Diagnostic Criteria of Pattern VEP in Adult Monocular Amblyopic Patients

Sun Hee Lim; Key Hwan Lim

doi:10.3341/jkos.2013.54.12.1875

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Lim and Lim: Diagnostic Criteria of Pattern VEP in Adult Monocular Amblyopic Patients

Original Article

J Korean Ophthalmol Soc 2013;54(12):1875-1881.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.12.1875

Diagnostic Criteria of Pattern VEP in Adult Monocular Amblyopic Patients

Sun Hee Lim, MD, Key Hwan Lim, MD, PhD

Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea

Address reprint requests to Key Hwan Lim, MD, PhD Department of Ophthalmology, Ewha Womans University Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea, Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: Limkh@ewha.ac.kr

Received 4 January 20135 June 2013 Accepted 8 October 2013

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 suggest a diagnostic criteria of pattern visual evoked potential (VEP) in adult monocular amblyopic patients in comparison to normal subjects.

Methods

The medical records of patients’ military service certificates from January 2000 to December 2011 were reviewed. The parameters of pattern VEP were analyzed by comparing monocular amblyopic patients with normal controls.

Results

This study included 47 monocular amblyopia and 39 normal control patients. All parameters of pattern VEP were statistically significantly different between monocular amblyopic eyes and normal eyes. The cut-off values for diagnosis of adult amblyopia using receiver operating characteristic (ROC) curve were 113.50 msec (P₁₀₀ latency), 1.05 (ratio of P₁₀₀ latency), 8.50 msec (interocular difference of P₁₀₀ latency), and 5.25 μV (interocular difference of P₁₀₀ amplitude). Cut-off value sensitivities were generally low: (51.1%, 70.2%, 53.2%, and 31.9%, respectively).

Conclusions

The value of pattern VEP parameters had limitations due to low sensitivity and could be considered as ancil-lary diagnostic criteria when diagnosing amblyopia.

Keywords: Adult, Diagnostic criteria, Monocular amblyopia, Parameters of pattern VEP, ROC

References

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Figure 1.

Receiver operating characteristics (ROC) curve of the parameters of visual evoked potential (VEP).

Figure 2.

Correlations between visual acuity (log MAR) and Visual evoked potential (VEP) parameters of amblyopic patients. Log MAR and ratio of P₁₀₀ latency (A) and interocular difference of P₁₀₀ latency (B) have positive correlation which is statistically significant (p < 0.05). Log MAR and P₁₀₀ amplitude (C) and ratio of P₁₀₀ amplitude (D) have negative correlation which is statistically significant (p < 0.05). Log MAR and P100 latency (E) and interocular difference of P₁₀₀ amplitude (F) have positive correlation which is not statistically significant (p > 0.05). ^* BCVA = best corrected visual acuity.

Table 1.

Clinical characteristics of the subjects

	Amblyopia	Normal	p-value^*
Subjects (numbers)	47	39
Age (years)	19.3 ± 1.7	20.5 ± 6.2	0.25
Visual acuity (log MAR)	0.88 ± 0.48	0.00 ± 0.01	0.00
Spherical equivalent (diopters)	-3.49 ± 3.15	0.30 ± 4.96	0.00
Parameters of visual evoked potential (VEP)
P₁₀₀ latency (msec)	118.69 ± 27.02	103.13 ± 5.53	0.00
P₁₀₀ amplitude (μV)	5.89 ± 3.23	10.46 ± 5.25	0.00
Ratio of P₁₀₀ latency	1.18 ± 0.32	1.03 ± 0.02	0.00
Ratio of P₁₀₀ amplitude	0.65 ± 0.36	0.78 ± 0.14	0.02
Interocular difference of P₁₀₀ latency (msec)	17.80 ± 28.73	2.82 ± 2.13	0.00
Interocular difference of P₁₀₀ amplitude (μV)	4.04 ± 2.72	2.35 ± 1.81	0.00

Values are presented as mean ± SD.

In the group of amblyopic patients, ratio of P₁₀₀ latency = (value of amblyopic eye)/(value of fellow eye), ratio of P₁₀₀ amplitude = (value of amblyopic eye)/(value of fellow eye); In the group of normal patients, ratio of P₁₀₀ latency = (higher value of P₁₀₀ latency)/(lower value of P₁₀₀ latency), ratio of P₁₀₀ amplitude = (lower value of P₁₀₀ amplitude)/(higher value of P₁₀₀ amplitude).

^* Student t-test.

Table 2.

Area under the receiver operating characteristics curve (AUC), sensitivity, specificity by each parameters of visual evoked potential (VEP)

	AUC	95% CI	Sensitivity (%)	Specificity (%)	Cut-off value^*
P₁₀₀ latency	0.776	0.673-0.858	51.1	97.4	113.50 msec
Ratio of P₁₀₀ latency	0.743	0.637-0.831	70.2	92.3	1.05
Interocular difference of P₁₀₀ latency	0.773	0.670-0.856	53.2	97.4	8.50 msec
Interocular difference of P₁₀₀ amplitude	0.696	0.587-0.791	31.9	92.3	5.25 μV

CI = confidence interval.

^* Cut-off value determined highest value of Youden's index (Sensitivity + Specificity - 1).

Table 3.

Value of each parameters of Visual evoked potential (VEP) in case of 100% specificity

	Sensitivity (%)	Specificity (%)	Value
P₁₀₀ latency	46.8	100	115.10 msec
Ratio of P₁₀₀ latency	48.9	100	1.10
Interocular difference of P₁₀₀ latency	44.7	100	11.10 msec
Interocular difference of P₁₀₀ amplitude	6.4	100	9.15 μV

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