title: Clinical use of multifocal visual-evoked potentials in a glaucoma practice: a prospective study.
abstract: OBJECTIVE
  To test a framework that describes how the multifocal visual-evoked potential (mfVEP) technique is used in a particular glaucoma practice.
  
  
  METHODS
  In this prospective, descriptive study, glaucoma suspects, ocular hypertensives and glaucoma patients were referred for mfVEP testing by a single glaucoma specialist over a 2-year period. All patients underwent standard automated perimetry (SAP) and mfVEP testing within 3 months. Two hundred and ten patients (420 eyes) were referred for mfVEP testing for the following reasons: (1) normal SAP tests suspected of early functional loss (ocular hypertensives, n = 43; and glaucoma suspects on the basis of suspicious optic disks, n = 52); (2) normal-tension glaucoma patients with suspected central SAP defects (n = 33); and (3) SAP abnormalities needing confirmation (n = 82).
  
  
  RESULTS
  All the glaucoma suspects with normal SAP and mfVEP results remained untreated. Of those with abnormal mfVEP results, 68 % (15/22) were treated because the abnormal regions on the mfVEP were consistent with the abnormal regions seen during clinical examination of the optic disk. The mfVEP was abnormal in 86 % (69/80) of eyes with glaucomatous optic neuropathy and SAP damage, even though it did not result in an altered treatment regimen. In NTG patients, the mfVEP showed central defects in 44 % (12 of 27) of the eyes with apparently normal central fields and confirmed central scotomata in 92 % (36 of 39), leading to more rigorous surveillance of these patients.
  
  
  CONCLUSIONS
  In a clinical practice, the mfVEP was used when clinical examination and subjective visual fields provided insufficient or conflicting information. This information influenced clinical management.
authors.affiliation: Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA. demoraesmd@gmail.com
authors.forename: Carlos Gustavo
authors.initials: CG
authors.lastname: De Moraes
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Liebmann
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
authors.forename: Donald C
authors.initials: DC
authors.lastname: Hood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005074:Evoked Potentials, Visual / Q000502:physiology*; D005260:Female; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D057066:Low Tension Glaucoma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D009885:Ophthalmology; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D014786:Vision Disorders / Q000175:diagnosis; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents