Faculty Bibliography

We discuss the use of synchronous-demodulation (lock-in) techniques for evoked potential retrieval. Application to electronically swept visual displays is emphasized. These techniques permit a visual threshold to be specified in 20 s, but their application to visual assessment requires careful consideration of several problems, notably alleged delay in the instrumentation, specification of the baseline response level, and the nature of EEG interference. In addition, since stimulus waveform information is lost in all lock-in methods, questions concerning what activity is contributing to the measured response must be answered. A technique addressing these issues and combining phase-sensitive detection and vector computation is presented

Electrophysiologic contrast sensitivity functions (CSF) have been estimated using lock-in amplifier signal retrieval of the visually evoked response (VER). These CSFs were compared with CSFs obtained psychophysically using the same stimulus conditions. The two measures of contrast sensitivity behave similarly in response to variations of temporal and spatial frequency. The major advantage of using real-time retrieval is speed. Threshold for a single spatiotemporal condition can be estimated in as little as 20 sec, making the application of electrophysiologic contrast sensitivity testing feasible for clinical populations

Using clinical and electrophysiologic measures, we evaluated the visual pathway of patients who had multiple sclerosis, 20/20 Snellen acuity, and no history of optic neuritis. Delayed latencies were found in the transient visual evoked potentials (VEPs) of 38% of the patients, and interocular latency differences were abnormal in 67%. Contrast VEPs were abnormal in 46%. Psychophysical determinations of contrast sensitivity were abnormal in 78%. Only 17% of the patients had dyschromatopsia, 36% had afferent pupillary abnormalities, and 59% had optic nerve pallor or nerve fiber layer loss. Psychophysical contrast evaluations and VEP studies were superior to other clinical evaluations in demonstrating visual dysfunction in these patients

Pattern evoked electroretinograms (PERG), diffuse flash electroretinograms (ERG) and visual evoked potentials were studied in patients with unilateral optic nerve disease. Patients with Snellen acuities of less than 6/30 did not have recordable PERGs in their affected eye, whereas their diffuse flash ERGs were normal. The VEPs were correspondingly reduced or absent when recorded from the poorer seeing eyes. A second group of patients with Snellen acuity between 6/6 and 6/30 in the involved eye showed reductions in the mean PERG amplitude of the affected as compared with the normal eyes. All affected eyes showed an abnormal contrast threshold measured with the PERG amplitude. Such results underscore the diagnostic value of the PERG in detecting even mildly affected cases of optic nerve disease

It is possible to record a pattern electroretinogram (PERG) of near normal amplitude in a situation when the eye containing the active electrode is occluded. Because PERG recording requires high amplification and sensitive signal retrieval techniques, the electrode in the occluded eye records a distant potential from the unoccluded eye. Referencing the active electrode to an ipsilateral ear diminishes, but does not eliminate the referred PERG potential. Such unlooked for interaction may provide misleading data in situations where binocular viewing is used because of poor vision in one eye; therefore, occlusion of the eye not being tested should be undertaken whenever possible