Comparison of measures of visual acuity in infants: Teller acuity cards and sweep visual evoked potentials

PURPOSE: This study compares the development of acuity in the same infants during one testing session using Teller acuity cards (TAC) and sweep visual evoked potentials (sVEP). We asked whether different testing methods in two centers would produce different developmental time courses. METHODS: Forty-eight infants were tested in two centers. The standard procedure for TAC was used. For sVEP acuity, the amplitude response curve derived from time-locked cortical activity was used to extrapolate to zero response, giving an acuity estimate for each infant. RESULTS: sVEP acuity was generally higher than TAC acuity. The rate of development was steeper for TAC than sVEP acuity with TAC starting at a much lower level. The ratio of sVEP to TAC acuity decreased exponentially with age reaching an asymptote of about 1.44 at 6 months. CONCLUSIONS: Results were indistinguishable between centers suggesting that comparison of acuity measures obtained using variations of these methods across centers is possible.     

Effects of postinatal stress on visual and auditory evoked potentials

Maturation of visual and auditory evoked potentials (mainly the P3 wave) of 10 controls and of 10 infants exposed to recurrent postnatal stressful events (crying spells lacking organic basis) have been compared. The sourse of maturation of P3 waves may serve as indicator of growth and nature of cognitive processes (including perception). Recurrent srying spells seemed to delay appearance of visual P3 wave, prolonged its latency, and delayed appearance of visible differences in the shape of visual P3 wave upon exposure of the subjects to different visual experiences. A compensatory increase of maturation of the auditory P3 wave appeared. The results suggest that recurrent exposure to stressful events during the early postnatal period may delay the ability of the memory banks of auditory engrams with unusual contents (including memory traces of stresses), a potential basis for future auditory hallucinations.     

Pattern-reversal visual evoked potentials in migraineurs with or without visual aura

To determine the possible electrophysiologic changes in migraineurs with or without visual aura, we investigated pattern-reversal visual evoked potentials in 39 patients. We compared the mean P100 latency and amplitude of 16 patients with aura, 23 patients without aura, and 17 age- and sex-matched normal subjects. There were no significant differences between groups. There was no correlation between age and the parameters in any group. However, in 7 of 23 patients without aura, the P100 latency was longer than the mean control value +2 SD. The mean disease duration in this subgroup was significantly longer than the means of the remaining 16 patients without aura or the patients with aura (P < 0.05 for each). This suggests the possibility that P100 latency prolongation is a consequence, but not an entity caused by the pathogenetic mechanism of the disease from the beginning.     

P300 potentials evoked by visual stimulation

INTRODUCTION: The P300 potential is a long-latency endogenous component of the event-related potentials to low-probability target stimuli. The same stimulus delivered without cognitive process does not provoke endogenous components; moreover event-related potentials are not dependent of the sensory pathways used for stimulating the subjects. P300 potential is a biological parameter used in scientific investigations in Clinical Neurophysiology, Neurology, Psychophysiology and Psychiatry. The most frequent methodology for obtaining P300 event-related potential is based on the 'odd-ball' paradigm using auditory stimulation. In this revision we analyzed the difficulties of this methodology and we propose to use the visual stimulation in order to obtain well defined P300 potential, based on a better signal to noise ratio and minor overlapping of exogenous and endogenous components of the evoked potentials. The improvement in the quality of the results obtained when comparing with auditory stimulation, it is supposed to facilitate that the use of P300 potential overflows the field of the investigation and permits their extensive use in the clinical practice.     

Topographic distribution of visual evoked potentials in optic neuropathy

INTRODUCTION: Digital treatment of electrical signals coming from the central nervous system on stimulation of the optic nerve path offers an objective method for evaluation of visual evoked potentials (VEP) shown graphically on a cerebral map. OBJECTIVE: To evaluate the topographical distribution of VEP in cases of optic neuropathy adding this parameter to the usual parameters of latency and amplitude. MATERIAL AND METHODS: We studied 35 patients with suspected optic neuropathy and normal findings on basic ophthalmological examination, in whom VEP and VEP mapping (VEPM) was done. RESULTS: In 26% of the cases there was no response for evaluation with the usual VEP recording techniques, whilst in those with VEPM this percentage was reduced to 11.5%. In the other cases there was a potential with characteristic distribution in the occipital areas and a maximally positive dipole posteriorly. CONCLUSION: VEPM is an objective method for evaluation of the visual pathway offering better discrimination than the usual VEP in more severe cases of neuropathy.     

Macular pigment and the colour-specificity of visual evoked potentials

A modified Moreland anomaloscope was used to examine two subjects, one with dense macular pigment, the other with relatively light pigmentation. Chromatic visual evoked potentials (VEPs) were elicited from these two subjects using coarse, isoluminant gratings of different sizes. Colour-specificity was verified by comparing chromatic onset VEPs (reflecting sustained activity) with chromatic reversal VEPs (reflecting mainly transient activity) and also by Fourier analysis (colour-specific responses are dominated by the fundamental, transient activity by the second harmonic). Achromatic (transient-type) intrusions, produced by large blue-green gratings could be related to the extent of subject-specific macular pigmentation.     

Pattern reversal visual evoked potentials in minor head injury

Pattern reversal visual evoked potentials (PR-VEPs) have been recorded in 50 patients with minor head injury (MHI) on days 1 and 30 after trauma and the data compared to 20 normals. None of the patients had visual complaints. The aim was to investigate a possible visual pathway affection in MHI and test the usefulness of PR-VEPs as an objective noninvasive tool in the detection of a possible subclinical affection of the visual system in MHI. P100 latency and amplitude had no significant difference compared to normals. Comparison of patient data on days 1 and 30 after trauma showed a significant latency decrease and amplitude increase on day 30, compared to day 1. These alterations were not age dependent. Our data suggest affection of the human visual pathway in MHI. PR-VEP recording seems to be a useful, objective, noninvasive tool, helping to identify possible subclinical affections of the visual pathway in MHI.     

Effect of anesthetics on sensory evoked potentials

The authors have reviewed the main effects of anaesthetic agents on sensory evoked potentials (EPs) in the auditory, somatosensory and visual modalities. Knowledge of EP changes induced by anesthetic drugs is important to avoid false alarms when monitoring neural structures at risk during surgery. Intraoperative EP monitoring is all the more efficient as the following points are taken into account: 1) whatever the sensory modality considered, EPs are more attenuated by volatile halogenated agents than by intravenous drugs; 2) the cortical components of EPs are more sensitive to anesthetic drugs than the brainstem components; 3) in each modality, the first component of the "primary cortical complex" is less attenuated by anaesthetic agents than the following cortical waves; 4) continuous administration of anaesthetic agents rather than acute administration (bolus) is preferred during EP monitoring. EPs also represent an objective means to assess the depth of surgical anaesthesia, since they may provide a reliable index of cortical depression. Amplitude changes of middle-latency auditory responses (Pa/Nb) seem to be a good marker for estimating depth of anaesthesia with the aid of EPs.     

The effect of motion on pattern-onset visual evoked potentials in adults and children

Visual evoked potentials can be elicited by a variety of visual stimuli, including pattern-onset and motion-onset. It may be desirable to combine pattern-onset with motion-onset stimuli, for example, to make a direct comparison between optokinetic nystagmus and visual evoked potential acuity thresholds. Both procedures employ grating stimuli; however, the gratings must be moving to produce optokinetic nystagmus. We compared pattern-onset visual evoked potentials with both a static and a moving pattern to investigate the effect of motion on the pattern-onset visual evoked potential waveform. Visual evoked potential recordings were made from 10 adults (aged 20-37 years) and 10 children (aged 5-7 years) with the active electrode at Oz. Stimuli consisted of onset of high-contrast vertical bars of three sizes (12', 30' and 60') both with and without motion (3 cycles/s). In a subgroup of subjects, visual evoked potentials were recorded to motion onset of constantly present gratings. Motion of the pattern had no significant effect on any of the latency components of the visual evoked potential waveform in adults or children. The amplitude of the C2-C3 component was significantly increased (p < 0.001) in adults. The motion appears to add a late negative component to the visual evoked potential similar to that produced by the motion-only stimulus. The latency of the early components of the pattern-onset visual evoked potential was unaffected by the presence of motion. Therefore, pattern-onset visual evoked potentials with moving gratings could be used to estimate visual acuity, and direct comparisons could be made between visual evoked potential and optokinetic nystagmus acuity thresholds with the use of the same stimulus parameters.     

Visual evoked potentials in patients with refraction amblyopia in the presence of high myopia

The informative value of a method for assessing the degree of amblyopia, developed by the author, was assessed in examinations of 16 children (29 eyes) with ametropic amblyopia caused by high myopia and 41 healthy controls. The method consists in recording the pattern-reversal visual evoked potentials (VEP) evoked by 4 patterns of different checksize and contrast. A relationship has been revealed between the VEP types detected by the proposed method and the degree of amblyopia (degree of vision acuity loss). The author came to a conclusion that in ametropic amblyopia, similarly as in stimulus deprivation amblyopia, changes of VEP develop that reflect the deterioration of contrast sensitivity function in low spatial frequencies. The developed VEP method with the modifications described in this paper may be useful in the diagnosis and objective evaluation of the degree of amblyopia.     

Fractal analysis of steady-state-flicker visual evoked potentials: feasibility

Electrophysiological models of visual evoked potential recording have assumed that response variability is caused predominantly by random noise added to a true steady signal. Since neuronal geometry has a fractal structure, neural activity may demonstrate deterministic nonlinear dynamics, i.e., chaos. We recorded several-minute time-series traces of the visual evoked potential magnitude in response to full-field flicker from three glaucoma patients and one normal subject. When plotted in phase space, the steady-state response derived from a lock-in amplifier shows an apparent so-called strange attractor (extended nonrepeating loops) rather than the pattern expected from a signal-plus-noise model (a fuzzy dot). The fractal dimension of this attractor may be a more sensitive indicator of early optic-nerve damage than are visual evoked potential latency or amplitude measures.     

Brain stem evoked potentials and visual evoked potentials in relation to the length of occupational exposure to low levels of toluene

In 49 printing-press workers occupationally exposed to toluene for approximately 21.6 years, the values of BEAP and VEP parameters were examined in relation to the length of exposure. With the exception of P2 wave, there was a significant increase in the latencies of all the BEAP waves examined as well as in the interpeak latency (IPL) P3-P4, whereas IPL P4-P5 decreased significantly with the length of exposure. The amplitude of all the VEP examined decreased significantly with the length of exposure. Toluene exposure was evaluated by measuring the concentration of toluene in peripheral blood and of hippuric acid in urine on Wednesday morning prior to the workshift, and of hippuric acid in urine after the workshift on the same day. According to the average concentration of hippuric acid in urine after the workshift, the levels of toluene exposure were estimated to range from 40-60 ppm. Evoked potentials were determined on Mondays 10-12 hours after a nonworking weekend.     

Stimulus duration, neural adaptation, and sweep visual evoked potential acuity estimates

PURPOSE: Results in several studies have suggested that the visual evoked potential (VEP) amplitude can vary with stimulus duration. The purpose of this study was to determine whether acuity estimates obtained by extrapolation of the sweep VEP are altered by this adaptation effect. METHODS: Sweep VEP data were obtained from 16 healthy observers under binocular viewing conditions. Data were acquired with a commercially available VEP unit using standard electrode recording techniques. Three sweeps (high spatial frequencies, medium spatial frequencies, and low spatial frequencies) were run. The subjects' visual acuity at the monitor distance was 6/6 for the high spatial frequency sweep. For the medium and low spatial frequency sweeps, the subjects were dioptrically blurred to 6/15 (medium spatial frequencies) or 6/30 (low spatial frequencies) at the monitor distance. Each sweep consisted of six spatial frequencies (contrast 80%; temporal frequency (TF) = 7.5 Hz; screen luminance = 100 candela [cd]/m2). For each spatial frequency, the stimulus duration was 8 seconds, partitioned into 1-second bins. A minimum of eight sweeps were obtained per subject. An acuity estimate was obtained for each second's data by fitting a line to the high spatial frequencies (excluding noise) and extrapolating this line to the x-axis. With this technique, estimates could not be obtained for 29 of 384 possible acuities. RESULTS: The sweep VEP acuities for the 16 subjects did not change significantly over the 8 seconds of data collection for the high, medium, or low spatial frequency sweep (repeated measures analysis of variance [ANOVA]: high, P = 0.25; medium, P = 0.50; low, P = 0.23). In any given subject, there was a 1- to 2-octave range in acuity estimates over the 8 seconds of stimulus presentation (high, 1.23+/-0.417 octaves; medium, 1.41+/-0.593 octaves; low, 1.52+/-0.475 octaves; mean +/- SD). CONCLUSIONS: These results suggest that there is not a significant change in sweep VEP acuity estimates over an 8-second stimulus presentation. Thus, neural adaptation does not significantly affect the clinical use of the sweep VEP.     

Neuronal generators of visual evoked potentials in humans: visual processing in the human cortex

PURPOSE: We wished to define the localization of cortical generators of visual (pattern) evoked potentials (VEP) and the temporal sequence of activation in the occipital region. METHODS: In 4 candidates for epilepsy surgery, a large array of subdural electrodes was placed over occipital areas. Checkerboard pattern reversal stimuli were generated and the epileptogenic focus was localized and functionally mapped. Magnetic resonance imaging did not show any occipital lesions in any of the 4 patients. RESULTS: The area first activated was the lingual gyrus in the mesial occipital lobe (negative potential peaks at approximately 70 ms), followed by an area superior to the calcarine fissure (negative peaks at approximately 80 ms). Later (starting at approximately 90 ms), there were positive potentials over the occipital pole and lingual gyrus, followed by potentials at the lateral occipital lobe. CONCLUSIONS: These data support the idea that VEP are generated in the mesial and lateral occipital cortex by different circumscribed neuronal generators with different latencies of activation. The scalp-recorded N1 and P1 potential peaks most likely derive from the progressive activation of neuronal masses in different regions of the occipital lobe.     

Effect of isoflurane and sevoflurane on evoked potentials and EEG

Evoked potentials and EEG are used to monitor the central nervous system and the depth of anesthesia in anesthetized patients. In this study, we examined EEG, VEP, SEP and ABR at various concentrations of isoflurane or sevoflurane, and evaluated the influence of volatile agents and their usefulness for the monitoring of the depth of anesthesia. With increasing concentrations of isoflurane and sevoflurane, AE (frequency which account for 80% of total voltage) showed dose-related reduction and EEG showed a trend toward a slower wave and higher amplitude. With increasing concentrations of isoflurane and sevoflurane, P100 of VEP showed a significant dose-related reduction in its amplitude and increase in its latency. So we could not record P100 at the level of the anesthesia of 1.0 MAC with 66% N2O. N20 of SEP can be easily recorded at any depth of anesthesia. And the trend showed consistent dose-related changes in amplitude and latency. With increasing concentrations of isoflurane and sevoflurane, wave III and V of ABR increased significantly in latency, but the changes were very small. In conclusion, the effect of isoflurane and that of sevoflurane on evoked potentials and EEG are similar with each other and with other volatile agents. SEP is the most consistent and reliable factor to monitor the depth of anesthesia neurophysiologically.     

The stabilization of cortical evoked potentials during selective visual attention

The event-related potentials (ERP) to lateralized moving visual stimuli (administered to the right and to the left of the subject) were recorded in six derivations in eight healthy subjects during passive viewing and selective attention to one of the stimuli (the relevant one), which demanded precise and rapid motor reaction. It was shown that during the selective voluntary attention correlation between successive ERP was substantially higher than that under conditions of passive (involuntary) attention, i.e. the ERP in the occipital, parietal, and frontal derivations during voluntary attention were more stable. The less was correlation between the ERP at passive viewing, the greater was the difference between the values of correlation coefficients during selective and passive attention. It is suggested that role of selected attention consists in stabilization of activity of the cortical structures, which are involved in solving the behavioral task.     

Objective specification of tritanopic confusion lines using visual evoked potentials

The minimum distinct border (MDB) between different isoluminant hues of a bipartite field was set subjectively by adjustment and then according to a 3-point rating allowing determination of the S-cone specific (tritanopic) axis. This rating was compared with visual evoked potentials (VEPs) generated by coarse, isoluminant gratings, modulated along the same chromatic axes. Psychophysically determined tritanopic gratings elicited monophasic onset VEPs with the longest latency for each subject. Departure from this axis produced additional earlier negative components (reflecting additional response mechanisms). Colour-selective VEPs can, therefore, objectively specify tritanopic confusion lines with a comparable degree of accuracy to MDB judgements.     

Nonlinear analysis of visual evoked potentials elicited by color stimulation

The relationship between chromatically modulated stimuli and visual evoked potentials (VEPs) was considered. VEPs of normal subjects elicited by chromatically modulated stimuli were measured under several color adaptations, and their binary kernels were estimated. Up to the second-order, binary kernels obtained from VEPs were so characteristic that the VEP-chromatic modulation system showed second-order nonlinearity. First-order binary kernels depended on the color of the stimulus and adaptation, whereas second-order kernels showed almost no difference. This result indicates that the waveforms of first-order binary kernels reflect perceived color (hue). This supports the suggestion that kernels of VEPs include color responses, and could be used as a probe with which to examine the color visual system.