The Role of the Flash Visual Evoked Potential in Evaluating Visual Function in Patients with Indirect Traumatic Optic Neuropathy

Mohammed, Mai; Mossallam, Ehab F; Allam, Ibrahim Y

doi:10.2147/opth.s301107

Cited by 9 publications

(10 citation statements)

References 17 publications

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“…In our study, young male patients were found with greater percentages of involvement, which is in concordance with the previous findings in indirect TON [ 4 , 25 ]. Among the demographic variables, age (>40 years) was found to be associated with poor visual outcomes.…”

Section: Discussionsupporting

confidence: 93%

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Prognosticators for Visual Outcome in Indirect Traumatic Optic Neuropathy: A Prospective Cohort Study

Gupta¹,

Tripathi²,

Gupta³

2023

Cureus

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IntroductionTraumatic optic neuropathy (TON), with indirect TON as its more prevalent form, is a dreadful cause of severe visual dysfunctions. The condition is known to have a contentious treatment plan and poor visual sequelae; hence, the assessment of prognostic signs becomes valuable. Prospective studies evaluating important predictors of visual recovery after traumatic optic nerve injury can particularly be helpful in a longitudinal observation. The possible roles of clinical variables need to be assessed. Absent visual evoked potential (VEP) records as a crucial finding associated with TON has reportedly valuable prognostic significance. This also needs to be explored. Hence, the study sought to determine the role of prognosticators in the visual outcome of the patients, with a focus on evaluating the role of VEPs in the severity and prognosis of indirect TON. MethodsA prospective observational study involving 40 patients with indirect TON was conducted. Ocular, neuroophthalmological, radiological, and neurophysiological variables, including flash VEP, were investigated at their initial visit and followed up until the end of six months. Final visual acuity was the primary outcome variable studied. Paired t-test was used to perform the comparison between the flash VEP variables for normal and affected eyes at the initial visit. Pearson correlation coefficient was computed for obtaining the association of initial visual acuity and flash VEP variables with the outcome variable. Relative risk was calculated and analysed for the prognosticators in univariate analysis. Statistical significance was defined as p < 0.05. ResultsStatistically significant variations in mean P100 latency, N75-P100, and P100-N145 amplitudes compared between normal and affected eyes in the patients at the initial visit were obtained (p < 0.0001; paired t-test). Pearson correlation coefficient for initial visual acuity and flash VEP variable as independent variables and final visual acuity as the dependent variable were statistically significant (p < 0.05). The relative risks for prognosticators with a statistically significant range of confidence intervals were poor initial visual acuity, greater relative afferent pupillary defect (RAPD) grades, deranged flash VEP variables (absent VEP, reduction in amplitude ratio (>50%), and increased interocular latency differences), loss of consciousness during injury, age greater than 40 years, and lack of improvement after 48 hours of steroid treatment. ConclusionThe identified negative prognosticators may be helpful in deciding the kind of therapeutic approach and predicting the visual outcome in patients with indirect TON.

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Section: Discussionsupporting

confidence: 93%

“…Flash VEP has been reported to have high predictive value in TON in recent studies [ 17 - 19 , 25 ]. The present study also analysed the VEP variables to assess their role as a prognosticator.…”

Section: Discussionmentioning

confidence: 99%

Prognosticators for Visual Outcome in Indirect Traumatic Optic Neuropathy: A Prospective Cohort Study

Gupta¹,

Tripathi²,

Gupta³

2023

Cureus

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“…Conventional PVEP and FVEP can be used for visual function evaluation, which can reflect the light sensitivity of the entire retinal optic nerve, including coarse incoming fibers from the peripheral retinal area and fine incoming fibers from the macula. The application of PVEP and FVEP in various studies, including optic nerve diseases, has been widely reported 14 , 15 . Furthermore, when accompanied by opacities in the ocular media, the role and significance of FVEP in the diagnosis and evaluation of visual function can be further demonstrated 16 , 17 .…”

Section: Discussionmentioning

confidence: 99%

SSFVEP as a potential electrophysiological examination for evaluating visual function of fundus diseases with vitreous hemorrhages: a clinical study

Yan,

He,

Chen

et al. 2024

Sci Rep

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To investigate the sensitivity and potential application of steady-state flash visual evoked potentials (SSFVEP) in assessing the visual function of fundus diseases with vitreous hemorrhage. 18 patients diagnosed with monocular vitreous hemorrhages in the fundus were examined the flash visual evoked potentials (FVEP) and SSFVEP in both eyes. The difference in the P2-wave amplitude of FVEP and the average amplitude of SSFVEP waveform between the diseased eyes and those without vitreous hemorrhage were statistically compared. There was no significant difference in the waveform of FVEP between both eyes. The amplitude of P2-wave from FVEP of the diseased eye was slightly lower than that without vitreous hemorrhage. However, the difference was not statistically significant (P = 0.111). The waveform of SSFVEP in the eye without vitreous hemorrhage showed a towering shape, while that of the diseased eye was flat. The average amplitude of SSFVEP in the diseased eye was statistically lower than that without vitreous hemorrhage (P = 0.036). The difference ratio of SSFVEP amplitude between both eyes was significantly greater than that of FVEP amplitude (P = 0.028). In some fundus diseases with vitreous hemorrhage, SSFVEP had a higher sensitivity than FVEP, providing a novel potential application for visual function assessment.

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“…Clinically, the Ocular Trauma Score is a tool used to predict functional outcome after eye injury 39 and has been validated in patients with major trauma 4 , however its parameters include initial visual acuity and presence of afferent pupillary defect, which are challenging to ascertain in patients with impaired cognition, and periorbital swelling respectively 9 . For cases of suspected ocular nerve trauma, ash visually evoked potentials have also been used to assess nerve function in these patients and are highly predictive of nal visual outcome 40 .…”

Section: Discussionmentioning

confidence: 99%

Trends in ocular injuries among major trauma patients in England and Wales from 2004 to 2021

Bashir,

Bouamra,

Kirwan

et al. 2023

Preprint

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Background Ocular trauma is a major cause of vision loss and injuries are often missed in multiply injured patients. Major trauma demographics in the UK have changed but no contemporary studies report ocular injuries in this cohort. We aimed to investigate ocular injury epidemiology and trends amongst major trauma patients in England and Wales from 2004–2021. Methods A retrospective analysis of prospectively collected Trauma Audit and Research Network (TARN) registry data was conducted. Major trauma was defined as injury severity score > 15, and ocular injuries were identified using AIS codes. Demographics, injury profiles, and outcomes were extracted. Descriptive statistics and 3-yearly trend data are reported. Results Of 287 267 major trauma cases, 2368 (0.8%) had ocular injuries, decreasing significantly from 1.87% (2004/06) to 0.66% (2019/21) (P < 0.0001). Males comprised 72.2% and median age was 34.5 years which increased (p < 0.0001). Road traffic collisions declined from 43.1–25.3% of ocular injury cases while falls increased and became the predominant mechanism (37.6% in 2019/21). Nonaccidental injuries increased from 15% (2004/06) to 26.5% (2016/18) (p < 0.0001). Concomitant head injury was present in 86.6% of cases. Ophthalmic procedures increased from 1.2% (2004/06) to 5% (2019/21) (p < 0.0001). Compared to previous TARN data, retinal injuries increased 3-fold to 18.6% and corneal injuries decreased from 31–6.6%. Conclusions Identifying sight-threatening injuries in polytrauma is challenging. Ocular injury epidemiology has changed significantly, though overall incidence is low. These findings may inform guideline development, resource allocation, and training priorities.

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The Role of the Flash Visual Evoked Potential in Evaluating Visual Function in Patients with Indirect Traumatic Optic Neuropathy

Cited by 9 publications

References 17 publications

Prognosticators for Visual Outcome in Indirect Traumatic Optic Neuropathy: A Prospective Cohort Study

Prognosticators for Visual Outcome in Indirect Traumatic Optic Neuropathy: A Prospective Cohort Study

SSFVEP as a potential electrophysiological examination for evaluating visual function of fundus diseases with vitreous hemorrhages: a clinical study

Trends in ocular injuries among major trauma patients in England and Wales from 2004 to 2021

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