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Clinical use of multifocal visual-evoked potentials in a glaucoma practice: a prospective study

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Abstract

Purpose To test a framework that describes how the multifocal visual-evoked potential (mfVEP) technique is used in a particular glaucoma practice. Methods In this prospective, descriptive study, glaucoma suspects, ocular hypertensives and glaucoma patients were referred for mfVEP testing by a single glaucoma specialist over a 2-year period. All patients underwent standard automated perimetry (SAP) and mfVEP testing within 3 months. Two hundred and ten patients (420 eyes) were referred for mfVEP testing for the following reasons: (1) normal SAP tests suspected of early functional loss (ocular hypertensives, n = 43; and glaucoma suspects on the basis of suspicious optic disks, n = 52); (2) normal-tension glaucoma patients with suspected central SAP defects (n = 33); and (3) SAP abnormalities needing confirmation (n = 82). Results All the glaucoma suspects with normal SAP and mfVEP results remained untreated. Of those with abnormal mfVEP results, 68 % (15/22) were treated because the abnormal regions on the mfVEP were consistent with the abnormal regions seen during clinical examination of the optic disk. The mfVEP was abnormal in 86 % (69/80) of eyes with glaucomatous optic neuropathy and SAP damage, even though it did not result in an altered treatment regimen. In NTG patients, the mfVEP showed central defects in 44 % (12 of 27) of the eyes with apparently normal central fields and confirmed central scotomata in 92 % (36 of 39), leading to more rigorous surveillance of these patients. Conclusions In a clinical practice, the mfVEP was used when clinical examination and subjective visual fields provided insufficient or conflicting information. This information influenced clinical management.

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Acknowledgments

This study was supported in part by grants EY09076 and EY02115 from the National Institutes of Health, Bethesda, MD; the Kwie Ding and Mae Sun Wang Research Fund of the New York Glaucoma Research Institute, New York, NY; and the Edith C. Blum Foundation, New York, NY (CGDM).

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Authors and Affiliations

  1. Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY, 10003, USA

    Carlos Gustavo De Moraes, Jeffrey M. Liebmann & Robert Ritch

  2. New York University School of Medicine, New York, NY, USA

    Carlos Gustavo De Moraes & Jeffrey M. Liebmann

  3. Department of Ophthalmology, The New York Medical College, Valhalla, NY, USA

    Robert Ritch

  4. Departments of Psychology and Ophthalmology, Columbia University, New York, NY, USA

    Donald C. Hood

Authors
  1. Carlos Gustavo De Moraes
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  2. Jeffrey M. Liebmann
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  3. Robert Ritch
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  4. Donald C. Hood
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Correspondence to Carlos Gustavo De Moraes.

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De Moraes, C.G., Liebmann, J.M., Ritch, R. et al. Clinical use of multifocal visual-evoked potentials in a glaucoma practice: a prospective study. Doc Ophthalmol 125, 1–9 (2012). https://doi.org/10.1007/s10633-012-9324-3

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  • DOI: https://doi.org/10.1007/s10633-012-9324-3

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