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Medical Forum / General / Vision / June 2007

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What diseases can be diagnosed with ERG?

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Danni - 25 Jun 2007 18:06 GMT
I have an ERG scheduled for 7/10.  My vision has been dramatically
deteriorating for about 1.5 yrs.  That's how long it's been since I noticed
it anyway.  My opthalmologist can't tell anything with a basic exam.  She
first thought it might be caused by Topomax I was taking for migraines, but
when I went off it there was no change.  I also had breast cancer 3 years ago
so one distinct concern is that it could be caused by an undiagnosed cancer
recurrence.  Of course, that has me scared witless.  My internal medicine
doctor thought it might be migraine related, but I don't know of any
permanent vision loss that can occur from migraines.  

My vision in one eye gradually became blurry - appears like an astigmatism on
a regular vision exam but is rapidly deteriorating -- too fast to keep up
with new lenses for glasses.  At first I noticed no pain but have gradually
realized I do have constant come-and-go pains -- some sharp shooting pains in
my eyeball, some around the eye socket, sometimes pressure in my forehead and
dull pain on the right side of my head all the way to the back.  All these
are transient -- coming and going all day.  Since I have migraines frequently
it took me a long time to realize I had pain related to the eye problem.
Lately it has seemed like my other eye may be affected, though the visual
difficulty in my other eye comes and goes.  The visual difficulty actually is
a lot like the vision problems I had during chemo but my eyes got better
after I finished chemo (though I needed glasses for the first time in my life)
, then the one eye just got worse and worse.

All that said, my question is what types of problems can be diagnosed with an
ERG besides the possibility of a cancer recurrence?  I'd rather it was just
about anything else besides cancer.  

Any input would be greatly appreciated.  I'm not fishing for a diagnosis,
just ideas about what else it might be besides cancer to give my mind
something else to feed on!

-- Danni
Dr Judy - 25 Jun 2007 22:18 GMT
> I have an ERG scheduled for 7/10.  My vision has been dramatically
> deteriorating for about 1.5 yrs.  That's how long it's been since I noticed
[quoted text clipped - 29 lines]
>
> -- Danni

Actually an ERG is not likely to find cancer in the eye, an MRI or
ultrasound would be the test for that.

The ERG is used to test the functioning of the cells of the retina and
a variety of retinal diseases, mostly genetic, have characteristic
abnormalities in the ERG.   They may do some other tests to look for
problems with the optic nerve as well.

Dr Judy
Danni - 25 Jun 2007 23:17 GMT
Apparently very rarely a cancer recurrence elsewhere in the body - not
actually in the eye - can cause changes in the rods or cones of the retina
resulting in vision loss.  My opthalmologist said it was a distant
possibility and my oncologist said it was so rare it was extremely unlikely.
Since the opthalmologist can't find anything else, she feels it's sensible to
exclude the possibility.  However, since I don't know of any other realistic
possible causes I'm worrying myself sick.  ;-)  

This afternoon I did find a list of issues that could be diagnosed with an
ERG but only one of them was even a remote possibility considering the other
symptoms or factors involved.  So I'm back at square one.

-- Danni

>Actually an ERG is not likely to find cancer in the eye, an MRI or
>ultrasound would be the test for that.
[quoted text clipped - 5 lines]
>
>Dr Judy
Nishant - 26 Jun 2007 05:23 GMT
> Apparently very rarely a cancer recurrence elsewhere in the body - not
> actually in the eye - can cause changes in the rods or cones of the retina
[quoted text clipped - 19 lines]
>
> >Dr Judy

There are three factors in your history which can lead to progessive
visual loss: History of migraine,breast carcinoma and use of Topamax.
Chronic migraine is a risk factor for development of ischemic optic
neuropathy. you will need to do color vision, visual field examination
and VEP to rule out this possibility
Ocular manifestations due to breast cancer can be ruled out by a
detailed fundus examination, B scan ultrasonography of the eye.
A syndrome consisting of acute myopia associated with secondary angle
closure glaucoma has been reported in patients receiving TOPAMAX.
Symptoms include acute onset of decreased visual acuity and/or ocular
pain. Symptoms typically occur within 1 month of initiating TOPAMAX
therapy. The primary treatment to reverse symptoms is discontinuation
of TOPAMAX as rapidly as possible, according to the judgment of the
treating physician.
Elevated intraocular pressure of any etiology, if left untreated, can
lead to serious sequelae including permanent vision loss.
can u mail details of ur ocular examinations?

regards
Dr Nishant Taneja
Consultant Retinologist
New Delhi
Danni - 26 Jun 2007 15:53 GMT
I don't know exact numbers/details.  The things I do know -

There doesn't appear to be increased pressure in the eye; pressure tests have
been normal.  That actually has seemed strange to me because my eye feels
like it is under pressure and it hurts worse when I have sinus pressure or
when I bend over.

The opthalmologist cannot see any physical abnormalities in the eye with a
regular detailed exam, my vision just continues to deteriorate.  She has not
done a test for my peripheral vision since I don't have insurance and my
peripheral vision doesn't appear to be diminished.

My eyes are also sensitive to light and to air blown on them - just like they
were during chemo only not as bad.  They burn (especially the right one) and
feel heavy or gritty as if they were dry.  My right eye feels that way
constantly; the left one occasionally.  My vision is consistently worse when
I watch TV and sometimes when I'm on the computer.  Being in a car with A/C
blowing or out in the weather causes my eyes to tear a lot and hurt, and my
vision is worse.  They also water excessively for periods of time, most days
but not all - notably when I am putting on eye makeup or when watching TV.
The opthalmologist did a dry eye test at my first visit and it was normal.
She did it again at my next visit and the results showed dry eyes.  However,
I didn't choose to use Restasis - I couldn't afford it and the dryness
doesn't seem to be all that bad to me.

The first indication that something was "off" was at a regular eye exam when
my right eye vision appeared to have developed an astigmatism since my visit
the previous year.  However, when it was rechecked about 10 minutes later the
vision was better.  The optometrist assumed I had rubbed my eye or something
prior to the first reading - though I really didn't think I had.  

Within a few months I could tell my vision in that eye had distinctly changed.
That's when I first went to the opthalmologist - last summer I think.  She
suspected Topomax first.  By then I had been on it about 10 months.  I
wouldn't have noticed early symptoms caused by the Topomax because I was
having such constant, severe migraines and accompanying visual difficulty.  I
went off the Topomax cold turkey (bad idea, but after a week of rebound
migraine I was OK) and there was no change in the vision.  It continued to
worsen.

Another weird thing I have wondered about - when I was on chemo my port was
on the right side of my chest.  My port developed a blood clot but it wasn't
bad enough to completely block the catheter so they continued to use it.
However, after every infusion I felt like I had a whole bag of fluids
backlogged in my right chest, shoulder, neck and head.  Over the course of
treatment the smaller blood vessels on my right chest, upper arm, neck, and
right side of my face became enlarged and they are very visible.  After
treatment, the catheter developed a leak and the port was removed.  However,
the site of my port -- right chest, shoulder, neck and right side of my head
still ache and hurt a lot.  The right side of my chest appears to have lost
most of the muscle/fat tissue - but that could be an affect of the double
mastectomy I had.  The tissue loss has been gradual - it wasn't there
immediately after the mastectomy.  I have wondered if the eye difficulty
could be connected.  I just don't know how that could be.

The severity also varies.  Some days are worse or better - though the vision
in my right eye never completely clears.  Today is a worse day and the whole
right side of my head hurts -- it will turn into a migraine within a few
hours if I can't stop it.  Today both eyes are blurry.

-- Danni

>There are three factors in your history which can lead to progessive
>visual loss: History of migraine,breast carcinoma and use of Topamax.
[quoted text clipped - 18 lines]
>Consultant Retinologist
>New Delhi
Anon E. Muss - 27 Jun 2007 06:08 GMT
>Apparently very rarely a cancer recurrence elsewhere in the body - not
>actually in the eye - can cause changes in the rods or cones of the retina
[quoted text clipped - 3 lines]
>exclude the possibility.  However, since I don't know of any other realistic
>possible causes I'm worrying myself sick.  ;-)  

It's called "cancer associated retinopathy", and it is extremely rare.
So rare that retinal oncologists see about 1 case a year on average,
maybe.  Probably happens more often than it gets diagnosed.

If you have some weird progressive vision loss your doctors are trying
to work up but have got them scratching their heads, then it makes
perfectly good sense that they would want to perform
electrodiagnostics (EOG/ERG).

Usually, that is done after the more traditional tests like a
comprehensive eye examination, color vision, threshold perimetry,
fluorescein angiography, neuroimaging, etc. are done.
p.clarkii@gmail.com - 26 Jun 2007 13:05 GMT
> I have an ERG scheduled for 7/10.  My vision has been dramatically
> deteriorating for about 1.5 yrs.  That's how long it's been since I noticed
[quoted text clipped - 29 lines]
>
> -- Danni

The ERG is a crude measure of the electrical activity of the retina.
certain peaks and troughs in the waveform of the ERG are considered to
be caused by different cell types in the retina.  It is not used very
often, but when it is, it is usually used to diagnose retinal
dystrophies.  It is analogous to the EKG which measures electrical
activity in the heart.

http://www.e-advisor.us/ERG/index.php
http://www.medhelp.org/lib/retinit.htm
http://www.medicinenet.com/electroretinography/article.htm
Kisame Hoshigaki - 26 Jun 2007 18:52 GMT
On Jun 26, 1:05 pm, p.clar...@gmail.com wrote:
> The ERG is a crude measure of the electrical activity of the retina.
> certain peaks and troughs in the waveform of the ERG are considered to
> be caused by different cell types in the retina.  It is not used very
> often, but when it is, it is usually used to diagnose retinal
> dystrophies.  It is analogous to the EKG which measures electrical
> activity in the heart.

Wow, cool!

You mean there is electricity running through my retina!?
spammer - 27 Jun 2007 01:43 GMT
On Jun 26, 1:52 pm, Kisame Hoshigaki
<absolutelyinvinci...@hotmail.com> wrote:
>  It is analogous to the EKG which measures electrical
> activity in the heart.
>
> Wow, cool!
>
> You mean there is electricity running through my retina!?

No, brain death shows no electrical activity.  :)
Mike Tyner - 27 Jun 2007 01:55 GMT
"Kisame Hoshigaki" <absolutelyinvincible@hotmail.com>

> Wow, cool!
>
> You mean there is electricity running through my retina!?

It isn't exactly an electric current. It's a wave of depolarization running
along the nerve fibers, generating a tiny electromagnetic field that can be
read as voltage, in the microvolt range.

-MT

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