Graham Stuart L, Klistorner Alexander I, Goldberg Ivan
Save Sight Institute, Sydney University, Syndey, New South Wales, Australia.
Arch Ophthalmol. 2005 Jun;123(6):729-39. doi: 10.1001/archopht.123.6.729.
To evaluate the role of objective perimetry using multifocal visual evoked potentials (mVEPs) in glaucoma practice, and to assess its utility in patients with inconclusive standard automated perimetry findings. Method A retrospective case series of 436 consecutive subjects referred for glaucoma investigation who underwent testing with the AccuMap V1.3 mVEP system (ObjectiVision Pty, Ltd, Sydney, New South Wales, Australia) within a defined 12-month period. Sensitivity was determined by comparing this testing with that of standard automated perimetry and that used in a subgroup in whom masked stereoscopic optic disc photographs were used as an alternative reference standard. Overall clinical diagnostic outcomes were assessed.
The mVEP changes were correlated with the stage of disease and Humphrey mean deviation (r = 0.78). The overall sensitivity for detecting glaucoma with established subjective field loss was 97.5% (early glaucoma, 95.0%), whereas 92.2% of low-risk suspects had normal mVEPs. When masked disc assessment alone was used for diagnosis of abnormality, sensitivity of mVEP (80.6%) and Humphrey visual field results (81.9%) were similar, but mVEP specificity was better (89.2% vs 79.5%). The mVEP was particularly useful in assessing excessive subjective field loss (45 eyes) by showing a much closer correlation with the clinical picture.
Multifocal VEP is an effective method for detecting visual field loss in glaucoma. It provides a valuable aid to the clinician in categorizing patients with unreliable, variable, unconfirmed, or excessive subjective field loss.
评估使用多焦视觉诱发电位（mVEPs）的客观视野检查在青光眼诊疗中的作用，并评估其在标准自动视野检查结果不明确的患者中的效用。方法：对436例连续转诊进行青光眼检查的患者进行回顾性病例系列研究，这些患者在规定的12个月内使用AccuMap V1.3 mVEP系统（澳大利亚新南威尔士州悉尼市ObjectiVision Pty，Ltd）进行了检测。通过将该检测结果与标准自动视野检查结果以及在一个亚组中使用的检测结果进行比较来确定敏感性，在该亚组中，使用遮蔽立体视盘照片作为替代参考标准。评估总体临床诊断结果。
mVEP变化与疾病阶段和汉弗莱平均偏差相关（r = 0.78）。检测已确诊主观视野缺损的青光眼的总体敏感性为97.5%（早期青光眼为95.0%），而92.2%的低风险可疑患者mVEPs正常。当仅使用遮蔽视盘评估来诊断异常时，mVEP的敏感性（80.6%）和汉弗莱视野结果的敏感性（81.9%）相似，但mVEP的特异性更好（89.2%对79.5%）。mVEP在评估过度主观视野缺损（45只眼）方面特别有用，因为它与临床情况的相关性更强。
多焦VEP是检测青光眼视野缺损的有效方法。它为临床医生对主观视野缺损不可靠、多变、未确诊或过度的患者进行分类提供了有价值的帮助。
