In this study, we more closely examined the shape and properties of the electrically evoked responses to compare them to the light-evoked responses. We considered two electrode configurations and found that the location of the stimulation reference is important and has an impact on the activation of the visual system. Although many studies have tested the efficacy of electrical stimulation, to our knowledge, no studies have systematically compared EEPs with VEPs. We demonstrated that if a single stimulation electrode is placed on the cornea, the EEP comes from the retina, and the current most likely flows through the entire visual system
42; searching the literature, we found very few reports providing insight on the information processing evoked by various single electrical impulses. Based on data presented in our current article and the literature,
25,33 electrical stimulation can evoke different responses using different electrode montages (transcranial versus transcorneal or transorbital).
9,48,50–52 Ideally, to positively affect vision, we expect to stimulate the visual system electrically in a manner most similar to the natural way of light stimulation, but with enhanced healing properties.
9,46 While designing the electrical stimulation paradigms, we must consider the effect of electrode placement, the spatial range of the current, and the strength of the impulse. Such technical considerations, however, are not the only concern. It is also critical to consider the anatomy of the visual system and its responsiveness to various stimuli. In the case of visual stimulation, the light is converted into current in the phototransduction cascade, and processing of the initial stimulus appears one layer after another. In the case of electrical stimulation, we simultaneously stimulate all cells in the neural retina, which we showed as a stronger synchronization (faster processing) in structures upstream in the visual system (SC and VCx). Electrical stimulation omits the sequential processing happening in the retina under native conditions,
53 even if the stimulation field is limited to the eyeball in the eye-eye montage. In the eye–neck montage, there is a more substantial impact on the visual pathways, which may have different functionality, especially if the disease effects have an impact beyond the retina. Knowing how the current flowing from the eye almost simultaneously stimulates other structures in the visual system may be crucial knowledge for the success of any therapy based on electrical stimulation. Thus, as a take-home message from our findings, any transorbital electrical stimulation paradigm should consider the real impact of the electrical field and the affected brain areas in order to deliver therapy in a precise manner.