Anna Brouwer

Summary, discussion & future perspectives As we described in the introduction of this thesis, some clinics already use the ERG in the management of birdshot uveitis. To justify this, they refer to the studies that state that the 30 Hz flicker response is helpful to detect an active inflammation, and that it may be used to decide when to taper systemic medication in birdshot uveitis. 20,21 However, these studies were conducted with small sample sizes. Though promising, these findings need to be replicated to be able to conclude that the 30 Hz flicker response is indeed the most sensitive marker and that it should be used for monitoring. Besides for diagnostic purposes (retinal dystrophy, masquerade syndromes, CAR and MAR) and the monitoring of birdshot, there are to our knowledge no other current uses for the ERG in uveitis. The primary aim of this thesis was to describe the retinal function in different types of uveitis and not its use in uveitis management. Therefore, future research is necessary to decide if the ERG has added value in monitoring and treatment decisions in uveitis entities besides birdshot. Still, we can speculate over the usefulness of the ERG in the management of uveitis and speculate what future research is necessary to be able to make claims about its usefulness for uveitis patients. Some ophthalmologists may state that a comparison between the ERG and other tests such as fluorescein angiography (FA), or optical coherence tomography (OCT) needs to be made first in order to prove an added value of the ERG, because such studies are currently lacking. However, neither FA nor OCT is superior over one another; they are complimentary to one another and both are important in the management of uveitis. 22 The same may be true for the ERG. FA and OCT are imaging techniques, whereas the ERG is a functional test which assesses a different aspect of the retina. Therefore, it may be of importance in the management of uveitis. Future studies should investigate the added value of the ERG. Many studies have shown that a persistence of inflammation often leads to a worse visual prognosis. Therefore, it is paramount for ophthalmologists to be able to discriminate between inflammation, or permanent damage due to this inflammation as soon and adequately as possible, because inflammation can be treated. The ERG may play an additional role in identifying such damage, because it is a functional test, rather than an imaging technique. Also, we observed in Chapter 3 that in some patients the ERG could improve. This implies that at least in some patients the ERG can detect damage at a stage when the retinal function can still recover. Because uveitis comprises such a large group of diseases, and many patients are categorized as having uveitis of unknown cause, the ERG may be more useful in some uveitis entities than in others. To determine if there is an additional role for the ERG in the management of uveitis, further research is necessary. An important step to answer this question would be to monitor patients over time. If patients with a prolonged cone b-IT have a worse 165 8