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Comparison of pattern visual-evoked potentials to perimetry in the detection of visual loss in children with optic
1Division of Ophthalmology, Children's Hospital & Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Insights
Visual evoked potentials (VEPs) are a reliable, objective tool for detecting visual field loss in children with optic pathway gliomas. Reduced VEP amplitude and signal-to-noise ratio at the midline electrode indicate visual field deficits, offering an alternative to standard testing.
Area of Science:
- Ophthalmology
- Neuroscience
- Pediatric Oncology
Background:
- Optic pathway gliomas are a significant cause of vision loss in children.
- Assessing visual field deficits in young children can be challenging due to intolerance to standard testing methods.
Purpose of the Study:
- To compare the efficacy of visual evoked potentials (VEPs) with standard visual field testing in children diagnosed with visual pathway gliomas.
- To determine if VEPs can serve as a reliable, objective alternative for detecting visual field loss in this pediatric population.
Main Methods:
- The study included 15 children with confirmed visual pathway gliomas.
- Goldmann visual field (GVF) testing and 3-channel VEPs were performed on 25 eyes.
- VEP parameters (amplitudes, latencies, SNRs) were compared between patients and controls. Humphrey visual field testing was also conducted on a subset of patients.
Main Results:
- A significant proportion of eyes (22/25) exhibited visual field defects, including hemianopia and generalized depression.
- VEP amplitudes and signal-to-noise ratios (SNRs) were significantly reduced at the midline electrode in eyes with visual field loss.
- While interhemispheric VEP asymmetry was observed, it was not a reliable indicator of hemianopic field defects.
Conclusions:
- Reduced midline VEP amplitude and SNR are sensitive indicators of visual field loss in children with optic pathway gliomas.
- VEPs offer a valuable, objective alternative to traditional visual field testing for children unable to tolerate standard assessments.
- Recommended VEP protocols include pattern-onset and check reversal stimuli across various spatial frequencies.
Purpose:
We sought to compare visual evoked potentials (VEPs) with standard visual field testing in children with visual pathway gliomas.
Methods:
Fifteen of 40 children with visual pathway gliomas verified on magnetic resonance imaging scan who cooperated with Goldmann visual field (GVF) and 3-channel VEPs were studied. GVFs were obtained in 25 eyes with adequate vision. VEP amplitudes, latencies, and signal-to-noise ratios (SNRs) were compared with control subjects. Four of the patients (5 eyes) also had Humphrey visual field testing.
Results:
Twenty-two of 25 eyes had a field defect, 15 eyes showed a relative or absolute hemianopia, 7 eyes showed a central or generalized depression, and 3 eyes were normal. In hemianopic eyes, 87% showed a depression (GVF) or reduced sensitivity (Humphrey field) in the opposite hemifield. VEP amplitudes and SNRs, normally largest at the midline electrode, were significantly reduced in all eyes with visual field loss. By comparison, lateral electrodes showed significantly lower amplitudes and SNRs in patients and controls. Interhemispheric VEP asymmetry (>2:1 ratio) was seen in 67% of patients with hemianopia and 53% of controls.
Conclusions:
Reduction of amplitude and SNR at the midline VEP electrode was a sensitive indicator of visual field loss. Interhemispheric VEP asymmetry was not reliable in detection of a hemianopic field defect. VEPs can be a reliable and objective alternative for the detection of visual loss due to optic pathway glioma in children who are intolerant to visual field testing. We recommend the test protocol include pattern-onset and check reversal stimuli of at least one high and one low spatial frequency.
