Pattern visual evoked potentials in the assessment of objective visual acuity in amblyopic children

The aim of this study was to determine the value of pattern visual evoked potentials (PVEP) to five consecutive check size patterns in the assessment of visual acuity (VA) in children. One hundred unilateral amblyopic (study group) and 90 healthy children with best-corrected visual acuity (BCVA) of 1.0 (control group) were planned to be included. PVEP responses to five consecutive check sizes (2°, 1°, 30′, 15′, and 7′) which are assumed to correspond to VAs of 0.1, 0.2, 0.4, 0.7 and 1.0 Snellen lines were recorded in both groups. Eighty-five children in the study group (85.0%) and 74 children in the control group (82.2%) who cooperated well with PVEP testing were included. Normal values for latency, amplitude, and normalized interocular amplitude/latency difference in each check size were defined in the control group. PVEP-estimated VA (PVEP-VA) in the amblyopic eye was defined by the normal PVEP responses to the smallest check size associated with normal interocular difference from the non-amblyopic eye, and was considered predictive if it is within ±1 Snellen line (1 decimal) discrepancy with BCVA in that eye. Mean age was 9.7 ± 1.9 and 9.9 ± 2.2 years in the study and the control groups, respectively. LogMAR (logarithm of minimum angle of resolution) Snellen acuity was well correlated with the logMAR PVEP-VA (r = 0.525, P < 0.001) in the study group. The Snellen line discrepancy between BCVA and PVEP-VA was within ±1 Snellen line in 57.6% of the eyes. PVEP to five consecutive check sizes may predict objective VA in amblyopic children.     

Usefulness of visual evoked potentials in visual acuity examination

Determination of visual acuity by means of VEP is carried out usually by the calculation of the amplitude function response from the value of pattern single element. That purpose is achieved by carrying out several tests of transient VEP performed each time with stimulation, using the pattern of different size of individual elements or changing sweep the following sizes of the pattern single element. Concentration of a patient is necessary during any examination and therefore in clinical practise the second of the listed methods is preferred because of its short duration. Correlation factor of visual acuity, determined by means of VEP and Snellen tests, differs depending on the examined group from about 0.4 to 0.9 and it is the lowest in case of ophthalmological disorders connected with optic nerve. Fixing of VEP optimal parameters when evaluating the visual acuity remains an open matter.     

Pattern visual evoked potentials visual acuity--the evaluation of visual acuity of less than 0.1

PURPOSE: We previously developed a new method for estimating objective visual acuity by means of pattern visual evoked potentials (PVEP). In this study, this method was applied to the evaluation of visual acuity of 0.05 and 0.01. METHODS: Ten subjects with visual acuity of 0.05 and ten normal subjects with visual acuity of 0.01 were examined. The visual acuity of the subjects was decreased step by step by means of plus spherical lenses of increasing power. In the PVEP study, the stimulus consisted of black and white checkerboards with a visual angle of 8 degrees (central stimulus) and a global field with a 5 degrees central circular scotoma (peripheral stimulus), contrast level of 15%, and a frequency of 0.7 Hz. One hundred PVEP responses were averaged per session. We reported that there was a linear relation between log subjective visual acuity of 0.1-1.0 and log check size of the patterns with PVEP. In reference to that, the check sizes of the patterns were estimated at 66' with visual acuity of 0.05, and 107' with visual acuity of 0.01. Each visual acuity was then used with other check sizes of three patterns. RESULTS: With central stimulus the P100 components of O1, O2, and Oz were recorded with 66' and 82' patterns at visual acuity of 0.05(central stimulus). The P100 components of O1, O2, and Oz were 107', 137' and 161' at visual acuity of 0.01(central stimulus). There was no P100 component at visual acuity of 0.05 and 0.01(peripheral stimulus). CONCLUSION: This method of PVEP is a useful tool as an objective estimation of visual acuity less than 0.1 and is presumed to stimulate preferentially the X retinal ganglion cell to parvocellular pathway.     

视觉诱发电位技术与视力客观评估

对视觉诱发电位技术及其发展历史、现状进行了必要介绍,并结合分析临床法医实践中眼损伤的特点对视觉诱发电位技术在视力评估中的应用进行了综述。     

Visual evoked potentials in children with congenital glaucoma]

Phasic and established visual evoked potentials (VEP) to homogeneous light field and chess patterns were studied in 25 patients (48 eyes) aged 1.5 months to 9 years with different stages of congenital glaucoma and in 114 age-matched healthy children. Patients with almost absolute and far progressed stages of the disease presented with gross changes of VEP to both large- and small-cell chess patterns. In patients with the initial stages of decompensated congenital glaucoma VEP to mostly large-cell chess patterns were altered. These data evidence the usefulness of examining the VEP to stimuli with low spatial frequency for the early detection of congenital glaucoma.     

Pattern visual evoked potentials in cases of ambiguous acuity loss

Thirty patients were referred to our visual evoked potential laboratory with complaints of profound acuity loss in one or both eyes. However, the objective ophthalmologic findings were normal, including pupillary reaction, and anterior segment and fundus examinations. Transient visual evoked potentials to a 2.3-c/deg sinusoidal grating pattern were found to be present in 26 of these 30 patients. Visual evoked potentials may be used as a measure of afferent pathway integrity.     

10-Hz flash visual evoked potentials predict post-cataract extraction visual acuity

Cataract patients suspected of having disease which might interfere with good postoperative visual function were referred for evaluation. Monocular steady-state luminance visual evoked potentials (VEPs) were elicited with closed eyes at a stimulus rate of 10 flashes/sec. VEPs were rated as either normal or abnormal. Patients with normal VEPs were predicted to have an acuity of 6/15 (20/50) or better. Patients with abnormal VEPs were predicted to have acuities of 6/18 (20/60) or worse. Postoperative acuities were determined for all patients who underwent surgery and who had no intraoperative or early postoperative complications. The association of preoperative VEPs and observed postoperative acuities were quantitatively compared by a 2 × 2 contingency table for the 59 eyes which met these criteria. The chi-square was significant (p < 0.001). The overall accuracy of prediction was 76%. Accuracy was 80% for patients with a preoperative acuity of 6/60 (20/200) or better and 75% for those whose postoperative acuity was 6/120 (20/400) or worse. This difference was not statistically significant.Research supported by an unrestricted departmental grant from Research to Prevent Blindness, Inc.     

扫描图形视觉诱发电位在视觉发育期儿童中的应用

背景 扫描图形视觉诱发电位(SPVEP)作为一种客观视功能检测技术,可被用于婴幼儿及合作度较差的成年人的客观视力测定.已有研究显示,振幅-视角对数( A-LogVA)回归方法可提高SPVEP推算视力的准确性. 目的 研究SPVEP在视觉发育期儿童中的应用,并比较两种不同的视力推断方法,即振幅-空间频率(A-SP)回归方法和A-LogVA回归方法在儿童,尤其是弱视儿童客观视力评估中的有效性和准确性.方法 选取3～12岁各种原因所致弱视儿童26例26眼为弱视组,同时选取与弱视组儿童年龄相匹配的正常儿童31人为正常组.检测其最佳矫正LogMAR视力,并使用视觉电生理仪检测SPVEP,选用0.99～12.89 cpd的10个不同空间频率正弦调制水平光栅连续刺激视网膜,结果经离散傅里叶分析后采用A-SP回归方法和A-LogVA回归方法计算SPVEP视力,对检测结果行相关性分析. 结果 在正常组,由A-SP回归方法和A-LogVA回归方法计算所得的SPVEP视力与LogMAR视力的相关系数分别为0.600 (P＜0.01)和0.733(P＜0.01),均数差异有统计学意义(F=113.173,P＜0.01).由A-SP回归方法所测得的SPVEP视力(A-SP视力)与LogMAR视力均数差值的绝对值为0.40±0.02,由A-LogVA回归方法所测得的SPVEP视力(A-LogVA视力)与LogMAR视力均数差值的绝对值为0.26±0.02,A-SP视力与A-LogVA视力均数差值的绝对值为0.14±0.02.在弱视组,由A-SP回归方法和A-LogVA回归方法计算所得的SPVEP视力与LogMAR视力的相关系数分别为0.134(P=0.515)和0.456(P＜0.05),均数差异有统计学意义(F=3.433,P＜0.05).A-SP视力与LogMAR视力均数差值的绝对值为0.07±0.05,A-LogVA视力与LogMAR视力均数差值的绝对值为0.12±0.05,A-SP视力与A-LogVA视力均数差值的绝对值为0.05±0.01.在不同视力段,SPVEP视力存在高估或低估现象. 结论 SPVEP可对正常视力及弱视儿童的客观视力进行评估,且A-LogVA回归方法推断所得客观视力更为准确.     

Measurement of infant visual acuity from pattern reversal evoked potentials

Visually evoked potentials (VEP) were recorded from infants between the ages of 2 and 6 months using a pattern reversal checker-board stimulus. Measurement of the amplitude of the VEP as a function of check size showed a peak at 30′ of arc for 2, 3 and 4 month old infants and at 15′ of arc for 5 and 6 month old infants. Furthermore, extrapolation of a regression line from the peak VEP check size to zero μV to estimate VEP acuity showed that VEP acuity improves from 20/150 at 2 months to 20/20 by 6 months.     

Visual evoked potentials in relation to visual acuity in macular disease

PURPOSE: To investigate how central retinal function contributes to pattern visual evoked cortical potentials (PVECPs), we recorded transient and steady-state PVECPs in patients with macular disease and compared the results with those of patients with optic neuritis. The results were also evaluated for correlation with visual acuity and kinetic perimetric measurements. METHODS: PVECPs to 3 rev/s stimulation (transient) and 12 rev/s stimulation (steady-state) for check sizes 15' and 30' were obtained from all patients and age-matched healthy controls. The peak latency and amplitude of the P100 component of the transient VECP and the amplitudes of the steady-state VECP were measured and evaluated. RESULTS: Patients with macular disease produced significant delay of P100 latency and amplitude attenuation of the steady-state VECP, as compared with healthy subjects. P100 latency delay was less in patients with macular disease than in those with optic neuritis, while the attenuation rate of the steady-state VECP amplitude was similar between groups. Visual acuity was correlated with P100 latency and steady-state VECP amplitude reduction. CONCLUSIONS: Although the delay of latency was less in patients with macular disease than in those with optic neuritis, the electrophysiologic alterations that occur in macular disease demonstrate a potential for diagnostic value at the level of the retina.     

The prognosis of the visual results of treating children with congenital cataracts based on visual evoked potentials

Examination of visual induced potentials on reversible chess-pattern in 46 children with bilateral congenital zonular cataracts before and after surgical intervention has revealed correlation between these potentials and degree of lens opacification. After cataract extraction, positive dynamics of the potentials was observed in case of slightly opacified lenses and was absent in intensive lens opacification. The authors consider it reasonable to use visual induced potentials for prognosticating visual results after surgical treatment of bilateral congenital zonular cataracts, this being of particular importance for early surgical interventions.     

Nonlinearities in binocular visual evoked potentials in children

Evidence is controversial in respect to the optimal conditions in which visual evoked potentials provide an objective measure of binocular visual function, related and unrelated to stereopsis, and there is little emphasis on the type of stimulus that produces facilitation in binocular recording. We investigated the effects of stimulus type (flicker or pattern), contrast, and temporal modulation on facilitation, which was defined as a binocular response greater than sum of monocular responses. Monocular and binocular responses to sinusoidally modulated flicker and grating patterns were recorded in children and Fourier analyzed. The relationship of the fundamental Fourier component for flicker and the second harmonic component for pattern were each examined as function of temporal modulation at two levels of contrast for monocular and binocular visual evoked potentials. Binocular facilitation was found across all conditions for flicker. Data suggest that processing of pattern and flicker has different sites of origin within the visual system. Facilitation in binocular visual evoked potentials also indicates that they are not a result of simple summation of monocular responses, since there appears a nonlinear component to such interaction.     

Subnormal visual acuity in children: prognosis and visual evoked cortical potential findings

Seventy-one children, age 4-12 years, with subnormal visual acuity (VA) in at least one eye (0.7 or less) were examined using visual evoked cortical potentials (VECPs) to pattern-reversal stimulation. Twenty-eight children with squint had mean VA 0.3 in squinting and 0.7 in non-squinting eyes. Thirty-one children had unexplained subnormal VA, mean 0.6. Twelve children with mild unclassifiable fundus abnormalities had mean VA 0.5. In the squinting eyes and the eyes with fundus abnormalities the mean latency of the VECP was significantly prolonged. In squinters the mean amplitude to stimulation of the squinting eyes and to binocular stimulation was significantly reduced. Statistically significant increase in the mean VA was observed in all groups except in the cases with visible fundus abnormalities. There was no statistically significant correlation between VECP parameters and final VA. In conclusion, VA prognosis could not be predicted from VECP data in individual cases.     

Albinism: diagnosis by visual evoked potentials]

BACKGROUND: In albinism the majority of the nerve fibers of the optic nerve originating from an eye are innervating the contralateral hemisphere. As a result of the predominantly monocular innervation of the left and right hemispheres, the unilateral activation of the visual cortex (lateralization) can be detected with visual evoked potentials (VEP). PATIENTS AND METHODS: The VEPs were elicited with pattern onset stimulation. Five channels were recorded (2 channels over the left and right occipital lobe and 1 in the midline). 22 Patients with pendular nystagmus and 15 normal volunteers were examined. 5 of the normal volunteers were also examined with simulated pendular nystagmus (5-10 degrees, 1 Hz). The nystagmus was simulated by a simple galvanometer scanner based optical system. RESULTS: Unilateral activation of the hemispheres (lateralisation) was never detectable by normal volunteers. The lateralization of the VEP was detectable in all patients with oculocutaneous albinism with pattern onset stimulation. CONCLUSION: The pathological crossing of the nerve fibres in the optic chiasm is always detectable in oculocutaneous and ocular albinism with multichannel pattern onset VEP. The lateralization of the VEP is a more sensitive indicator of ocular albinism than other symptoms like macular hypoplasia, hypopigmentation, iris transillumination, nystagmus, reduced visual acuity et cetera.     

Pattern visual evoked cortical potentials predict postoperative visual acuity after cataract surgery in patients with glaucoma

Visual acuity after cataract surgery in patients with glaucoma cannot be predicted accurately. We studied preoperative recordings of pattern visual evoked cortical potentials (PVECPs) to evaluate postoperative vision in patients with glaucoma and cataract. Fifty patients with glaucoma and no cataract and 31 patients with glaucoma and cataract who underwent phacoemulsification were included in this study. Age and P100 component significantly correlated with postoperative visual acuity with multiple linear regression analysis. A significantly greater number of patients with glaucoma, cataract, and a P100 component preoperatively showed a visual acuity of 0.7 or better postoperatively, as compared to those without a P100 component. PVECP before cataract surgery was able to predict postoperative good visual acuity in patients with glaucoma and cataract.