title: Evaluation of optic neuropathy in multiple sclerosis using low-contrast visual evoked potentials.
abstract: BACKGROUND
  Contrast acuity (identification of low-contrast letters on a white background) is frequently reduced in patients with demyelinating optic neuropathy associated with multiple sclerosis (MS), even when high-contrast (Snellen) visual acuity is normal. Since visual evoked potentials (VEPs) induced with high-contrast pattern-reversal stimuli are typically increased in latency in demyelinating optic neuropathy, we asked if VEPs induced with low-contrast stimuli would be more prolonged and thus helpful in identifying demyelinating optic neuropathy in MS.
  
  
  METHODS
  We studied 15 patients with clinically definite MS and 15 age-matched normal controls. All subjects underwent a neuro-ophthalmologic assessment, including measurement of high-contrast visual acuity and low-contrast acuities with 25%, 10%, 5%, 2.5%, and 1.25% contrast Sloan charts. In patients with MS, peripapillary retinal nerve fiber layer (RNFL) thickness was determined using optical coherence tomography. Monocular VEPs were induced using pattern-reversal checkerboard stimuli with 100% and 10% contrast between checks, at 5 spatial frequencies (8-130 minutes of arc).
  
  
  RESULTS
  VEP latencies were significantly increased in response to low- compared with high-contrast stimuli in both groups. VEP latencies were significantly greater in patients with MS than controls for both high- and low-contrast stimuli. VEP latencies correlated with high- and low-contrast visual acuities and RNFL thickness. VEPs were less likely to be induced with low- than with high-contrast stimuli in eyes with severe residual visual loss.
  
  
  CONCLUSIONS
  Visual evoked potentials obtained in patients with multiple sclerosis using low-contrast stimuli are increased in latency or absent when compared with those obtained using high-contrast stimuli and, thus, may prove to be helpful in identifying demyelinating optic neuropathy.
authors: Departments of Neurology, University Hospitals Case Medical Center, Cleveland, USA. mj.thurtell@gmail.com
authors: M J
authors: MJ
authors: Thurtell
authors: E
authors: E
authors: Bala
authors: S S
authors: SS
authors: Yaniglos
authors: J C
authors: JC
authors: Rucker
authors: N S
authors: NS
authors: Peachey
authors: R J
authors: RJ
authors: Leigh
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015350:Contrast Sensitivity / Q000502:physiology*; D004569:Electroencephalography / Q000379:methods; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000209:etiology*; D010775:Photic Stimulation / Q000379:methods; D011930:Reaction Time / Q000502:physiology*; D013223:Statistics as Topic; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity / Q000502:physiology