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Isolated-check visual evoked potential: a more sensitive tool to detect traumatic optic neuropathy after orbital fracture

  • Trauma
  • Published:
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Abstract

Purpose

To establish a more sensitive diagnostic tool for traumatic optic neuropathy (TON), we explored the diagnostic efficacy of isolated-check visual evoked potential (ic-VEP) for TON in orbital fracture and compared ic-VEP with pattern-reversal visual evoked potential (P-VEP) testing.

Methods

This was a prospective single-center study. A total of 137 eyes from 131 patients diagnosed between December 2016 and October 2019 with orbital fractures were included in the study. Injury history, best-corrected visual acuity (BCVA), visual field, computed tomography (CT), P-VEP, and ic-VEP data were collected. Parameters of ic-VEP (signal-to-noise ratio [SNR]) and P-VEP (peak latency and amplitude of P100) were compared and diagnostic accuracy was analyzed.

Results

TON was associated with worse BCVA than non-TON (median 0.52 versus 0.10 logMAR, P < 0.001). SNRs were negatively associated with the P100 peak latency while positively associated with the P100 amplitude. The sensitivity of ic-VEP for TON (79.6%) was higher than that of P-VEP (61.2%, P = 0.049), although this difference was not statistically significant after Bonferroni correction. Using ic-VEP and P-VEP together could increase sensitivity (87.8%). Maximum areas under curve were obtained using the SNR criteria of 1.3, 1.47, and 1.54 at 8%, 16%, and 32% depth of modulation, respectively.

Conclusion

ic-VEP was more sensitive than P-VEP in diagnosing TON, and a combination of the two examination tests was recommended. The use of ic-VEP as the new diagnostic standard technique for TON should be considered.

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Data can be assessed by reasonable requirement by contacting the corresponding author.

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Acknowledgments

The authors are thankful to all the technicians at Peking University Third Hospital for their help in operating the isolated-check visual evoked potential (ic-VEP) and pattern-reversal visual evoked potential (P-VEP) equipment used in this study. They acknowledge the National Science and Technology Major Project for the financial support.

Funding

This study was supported by the Chinese National Science and Technology Major Project (grant number, 2018Z × 10101004).

Author information

Author notes

  1. Yanjie Tian and Yinhao Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Peking University Third Hospital, No. 49, Garden North Road, Haidian District, Beijing, China

    Yanjie Tian, Yinhao Wang, Ziyuan Liu & Xuemin Li

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Contributions

Xuemin Li had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Yanjie Tian, Yinhao Wang, and Xuemin Li contributed to the study concept and design. Yinhao Wang and Ziyuan Liu contributed to the acquisition, analysis, and interpretation of data. Yinhao Wang and Ziyuan Liu drafted the manuscript. All authors contributed to the critical revision of the manuscript for important intellectual content and gave their final approval.

Corresponding author

Correspondence to Xuemin Li.

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This study was approved by the Peking University Third Hospital (PUTH) Ethics Committee. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent for participation was obtained from all participants in the study.

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Tian, Y., Wang, Y., Liu, Z. et al. Isolated-check visual evoked potential: a more sensitive tool to detect traumatic optic neuropathy after orbital fracture. Graefes Arch Clin Exp Ophthalmol 259, 547–555 (2021). https://doi.org/10.1007/s00417-020-04895-2

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