Gaze-contingent flicker pupil perimetry detects scotomas in patients with cerebral visual impairments or glaucoma

The pupillary light reflex is weaker for stimuli presented inside as compared to outside absolute scotomas. Pupillograph perimetry could thus be an objective measure of impaired visual processing. However, the diagnostic accuracy in detecting scotomas has remained unclear. We quantitatively investigated the accuracy of a novel form of pupil perimetry. The new perimetry method, termed gaze-contingent flicker pupil perimetry, consists of the repetitive on, and off flickering of a bright disk (2 hz; 320 cd/m; 4° diameter) on a gray background (160 cd/m) for 4 seconds per stimulus location. The disk evokes continuous pupil oscillations at the same rate as its flicker frequency, and the oscillatory power of the pupil reflects visual sensitivity. We monocularly presented the disk at a total of 80 locations in the central visual field (max. 15°). The location of the flickering disk moved along with gaze to reduce confounds of eye movements (gaze-contingent paradigm). The test lasted ~5 min per eye and was performed on 7 patients with cerebral visual impairment (CVI), 8 patients with primary open angle glaucoma (age >45), and 14 healthy, age/gender-matched controls. For all patients, pupil oscillation power (FFT based response amplitude to flicker) was significantly weaker when the flickering disk was presented in the impaired as compared to the intact visual field (CVI: 12%, AUC = 0.73; glaucoma: 9%, AUC = 0.63). Differences in power values between impaired and intact visual fields of patients were larger than differences in power values at corresponding locations in the visual fields of the healthy control group (CVI: AUC = 0.95; glaucoma: AUC = 0.87). Pupil sensitivity maps highlighted large field scotomas and indicated the type of visual field defect (VFD) as initially diagnosed with standard automated perimetry (SAP) fairly accurately in CVI patients but less accurately in glaucoma patients. We provide the first quantitative and objective evidence of flicker pupil perimetry's potential in detecting CVI-and glaucoma-induced VFDs. Gaze-contingent flicker pupil perimetry is a useful form of objective perimetry and results suggest it can be used to assess large VFDs with young CVI patients whom are unable to perform SAP

The folding fingerprint of visual cortex reveals the timing of human V1 and V2

Primate neocortex contains over 30 visual areas. Recent techniques such as functional magnetic resonance imaging (fMRI) have successfully identified many of these areas in the human brain, but have been of limited value for revealing the temporal dynamics between adjacent visual areas, a critical component of understanding visual cognition. The voltages recorded at the scalp, electroencephalography (EEG), is a direct measure of neural activity that reflects the summed activity across all brain areas. Identifying the cortical sources that contribute to the EEG is a difficult problem. We developed an anatomically constrained dipole search method that solves the traditional problems by combining fMRI, EEG and many stimuli that activate small cortical regions. The method provides a means to validate the extracted waveforms. Both V1 and V2 waveforms have similar onset latencies as well as dynamics that can explain previous controversial findings about the responses of these areas

Amblyopic deficit beyond the fovea : delayed and variable single-trial ERP response latencies, but unaltered amplitudes

Purpose. Amblyopia was first described as a deficit of central vision. However, it has long been debated whether this dysfunction is limited to the fovea or whether extrafoveal vision is also affected, as studies concerning the latter are equivocal. The purpose of the study was to resolve this issue. Methods. We investigated the amblyopic effect on event-related potentials (ERPs) with foveal and perifoveal stimuli, either matched in size based on cortical magnification or presented as large annular stimuli. In two separate experiments we measured ERPs on amblyopic patients and control subjects using face images. Latency and amplitude of averaged ERPs and their single-trial distributions were analyzed. Results. When the fovea was stimulated, latency and amplitude of the early averaged ERP components increased and were reduced, respectively, in the amblyopic compared with the fellow eye. Importantly, perifoveal stimulation also elicited similar amblyopic deficits, which were clearly significant in the case of using cortical magnification scaled stimuli. However, single-trial peak analysis revealed that foveal and perifoveal effects differed in nature: Peak amplitudes were reduced only in foveal stimulation, while latencies were delayed and jittered at both the fovea and perifovea. Event-related potentials obtained from fellow eyes were not significantly different from those of normal observers. Conclusions. Our findings revealed the existence of amblyopic deficits at the perifovea when the stimulated cortical area was matched in size to that of foveal stimulation. These deficits manifested themselves only in the temporal structure of the responses, unlike foveal deficits, which affected both component amplitude and latency

Driving steady-state visual evoked potentials at arbitrary frequencies using temporal interpolation of stimulus presentation

Date of Acceptance: 29/10/2015 We thank Renate Zahn for help with data collection. This work was supported by Deutsche Forschungsgemeinschaft (AN 841/1-1, MU 972/20-1). We would like to thank A. Trujillo-Ortiz, R. Hernandez-Walls, A. Castro-Perez and K. BarbaRojo (Universidad Autonoma de Baja California) for making Matlab code for non-sphericity corrections freely available.Peer reviewedPublisher PD

Topographic mapping of retinal function with the SLO-mfERG under simultaneous control of fixation in Best's disease

Purpose: To introduce the scanning laser ophthalmoscope-evoked mfERG (SLO-mfERG) as a new method to measure focal retinal function. Methods: Sixty-two healthy individuals and 12 patients with Best's disease were examined. mfERGs were recorded using a scanning laser ophthalmoscope as a stimulator and trigger device (He-Neon 632.8 nm) as well as a fundus-monitoring system (infrared 730 nm). Results: Amplitudes in the central concentric area were found to be significantly lower in patients with Best's disease than in healthy controls, while no significant differences were found for the more peripheral areas. Conclusion: SLO-mfERG is a reliable new technique for topographic mapping of retinal function under simultaneous control of fixation

Eletroretinograma de padrão reverso no diagnóstico e acompanhamento das afecções da via óptica anterior

The pattern electroretinogram is an electrophysiological test that assesses the function of inner retinal layers, particularly the ganglion cells layer of retina, using a reversing checkerboard or grating pattern that produces no change in average luminance over time. The normal pattern electroretinogram is composed of a proeminent positive component (P50) and a large later negative component (N95). Since structural damage that compromises the retinal ganglion cell layer can lead to pattern electroretinogram changes, particularly in the N95 amplitude, the test can be useful in the treatment of a number of anterior visual pathway diseases. In this article, we review the methods for recording pattern electroretinogram and its usefulness in the diagnosis and management of diseases including inflammatory, hereditary, ischemic and compressive lesions of the anterior visual pathway.O eletroretinograma de padrão reverso é um teste eletrofisiológico que avalia a função das camadas internas da retina, especialmente a camada de células ganglionares, através de um estímulo em xadrez ou em barras que não apresenta variação na luminância do estímulo. É composto de um componente positivo (P50) e um componente negativo (N95) tardio. Uma vez que lesões estruturais às células ganglionares da reitna podem levar a alterações no eletroretinograma de padrão reverso, especialmente na amplitude da onda N95, o teste pode ser útil no tratamento de várias doenças da via óptica anterior. Neste artigo revisamos os métodos de obtenção do eletroretinograma de padrão reverso e a sua utilidade no diagnóstico e acompanhamento de doenças incluindo lesões inflamatórias, hereditárias, isquemicas e compressivas na via óptica anterior

Multiple sclerosis-like neurological manifestations in a coeliac patient: nothing is as it seems

Cobalamin (vitamin B(12)) deficiency occurs with several disorders, involving different organs and systems, including blood, bowel, nervous system and eyes. Although the most important features are usually haematological ones, presence of neurological involvement, in the absence of blood count alterations, has just been described in the literature. Here we report the case of a 48-year-old man, suffering from coeliac disease for approximately 5 years, vegetarian, who was admitted to our department, referring dysaesthesia of the left lower limb, decreased libido and erectile dysfunction. Vitamin B(12) deficiency was proved, even in the absence of blood count alteration, and treated with a vitamin supplement, resulting in complete remission

Diagnosis of multiple sclerosis: progress and challenges

The diagnosis of multiple sclerosis (MS) is based on typical neurological symptoms and signs along with evidence of dissemination of central nervous system (CNS) lesions in space and time. Magnetic resonance imaging (MRI) is often sufficient to confirm the diagnosis when characteristic lesions of MS accompany a typical clinical syndrome, but in some patients, further supportive information can be obtained from cerebrospinal fluid examination and neurophysiological testing. It is important to differentiate MS not only from other diseases in which demyelination is a feature e.g. neuromyelitis spectrum disorder (NMOSD) and acute disseminated encephalomyelitis (ADEM), but also non-demyelinating conditions such as chronic small vessel disease and other inflammatory, granulomatous, infective, metabolic and genetic causes that can mimic MS. Advances in MRI, serological and genetic tests have greatly helped in distinguishing MS from these conditions, but misdiagnosis can occur. In this review, we explore the progress and challenges in the diagnosis of MS with reference to diagnostic criteria, important differential diagnoses, current controversies and uncertainties, and future prospects