Head-down posture induces PERG alterations in early glaucoma

Lori M. Ventura, Iuri Golubev, William Lee, Izuru Nose, Jean Marie Parel, William J. Feuer, Vittorio Porciatti

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


PURPOSE:: To probe susceptibility of retinal ganglion cells (RGC) to physiological stressors associated with moderate head-down body tilt in patients with suspicion of glaucoma or early manifest glaucoma (EMG). METHODS:: One hundred nine subjects with best corrected visual acuity (BCVA) ≥20/20 and no disease other than glaucoma [glaucoma suspects (GS)=79, EMG=14, normal controls (NC)=16 and comparable age range were tested. Noncontact intraocular pressure (IOP), pattern electroretinogram (PERG), and brachial blood pressure/heart rate measurements were performed in 3 consecutive conditions (̃0038 min apart): seated (baseline), -10-degree whole body head-down tilt (HDT), and seated again (recovery). PERG amplitude and latency, IOP, and systolic/diastolic blood pressures, heart rate, calculated mean central retinal artery pressure, ocular perfusion pressure, and systolic/diastolic perfusion pressures were evaluated. RESULTS:: During HDT, IOP significantly (P<0.001) increased in all groups approximately to the same extent (approximately 20%). PERG amplitude did not change in NC but decreased significantly (P<0.001) in patients (GS, -25%, EMG -23%). PERG phase become delayed in NC (-1.6%, P=0.04) but more so in patients (GS, -2.7%, P<0.001; EMG, -6.0%, P<0.001). The proportion of patients with PERG alterations significantly (P<0.05) exceeding those occurring in age-adjusted and baseline-adjusted NC were, GS: amplitude 20%, phase 15%; EMG: amplitude 14%, phase 50%. All measures recovered baseline values after HDT. CONCLUSIONS:: Moderate HDT induces temporary worsening of RGC function in a subpopulation of GS and EMG patients. This noninvasive protocol may help disclose abnormal susceptibility of RGCs in a subset of the patients at risk of glaucoma.

Original languageEnglish (US)
Pages (from-to)255-264
Number of pages10
JournalJournal of glaucoma
Issue number3
StatePublished - Mar 2013


  • Body posture
  • Glaucoma
  • IOP
  • Pattern electroretinogram
  • Retinal ganglion cell function

ASJC Scopus subject areas

  • Ophthalmology


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