Clinical Aspects of the Visually Evoked Potential

The visually evoked potential (VEP) was studied in normal and abnormal human subjects, and in Rhesus monkeys with central, paracentral, and peripheral photocoagulation lesions. A relatively simple protocol for clinical VEP testing is described. The monkeys showed similar VEP responses but these were smaller in amplitude than those obtained from human subjects. Central, but not paracentral or peripheral retinal lesions were associated with VEP abnormalities. For both monkey and human subjects, some variability of responses between normal and subjects was noted. Generally, there are differences in VEP responses obtained from the affected eye of abnormal subjects who had one eye which could serve as a control, as compared to responses from the normal eye. In these subjects as well as in subjects with two abnormal eyes, computer analysis of digitized VEP data from 10 Hz stimulus responses was performed. Fourier transformation analyses showed abnormalities which could be detected easily by evaluating the pattern of the amplitudes of the fundamental and first three harmonics. With this technique, it was possible to group correctly normal VEP's with eyes with normal visual acuity (greater than or equal to 20/30 or 0.67), and abnormal VEP's with eyes with poor visual acuity (less than 20/30 or 0.67) in 72% of cases. Analysis of the data obtained with 1 Hz and 10 Hz stimulation suggests that the components of the VEP related to visual acuity occur within the first 60-100 msec of the response, corresponding to the primary evoked response of Chiganek. The second, smaller wave of the response complex to 10 Hz flash stimuli corresponds to the primary evoked response, and is closely related to visual acuity. This was further supported in another series in which the digitized data was filtered around the stimulating frequency. It was possible to recognize visually this VEP waveform and subjectively interpret the record correctly in 85% of eyes with regard to visual acuity. Therefore, the clinician can "read" the VEP record in response to nonpatterned flash stimuli. This test was further validated in a series of patients with opacities of the ocular media, such as cataract, corneal scarring, and vitreous hemorrhage. VEP promises to become a procedure of diagnostic and prognostic value in ophthalmology.