ. Enhancing risk assessment in patients with diabetic retinopathy by combining measures of retinal function and structure. Transl Vis Sci Technol. 2020;9(9):40. doi:10.1167/tvst.9.9.40