EXTENDED REPORT

Objective perimetry using the multifocal visual evoked potential in central visual pathway lesions

A I Klistorner, S L Graham, J Grigg and C Balachandran

Save Sight Institute, Department of Ophthalmology, Sydney University, Sydney, Australia

Correspondence to:
Correspondence to:
Dr S Graham
Save Sight Institute, Sydney Eye Hospital, Macquarie Street, PO Box 1614, Sydney 2001, Australia; stuart{at}eye.usyd.edu.au

Aims: To examine the ability of the multifocal pattern visual evoked potential (mVEP) to detect field loss in neurological lesions affecting the visual pathway from the chiasm to the cortex.

Method: The mVEPs recorded in the clinic were retrospectively reviewed for any cases involving central neurological lesions. Recordings had been performed with the AccuMap V1.3 objective perimeter, which used an array of four bipolar occipital electrodes to provide four differently oriented channels for simultaneous recording. 19 patients with hemianopias were identified. Of these there were 10 homonymous hemianopias with hemifield type loss, two bitemporal hemianopias, and seven homonymous hemianopias with quadrantanopic distribution. A comparison with subjective field results and CT/MRI findings was done to determine the relation between the two methods of visual field mapping and any relation with the anatomical location of the lesion and the mVEP results.

Results: In all hemianopic type cases (12) the defect was demonstrated on the mVEP and showed good correspondence in location of the scotoma (nine homonymous and two bitemporal). The topographic distribution was similar but not identical to subjective testing. Of the seven quadrantanopic type hemianopias, only four were found to have corresponding mVEP losses in the same areas. In the three cases where the mVEP was normal, the type of quadrantanopia had features consistent with an extra-striate lesion being very congruous, complete, and respecting the horizontal meridian.

Conclusions: The mVEP can detect field loss from cortical lesions, but not in some cases of homonymous quadrantanopia, where the lesion may have been in the extra-striate cortex. This supports the concept that the mVEP is generated in V1 striate cortex and that it may be able to distinguish striate from extra-striate lesions. It implies caution should be used when interpreting "functional" loss using the mVEP if the visual field pattern is quadrantic.

Abbreviations: CVA, cerebrovascular accident; FDT, frequency doubled threshold; FIR, finite impulse response; HVF, Humphrey visual field; mVEP, multifocal pattern visual evoked potential; VEP, visual evoked potential

Keywords: multifocal pattern visual evoked potential; perimetry

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Danesh-Meyer, H. V., Carroll, S. C., Gaskin, B. J., Gao, A., Gamble, G. D. (2006). Correlation of the multifocal visual evoked potential and standard automated perimetry in compressive optic neuropathies.. IOVS 47: 1458-1463 [Abstract] [Full Text]