Correlation of OCT and Hemifield Pattern VEP in Hemianopia

Yong Park Sung; Hyouk Park Sang; Joo Ha Seung; Hee Park Song

doi:10.3341/jkos.2008.49.11.1819

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Sung, Sang, Seung, and Song: Correlation of OCT and Hemifield Pattern VEP in Hemianopia

Original Article

J Korean Ophthalmol Soc 2008;49(11):1819-1828.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.11.1819

Correlation of OCT and Hemifield Pattern VEP in Hemianopia

Yong Park Sung, M.D., Hyouk Park Sang, M.D., Joo Ha Seung, M.D., Hee Park Song, M.D.

Department of Ophthalmology, Soonchunhyang University School of Medicine, Seoul, Korea

Address reprint requests to Song Hee Park, M.D. Department of Ophthalmology, Soonchunhyang University Seoul Hospital #657 Hannam-dong, Yongsan-gu, Seoul 140-743, Korea Tel: 82-2-709-9354, Fax: 82-2-798-7797, E-mail: parksonghee55@hanmail.net

Received 28 August 2008 Accepted 12 March 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the correlation between RNFL thickness changes measured by OCT and hemifield pattern VEP in hemianopic visual field loss.

Methods

Twelve eyes of six patients with hemianopia were studied. Two patients had bitemporal hemianopia caused by chiasmal tumor, one patient had inferior hemianopia caused by traumatic optic neuropathy, and three patients had homonymous hemianopia caused by occipital lobe lesions. The retinal nerve fiber layer thickness around the optic disc was measured by optical coherence tomography (OCT) and visual pattern evoked potentials were measured using hemifield stimulations.

Results

Normal eyes of traumatic optic neuropathy patients were excluded from the analysis. The retinal nerve fiber layer thickness as measured by OCT corresponded to the visual field defect in 9 of 11 eyes (81.8%) and the hemifield pattern VEP response corresponded to visual field defect in 7 of 11 eyes (63.6%).

Conclusions

RNFL thickness measurement by OCT and hemifield PVEP are useful in evaluation of patients with hemianopia. However, they should be performed with caution, and compared with various clinical examinations because of their incomplete correlation with visual field defects.

Keywords: Hemianopia, Hemifield pattern visual evoked potentials, Optical coherence tomography

References

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Figure 1.

The position of hemifield pattern visual evoked potentials electrode.

Figure 2.

Examination technique of hemifield pattern visual evoked potentials. (A, B, C)=electrode (D, E)=hemifield stimulation.

Figure 3.

4 channels of hemifield pattern visual evoked potentials.

Figure 4.

Brain MRI of a 25-year-old woman who had bitemporal hemianopia (Case 1). (A) 3.5×3.8×2.3 cm-sized lesion with enhancement was identified in suprasellar area (blue arrows). (A) axial scan (B) coronal scan.

Figure 5.

Case 1. Visual field by Humphrey perimetry (A, B) shows bitemporal hemianopia. Retinal nerve fiber layer thickness measured by optical coherence tomography shows thinning in mainly temporal and nasal areas in both eyes. (correspond to temporal hemianopia)

Figure 6.

Hemifield pattern visual evoked potentials results of the Case 1 patient. The results of both eyes correspond to temporal hemianopia.

Figure 7.

Brain MRI of 62 years old man who had right homonymous hemianopia (Case 2). Acute infarction in the left posterior cerebral artery territory was identified (Blue arrows). (A) T2 Weighted image (B) diffusion view.

Figure 8.

Visual field by Goldmann perimetry (A, B) and retinal nerve fiber layer thickness measured by Optical coherence tomography (C) of Case 2 patient. Right homonymous hemianopia and normal RNFL thickness were identified.

Figure 9.

Hemifield pattern visual evoked potentials of Case 2 patient. At right hemifield stimulation ‘delayed latency’ was identified in both eyes. But at left hemifield stimulation normal latency was identified in both eyes. Monocular P100 latency, amplitude difference were significant in both of eyes (latency difference > 9 ms, amplitude difference > 1 µV). So the results of the right eye correspond to temporal hemianopia, and the results of left eye correspond to nasal hemianopia.

Table 1.

Demographic characteristics of patients

Patient	Age (years)	Gender	BCVA^*	Diagnosis	Visual field defect (hemianopia)
1	36	F	OD) 0.9 OS) LP(+)	Pituitary adenoma	Bitemporal
2	25	F	OU) 1.0	Craniopharyngioma	Bitemporal
3	37	F	OD) 0.2 OS) 0.16	Left occipital lesion by head trauma	Right homonymous
4	38	M	OD) 0.1 OS) 1.0	Traumatic optic neuropathy	Right inferior
5	62	M	OD) 0.63 OD) 0.5	Acute left PCA infarction	Right homonymous
6	45	F	OD) 0.5 OS) 0.32	Diffuse axonal injury by head trauma	Right homonymous

^* BCVA=best corrected visual acuity.

Table 2.

Pattern evoked potentials normative data of our laboratory (60 normal subjects)

	Sex			Decades (Mean±SD)
	Sex	2nd	3rd	4th	5th	6th	7th
Mean age (y)	M	16.8	26.2	33.4	43.8	54.1	63.4
	F	17.3	25.3	35.2	44.2	53.8	62.7
Latency of P100 (msec)	M	95.8±3.4	94.8 ±4.1	92.7 ±2.8	94.3 ±4.5	96.8 ±3.7	90.8 ±4.7
	F	96.9±4.2	93.7 ±3.7	94.6 ±3.8	95.7 ±4.9	92.7 ±3.6	93.2 ±3.7
Interocular hemifield P100	M	2.2±1.5	1.8±1.2	1.9±0.8	2.4±1.7	1.8±1.1	1.6±1.3
latency difference (msec)	F	2.5±1.9	2.3±1.8	2.0±1.3	1.9±1.6	2.1±1.6	2.0±1.3
Monocular hemifield P100	M	1.9±1.2	2.2±1.6	1.9±1.1	2.2±1.0	2.0±0.9	2.2±0.7
latency difference (msec)	F	2.3±1.3	2.7±1.6	1.8±0.8	2.3±1.7	2.3±1.2	1.3±0.9

Table 3.

Retinal nerve fiber layer thickness measured by optical coherence tomography

							Thickness of RNFL (µm)
Eye	Average		Quadrants								Clock hours
		Sup.^* T	Temp.^†	Inf.^‡	Nas.^§	1	2	3	4	5	6	7	8	9	10	11	12
								Nas.				Inf.		Temp.		Sup.
												Temp.				Temp.
1	64.83	81	34	103	42	44	46	45	35	79	146	84	30	30	41	89	109
2	48.14	53	43	58	40	46	43	39	36	40	81	53	35	46	47	49	63
3	85.95	116	57	121	50	85	67	40	43	86	161	116	37	44	91	152	110
4	83.29	119	51	118	45	80	63	34	38	71	129	155	51	26	77	137	141
5	69.75	92	48	103	36	60	30	29	49	74	134	100	36	37	71	129	88
6	64.50	78	50	81	49	108	70	38	39	78	85	81	57	48	44	47	79
7	53.91	38	30	109	38	32	33	33	49	118	127	84	34	28	29	40	41
8	105.39	123	73	153	72	122	80	53	82	138	170	152	70	67	83	132	115
9	99.28	112	70	123	92	88	111	88	76	97	114	159	80	48	84	118	129
10	98.18	115	71	121	86	116	114	71	74	105	117	140	63	57	93	99	129
11	75.28	100	37	113	50	65	39	49	62	79	152	109	30	28	54	106	129
12	94.66	98	59	106	116	134	136	106	106	126	116	76	64	65	47	63	97

^* Sup=Superior

^† Temp=Temporal

^‡ Inf=Inferior

^§ Nas=Nasal.

Table 4.

Retinal nerve fiber layer thickness measured by optical coherence and correspondence to visual field defect

Eye	Period^*	Visual field defect	RNFL^† thickness measured by OCT^‡	Correspondance to VF^§ defect
1	72 months	Temporal hemianopia	Temporal, nasal RNFL thinning	Yes
2	72 months	Temporal hemianopia	Superior, temporal, inferior, nasal RNFL thinning	Yes
3	7 months	Temporal hemianopia	Temporal, nasal RNFL thinning	Yes
4	7 months	Temporal hemianopia	Temporal, nasal RNFL thinning	Yes
5	9 months	Temporal hemianopia	Superior, temporal, nasal RNFL thinning	Yes
6	9 months	Nasal hemianopia	Superior, inferior RNFL thinning	Yes
7	8 months	Inerior hemianopia	Superior, temporal, nasal RNFL thinning	Yes
8	8 months	No field defect	No thinning	Normal eye
9	1 week	Temporal hemianopia	No thinning	No
10	1 week	Nasal hemianopia	No thinning	No
11	36 months	Temporal hemianopia	Temporal, nasal RNFL thinning	Yes
12	36 months	Nasal hemianopia	Superior, inferior RNFL thinning	Yes

^* Period=time to OCT performance after initial diagnosis or trauma

^† RNFL=retinal neve fiber layer

^‡ OCT=optical coherence tomography

^§ VF=visual field.

Table 5.

The results of hemifield pattern visual evoked potentials and correspondence to visual field defect

Eye	OD /OS	VF defect	Right. Hemifie	eld stimulation	Left. Hemifield stimulation		Mono-diff^†	Correspondance to VF defect
			P100 latency	Inter-diff^*	P100 latency	Inter-diff
1	OD	TH^‡	Delayed latency		Delayed latency		Latency: sig^§ Amplitude: sig	Yes
2	OS	TH	P1 destruction		No response			No
3	OD	TH	P1 destruction		Normal			Yes
4	OS	TH	Normal		P1 destruction			Yse
5	OD	TH	P1 destruction		P1 destruction			No
6	OS	NH^∏	P1 destruction		P1 destruction			No
7	OD	IH^#	P1 destruction		P1 destruction			Yes
8	OS	Normal	Normal		Normal		Latency: not sig Amplitude:not sig	Normal eye
9	OD	TH	Delayed latency	Latency: not sig	Normal	Latency: not sig	Latency: sig Amplitude: sig	Yes
10	OS	NH	Delayed latency	Amplitude: not sig	Normal	Amplitude:not sig	Latency: sig Amplitude: sig	Yes
11	OD	TH	Normal	Latency: not sig	Normal	Latency: not sig	Latency: sig Amplitude:sig	Yes
12	OS	NH	Normal	Amplitude: not sig	Normal	Amplitude: not sig	Latency: not sig Amplitude: not sig	No

^* Interocular hemifield P100 difference

^† Monocular hemifield P100 difference

^‡ Temporal hemianopia

^§ Significant

^Π Nasal hemianopia

^# Inferior hemianopia.

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