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Contribution of objectively measured grating acuity by sweep visually evoked potentials to the diagnosis of unexplained visual loss

  • Neurophthalmology
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Abstract

Purpose

To investigate the diagnostic contribution of grating visual acuity (GVA) measured by sweep pattern-reversal visually evoked potentials (SPRVEP) in unexplained visual loss (UVL).

Methods

This case-control study included adult patients under suspicion of UVL referred to SPRVEP and transient pattern-reversal visually evoked potentials (TPRVEP) testing. Optotype visual acuity (OVA) was measured by ETDRS 4-meter chart and GVA by SPRVEP. UVL patients were assigned into three distinctive categories, according to the presence of ocular disease, motivation, and electrophysiological evaluation, as follows: exaggerators, malingerers, and psychogenic. Healthy controls and patients with organic visual loss were also tested. Receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance of GVA and TPRVEP parameters.

Results

A total of 76 patients with UVL were analyzed: 60 (79.0%) exaggerators, 11 (14.4%) malingerers, and 5 (6.6%) psychogenic. Controls were 49 subjects evaluated for TPRVEP and 28 subjects for SPRVEP. There were 13 patients with organic visual loss enrolled. Mean difference between OVA and GVA was 1.19±0.67 (median=0.84; 95% CI: 1.04 to 1.34) in UVL and 0.14 ±0.09 (median= 0.14; 95% CI: 0.08 to 0.20) in organic visual loss. The area under the ROC curve (AUC) of GVA to distinguish UVL from healthy controls was 0.998 with a cutoff of 0.09 logMAR showing specificity of 100% and sensitivity of 96.0%.

Conclusions

GVA measured by SPRVEP had good diagnostic validity to discriminate patients with unexplained visual loss from healthy controls and patients with organic visual loss, demonstrating its contribution to the diagnosis of this condition.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES)- Finance Code 001.

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Authors and Affiliations

  1. Laboratório de Eletrofisiologia Visual Clínica, Departamento de Oftalmologia e Ciências Visuais Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, R. Botucatu 816 CEP, São Paulo, SP, 04023-062, Brazil

    Tarciana de Souza Soares, Adriana Berezovsky, Paula Yuri Sacai, Arthur Gustavo Fernandes, Daniel Martins Rocha, Carina Verna, Patrícia de Freitas Dotto, Sung Eun Song Watanabe & Solange Rios Salomão

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  1. Tarciana de Souza Soares
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  2. Adriana Berezovsky
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  9. Solange Rios Salomão
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Correspondence to Solange Rios Salomão.

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de Souza Soares, T., Berezovsky, A., Sacai, P.Y. et al. Contribution of objectively measured grating acuity by sweep visually evoked potentials to the diagnosis of unexplained visual loss. Graefes Arch Clin Exp Ophthalmol 260, 1687–1699 (2022). https://doi.org/10.1007/s00417-021-05385-9

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