April 2010
Volume 51, Issue 13
ARVO Annual Meeting Abstract  |   April 2010
Selective Stimulation of Non-Redundant Pathways Enhances the Detection of Glaucoma Using Multifocal Vep
Author Affiliations & Notes
  • A. Klistorner
    Dept Ophthalmology, Sydney University, Sydney, Australia
  • H. Arvind
    Dept Ophthalmology, Sydney University, Sydney, Australia
  • J. Grigg
    Dept Ophthalmology, Sydney University, Sydney, Australia
  • S. L. Graham
    Ophthalmology and Visual Science, ASAM Macquarie University Sydney, Sydney, Australia
  • Footnotes
    Commercial Relationships  A. Klistorner, Sydney University, P; H. Arvind, None; J. Grigg, None; S.L. Graham, Sydney University, P.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 5489. doi:
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      A. Klistorner, H. Arvind, J. Grigg, S. L. Graham; Selective Stimulation of Non-Redundant Pathways Enhances the Detection of Glaucoma Using Multifocal Vep. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5489.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : In a recent study, we demonstrated superior performance of Blue-on-Yellow pattern-onset multifocal VEP in identifying glaucomatous visual field defects as compared to black and white pattern-reversing checkerboard stimulation. We hypothesized that Blue-on-Yellow stimulation specifically targets non-redundant koniocellular visual pathways, enhancing identification of early losses. Current study was aimed at investigating comparative sensitivity of various pathways using temporally similar (pattern-onset) stimulus presentation technique.

Methods: : 23 patients with early perimetrically proven glaucoma (MD < 6 dB, repeatable defects) underwent mfVEP using three different pattern-onset stimulation conditions: high (98%) luminance contrast achromatic (HC), low (50%) luminance contrast achromatic (LC) and Blue-on-Yellow (BonY) stimulation to preferentially stimulate parvocellular, magmocellular and koniocellular pathways respectively. The order of tests was randomized. Normal database (30 healthy subjects) was constructed for each test condition.

Results: : The HVF identified scotomas in 28 eyes of the 23 patients. 21 of the scotomas were identified by HC mfVEP (75%), 26 were identified by BonY (93%) and all 28 (100%) by LC mfVEP. Comparison of defect severity using Accumap Severity Index (ASI) demonstrated largest averaged value for LC (62.7 + 28.5), followed by BonY (56.5 + 28.8) with HC showing less abnormality (41.5 + 31.5). ANOVA revealed significant differences between the groups, with LC and BonY ASI values significantly larger than HC (p<0.001 and p<0.01 respectively), but no significant difference between LC and BonY (p=0.16).

Conclusions: : Both BonY and LC achromatic mfVEP performed significantly better than HC pattern-onset stimulation in identifying early glaucomatous defects. Enhanced performance of BonY and LC may be attributed to non-redundancy of the koniocellular and magnocellular pathways.

Keywords: electrophysiology: clinical 

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