Making Believers out of Skeptics

Matt Young (Media MICE):

Hi, I am Matt Young, CEO of Media MICE. I’m here with Professor Andre Messias to talk about a piece of technology, the RETeval^® ERG from LKC Technologies, that has revolutionized the way he approaches electroretinography.

Dr. Messias, can you briefly explain how you use RETeval?

Professor Andre Messias (University of São Paulo):

RETeval is a handheld device. You use it as any other ERG system. You put your electrodes on the eyes and on the skin and you do the dark adaptation or light adaptation as you used to. You choose the protocol and you run the protocol for the recordings. It is a basic ERG system, but it’s handheld.

Matt Young:

Before you used RETeval, you were a critic of the device. Can you explain why you believed traditional ERG was superior and why or how you changed your mind?

Professor Andre Messias:

What you call a traditional ERG is this system that you’ve been using so far. And they have big amplifiers, they have big stimulators, they are calibrated, they have filters. It’s difficult to imagine that you can put all that development in the small machine. That’s why I’m not critical but I just think that the using the bigger machines, you can have more features in the amplifiers and in the stimulators.

Matt Young:

Now that you’re using RETeval, how does it out add value to your practice?

Professor Andre Messias:

I realized that the RETeval can produce reliable and reproducible responses. It has limitations due to the size and the software and so on, but once you perform it correctly, it is reproducible and has reliable results.

Matt Young:

And how does the device impact patient care and management?

Professor Andre Messias:

The machine allows you to go where the patient is.  If the patient is on the bed, in the surgical theater, or a child that doesn’t allow you to put her in a chin rest, then you can use a handheld machine to approach the patient more easily. You can achieve more and a higher number of patients. You can go where the patients are.

Matt Young:

What are some additional benefits of using the RETeval device?

Professor Andre Messias:

RETeval has been done with skin electrodes, a very fancy electrodes, that you can put on the skin easily and has normative data for these electrodes. And efficacy did a nice piece of work in the software. You have a very flexible software to program your own protocols. You can do clinical ERG, very simple ERG, but you can also do research ERG with it.

Matt Young:

You recently used RETeval in a study you conducted in glaucoma. You found that ERG photopic hill shows promise in the early detection of glaucoma. Could you explain a bit more?

Professor Andre Messias:

The photopic hill is when you don’t use one single stimulus but you use a series of increasing luminance stimulus and then you calculate the interrelation between the stimulus intensity and the B wave amplitude. In doing so some people have shown that some neural neuropathy or some disease of the optic nerve show changes in ERG or in the photopic health. We were interested to find if the glaucoma also showed its differences. And we indeed found that a group of early glaucoma patients have slightly changed photopic hill responses.

Matt Young:

Should ERG be done for all patients?

Professor Andre Messias:

No, of course not. Every test that we perform should be done when we need them, when the doctor says it is important for his purposes. But ERG is the only one objective measurement of the retinal function. If the system allows me to do objective measurement of retinal functions in an easy way, then it would be good for my practices.

Matt Young:

In your opinion, how does the RETeval represent the evolution of ERG?

Professor Andre Messias:

It’s revolutionary because it’s simple. It allows me to perform the ERG wherever I go with the machine and I don’t have to run big protocols. I have to know its limitations and I have to know what it’s for. But it allows me to do a more simple test. When a test is too complicated, it’s difficult for me to perform and to teach and to find people with expertise to analyze the data. If the system comes with a simplified procedure, then it’s easy for me to use it.

Matt Young:

Is there anything else that makes this revolutionary?

Professor Andre Messias:

Yes, they have good skin electrodes, they have a good system for doing the ERG with small preview, and they have a very solid normal database.

Matt Young:

Finally, why is this change in approach to ERG testing so important?

Professor Andre Messias:

It is important because so far, the ERG has been very difficult to be perform. It requires a long training and long studies to understand the ERGs and to perform it. They invested in a way of simplifying the test for it to be more available for people that are not the experts in the electrophysiology. In this way simplifying the test should be a good way to turn it more accessible.

Matt Young:

Professor Macias thanks so much for joining us to talk about this important topic today.

Professor Andre Messias:

Thank you very much, thank you.