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T.D. France, J.N. Ver Hoeve; Sweep VEP Visual Acuity Testing in a Busy Pediatric Eye Clinic: Clinical Indications and Results . Invest. Ophthalmol. Vis. Sci. 2005;46(13):678.
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Background: The determination of visual acuity is difficult in infants and developmentally delayed children. Sweep VEP visual acuity (sVEP) testing has been used in laboratory settings and found to be an accurate and repeatable method in these patients but it has not been used as a routine method of visual acuity assessment in a clinical setting. Purpose: To review the results of the sVEP as used in a busy pediatric eye clinic. Methods: All children seen by the authors that had a sVEP visual acuity test as part of their pediatric eye exam over a one year period were reviewed. Children were included if they were being seen for the first time and were two years of age or younger, had developmental delays that prevented them from performing the usual visual acuity tests (HOTV, Snellen, etc) or there was a need to determine changes in vision over time such as being treated for amblyopia. 136 patients that had a total of 200 sVEP tests during this time. The pretest (working) diagnosis was compared for each group. The final (post test) diagnosis was then determined based upon the visual acuity findings. Results: One hundred thirty six children, (60 males, 76 females, average age 1.96 years, range 2 months to 17.8 years had a total of 200 sVEP tests over a twelve month period in 2002–03 as part of their pediatric eye examination. This group was subdivided into those patients with and without developmental delays. Eighty–nine patients were considered developmentally normal, 42 males, 47 females, average age 1.96 years, range 2 months to 6.95 years. Pre Test diagnosis for this group (n = 125 tests, some with multiple diagnoses) included strabismus (43), amblyopia (45), cataract (14), neurologic defects (16), high refractive error (12) and the question of visual responses (26). Based on the sVEP acuity, only 19/45 of the suspected amblyopic patients had amblyopia at the time of the testing. Overall, 96/125 (77%) had a normal vision response. Forty eight developmentally delayed patients, 18 males, 30 females, average age 4.0 years, range 4 months to 17.8 years, had a total of 74 sVEP tests. Pre test diagnoses included neurologic deficit (63), poor visual responses (13), amblyopia (15), strabismus (7) and cataract (7). In this group only 35 of 74 (47%) of the tests showed normal visual responses. Conclusions: The sweep VEP visual acuity test can be successfully used in the clinical setting to determine visual acuity in infants and children with developmental delays. Our experience shows that this test can help to determine the presence of normal visual development in these children and to help with the determination of treatment requirements and results.
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