Electroretinographic Patterns of Retinitis Pigmentosa in a Palestinian Cohort: A Clinical and Functional Characterization

Retinitis pigmentosa (RP) is a progressive rod–cone dystrophy and the most common inherited retinal disease worldwide. Electroretinography (ERG) provides an objective measure of retinal function and is essential for staging severity and guiding therapy. However, ERG data from Middle Eastern populations remain limited. In this cross-sectional study, 71 Palestinian patients with clinically confirmed RP underwent full-field ERG (ffERG) using ISCEV 2022 standards. Responses were classified into mild, moderate, and severe categories. Clinical variables including age, disease duration, best-corrected visual acuity (BCVA), and optical coherence tomography (OCT) findings were analyzed. Severe ERG loss was present in 40.8% of patients and was strongly associated with longer disease duration and reduced visual acuity. Disease duration showed a robust negative correlation with rod-specific DA 0.01 b-wave amplitude (r = − 0.95, p < 0.0001), confirming its value as a marker of progression. In contrast, BCVA and OCT-derived central macular thickness correlated poorly with ERG measures, underscoring the functional–structural dissociation in RP. Genetic testing (35.2% of cases) identified mutations in RPGR, RHO, USH2A, CRB1, and others. These findings establish baseline ERG profiles for Palestinian RP patients, support ERG-based severity grading, and emphasize the importance of electrophysiology for diagnosis, prognostic counseling, and therapeutic eligibility in underrepresented populations.