Faculty Bibliography

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

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