Clinical S-cone ERG recording with a commercial hand-held full-field stimulator

Our purpose was to explore S-cone ERG protocols for a commercial full-field hand-held stimulator that contains colored LEDs, and to see whether the test would be useful as a part of routine ERG testing. S-cone responses were elicited by blue flashes over a longer-wavelength background. With the standard stimulator containing blue (461 nm), green (513 nm) and red (652 nm) LEDs, we were unable to obtain satisfactory responses. Reproducible S-cone ERGs were obtained with a stimulator that had been custom-fitted with shorter-wavelength blue (440 nm) LEDs for stimulation, and orange (590 nm) LEDs for background adaptation. S-cone responses took only a few minutes to record, and the typical waveform showed a slow peak at 45-50 ms with amplitude 3-9 μV, but ranging from 0 μV to more than 10 μV. Larger waves appeared in a patient with enhanced S-cone syndrome. S-cone responses could also be obtained with an alternating blue-orange flicker protocol. We added the S-cone response to our regular ERG protocol for a number of months. Although most normal subjects and patients showed recognizable S-cone responses with this stimulator, the amplitudes were small and there was too much variability to make the technique effective for routine clinical testing. In general, the S-cone responses followed the standard cone ERG responses in disease.