Skip to main content

Predicting potential acuities in amblyopes

Predicting post-therapy acuity in amblyopes

Documenta Ophthalmologica volume 114, pages 135–145 (2007)Cite this article

Abstract

Purpose

Amblyopic patients, or their parents, often want to know the potential for success before committing to treatment. Recent reports have indicated that the pattern visual evoked potential (pVEP) can be used as a predictor of the success of amblyopia therapy. Unfortunately, these studies did not determine if acuity estimates from pVEPs could accurately predict the acuity post-treatment. Furthermore, pVEPs are not always practical to obtain because of the time necessary to acquire the data. Sweep VEPs (sVEP) offer the advantage of rapidly estimating visual acuity in amblyopic patients. In this retrospective study, the relationship between sVEP acuities measured pre-amblyopic therapy and Snellen acuities measured post-amblyopic therapy was determined.

Methods

Seventeen patients with amblyopia were studied. Monocular sVEP and Snellen acuities were determined pre-amblyopic therapy and Snellen acuities were determined post-amblyopic therapy. An Enfant 4010 computer system was used to produce the stimuli, record the VEPs, and extrapolate the acuity. The stimuli were horizontally oriented, sine wave gratings (11 spatial frequencies from 2 to 24 cpd) with a contrast of 80%, counterphased at 7.5 Hz. Standard VEP recording techniques were employed. Therapy consisted of the full refractive correction and occlusion combined with active vision therapy.

Results

The patients demonstrated a significant improvement in pre- to post-amblyopic therapy Snellen acuities (P < 0.00001). The intraclass correlation coefficient (r i) between the pre-therapy sVEP acuities and the post-therapy Snellen acuities was 0.73. A paired t-test did not find a significant difference between the two sets of data (P = 0.94). For the amblyopes in this study, the average difference (±SD) in the sVEP acuity estimate and the final Snellen visual acuity was +0.002 ± 0.123 logMAR acuity lines.

Conclusion

The results indicate that pre-amblyopic therapy sVEP acuity can be a good predictor of post-amblyopic therapy Snellen acuity.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Crawford MLJ, Blake R, Cool SJ et al (1975) Physiological consequences of unilateral and bilateral eye closure in macaque monkeys: some further observations. Brain Res 84:150–154

    PubMed  Article  CAS  Google Scholar 

  2. Hubel DH, Wiesel TN, LeVay S (1977) Plasticity of ocular dominance columns in monkey striate cortex. Philos Trans R Soc Lond B Biol Sci 278(961):377–409

    PubMed  CAS  Google Scholar 

  3. Blakemore C, Garey LJ, Vital-Durand F (1978) The physiological effects of monocular deprivation and their reversal in the monkey’s visual system. J Physiol 283:223–262

    PubMed  CAS  Google Scholar 

  4. von Noorden GK, Crawford MLJ (1981) The effects of total unilateral occlusion vs lid suture on the visual system of infant monkeys. Invest Ophthalmol Vis Sci 21:142–146

    Google Scholar 

  5. Boothe RG, Dobson V, Teller DY (1985) Postnatal development of vision in human and nonhuman primates. Ann Rev Neurosci 8:495–545

    PubMed  Article  CAS  Google Scholar 

  6. Daw NW (1998) Critical periods and amblyopia. Arch Ophthalmol 116(4):502–505

    PubMed  CAS  Google Scholar 

  7. Harwerth RS, Smith EL 3rd, Duncan GC et al (1986) Multiple sensitive periods in the development of the primate visual system. Science 232(4747):235–238

    PubMed  Article  CAS  Google Scholar 

  8. Westheimer G (2003) Visual Acuity. In: Kaufman PL, Alm A (eds) Adler’s physiology of the eye, clinical application. St. Louis, Mosby 453–469

    Google Scholar 

  9. Sakagami M, Pan X, Uttl B (2006) Behavioral inhibition and prefrontal cortex in decision-making. Neural Netw 19:1255–1265

    PubMed  Article  Google Scholar 

  10. Rudebeck PH, Walton ME, Smyth AN et al (2006) Separate neural pathways process different decision costs. Nat Neurosci 9(9):1161–1168

    PubMed  Article  CAS  Google Scholar 

  11. Hon N, Epstein RA, Owen AM et al (2006) Frontoparietal activity with minimal decision and control. J Neurosci 26(38):9805–9809

    PubMed  Article  CAS  Google Scholar 

  12. Lerner Y, Pianka P, Azmon B et al (2003) Area-specific amblyopic effects in human occipitotemporal object representations. Neuron 40(5):1023–1029

    PubMed  Article  CAS  Google Scholar 

  13. Choi MY, Lee DS, Hwang JM et al (2002) Characteristics of glucose metabolism in the visual cortex of amblyopes using positron-emission tomography and statistical parametric mapping. J Pediatr Ophthalmol Strabismus 39(1):11–19

    PubMed  Google Scholar 

  14. Kiorpes L, McKee SP (1999) Neural mechanisms underlying amblyopia. Curr Opin Neurobiol 9(4):480–486

    PubMed  Article  CAS  Google Scholar 

  15. De Valois RL, De Valois KK (1990) Multiple spatial frequency channels. In: Broadbent DE (ed) Spatial vision. Oxford University Press, Oxford, 176–211

    Google Scholar 

  16. Selenow A, Ciuffreda KJ, Mozlin R et al (1986) Prognostic value of laser interferometric visual acuity in amblyopia therapy. Invest Ophthalmol Vis Sci 27(2):273–237

    PubMed  CAS  Google Scholar 

  17. Gstalder RJ, Green DG (1971) Laser interferometric acuity in amblyopia. J Pediatr Ophthalmol 8:251–256

    Google Scholar 

  18. Vernon SA, Hardman-Lea S, Rubinstein MP et al (1990) White light interferometry in amblyopic children–a pilot study. Eye 4(Pt 6):802–5

    PubMed  Google Scholar 

  19. Wildberger H. (1982) The relationship between visual evoked potentials (VEPs) and visual acuity in amblyopia. Docum Ophthal Proc Series 31:385–380

    Google Scholar 

  20. Iliakis E, Moschos M, Hontos N et al (1996) The prognostic value of visual evoked response latency in the treatment of amblyopia caused by strabismus. Doc Ophthalmol 92:223–228

    PubMed  Article  Google Scholar 

  21. Schroeder CE, Tenke CE, Givre SJ et al (1991) Striate cortical contribution to the surface-recorded pattern-reversal VEP in the alert monkey. Vision Res 31(7–8):1143–1157

    PubMed  Article  CAS  Google Scholar 

  22. Wilcox LM Jr, Sokol S (1980) Changes in the binocular fixation patterns and the visually evoked potential in the treatment of esotropia with amblyopia. Ophthalmology 87:1273–1281

    PubMed  Google Scholar 

  23. Galloway NR, Barber C (1982) Transient visual evoked potential monitoring of disuse amblyopia. Docum Ophthal Proc Series 31:377–384

    Google Scholar 

  24. Howe JW, Mitchell KW, Robson C (1981) Electrophysiological assessment of visual acuity. Trans Ophthalmol Soc U K 101:105–108

    PubMed  CAS  Google Scholar 

  25. Jenkins TCA, Douthwaite WA, Peedle JE (1985) The VER as a predictor of normal visual acuity in the adult human eye. Ophthalmic Physiol Opt 5:441–449

    PubMed  Article  CAS  Google Scholar 

  26. Fagan JE, Yolton RE (1985) Theoretical reliability of visual evoked response-based acuity determinations. Am J Optom Physiol Opt 62:95–99

    PubMed  Google Scholar 

  27. Friendly DS, Weiss IP, Barnet AB et al (1986) Pattern reversal visual evoked potentials in the diagnosis of amblyopia in children. Am J Optom Physiol Opt 102:329–339

    CAS  Google Scholar 

  28. Jenkins TCA, Douthwaite WA (1988) An objective VER assessment of visual acuity compared with subjective measures. Am J Optom Physiol Opt 65:957–961

    PubMed  CAS  Google Scholar 

  29. Steele M, Seiple WH, Carr RE et al (1989) The clinical utility of visual-evoked potential acuity testing. Am J Ophthalmol 108:572–577

    PubMed  CAS  Google Scholar 

  30. Ohn Y, Katsumi O, Matsui Y et al (1994) Snellen visual acuity versus pattern reversal visual-evoked response acuity in clinical applications. Ophthalmic Res 26:240–252

    PubMed  CAS  Google Scholar 

  31. Gottlob I, Fendick MG, Guo S et al (1990) Visual acuity measurements by swept spatial frequency visual-evoked-cortical potentials (VECPs): clinical application in children with various visual disorders. J Pediatr Ophthalmol Strabismus 27:40–47

    PubMed  CAS  Google Scholar 

  32. Cibis GW, Fitzgerald KM (1995) Amblyopia in unilateral congenital ptosis: early detection by sweep visual evoked potential. Graefes Arch Clin Exp Ophthalmol 233:605–609

    PubMed  Article  CAS  Google Scholar 

  33. Thompson DA, Moller H, Russell-Eggitt I et al (1996) Visual acuity in unilateral cataract. Br J Ophthalmol 80:794–798

    PubMed  CAS  Google Scholar 

  34. Katsumi O, Arai M, Wajima R et al (1996) Spatial frequency sweep pattern reversal VER acuity vs snellen visual acuity: effect of optical defocus. Vision Res 36:903–909

    PubMed  Article  CAS  Google Scholar 

  35. Ridder WH 3rd, McCulloch D, Herbert AM (1998) Stimulus duration, neural adaptation, and sweep visual evoked potential acuity estimates. Invest Ophthalmol Vis Sci 39(13):2759–2768

    PubMed  Google Scholar 

  36. Norcia AM, Tyler CW (1985) Spatial frequency sweep VEP: visual acuity during the first year of life. Vision Res 25:1399–1408

    PubMed  Article  CAS  Google Scholar 

  37. Strasburger H, Remky A, Murray IJ et al (1996) Objective measurement of contrast sensitivity and visual acuity with the steady-state visual evoked potential. Ger J Ophthalmol 5:42–52

    PubMed  CAS  Google Scholar 

  38. Ridder WH 3rd (2004) Methods of visual acuity determination with the spatial frequency sweep visual evoked potential. Doc Ophthalmol 109(3):239–247

    PubMed  Article  Google Scholar 

  39. Day SH, Orel-Bixler DA, Norcia AM (1988) Abnormal acuity development in infantile esotropia. Invest Ophthalmol Vis Sci 29:327–329

    PubMed  CAS  Google Scholar 

  40. Orel-Bixler DA, Norcia AM (1988) Predicting optotype visual acuity from grating acuity in strabismus and anisometropia. Invest Ophthalmol Vis Sci 29:S10

    Google Scholar 

  41. Gottlob I, Wizov SS, Odom JV et al (1993) Predicting optotype visual acuity by swept spatial visual-evoked potentials. Clin Vision Sci 8:417–423

    Google Scholar 

  42. Holmes JM, Edwards AR, Beck RW et al (2005) A randomized pilot study of near activities versus non-near activities during patching therapy for amblyopia. J Aapos 9(2):129–136

    PubMed  Article  Google Scholar 

  43. Krumholtz I, FitzGerald D (1999) Efficacy of treatment modalities in refractive amblyopia. J Am Optom Assoc 70(6):399–404

    PubMed  CAS  Google Scholar 

  44. Ciuffreda KJ, Levi DM, Selenow A (1991) Amblyopia: Basic and Clinical Aspects. Boston, MA: Butterworth-Heinemann

    Google Scholar 

  45. Ciuffreda KJ, Kenyon RV, Stark L (1979) Fixational eye movements in amblyopia and strabismus. J Am Optom Assoc 50:1251–1258

    PubMed  CAS  Google Scholar 

  46. Caloroso EE, Rouse MW (1993) Clinical Management of Strabismus. Butterworth-Heinemann, Boston, pp 175–199

  47. Optometric Clinical Practice Guideline (2004) Care of the patient with amblyopia. St. Louis: American Optometric Association

  48. Arai M, Katsumi O, Paranhos FR et al (1997) Comparison of Snellen acuity and objective assessment using the spatial frequency sweep PVER. Graefes Arch Clin Exp Ophthalmol 235(7):442–447

    PubMed  Article  CAS  Google Scholar 

  49. Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8(2):135–160

    PubMed  Article  CAS  Google Scholar 

  50. Baitch LW, Ridder WH 3rd, Harwerth RS, et al (1991) Binocular beat VEPs: losses of cortical binocularity in monkeys reared with abnormal visual experience. Invest Ophthalmol Vis Sci 32(12):3096–3103

    PubMed  CAS  Google Scholar 

  51. Kiorpes L, Tang C, Movshon JA (1999) Factors limiting contrast sensitivity in experimentally amblyopic macaque monkeys. Vision Res 39(25):4152–4160

    PubMed  Article  CAS  Google Scholar 

  52. Ciuffreda KJ, Kenyon RV (1983) Accommodative vergence, accommodation in normals, amblyopes, and strabismics, In: Ciuffreda KJ (ed) Vergence eye movements: basic and clinical aspects. Butterworths: Boston, MA, 101–173

    Google Scholar 

  53. Jeffreys DA (1971) Cortical source locations of pattern-related visual evoked potentials recorded from the human scalp. Nature 229:502–504

    PubMed  Article  CAS  Google Scholar 

  54. Jeffreys DA, Axford JG (1972) Source locations of pattern-specific components of human visual evoked potnetials. I. Component of striate cortical origin. Exp Brain Res 16:1–21

    PubMed  CAS  Google Scholar 

  55. Jeffreys DA, Axford JG (1972) Source locations of pattern-specific components of human visual evoked potentials. II. Component of extrastriate origin. Exp Brain Res 16:22–40

    PubMed  CAS  Google Scholar 

  56. Srebro R (1985) Localization of visually evoked cortical activity in humans. J Physiol 360:233–246

    PubMed  CAS  Google Scholar 

  57. Maier J, Dagnelie G, Spekreijse H, et al (1987) Principal component analysis for source localization of VEPs in man. Vision Res 27:165–177

    PubMed  Article  CAS  Google Scholar 

  58. Schroeder CE, Tenke CE, Givre SJ (1992) Subcortical contributions to the surface-recorded flash-VEP in the awake macaque. Electroencephalogr Clin Neurophysiol 84(3):219–231

    PubMed  Article  CAS  Google Scholar 

  59. Repka MX, Beck RW, Holmes JM et al (2003) A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol 121(5):603–611

    PubMed  Article  Google Scholar 

  60. Scheiman MM, Hertle RW, Beck RW et al (2005) Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 123(4):437–447

    PubMed  Article  Google Scholar 

  61. Wick B, Wingard M, Cotter S et al (1992) Anisometropic amblyopia: is the patient ever too old to treat? Optom Vis Sci 69:866–878

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgement

The statistical analysis was performed by Paul DeLand, Ph.D.

Author information

Affiliations

  1. Southern California College of Optometry, 2575 Yorba Linda Blvd, Fullerton, CA, 92831, USA

    William H. Ridder III & Michael W. Rouse

Authors
  1. William H. Ridder III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael W. Rouse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William H. Ridder III.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ridder, W.H., Rouse, M.W. Predicting potential acuities in amblyopes. Doc Ophthalmol 114, 135–145 (2007). https://doi.org/10.1007/s10633-007-9048-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10633-007-9048-y

Keywords

  • Visual evoked potential
  • Visual acuity
  • Amblyopia
  • Anisometropia
  • Strabismus