What monitor can replace the cathode-ray tube for visual stimulation to elicit multifocal electroretinograms?

To compare a conventional cathode-ray tube (CRT) screen to organic light-emitting diode (OLED) and liquid crystal display (LCD) screens as visual stimulators to elicit multifocal electroretinograms (mfERGs), mfERGs were recorded from seven eyes of seven healthy volunteers (21 ± 2 years). The mfERGs elicited by a conventional CRT screen (S710, Compaq Computer Co.) were compared to those elicited by a studio-grade master OLED monitor (PVM-1741, Sony, Japan) and a conventional LCD (S1721, Flexscan, Eizo Nanao Corp., Japan). The luminance changes of each monitor were measured with a photodiode. CRT, OLED, and LCD screens with a frame frequency of 60 Hz were studied. A hexagonal stimulus array with 61 stimulus elements was created on each monitor. The serial white stimuli of the OLED screen at 60 Hz did not fuse, and that of the LCD screens fused. The amplitudes of P1 and P2 of the first-order kernels of the mfERGs were not significantly different from those elicited by the CRT and OLED screens, and the P1 amplitude of the first-order kernel elicited by the LCD stimuli was significantly smaller than that elicited by the CRT in all the groups of the averaged hexagonal elements. The implicit times were approximately 10 ms longer in almost all components elicited by the LCD screen compared to those elicited by the CRT screen. The mfERGs elicited by monitors other than the CRT should be carefully interpreted, especially those elicited by LCD screens. The OLED had good performance, and we conclude that it can replace the CRT as a stimulator for mfERGs; however, a collection of normative data is recommended.

Decreased nasal-temporal asymmetry of the second-order kernel response of multifocal electroretinograms in eyes with normal-tension glaucoma.

PURPOSE: To determine whether multifocal electroretinograms (mfERGs) can provide an index for identification of glaucomatous optic neuropathy in patients with normal-tension glaucoma (NTG). METHODS: mfERGs were recorded in 30 normal volunteers (30 eyes) and 20 patients (20 eyes) with normal-tension glaucoma (NTG). Visual field examinations were performed with a Humphrey field analyzer, and all NTG patients had unilateral hemifield defects. The mfERGs were elicited by a binary m-sequence of flashes from 37 hexagonal elements that subtended an overall visual angle of 50 degrees x 40 degrees. The mfERGs were summed and analyzed for predetermined retinal loci. These mfERGs were compared with the perimetric findings of the corresponding visual fields. RESULTS: In normal volunteers, the amplitude of the second-order kernel within the central 5 degrees of the nasal hemisphere was significantly smaller than in that of the temporal hemisphere (Wilcoxon signed-rank test, P = 0.0001). In NTG patients, this asymmetry of the two hemispheres was reduced or not present. The ratio of the amplitude of the mfERGs from the nasal and temporal hemispheres (N/T amplitude ratio) in normal control volunteers was significantly different from that of NTG patients with a hemifield defect (analysis of variance, P = 0.0001). When the cutoff value for the N/T amplitude ratio was set at 0.83 for discriminating glaucomatous eyes from normal eyes, the sensitivity was 65.0% with a specificity of 96.7%. The area under the receiver-operating characteristic curve of the N/T amplitude ratio was 0.86. The N/T amplitude ratio and the visual field indices were significantly correlated. CONCLUSION: A decrease in the nasal-temporal asymmetry in the amplitude of the second-order kernel responses within the central 5 degrees of glaucoma patients' eyes indicated a dysfunction of the inner retinal layers, including of the retinal ganglion cells.

[Verification of multifocal electroretinogram Veris III system for clinical problems].

PURPOSE: To verify the usefulness of the Veris III system, which is said to be problematic in clinical applications for recording multifocal electroretinograms (mfERG) by an ophthalmologist. METHODS: A test wave was input to the system and the data were analyzed using Veris Science software. The items tested were overlapping, spatial averaging, combination procedures, and emission properties of the cathode ray tube (CRT) monitor (B 4). RESULTS: Overlapping was not observed under the standard stimulus conditions. The data resulting from both spatial averaging and combination procedures coincided with the theoretical calculated data defined by both procedures. Analysis of the emission properties of the CRT monitor showed that it took 85 mu seconds from the beginning to the end of the bright emission. CONCLUSIONS: No clinical problems were found in the M-sequence program, the spatial averaging procedure, or the combination procedure using several test waves. It is necessary to pay attention to the configuration of pattern stimulation on the CRT monitor (B 4), because it has a very steep emission during a very short time.

Study of the visual evoked magnetic field with the m-sequence technique.

PURPOSE: Multifocally stimulated visual evoked magnetic field (VEF) examination with an m-sequence technique (multifocal VEF; mVEF) was studied, and the neural generators at peaks of mVEF were estimated in the visual cortex. METHODS: Visual field stimulation was generated by a multifocal testing system with use of the m-sequence technique. The stimulation pattern covered a central area extending from 0.6 degrees to 10 degrees in radius outward from the center of four visual-field quadrants. The stimulation pattern was projected onto a screen by a liquid crystal projector. VEFs of 14 healthy adults were recorded with a 160-channel, whole-head-type magnetoencephalography (MEG) system. The output signals of 16 selected MEG sensors covering the occipital region were recorded for each subject with the multifocal testing system, and the second-order responses were calculated. The analyzed response data files were transferred to the MEG system, a single equivalent current dipole (ECD) was estimated to locate the neural generator, and the localization was superimposed onto the corresponding brain magnetic resonance image of the subject. RESULTS: mVEFs showed three peak waves (N75m, P100m, N145m) in 75% of the subjects and two peak waves (N75m, N145m) in 25%. (N, P and m denote negative, positive, and magnetic fields, respectively.) Latencies of the first and the last peak were similar between the two kinds of peak waves. ECD examination showed more than 97% of goodness of fit at all peaks, and the relation between EDCs and the stimulated visual field coincided with a retinotopic organization that fit a cruciform model in all subjects. ECD depths from the occipital pole were similar to the depth expected from the human linear cortical magnification factor model in all subjects. Main neural generators of all mVEF components (N75m, P100m, N145m) were shown in the striate cortex (V1). CONCLUSIONS: Testing the VEF with an m-sequence technique showed stable responses to simultaneous stimulation of four visual-field quadrants. Consistency of correlation of the estimated ECD with the known cortical organization of the primary visual cortex confirmed the reliability of this examination. The three mVEF peaks were thought to derive mainly from V1 activity.

Nonlinear component of the electroretinogram recorded from the posterior pole of normal and highly myopic human eyes.

To extract the nonlinear component of the electroretinogram (ERG) from the posterior pole (pp) of the human ocular fundus and to evaluate the possibility of its clinical application, three types of stimulus modes - double-flash, single-flash, and delayed single-flash stimuli - were produced using a conventional electrophysiological system. A large hexagonal element was presented on a CRT monitor, and ppERGs were recorded from 14 normal eyes and 16 eyes of eight highly myopic patients. The nonlinear component of the ppERG was obtained by subtracting the single-flash ERG and delayed single-flash ERG responses from the double flash ERG response. Three peaks were commonly observed in the nonlinear component of ppERG, all of which were significantly depressed in patients with high myopia. ppERGs that can be obtained using a simple algorithm might be useful in clinical applications.