Visual-evoked response, pattern electroretinogram, and psychophysical magnocellular thresholds in glaucoma, optic...

The purpose of this study is to compare visual-evoked response (VEP) pattern electroretinogram (PERG) and psychophysical thresholds to the same stimulus, designed to be optimal for the magnocellular system, in suspects and patients with early glaucoma, patients with optic nerve disease, dyslexic children, and age-matched controls.

Stimuli were low spatial frequency sinusoidal luminance profile gratings abruptly phase reversing at 7.14 Hz. Electrophysiological recordings were made at 50%, 30%, 20%, 10%, and 5% contrast. Threshold was the lowest contrast evoking a clear response at the stimulus frequency. Three independent judges scored the traces. Psychophysical thresholds were obtained by ascending and descending method of limits. VEPs and PERGs to International Society for Clinical Electrophysiology of Vision (ISCEV) standards and to increasing spatial frequencies were obtained as parvocellular specific controls. Patients were diagnosed independently by the referring professionals.

Parvocellular-specific responses were normal, except in cases with explicable visual acuity loss. The judges scores correlated highly (> 0.9). VEPs and PERGs correlated highly and each correlated less well with psychophysics in normals, glaucoma, and dyslexia but the opposite occurred in optic nerve disease. VEPs had the lowest normal values and least variance (all adults < 5%, children < 10%, PERGs < 20%). In glaucoma, VEP magnocellular deficits occurred in 85% of recently diagnosed positive cases, 48% of high-risk suspects, 39% of low-risk suspects, and ocular hypertensives. Approximately 28% of dyslexics had VEP magnocellular deficits. PERG losses were less frequent. There was a clear dichotomy and low correlations between psychophysics and electrophysiology both within and between groups. Psychophysical threshold elevations were absent in all glaucoma groups, often large in optic atrophy and small (2.5%) but highly significant in dyslexia.

Contrast thresholds to magnocellular-specific stimuli are consistent in cortex and retina. VEPs are more reliable. Psychophysics seems to tap different mechanisms. VEPs are very sensitive to early glaucoma. The lack of VEP loss in dyslexia suggests the other losses are artifactual. Further research is needed to see if stimuli even more like the frequency-doubling technology are more useful clinically.