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Elettrofisiologia oculare
È una disciplina diagnostica che utilizza test non invasivi per studiare i fenomeni elettrici associati a processi fisiologici come la visione e l’attività cerebrale. Esplorando la funzionalità delle strutture visive e le eventuali patologie, è per l’occhio ciò che l’elettroencefalogramma rappresenta per il cervello o l’elettrocardiogramma per il cuore.
Lo studio elettrofisiologico valuta diverse funzioni visive avvalendosi di esami specifici. È molto utile per differenziare l’origine delle patologie visive: è possibile, con questo esame, individuare difetti della retina, delle vie ottiche o del cervello. La principale applicazione clinica è rappresentata dall’identificazione delle malattie del nervo ottico e dalla localizzazione di eventuali alterazioni. Inoltre, il loro utilizzo è indispensabile per monitorare lo sviluppo delle vie ottiche nei prematuri e nei pazienti con disturbi cerebrali.
Gli esami che vengono effettuati sono: elettroculogramma (EOG), elettroretinogramma (ERG), potenziali evocati visivi (PEV) e l’elettroretinogramma da pattern (PERG).
(EOG) è un esame elettrofisiologico che viene eseguito per valutare la funzionalità dell’epitelio pigmentato retinico (ossia il primo dei dieci strati che formano la retina)..
(ERG) è un esame elettrofisiologico con cui si misura l’attività della retina dopo la stimolazione con flash luminosi.
Cosa permette di misurare?
L’esame permette al medico di valutare se il difetto è nei coni (fotorecettori retinici che permettono la visione centrale a colori), nei bastoncelli (fotorecettori attivi specialmente ai margini del campo visivo e a bassi livelli di luminosità ) oppure nelle cellule di Müller (che hanno funzioni nutritive per la retina) nonché nelle cellule bipolari (che connettono i coni e i bastoncelli con le cellule ganglionari che formano il nervo ottico).
L’ERG focale (FERG) è eseguito dopo la dilatazione farmacologica delle pupille. L’esame ha una durata di un’ora. Vengono posti degli elettrodi cutanei sulla cute e sulla superficie dell’occhio dopo aver instillato un collirio anestetico; essi registrano l’attività centrale della retina indotta da stimoli visivi, quali barre verticali bianche e nere nonché flash luminosi di varia intensità e frequenza.
Cosa sono i PEV e PERG?
Potenziali evocati visivi (PEV).
esame neurofisiologico che misura la trasmissione dell’impulso nervoso lungo le vie ottiche, dove la conduzione nervosa appare frequentemente rallentata nella SM, soprattutto a livello del nervo ottico.
L’elettroretinogramma evocato da uno stimolo flash è un esame elettrofisiologico in uso da molti anni per indagare la funzionalità degli strati retinici più esterni.
Al fine di valutare l’attività delle cellule degli strati retinici più interni ed in particolare delle cellule ganglionari sono state sviluppate tecniche di registrazione di elettroretinogramma evocato da uno stimolo strutturato o PERG.
Quando sono richiesti?
Gli esami elettrofisiologici sono considerati dei test che permettono una diagnosi obiettiva. Possono anche essere utilizzati proficuamente nei pazienti in età infantile per studiare lo sviluppo dell’apparato visivo