Normative ranges and specificity of the multifocal VEP

Fortune, Brad; Zhang, Xian; Hood, Donald C.; Demirel, Shaban; Johnson, Chris A.

doi:10.1007/s10633-004-3300-5

Cited by 54 publications

(75 citation statements)

References 36 publications

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“…Approximately, 30% fewer eyes were classified as abnormal by the 1-Run mfVEP as compared with the 2-Run mfVEP. This is most likely due to the decrease in the lower limit of the normal SNR range for the 1-Run mfVEP, 25 creating a "floor effect" (discussed later). The third row of Table 1, however, shows that the classification agreement between 1-Run and 2-Run mfVEPs was close to 90%.…”

Section: Resultsmentioning

confidence: 99%

“…The greater number of abnormalities determined by the 2-Run mfVEP is attributable to the improvement in SNR, especially to the increase in the lower limit of the normal SNR range at each location, a predictable consequence of increased signal averaging. 25 However, some of the increase in the number of abnormalities also contributed to a slightly higher false alarm rate for the 2-Run mfVEP. In general though, there was slightly greater enhancement of sensitivity, as compared with the trade-off in specificity for the 2-Run mfVEP.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 96%

“…25 Similarly, the interocular ratio (of rootmean-squared amplitude) at each location was converted to a z-score and assigned a probability value on the basis of the corresponding local normal distribution. The z-scores for 2-Run mfVEPs were based on 2-Run normative values obtained from controls; accordingly, the 1-Run z-scores were based on 1-Run normative data from controls (ie, the first run for each eye from the ABBA group of 2).…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…This maintains high specificity. 24 For example, in a separate group of 100 control subjects, 25 only 2 of 200 normal eyes (1%) were "outside normal limits" whereas 18 others were classified as "borderline" by the MRA.…”

Section: Confocal Scanning Laser Ophthalmoscopymentioning

confidence: 99%

“…18,25,28 The definition of a cluster was 2 or 3 contiguous locations within a single hemifield. Each of the various cluster criteria was specified as a unique combination of cluster size and probability level (z-score) of the individual points within the cluster.…”

Section: Multifocal Vepmentioning

confidence: 99%

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Effect of Recording Duration on the Diagnostic Performance of Multifocal Visual-evoked Potentials in High-risk Ocular Hypertension and Early Glaucoma

Fortune

Zhang²,

Hood³

et al. 2008

Journal of Glaucoma

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Purpose-To evaluate the effect on diagnostic performance of reducing multifocal visualevoked potential (mfVEP) recording duration from 16 to 8 minutes per eye.Methods-Both eyes of 185 individuals with high-risk ocular hypertension or early glaucoma were studied. Two 8-minute mfVEP recordings were obtained for each eye in an ABBA order using VERIS. The first recording for each eye was compared against single run (1-Run) mfVEP normative data; the average of both recordings for each eye was compared against 2-Run normative data. Visual fields (VFs) were obtained by standard automated perimetry (SAP) within 22.3±27.0 days of the mfVEP. Stereo disc photographs and Heidelberg Retina Tomograph images were obtained together, within 24.8±50.4 days of the mfVEP and 33.1±62.9 days of SAP. Masked experts graded disc photographs as either glaucomatous optic neuropathy or normal. The overall Moorfields Regression Analysis result from the Heidelberg Retina Tomograph was used as a separate diagnostic classification. Thus, 4 diagnostic standards were applied in total, 2 based on optic disc structure alone and 2 others based on disc structure and SAP.Results-Agreement between the 1-Run and 2-Run mfVEP was 90%. Diagnostic performance of the 1-Run mfVEP was similar to that of the 2-Run mfVEP for all 4 diagnostic standards. Sensitivity was slightly higher for the 2-Run mfVEP, whereas specificity was slightly higher for the 1-Run mfVEP.Conclusions-If higher sensitivity is sought, the 2-Run mfVEP will provide better discrimination between groups of eyes with relatively high signal-to-noise ratio (eg, early glaucoma or high-risk suspects). But if higher specificity is a more important goal, the 1-Run mfVEP provides adequate sensitivity and requires only half the test time. Considered alongside prior studies, the present results suggest that the 1-Run mfVEP is an efficient way to confirm (or refute) the extent of VF loss in patients with moderate or advanced glaucoma, particularly in those with unreliable VFs, including malingering or other "functional" forms of VF loss. 2,11,13,19 and in glaucoma suspect eyes with completely normal SAP VFs. 4,5,9,14,18,19 Longitudinal follow-up should reveal whether such mfVEP defects represent greater sensitivity of the mfVEP to detect early functional loss, or alternatively, a higher false alarm rate. Meanwhile, cross-sectional studies have found that the diagnostic performance of mfVEP and SAP are similar when an independent diagnostic standard is applied (eg, one based on optic disc structure). 14,18 The mfVEP test duration, however, can be considerably longer than SAP, particularly when the Swedish Interactive Thresholding Algorithm (SITA) is used as the SAP test strategy 20 and two 8-minute mfVEP recordings are acquired for each eye, as in many previous studies (eg, Ref. 18 ). Therefore, the purpose of the present study was to evaluate the potential effect of reducing the recording duration, from 16 to 8 minutes per eye, on the diagnostic performance of the mfVEP in eyes with high-risk ...

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Section: Resultsmentioning

confidence: 99%

Section: Nih-pa Author Manuscriptmentioning

confidence: 96%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Section: Confocal Scanning Laser Ophthalmoscopymentioning

confidence: 99%

Section: Multifocal Vepmentioning

confidence: 99%

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Effect of Recording Duration on the Diagnostic Performance of Multifocal Visual-evoked Potentials in High-risk Ocular Hypertension and Early Glaucoma

Fortune

Zhang²,

Hood³

et al. 2008

Journal of Glaucoma

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Understanding Disparities Among Diagnostic Technologies in Glaucoma

Moraes

Liebmann²,

Ritch³

et al. 2012

Arch Ophthalmol

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Objective To investigate causes of disagreement among 3 glaucoma diagnostic techniques: standard automated achromatic perimetry (SAP), the multifocal visual evoked potential technique (mfVEP), and optical coherence tomography (OCT). Methods In a prospective cross-sectional study, 138 eyes of 69 patients with glaucomatous optic neuropathy were tested using SAP, the mfVEP, and OCT. Eyes with the worse and better mean deviations (MDs) were analyzed separately. If the results of 2 tests were consistent for the presence of an abnormality in the same topographic site, that abnormality was considered a true glaucoma defect. If a third test missed that abnormality (false-negative result), the reasons for disparity were investigated. Results Eyes with worse MD (mean [SD], −6.8 [8.0] dB) had better agreements among tests than did eyes with better MD (−2.5 [3.5] dB, P<.01). For the 94 of 138 hemi-fields with abnormalities of the more advanced eyes, the 3 tests were consistent in showing the same hemifield abnormality in 50 hemifields (53%), and at least 2 tests were abnormal in 65 of the 94 hemifields (69%). The potential explanations for the false-negative results fell into 2 general categories: inherent limitations of each technique to detect distinct features of glaucoma and individual variability and the distribution of normative values used to define statistically significant abnormalities. Conclusions All the cases of disparity could be explained by known limitations of each technique and inter-individual variability, suggesting that the agreement among diagnostic tests may be better than summary statistics suggest and that disagreements between tests do not indicate discordance in the structure-function relationship.

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Sparse multifocal stimuli for the detection of multiple sclerosis

Ruseckaite¹,

Maddess²,

Danta

et al. 2005

Annals of Neurology

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We compared the diagnostic capabilities of contrast reversal and sparse pattern pulse stimulation for dichoptic multifocal visual evoked potentials (mfVEPs) measured in normal subjects and multiple sclerosis (MS) patients. Multifocal responses were obtained from 27 normal subjects and 50 relapsing-remitting patients, 26 of whom had experienced optic neuritis (ON+). The patient groups were matched for length of disease and number of clinical attacks. Compared with the responses of normal subjects those of MS patients had significantly smaller response amplitudes, lower signal-to-noise ratios, more complex response waveforms, and longer response delays. The effects were larger for sparser stimuli. Sensitivities and specificities for the different stimulus types were estimated from receiver operator characteristic (ROC) plots. Bootstrap estimates of the accuracies of the ROCs for the most promising measure, the template delays, indicated the sparsest stimulus would deliver 92% sensitivity at a false-positive rate of 0%. In contrast, at 92% sensitivity the conventional mfVEP stimulus misdiagnosed more than 20% of the normal population. The results were similar for patients with no history of ON (ON-). In performing well in patients with no history of ON, the sparse mfVEPs seem to measure progressive damage associated with axon and gray matter losses rather than damage associated with a history of serious inflammation.

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Normative ranges and specificity of the multifocal VEP

Cited by 54 publications

References 36 publications

Effect of Recording Duration on the Diagnostic Performance of Multifocal Visual-evoked Potentials in High-risk Ocular Hypertension and Early Glaucoma

Effect of Recording Duration on the Diagnostic Performance of Multifocal Visual-evoked Potentials in High-risk Ocular Hypertension and Early Glaucoma

Understanding Disparities Among Diagnostic Technologies in Glaucoma

Sparse multifocal stimuli for the detection of multiple sclerosis

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