Purchase this article with an account.
B. Fortune, S. Demirel, X. Zhang, D.C. Hood, E. Patterson, A. Jamil, S.L. Mansberger, G.A. Cioffi, C.A. Johnson; Comparison Between Multifocal Visual Evoked Potentials (mfVEP) and Standard Automated Perimetry (SAP) in High–Risk Ocular Hypertension and Early Glaucoma . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1126.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To compare the diagnostic performance of mfVEP and SAP in eyes with high–risk ocular hypertension or early glaucoma.
185 individuals with high–risk ocular hypertension or early glaucoma ranged in age from 37 to 87 (mean ± SD: 61 ± 11 yrs). Pattern–reversal mfVEPs were obtained using VERIS, a 4–electrode array, and analyzed with custom software.1 SAP visual fields were obtained using the SITA–standard threshold algorithm within 22.3 (± 27) days of the mfVEP. Abnormalities on the mfVEP were defined using a variety of cluster criteria.2 Abnormalities on SAP were defined as pattern standard deviation (PSD) p < 0.05 or GHT ONL (OHTS criteria). A stereophotograph of each optic disc, taken within 19 (± 27) days of the mfVEP, was graded as either glaucomatous (GON) or normal (N) by two independent masked experts, disagreements were adjudicated by a third masked expert. Sensitivity for mfVEP or SAP was defined as the % of GON eyes that had an abnormality on the functional test. Specificity was defined as the % of N eyes that had a normal functional test.
Disc photos from 50% of eyes were graded GON. In 71 subjects (38%) both eyes were graded GON. The average SAP mean deviation (MD) was 0.3 ± 2.1 dB (range +3.9 to –10.1 dB); average PSD was 2.3 ± 1.9 dB (range 1.0 to 16.1 dB). By OHTS criteria, 83 eyes (22%) had an abnormal SAP. The abnormality rate for mfVEP ranged from 14 to 45%, depending on the cluster criterion used. Using a criterion with a specificity2 of 90%, 102 eyes (28%) had an abnormal mfVEP. For criteria with specificities of 95% and 98.5%, respectively, 88 eyes (24%) and 52 eyes (14%) had an abnormal mfVEP. Concordance between SAP and mfVEP ranged from 75 to 81%. Sensitivity of SAP to detect GON, using OHTS criteria, was 29%, while specificity was 84%. Sensitivity of the mfVEP to detect GON, for cluster criteria with specificity between 84 and 87%, ranged from 28% to 32%.
The mfVEP and SAP performed in a similar manner. However, they agreed in only ∼80% of eyes, suggesting that they may detect slightly different deficits. The diagnostic performance of both SAP and the mfVEP were relatively poor when GON was used as a reference standard. This suggests that structural and functional abnormalities do not correlate well in early glaucoma, and questions use of one as a reference standard for the other.  Hood & Zhang 2000  Fortune et al. 2004
This PDF is available to Subscribers Only