Conducting shorter VEP tests to estimate visual acuity via assessment of SNR

The estimation of visual acuity (VA) via visual evoked potentials (VEP) is a valuable measure for all preverbal and non-verbal subjects whether adults or children. The aim of this study is to introduce a novel technique of VEP acquisition based on estimates of signal-to-noise ratio (SNR) and comparison to a predefined detection threshold. We aim to demonstrate the reduction in total study time without compromising the accuracy of the VEP-determined acuity estimate.

The VEP-determined acuity of twelve normal subjects was assessed via a spatial frequency (SF) sweep. A pattern reversal checkerboard stimulus utilised SFs ranging from 0.1 to 28 cycles per degree (cpd). Using linear extrapolation and Bland-Altman analysis, VEP-acquired acuity was compared to a conventional Snellen Acuity measurement. An SNR test, Fsp, assessed signal quality to determine the minimum amount of sweep data required for VEP-based VA estimation.

VEP acuity estimates correlated strongly (r2=0.91, SD=0.06), leading to a VA limit via extrapolation. Bland-Altman analysis revealed agreement between tests is statistically valid (95% CI -0.11 to 0.42 logMAR). The Fsp statistic indicated SFs 1.3-3.6 cpd yielded Fsp>3.1 within 15 s of acquisition with frequencies>3.6 cpd being sub-threshold. The Kruskal-Wallis statistic compared final Fsp values for SFs as groups, where F=208.82 ranking each frequency, with frequencies>7.2 cpd ranking lowest.

The Fsp as an SNR measurement shows that rapid, quality-driven clinical tests for VEP-based acuity estimates can be conducted without compromising accuracy.