Flash Visual Evoked Potentials Predict Visual Outcome in Traumatic Optic Neuropathy

Holmes, Mark; Sires, Bryan S.

doi:10.1097/01.iop.0000134272.55294.4c

Cited by 43 publications

(39 citation statements)

References 9 publications

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“…Both pattern reversal and flash VEP testing have been described as accurate in predicting VA in the literature 36,37 with a reduction of amplitude and latency in the flash VEP being of particular importance. 37 The presence as well as amplitude of VEP has been demonstrated to be predictive of long-term outcome. When the VEP is absent, recovery of vision is unlikely.…”

Section: Discussion Investigationmentioning

confidence: 99%

“…[37][38][39] In another study investigating ON regeneration following intravitreal implantation of a peripheral nerve graft in rats, Mn(2 þ )-enhanced MRI (MEMRI) and DTI findings were correlated with immunohistochemical evidence of axon regeneration. 40,41 Several studies have employed optical coherence tomography (OCT) to document thinning of the retinal nerve fiber layer (RNFL) following trauma to the ON.…”

Section: Discussion Investigationmentioning

confidence: 99%

“…The positive effects observed included improved microcirculation, energy metabolism, postinjury histology, and functional outcomes. 2,8,37 In addition, the ability of steroids to reduce swelling and their antioxidant properties have been postulated to be of benefit. 51 Though promising, these initial studies were anecdotal and inadequate as they were nonrandomized, retrospective, and did not have controls making it difficult to draw conclusions.…”

Section: Medicalmentioning

confidence: 99%

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Traumatic Optic Neuropathy: A Review

Kumaran

Sundar

Chye

2015

Craniomaxillofacial Trauma & Reconstruction

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The aim of this article is to evaluate current literature on investigation and management of traumatic optic neuropathy (TON), propose recommendations for diagnosis and management, and explore novel future treatments. TON, though uncommon, causes substantial visual loss. Without clear guidelines, there is much ambiguity regarding its diagnosis and management. Investigation and treatment (conservative, medical, surgical, and combined) vary widely between centers. Electronic databases PubMed, MEDLINE, PROSPERO, CENTRAL, and EMBASE were searched for content that matched "Traumatic optic neuropathy." Articles with abstracts and full text available, published in the past 10 years, written English and limited to human adults, were selected. All study designs were acceptable except case reports and case series with fewer 10 patients. All abstracts were then evaluated for relevance. References of these studies were evaluated and if also relevant, included. A total of 2,686 articles were retrieved and 43 examined for relevance. Of these, 23 articles were included. TON is a clinical diagnosis. Visual-evoked potential is useful in diagnosis and prognosis. Computed tomography demonstrates canal fractures and concomitant injuries. Magnetic resonance images should be reserved for select and stable patients. Conservative treatment is appropriate in mild TON. Steroids are of questionable benefit and may be harmful. Surgery should be reserved for patients with radiological evidence of compression and individualized.

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Section: Discussion Investigationmentioning

confidence: 99%

Section: Discussion Investigationmentioning

confidence: 99%

Section: Medicalmentioning

confidence: 99%

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Traumatic Optic Neuropathy: A Review

Kumaran

Sundar

Chye

2015

Craniomaxillofacial Trauma & Reconstruction

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“…The use of flash VEP may be regarded as a better tool for patients with poor vision, but in our series no patients had visual acuity of LP, and all patients with NLP vision had unrecordable PVEPs. However, in a study of the value of VEP in patients with ITON, Holmes and Sires (2004) reported their results with flash VEPs in 11 patients, in which they were obtained only once within 72 h of admission. In 4 patients who had NLP and 1 with 20/400 vision, no amplitude was detected.…”

Section: Discussionmentioning

confidence: 96%

Levodopa-Carbidopa May Improve Vision Loss in Indirect Traumatic Optic Neuropathy

Razeghinejad

Rahat

2010

Journal of Neurotrauma

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To compare the effect of levodopa-carbidopa on the visual outcome of patients with indirect traumatic optic neuropathy (ITON), this randomized, double-blind, placebo-controlled study was conducted on 32 patients with ITON within 6 days after trauma. Patients underwent a complete ocular examination, pattern visual evoked potential (PVEP) testing, and high-resolution orbital computed tomography (CT) scanning. All patients received high-dose intravenous methylprednisolone, and levodopa was also administered to the levodopa group. The main outcome measures were best corrected visual acuity and PVEP results at the last-completed examination. The study was completed on 16 patients in the levodopa group and 10 patients in the placebo group because the others were lost to follow-up. There were no statistically significant differences for age, sex, involved eye, ocular and CT scan findings, pretreatment visual acuity, frequency of recordable PVEPs, and follow-up. In the levodopa group the visual acuity improved significantly after treatment (p = 0.009), but not in the placebo group (p = 0.34). After treatment the visual acuity in the levodopa group was 2.1 ± 2.1, and in the placebo group was 3.9 ± 1.2 (p = 0.008). In those who had visual acuity less than or equal to figure count, significant improvement in visual acuity was observed in the levodopa group (p = 0.03), but not in the placebo group (p = 0.34). However, the final visual acuity in these patients was comparable after treatment (p = 0.21). Nine patients (56.2%) in the levodopa group, and 1 (10%) in the placebo group, experienced improvement in visual acuity (p = 0.02). The frequency of unrecordable PVEPs were comparable in both groups (p = 0.09). Patients treated with levodopa within 6 days of onset of ITON were more likely to experience improvement in visual acuity than those in the placebo group.

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“…The studies mentioned absent VEP, loss of consciousness, and visual acuity as important predictors. [10] Functional visual disorders (malingering and factitious disorders) constituted the next common condition for the referral (27.6% of the patients). Patients presented with bilateral loss of vision in the majority.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the clinical applications of visual evoked potentials in patients presenting with visual dysfunctions - A retrospective study

Gupta¹,

Garg²,

Gupta³

2018

Natl J Physiol Pharm Pharmacol

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Background:The clinical applicability of visual evoked potential (VEP) tests has been progressively extending in neuro-ophthalmological workups. The role in monitoring and follow-ups are emerging as even more useful applications. Aims and Objectives: The present study aimed to assess the clinical role of pattern-reversal VEP (PRVEPs) in visual disorders with presumptive optic nerve involvement. Materials and Methods: PRVEP records of 58 patients with unilateral/bilateral visual loss in a study period of 1½ year were retrospectively analyzed. P100 latencies and N75-P100 amplitudes were compared with those of 60 age and sex-matched controls. Variations beyond three standard deviations were applied to define significant abnormalities. PRVEP records obtained by follow-up in some conditions were also assessed. Results: Traumatic optic neuropathy (32.76%) was the most common condition confronted, with major PRVEP finding as absent waveforms/reduced amplitudes. Monitoring of VEP records revealed improvement in 50% of patients on corticosteroid therapy. Functional visual disorders constituted 27.6% with 93.75% of subjects confirmed by PRVEP. Ethambutol-induced toxic optic neuropathy (20.69%) was associated with significant P100 delay bilaterally, in the majority. Out of which, 50% showed improved PRVEP records after 1 month of cessation of drug. Multiple sclerosis and optic neuritis though rarer conditions (3.44% and 6.89%, respectively) exhibited characteristic electrophysiological findings which helped confirming the diagnosis. Diabetic optic neuropathy (3.4%) and some very rare conditions also constituted the referrals. Conclusion: VEPs provides sensitive adjuncts to diagnosis in various visual disorders and contributes as important monitoring tools for objectively assessing the recovery and ophthalmological status.

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Flash Visual Evoked Potentials Predict Visual Outcome in Traumatic Optic Neuropathy

Abstract: Flash visual evoked potentials are highly predictive of the degree of visual function in unilateral TON. Finding FVEP amplitudes that are at least 50% of the normal eye appears to be critical in anticipating good, long-term visual outcome.

Cited by 43 publications

References 9 publications

Traumatic Optic Neuropathy: A Review

Traumatic Optic Neuropathy: A Review

Levodopa-Carbidopa May Improve Vision Loss in Indirect Traumatic Optic Neuropathy

Evaluating the clinical applications of visual evoked potentials in patients presenting with visual dysfunctions - A retrospective study

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