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Use in the Differential Diagnosis of Optic Neuropathy

Phyllis Bobak, PhD; Robert Friedman, MD; Mitchell Brigell, PhD; James Goodwin, MD; Robert Anderson, PhD

Arch Ophthalmol. 1988;106(7):936-940.

Abstract
• The usefulness of the visual evoked potential (VEP) in differential diagnosis increases when stimulus parameters such as check size and grating orientation are varied. In this study we varied the stimulation frequency. Temporal frequency-specific abnormalities were compared in three patient categories, including retrobulbar optic neuritis (eight patients), pseudotumor cerebri (11 patients), and thyroid eye disease (seven patients). All patients had minimal clinical evidence of optic nerve damage when tested. A 2.3 cycle-per-degree sinusoidal grating of 55% contrast was phase reversed at either 1 or 4 Hz. The P₁ latency of the 1-Hz data and the phase at 8 Hz, the second harmonic of the 4-Hz input frequency, were measured. In retrobulbar neuritis, latency (phase) was severely abnormal at both temporal frequencies. In thyroid eye disease, VEP phase was abnormal at 8 Hz while the P₁ latency was normal at 1 Hz. The P₁ latency and phase were normal in most cases of pseudotumor cerebri. The results suggest differing mechanisms for damage in compressive vs primary demyelinating neuropathies.

Author Affiliations
From the Departments of Ophthalmology (Drs Bobak, Friedman, Brigell, and Goodwin) and Biostatistics (Dr Anderson), University of Illinois at Chicago. Dr Brigell is now with the Department of Neurology, Loyola University Medical Center, Maywood, Ill.

Footnotes
Accepted for publication Dec 3, 1987.

Reprint requests to The Eye and Ear Infirmary, 1855 W Taylor St, Chicago, IL 60612 (Dr Bobak).

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