Documenta Ophthalmologica

, Volume 126, Issue 1, pp 45–56 | Cite as

A comparison of the performance of three visual evoked potential-based methods to estimate visual acuity

  • Anne KurtenbachEmail author
  • Hana Langrová
  • Andre Messias
  • Eberhart Zrenner
  • Herbert Jägle
Original Research Article



To compare visual acuities estimated by three methods of visual evoked potential (VEP) recordings to those obtained by two subjective measures [ETDRS and FrACT (Freiburg acuity test)].


Ten healthy subjects, aged between 26 and 67 years (mean 43.5), were examined. Best-corrected acuity determined by the ETDRS was between 0.03 and −0.3 logMAR (mean −0.06). Sweep VEPs (sweepVEP), pattern appearance VEPs (pappVEP) and steady-state VEPs (ssVEP) were recorded with two electrode placements (10–20 and Laplace) with best optical correction and with artificially degraded vision using five Bangerter occlusion foils, reducing acuity to about 0.1, 0.22, 0.52, 0.7 and 1.0 logMAR (0.8, 0.6, 0.3, 0.2 and 0.1 decimal scale). Two runs were performed.


ETDRS and FrACT acuities showed good agreement, even though ETDRS seemed to underestimate acuity compared with FrACT at higher acuities. Laplace derivation did not improve any of the VEP-estimated acuities over the 10–20. SweepVEP tended to overestimate lower FrACT acuities, but showed good repeatability. PappVEP placed FrACT acuities into correct or neighboring categories in 87 % of cases. Average ssVEP acuity showed little difference to those of FrACT but variance was larger. ROC analysis for typical clinical application showed good performance for all three methods.


The two subjective measurements of acuities are well correlated. Under the conditions of our experiment, sweepVEP results were less variable and had a better repeatability than ssVEP acuities, whose analysis, in contrast to sweepVEP, can be automated. PappVEP estimates, however, offer a viable alternative, that is, quicker but of lower performance regarding the detection of low acuity thresholds. All methods had a good performance regarding minimum acuity detection if an average of two runs is used.


Visual acuity Visual evoked potentials Electrophysiology Electrode placement 



Supported by a German Research Foundation grant JA997/8-1, the Tistou and Charlotte Kerstan Foundation Vision 2000 and the Malloch foundation.

Conflict of interest



  1. 1.
    Campbell FW, Maffei L (1970) Electrophysiological evidence for the existence of orientation and size detectors in the human visual system. J Physiol 207(3):635–652PubMedGoogle Scholar
  2. 2.
    Harter MR, White CT (1970) Evoked cortical responses to checkerboard patterns: effect of check-size as a function of visual acuity. Electroencephalogr Clin Neurophysiol 28(1):48–54PubMedCrossRefGoogle Scholar
  3. 3.
    Tyler CW, Apkarian P, Levi DM, Nakayama K (1979) Rapid assessment of visual function: an electronic sweep technique for the pattern visual evoked potential. Invest Ophthalmol Vis Sci 18(7):703–713PubMedGoogle Scholar
  4. 4.
    Wiener DE, Wellish K, Nelson JI, Kupersmith MJ (1985) Comparisons among Snellen, psychophysical, and evoked potential visual acuity determinations. Am J Optom Physiol Opt 62(10):669–679PubMedCrossRefGoogle Scholar
  5. 5.
    Johansson B, Jakobsson P (2000) Fourier analysis of steady-state visual evoked potentials in subjects with normal and defective stereo vision. Doc Ophthalmol 101(3):233–246PubMedCrossRefGoogle Scholar
  6. 6.
    Towle VL, Harter MR (1979) Objective determination of human visual acuity from the visual evoked potential. Percept Psychophys 25(6):497–500PubMedCrossRefGoogle Scholar
  7. 7.
    Chan H, Odom JV, Coldren J, Dove C, Chao GM (1986) Acuity estimated by visually evoked potentials is affected by scaling. Doc Ophthalmol 62(1):107–117PubMedCrossRefGoogle Scholar
  8. 8.
    Harter MR, Towle VL, Zakrzewski M, Moyer SM (1977) An objective indicant of binocular vision in humans: size-specific interocular suppression of visual evoked potentials. Electroencephalogr Clin Neurophysiol 43(6):825–836PubMedCrossRefGoogle Scholar
  9. 9.
    Heine S, Ruther K, Isensee J, Zrenner E (1999) Clinical significance of objective vision assessment using visually evoked cortical potentials induced by rapid pattern sequences of different spatial frequency. Klin Monatsbl Augenheilkd 215(3):175–181PubMedCrossRefGoogle Scholar
  10. 10.
    Odom JV, Hoyt CS, Marg E (1981) Effect of natural deprivation and unilateral eye patching on visual acuity of infants and children. Evoked potential measurements. Arch Ophthalmol 99(8):1412–1416PubMedCrossRefGoogle Scholar
  11. 11.
    Sokol S (1978) Measurement of infant visual acuity from pattern reversal evoked potentials. Vis Res 18(1):33–39PubMedCrossRefGoogle Scholar
  12. 12.
    Bach M, Maurer JP, Wolf ME (2008) Visual evoked potential-based acuity assessment in normal vision, artificially degraded vision, and in patients. Br J Ophthalmol 92(3):396–403PubMedCrossRefGoogle Scholar
  13. 13.
    Howe JW, Mitchell KW (1984) The objective assessment of contrast sensitivity function by electrophysiological means. Br J Ophthalmol 68(9):626–638PubMedCrossRefGoogle Scholar
  14. 14.
    Ohn YH, Katsumi O, Matsui Y, Tetsuka H, Hirose T (1994) Snellen visual acuity versus pattern reversal visual-evoked response acuity in clinical applications. Ophthalmic Res 26(4):240–252PubMedCrossRefGoogle Scholar
  15. 15.
    Regan D (1977) Speedy assessment of visual acuity in amblyopia by the evoked potential method. Ophthalmologica 175(3):159–164PubMedCrossRefGoogle Scholar
  16. 16.
    Teping C (1981) Determination of visual acuity by the visually evoked cortical potential (author’s transl). Klin Monatsbl Augenheilkd 179(3):169–172PubMedCrossRefGoogle Scholar
  17. 17.
    Hajek A, Zrenner E (1988) Improved objective visual assessment with visual evoked cortical potentials by rapid pattern stimuli sequences of different spatial frequency. Fortschr Ophthalmol 85(5):550–554PubMedGoogle Scholar
  18. 18.
    McBain VA, Robson AG, Hogg CR, Holder GE (2007) Assessment of patients with suspected non-organic visual loss using pattern appearance visual evoked potentials. Graefes Arch Clin Exp Ophthalmol 245(4):502–510PubMedCrossRefGoogle Scholar
  19. 19.
    Bach M (1996) The Freiburg visual acuity test. Optom Vis Sci 73:49–53PubMedCrossRefGoogle Scholar
  20. 20.
    American Encephalographic Society (1994) Guideline thirteen: guidelines for standard electrode position nomenclature. J Clin Neurophysiol 11:111–113Google Scholar
  21. 21.
    Jasper HH (1957) Report of the Committee on methods of clinical examination in electroencephalography. Appendix: the ten-twenty electrode system of the international federation. Electroencephalogr Clin Neurophysiol 10:371–375Google Scholar
  22. 22.
    Odom JV, Bach M, Barber C, Brigell M, Marmor MF, Tormene AP, Holder GE, Vaegan (2004) Visual evoked potentials standard. Doc Ophthalmol 108(2):115–123PubMedCrossRefGoogle Scholar
  23. 23.
    Hjorth B (1975) An on-line transformation of EEG scalp potentials into orthogonal source derivations. Electroencephalogr Clin Neurophysiol 39(5):526–530PubMedCrossRefGoogle Scholar
  24. 24.
    Mackay AM, Bradnam MS, Hamilton R (2003) Rapid detection of threshold VEPs. Clin Neurophysiol 114(6):1009–1020PubMedCrossRefGoogle Scholar
  25. 25.
    Mackay AM, Hamilton R, Bradnam MS (2003) Faster and more sensitive VEP recording in children. Doc Ophthalmol 107(3):251–259PubMedCrossRefGoogle Scholar
  26. 26.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedCrossRefGoogle Scholar
  27. 27.
    Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M (2006) Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Invest Ophthalmol Vis Sci 47(3):1236–1240PubMedCrossRefGoogle Scholar
  28. 28.
    Wesemann W (2002) Visual acuity measured via the Freiburg visual acuity test (FVT), Bailey Lovie chart and Landolt Ring chart. Klin Monatsbl Augenheilkd 219(9):660–667PubMedCrossRefGoogle Scholar
  29. 29.
    Knudsen LL (2003) Visual acuity testing in diabetic subjects: the decimal progression chart versus the Freiburg visual acuity test. Graefes Arch Clin Exp Ophthalmol 241:615–618CrossRefGoogle Scholar
  30. 30.
    Dennis RJ, Beer JM, Baldwin JB, Ivan DJ, Lorusso FJ, Thompson WT (2004) Using the Freiburg Acuity and Contrast Test to measure visual performance in USAF personnel after PRK. Optom Vis Sci 81(7):516–524PubMedCrossRefGoogle Scholar
  31. 31.
    Lange C, Feltgen N, Junker B, Schulze-Bonsel K, Bach M (2009) Resolving the clinical acuity categories “hand motion” and “counting fingers” using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol 247(1):137–142PubMedCrossRefGoogle Scholar
  32. 32.
    Beers AP, Riemslag FC, Spekreijse H (1992) Visual evoked potential estimation of visual activity with a Laplacian derivation. Doc Ophthalmol 79(4):383–389PubMedCrossRefGoogle Scholar
  33. 33.
    Manahilov V, Riemslag FC, Spekreijse H (1992) The Laplacian analysis of the pattern onset response in man. Electroencephalogr Clin Neurophysiol 82(3):220–224PubMedCrossRefGoogle Scholar
  34. 34.
    Harding GF, Rubinstein MP (1980) The scalp topography of the human visually evoked subcortical potential. Invest Ophthalmol Vis Sci 19(3):318–321PubMedGoogle Scholar
  35. 35.
    Maier J, Dagnelie G, Spekreijse H, van Dijk BW (1987) Principal components analysis for source localization of VEPs in man. Vis Res 27(2):165–177PubMedCrossRefGoogle Scholar
  36. 36.
    Proverbio AM, Zani A, Avella C (1997) Hemispheric asymmetries for spatial frequency discrimination in a selective attention task. Brain Cogn 34(2):311–320PubMedCrossRefGoogle Scholar
  37. 37.
    Wolf M (2006) Objektive Visusbestimmung mit Visuell Evozierten Potentialen. Albert-Ludwigs-Universität, Freiburg i.BrGoogle Scholar
  38. 38.
    Ridder WH III, Tong A, Floresca T (2012) Reliability of acuities determined with the sweep visual evoked potential (sVEP). Doc Ophthalmol 124(2):99–107PubMedCrossRefGoogle Scholar
  39. 39.
    Souza GS, Gomes BD, Saito CA, da Silva Filho M, Silveira LC (2007) Spatial luminance contrast sensitivity measured with transient VEP: comparison with psychophysics and evidence of multiple mechanisms. Invest Ophthalmol Vis Sci 48(7):3396–3404PubMedCrossRefGoogle Scholar
  40. 40.
    Mullen K (1987) Spatial influences of colour opponent contributions to pattern detection. Vis Res 27:829–839PubMedCrossRefGoogle Scholar
  41. 41.
    Arai M, Katsumi O, Paranhos FR, Lopes De Faria JM, Hirose T (1997) Comparison of Snellen acuity and objective assessment using the spatial frequency sweep PVER. Graefes Arch Clin Exp Ophthalmol 235(7):442–447PubMedCrossRefGoogle Scholar
  42. 42.
    Banks MS (1977) Visual acuity development in human infants: a re-evaluation. Invest Ophthalmol Vis Sci 16(2):191–193PubMedGoogle Scholar
  43. 43.
    Zhou P, Zhao MW, Li XX, Hu XF, Wu X, Niu LJ, Yu WZ, Xu XL (2007) A new method of extrapolating the sweep pattern visual evoked potential acuity. Doc Ophthalmol 117(2):85–91PubMedCrossRefGoogle Scholar
  44. 44.
    Ridder WH 3rd (2004) Methods of visual acuity determination with the spatial frequency sweep visual evoked potential. Doc Ophthalmol 109(3):239–247PubMedCrossRefGoogle Scholar
  45. 45.
    Yadav NK, Almoqbel F, Head L, Irving EL, Leat SJ (2009) Threshold determination in sweep VEP and the effects of criterion. Doc Ophthalmol 119(2):109–121PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Anne Kurtenbach
    • 1
    Email author
  • Hana Langrová
    • 2
  • Andre Messias
    • 1
    • 3
  • Eberhart Zrenner
    • 1
  • Herbert Jägle
    • 1
    • 4
  1. 1.Institute for Ophthalmic ResearchUniversity of TübingenTübingenGermany
  2. 2.University Eye HospitalHradec KrálovéCzech Republic
  3. 3.Department of Ophthalmology, School of Medicine of Ribeirão PretoUniversity of São PauloSão PauloBrazil
  4. 4.Department of OphthalmologyUniversity Hospital RegensburgRegensburgGermany

Personalised recommendations