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V.C. Greenstein, X. Zhang, B. Wangsupadilok, R. Ritch, J. Liebmann, T.M. Grippo, D.C. Hood; Detecting and Monitoring Progression of Visual Field Defects In Glaucoma Suspects with the mfVEP: A Longitudinal Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4007.
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To determine whether the multifocal visual evoked potential (mfVEP) can detect visual field defects and progression in glaucoma suspect (GLS) eyes with normal achromatic perimetry results.
69 GLS eyes of 39 patients were followed for 1–3 yrs. The criteria for GLS included vertical cup–disc ratio>=0.6, and/or disc asymmetry>=0.2, and/or a parapapillary nerve fiber layer defect, and/or focal disc notching, and/or disc hemorrhage. All eyes had normal achromatic perimetry, as defined by a PSD within 95% and a glaucoma hemifield test within normal limits on the Humphrey visual field 24–2 program. Monocular mfVEPs were obtained from each eye using a pattern–reversal dartboard array, 44.5 deg in diameter, and containing 60 sectors. Recording electrodes were placed at the inion (I) and I+4 cm, and also at two lateral locations up 1 cm and over 4 cm from I. Monocular and interocular analyses were performed [1,2]. For the mfVEP, a hemifield was defined as abnormal based on the following cluster test [3,4]: if 2 or more contiguous points had p<0.01, or 3 or more contiguous points had p<0.05 with at least one of these points with p<0.01. An eye was defined as abnormal if either one or both hemifields had a cluster of abnormal points. Progression was defined as an addition of a new cluster and/or expansion (more abnormal points) of an existing cluster.
Of the 69 GLS eyes, 14 eyes (20%) had abnormal mfVEPs on the first visit. On follow–up, 10 of these eyes retained their abnormal mfVEP hemifields with 4 showing progression, all had normal achromatic perimetry. Of the 55 eyes (80%) without a deficit, 49 (71%) remained stable and 6 (8%) developed clusters of abnormal points at follow–up.
The mfVEP can detect field defects in GLS eyes that are not detected by achromatic automated perimetry. The mfVEP also detects progression of the deficits. Ref: 1.Hood et al (2002) Arch Ophthalmol. 2.Hood and Greenstein (2003) Prog Ret Eye Res. 3.Chauhan et al (1998) Doc Ophth 4. Goldberg et al (2002) Am J Opthalmol.
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