Clinical Application of Objective Perimetry Using Multifocal Visual Evoked Potentials in Glaucoma Practice

Abstract

Objectives: To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method: A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (Ob-jectiVision Pty, Ltd, Sydney, New South Wales, Australia) within a defined 12-month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed. Results: The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r=0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0%), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6%) and Humphrey visual field results (81.9%) were similar, but mVEP specificity was better (89.2% vs 79.5%). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture. Conclusions: Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.

Retinotopic organization of primary visual cortex in glaucoma: Comparing fMRI measurements of cortical function with visual field loss

“…A number of studies have demonstrated an ability to detect glaucomatous damage using multifocal visual evoked potentials (mfVEP) (Klistorner et al, 1998;Graham et al, 2000;Hood et al, 2000;Hasegawa et al, 2001;Goldberg et al, 2002;Hood and Greenstein, 2003;Thienprasiddhi et al, 2003;Hood et al, 2004;Graham et al, 2005), positron emission tomography (PET) (Kiyosawa et al, 1989), and single photon emission computed tomography (SPECT) Yoshida et al, 2006). Each technique has its limitations.…”

Objective Assessment of Local Retinal Function by Focal Macular and Multifocal Electroretinograms

“…Scotomas can be identified, and field defects in glaucomatous optic neuropathy and optic neuritis have been well defined. (Klistorner et al, 2000;Hood et al, 2000Hood et al, , 2003Hood et al, , 2004Goldberg et al, 2002;Graham et al, 2005) The mfERGs and multifocal visual evoked potentials (mfVEPs) recorded from a patient who developed an acute visual field loss after vitrectomy are shown in Figure 13. (Shinoda et al, 2000) The patient had undergone uncomplicated vitrectomy for a long-lasting vitreous hemorrhage associated with proliferative diabetic retinopathy.…”

Effect of Recording Duration on the Diagnostic Performance of Multifocal Visual-evoked Potentials in High-risk Ocular Hypertension and Early Glaucoma

“…2,11,13,19 and in glaucoma suspect eyes with completely normal SAP VFs. 4,5,9,14,18,19 Longitudinal follow-up should reveal whether such mfVEP defects represent greater sensitivity of the mfVEP to detect early functional loss, or alternatively, a higher false alarm rate. Meanwhile, cross-sectional studies have found that the diagnostic performance of mfVEP and SAP are similar when an independent diagnostic standard is applied (eg, one based on optic disc structure).…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Although most of these studies have demonstrated close agreement between mfVEP and standard automated perimetry (SAP), some have shown that mfVEP abnormalities appear in regions (eg, hemifields) of the VF that have normal sensitivity on SAP, 2,11,13,19 and in glaucoma suspect eyes with completely normal SAP VFs. 4,5,9,14,18,19 Longitudinal follow-up should reveal whether such mfVEP defects represent greater sensitivity of the mfVEP to detect early functional loss, or alternatively, a higher false alarm rate. Meanwhile, cross-sectional studies have found that the diagnostic performance of mfVEP and SAP are similar when an independent diagnostic standard is applied (eg, one based on optic disc structure).…”

“…Meanwhile, cross-sectional studies have found that the diagnostic performance of mfVEP and SAP are similar when an independent diagnostic standard is applied (eg, one based on optic disc structure). 14,18 The mfVEP test duration, however, can be considerably longer than SAP, particularly when the Swedish Interactive Thresholding Algorithm (SITA) is used as the SAP test strategy 20 and two 8-minute mfVEP recordings are acquired for each eye, as in many previous studies (eg, Ref. 18 ).…”