Clinical application of objective perimetry using multifocal visual evoked potentials in glaucoma practice.
OBJECTIVE
To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (ObjectiVision Pty, Ltd, Sydney, New South Wales, Australia) within a defined 12-month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed.


RESULTS
The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r = 0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0%), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6%) and Humphrey visual field results (81.9%) were similar, but mVEP specificity was better (89.2% vs 79.5%). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture.


CONCLUSIONS
Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.
Graham
Stuart L
SL
Save Sight Institute, Sydney University, Syndey, New South Wales, Australia. stuart@eye.usyd.edu.au
Klistorner
Alexander I
AI
Goldberg
Ivan
I
D005074:Evoked Potentials, Visual; D005901:Glaucoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007429:Intraocular Pressure; D009798:Ocular Hypertension / Q000175:diagnosis / Q000503:physiopathology; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D011364:Professional Practice; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields