Association Between Optic Nerve Head Blood Flow Measured Using Laser Speckle Flowgraphy and Radial Arterial Pressure During Aortic Arch Surgery.

OBJECTIVE: This study was designed to investigate the association between ocular blood flow measured using laser speckle flowgraphy (LSFG) and radial arterial pressure during aortic arch surgery. DESIGN: A prospective study. SETTING: A single university hospital. PARTICIPANTS: This study included 24 patients undergoing aortic arch surgery with cardiopulmonary bypass (CPB) using antegrade selective cerebral perfusion (SCP). INTERVENTIONS: Measurement of optic nerve head blood flow using LSFG and radial arterial pressure via a catheter in the radial artery METHODS AND MAIN RESULTS: Antegrade SCP was managed with 24℃ and 40-to-60 mmHg at the right radial artery, which usually corresponds to a flow rate of 10 mL/kg/min. Optic nerve head blood flow using LSFG and radial arterial blood pressure were evaluated simultaneously at the right side and recorded at the following 4 points: after the induction of anesthesia (phase 1), after the beginning of CPB (phase 2), after the beginning of antegrade SCP (phase 3), and after cessation of CPB (phase 4). A moderate positive correlation between %change of mean blur rate in the optic nerve head measured using LSFG and %change of radial mean arterial pressure was identified (r = 0.604, p < 0.001). Bland-Altman analysis showed that the bias (mean difference) was -1.2% (95% limits of agreement -47.4% to 45.0%), indicating good agreement between %changes of the values recorded using the 2 measurements. CONCLUSIONS: Intraoperative monitoring of optic nerve head blood flow using LSFG can be used as an additional cerebral perfusion parameter during aortic arch surgery with CPB using antegrade SCP.

Ocular Blood Flow Measured Using Laser Speckle Flowgraphy During Aortic Arch Surgery With Antegrade Selective Cerebral Perfusion.

OBJECTIVE: The objective of this study was to evaluate the validity of ocular blood flow measured using laser speckle flowgraphy (LSFG) for the assessment of cerebral perfusion during aortic arch surgery. DESIGN: A prospective study. SETTING: A single university hospital. PARTICIPANTS: The study included 17 patients undergoing aortic arch surgery with cardiopulmonary bypass (CPB) using antegrade selective cerebral perfusion (ASCP). INTERVENTIONS: Measurement of ocular blood flow using LSFG. MEASUREMENTS AND MAIN RESULTS: Measurement of ocular perfusion that is supplied mainly from the ophthalmic artery might be useful as an indicator of cerebral blood flow because the ophthalmic artery is the first branch of the internal carotid artery. Recently, LSFG has been developed for noncontact estimation of ocular perfusion using the laser speckle phenomenon. In this study, the LSFG system was used to measure blood flow in the optic nerve head during aortic arch surgery with CPB using ASCP. The blood flow in the optic nerve head during ASCP was statistically significantly reduced by 40.6% compared with the baseline value after anesthetic induction. CONCLUSIONS: Ocular blood flow measured using LSFG showed favorable validity for assessment of cerebral perfusion during aortic arch surgery with ASCP.

EFFECTS OF PANRETINAL PHOTOCOAGULATION ON CHOROIDAL THICKNESS AND CHOROIDAL BLOOD FLOW IN PATIENTS WITH SEVERE NONPROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To evaluate the choroidal thickness and choroidal blood flow in the subfoveal region quantitatively after panretinal photocoagulation (PRP) in eyes with severe nonproliferative diabetic retinopathy. METHODS: This was a prospective comparative study of 24 eyes of 24 patients with type II diabetes and severe nonproliferative diabetic retinopathy with no macula edema. The foveal retinal thickness and choroidal thickness were measured by enhanced depth imaging optical coherence tomography. The subfoveal choroidal blood flow was represented by the mean blur rate obtained by laser speckle flowgraphy. The intraocular pressure, blood pressure, pulse rate, and hemoglobin A1c level (HbA1c) were also measured before and after PRP. RESULTS: The mean foveal retinal thickness did not change significantly during the follow-up period. The mean subfoveal choroidal thickness was reduced significantly from 327.4 µm at the baseline to 286.3 µm at 1 month and 285.0 µm at 3 months after PRP. The mean blur rate ratio decreased significantly to 87.5% at 1 month and 86.0% at 3 months of the baseline values. There was a significant correlation between the subfoveal choroidal thickness and subfoveal choroidal blood flow after PRP. After PRP, the best-corrected visual acuity, intraocular pressure, mean arterial pressure, ocular perfusion pressure, pulse rate, and HbA1c did not change significantly. CONCLUSION: The success of PRP in treating eyes with severe nonproliferative diabetic retinopathy is probably due to the significant reduction of the subfoveal choroidal thickness and subfoveal choroidal blood flow after PRP.

The effect of blue-blocking intraocular lenses on circadian biological rhythm: protocol for a randomised controlled trial (CLOCK-IOL colour study).

INTRODUCTION: Blue light information plays an important role in synchronising internal biological rhythm within the external environment. Circadian misalignment is associated with the increased risk of sleep disturbance, obesity, diabetes mellitus, depression, ischaemic heart disease, stroke and cancer. Meanwhile, blue light causes photochemical damage to the retina, and may be associated with age-related macular degeneration (AMD). At present, clear intraocular lenses (IOLs) and blue-blocking IOLs are both widely used for cataract surgery; there is currently a lack of randomised controlled trials to determine whether clear or blue-blocking IOLs should be used. METHODS AND ANALYSIS: This randomised controlled trial will recruit 1000 cataract patients and randomly allocate them to receive clear IOLs or blue-blocking IOLs in a ratio of 1:1. The primary outcomes are mortality and the incidence of cardiovascular disease, cancer and AMD. Secondary outcomes are fasting plasma glucose, triglycerides, cholesterol, glycated haemoglobin, sleep quality, daytime sleepiness depressive symptoms, light sensitivity, the circadian rhythm of physical activity, wrist skin temperature and urinary melatonin metabolite. Primary outcomes will be followed until 20 years after surgery, and secondary outcomes will be assessed at baseline and 1 year after surgery. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Institutional Review Board of Nara Medical University (No. 13-032). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications, scientific conferences and the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) home page. TRIAL REGISTRATION NUMBER: UMIN000014680.

Choroidal thickness and choroidal blood flow after intravitreal bevacizumab injection in eyes with central serous chorioretinopathy.

BACKGROUND AND OBJECTIVE: To quantitatively evaluate choroidal thickness (CT) and choroidal blood flow in the subfoveal region after intravitreal bevacizumab injection (IVB) for the treatment of chronic central serous chorioretinopathy (CSC). PATIENTS AND METHODS: Prospective, comparative study of 20 eyes with chronic CSC and and 20 fellow eyes treated with 1.25 mg/0.05 mL IVB. Subfoveal CT and serous retinal detachment height were measured using enhanced depth imaging optical coherence tomography. Subfoveal choroidal blood flow was assessed by the mean blur rate of laser speckle flowgraphy. IOP, blood pressure, and pulse rate, and ocular perfusion pressure were also measured. All measurements were made before and after IVB. RESULTS: Subfoveal fluid was not present after IVB in the affected eyes. The mean subfoveal CT decreased from 335 µm at baseline to 304 and 291 µm at 1 and 3 months, respectively, after IVB. Average mean blur rate ratio decreased from baseline to 92.9% and 88.0% at 1 and 3 months, respectively. In the fellow eyes, subfoveal CT and choroidal blood flow decreased slightly from baseline. There was a significant correlation between the decrease in subfoveal CT and choroidal blood flow after IVB in affected eyes. IOP, mean arterial pressure, pulse rate, and ocular perfusion pressure did not change significantly after IVB. CONCLUSION: IVB significantly reduced subfoveal CT, choroidal blood flow, and subretinal fluid absorption in eyes with chronic CSC. The reduction of subfoveal CT after IVB was likely caused by the reduction of subfoveal choroidal blood flow.

Short-term influence of cataract surgery on circadian biological rhythm and related health outcomes (CLOCK-IOL trial): study protocol for a randomized controlled trial.

BACKGROUND: Light information is the most important cue of circadian rhythm which synchronizes biological rhythm with external environment. Circadian misalignment of biological rhythm and external environment is associated with increased risk of depression, insomnia, obesity, diabetes, cardiovascular disease, and cancer. Increased light transmission by cataract surgery may improve circadian misalignment and related health outcomes. Although some observational studies have shown improvement of depression and insomnia after cataract surgery, randomized controlled trials are lacking. We will conduct a parallel-group, assessor-blinded, simple randomized controlled study comparing a cataract surgery group at three months after surgery with a control group to determine whether cataract surgery improves depressive symptoms, sleep quality, body mass regulation, and glucose and lipid metabolism. METHODS/DESIGN: We will recruit patients who are aged 60 years and over, scheduled to receive their first cataract surgery, and have grade 2 or higher nuclear opacification as defined by the lens opacities classification system III. Exclusion criteria will be patients with major depression, severe corneal opacity, severe glaucoma, vitreous haemorrhage, proliferative diabetic retinopathy, macular oedema, age-related macular degeneration, and patients needing immediate or combined cataract surgery. After baseline participants will be randomized to two groups. Outcomes will be measured at three months after surgery among the intervention group, and three months after baseline among the control group. We will assess depressive symptoms as a primary outcome, using the short version geriatric depression scale (GDS-15). Secondary outcomes will be subjective and actigraph-measured sleep quality, sleepiness, glycated haemoglobin, fasting plasma glucose and triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, abdominal circumference, circadian rhythms of physical activity and wrist skin temperature, and urinary melatonin metabolite. Chronotype and visual function will be assessed using the 'morningness-eveningness' questionnaire, the Munich chronotype questionnaire, and the National Eye Institute Visual Function Questionnaire. DISCUSSION: Although there are potential limitations due to the difference in duration from baseline survey to outcome measurements between two groups, any seasonal effect on the outcome measurement will be balanced as a result of continuous inclusion of participants through the year, and outcomes will be adjusted for day length at outcome measurements at analysis. TRIAL REGISTRATION: UMIN000014559, UMIN Clinical Trials Registry, registered on 15 July 2014.

Ocular blood flow before, during, and after vitrectomy determined by laser speckle flowgraphy.

BACKGROUND AND OBJECTIVE: Vitrectomy markedly alters the intraocular milieu, which can then affect the physiology of the retina and choroid. This study investigates whether vitrectomy also alters ocular blood flow as determined by laser speckle flowgraphy (LSFG). PATIENTS AND METHODS: Twenty eyes of 20 patients that underwent vitrectomy for idiopathic macular hole or epiretinal membrane were studied. Standard 23-gauge microincision vitreous surgery was performed. Ocular blood flow of the optic nerve head, retinal vessels, and choroid was determined by LSGF before, during, and 2 weeks and 1 month after vitrectomy. RESULTS: Postoperative blood flow of the optic nerve head, retinal vessels, and choroid did not differ significantly from preoperative values. Intraoperative blood flow of the optic nerve head and retinal vessels decreased significantly from baseline with increasing infusion pressure from 20 mm Hg to 40 mm Hg (P < .01), and choroidal blood flow decreased significantly when the infusion pressure increased from 8 mm Hg to 20 mm Hg and from 20 mm Hg to 40 mm Hg (both P < .01). CONCLUSION: Blood flow did not differ significantly postoperatively versus preoperatively, but it was significantly reduced during vitrectomy with increasing infusion pressure. Careful attention should be paid to infusion pressure during vitrectomy.

[Night visual function of glaucoma patients with good photopic vision].

PURPOSE: To measure night visual function of glaucoma patients with good photopic vision. SUBJECTS AND METHODS: Patients aged 30-59 years who were diagnosed with glaucoma in the outpatient clinic of Nara Medical University, and showed a corrected visual acuity of > or = 1.0 in both eyes. The patients were classified using static threshold perimetry with a Humphrey field analyzer into two groups, with a mean deviation of -6 dB or better (early-stage glaucoma group) or a mean deviation worse than -6dB (intermediate/late-stage glaucoma group), and night visual function was measured. In addition, the patients were compared with normal controls without eye disease other than refractive error. RESULTS: The early-stage glaucoma group included 26 patients, and the intermediate/late-stage glaucoma group included 22 patients. There were 23 controls. Night visual function differed among the 3 groups. With the progression of visual field defects, the night visual function decreased. CONCLUSION: These results suggest that night visual function can be used as a new parameter for the evaluation of visual function in glaucoma patients.

Asymptomatic and symptomatic postoperative visual dysfunction after cardiovascular surgery with cardiopulmonary bypass: a small-sized prospective observational study.

OBJECTIVE: Postoperative visual dysfunction (POVD) after cardiovascular surgery rarely is reported, since it is more likely underdetected and underreported. This study was designed to verify the presence of POVD, including a variety of asymptomatic as well as symptomatic visual dysfunctions after cardiovascular surgery with cardiopulmonary bypass (CPB). DESIGN: A prospective observational study. SETTING: Cardiothoracic surgery in a medical university hospital. PARTICIPANTS: Seventy-one patients undergoing elective cardiovascular surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were assessed by a battery of 7 neuro-ophthalmic examinations preoperatively and postoperatively, including fundus, visual field, eye movement, color vision, visual acuity, intraocular pressure, and critical flicker frequency. Patients were considered to have POVD if they had postoperative new abnormal findings of neuro-ophthalmic examinations. One patient was excluded due to a failure of postoperative neuro-ophthalmic examinations. In 16 of 70 patients analyzed in this study, selective cerebral perfusion was required for aortic arch surgery. Of 70 patients, a total of 8 patients (11.4%) had postoperative new abnormal findings in neuro-ophthalmic examinations, including new visual field deficits in 4, reduced visual acuity in 4, and/or increased intraocular pressure in 1 patient. Of these 8 patients, symptomatic POVD was recognized in 1 patient (1.4%) with postoperative visual field deficit and reduced visual acuity. There were no new abnormal findings compared with preoperative results in postoperative funduscopy, eye movement, color vision, and critical flicker frequency. CONCLUSIONS: These results indicated that the asymptomatic as well as symptomatic POVD can develop after cardiovascular surgery with CPB, and their incidence may be relatively high.

Multifocal electroretinograms in age-related macular degeneration before and after photodynamic therapy.

PURPOSE: To evaluate multifocal electroretinograms (mfERG) and macular retinal thickness before and after photodynamic therapy (PDT) for predominantly classic choroidal neovascularization (CNV) (classic type) and occult with no classic CNV (occult type). METHODS: Recording of mfERG and measurement of macular retinal thickness were performed before and after PDT in 19 patients (19 eyes) with the classic type and 24 (26 eyes) with the occult type. The evaluation items were the amplitude of the first negative wave (N1), the amplitude from the peak of the negative wave to that of the following positive wave (P1), and the peak latencies of the negative and positive waves. RESULTS: Compared with mfERG before PDT, that after PDT showed a significant decrease in the P1 latency in the central area (31.1 ± 1.9 ms before and 29.6 ± 1.6 ms after PDT) for the classic type and significant decreases in both the central (32.0 ± 2.0 ms before and 30.5 ± 2.4 ms after PDT) and peripheral (30.2 ± 2.0 ms before and 29.5 ± 2.0 ms after PDT) areas for the occult type. Optical coherence tomography showed significant decreases in macular retinal thickness in both groups (464 and 314 µm before and after PDT, respectively, for the classic type and 516 and 340 µm for the occult type). CONCLUSIONS: After PDT, retinal function evaluated by mfERG improved for both the classic and occult types, and the recovery of P1 latency may be due to improvement in retinal edema.

Design of an injectable in situ gelation biomaterials for vitreous substitute.

To adapt the physical properties of living materials to their biological function, nature developed various types of polymers with outstanding physical behavior. One example is the vitreous body, which is important intraocular elements not only because of its optical and mechanical performances, but also due to its important role in the pathogenesis and treatment of conditions affecting adjacent tissues and eventually the whole eye. Here, we report a novel biocompatible material for injectable vitreous substitute, composed of thermosensitive amphiphilic polymer, which is capable of forming a transparent gel in the vitreous cavity. It is nontoxic, provides adequate support for the retina, and allows light to reach the sensory elements at the back of the eye. The amphiphilic polymer exhibits mechanical stability by assembling to form highly interconnected hydrophobic domains, which leads to the constitution of a network structure.

Retinal nerve fiber layer thickness changes following optic neuritis caused by multiple sclerosis.

PURPOSE: To evaluate the peripapillary retinal nerve fiber layer (RNFL) thickness with scanning laser polarimetry in patients with optic neuritis (ON) caused by multiple sclerosis. METHODS: Peripapillary RNFL thickness was measured with a GDx VCC in 14 eyes of 13 patients with ON (nonrecurrent group), in 18 eyes of 11 patients with recurrent ON (recurrent group), and in 48 eyes of 48 healthy subjects (healthy group). The temporal, superior, nasal, inferior thickness (TSNIT) average, superior average, and inferior average of GDx VCC measurements were compared across the three groups. We calculated correlation coefficients between each of the three GDx VCC parameters and both the mean deviation (MD) of the Humphrey 30-2 full threshold visual field and the visual acuity (VA). RESULTS: The three parameters showed statistically significant differences across the three groups. There was no correlation between any of the three GDx VCC parameters and MD or VA in the nonrecurrent group, but there was significant correlation between each of the three GDx VCC parameters and MD in the recurrent group. CONCLUSIONS: ON caused morphological changes in the peripapillary RNFL, and recurrent ON aggravated the deterioration and caused diffuse rather than regional damage to the peripapillary RNFL.

Changes in intraocular pressure during cardiac surgery with and without cardiopulmonary bypass.

PURPOSE: Data on intraocular pressure (IOP) during cardiac surgery with cardiopulmonary bypass (CPB) and anesthetic management are limited. This study was conducted to investigate changes in IOP during cardiac surgery with and without CPB. METHODS: IOP was intraoperatively measured in patients undergoing elective cardiac surgery with (n = 35) or without (n = 11) CPB. Measurements were performed using a Tonopen(®) XL hand-held tonometer at the following five time points in patients with CPB: (1) 30 min after anesthesia induction (baseline), (2) prior to CPB, (3) 60 min after the beginning of CPB, (4) before cessation of CPB, and (5) at the end of operation; and in patients without CPB: (1) 30 min after anesthesia induction (baseline), (2) prior to anastomosis, (3) during left anterior descending artery anastomosis, (4) during left circumflex or right coronary artery anastomosis (head-down position), and (5) at the end of operation. RESULTS: In patients with CPB, IOP values at points 3 and 4 were significantly decreased compared with baseline values and returned to baseline levels at point 5. In patients without CPB, values were significantly increased and peaked at point 4 in the head-down position compared with baseline and prior to anastomosis. CONCLUSION: Results indicate that during cardiac surgery, IOP values decreased during CPB and increased during anastomosis in the head-down position in patients without CPB.

Relationship between postoperative refractive outcomes and cataract density: multiple regression analysis.

PURPOSE: To evaluate the relationship between cataract density and the deviation from the predicted refraction. SETTING: Department of Ophthalmology, Nara Medical University, Kashihara, Japan. METHODS: Axial length (AL) was measured in eyes with mainly nuclear cataract using partial coherence interferometry (IOLMaster). The postoperative AL was measured in pseudophakic mode. The AL difference was calculated by subtracting the postoperative AL from the preoperative AL. Cataract density was measured with the pupil dilated using anterior segment Scheimpflug imaging (EAS-1000). The predicted postoperative refraction was calculated using the SRK/T formula. The subjective refraction 3 months postoperatively was also measured. The mean absolute prediction error (MAE) (mean of absolute difference between predicted postoperative refraction and spherical equivalent of postoperative subjective refraction) was calculated. The relationship between the MAE and cataract density, age, preoperative visual acuity, anterior chamber depth, corneal radius of curvature, and AL difference was evaluated using multiple regression analysis. RESULTS: In the 96 eyes evaluated, the MAE was correlated with cataract density (r = 0.37, P = .001) and the AL difference (r = 0.34, P = .003) but not with the other parameters. The AL difference was correlated with cataract density (r = 0.53, P<.0001). CONCLUSION: The postoperative refractive outcome was affected by cataract density. This should be taken into consideration in eyes with a higher density cataract.

Anisotropic swelling behavior of the cornea.

The phase equilibrium property and structural and dynamical properties of pig cornea were studied by macroscopic observation of swelling behavior, dynamic light scattering (DLS), and small-angle X-ray scattering (SAXS) under various conditions. It was found that the corneal gel collapses into a compact state isotropically or anisotropically depending on the external conditions. The corneal gel collapses uniformly into a compact state at a temperature above 55 degrees C because of the denaturation of collagen, whereas it collapses along an axis parallel to the optic axis with increasing NaCl concentration. Anisotropic deswelling was also observed during desiccation. SAXS measurements revealed that the periodicity of the collagen fiber of the cornea does not change even at higher NaCl concentration, which indicates that hydration and dehydration resulting from changes in salt concentration simply cause swelling and deswelling of the glycosaminoglycan (GAG), which is located between the regular two-dimensional lattices of collagen fibers, which obliges the change in thickness. From observations of the dynamics of light scattered by the corneal gel, intensity autocorrelation functions that revealed two independent diffusion coefficients were obtained. Divergent behavior in the measured total scattered light intensities and diffusion coefficients with varying temperature was observed. That is, a slowing of the dynamic modes accompanied by increased "static" scattered intensities was observed. This is indicative of the occurrence of a phase transition as a function of temperature.

Effects of astigmatism on the Humphrey Matrix perimeter.

PURPOSE: To evaluate the influence of astigmatism in terms of its amount and direction on the results of Humphrey Matrix perimetry. METHODS: A total of 31 healthy volunteers from hospital staff were consecutively recruited to undergo repeat testing with Humphrey Matrix 24-2 full threshold program with various induced simple myopic astigmatism. All subjects had previous experience (at least twice) with Matrix testing. To produce simple myopic astigmatism, a 0 diopter (D), +1 D, or +2 D cylindrical lens was added and inserted in the 180 degrees direction and in the 90 degrees direction after complete correction of distance vision. The influences of astigmatism were evaluated in terms of the mean deviation (MD), pattern standard deviation (PSD), and test duration (TD). RESULTS: A significant difference was observed only in the MD from five sessions. The MD in cases of 2 D inverse astigmatism was significantly lower than that in the absence of astigmatism. CONCLUSIONS: In patients with inverse myopic astigmatism of > or =2 D, the influences of astigmatism on the visual field should be taken into consideration when the results of Humphrey Matrix perimetry are evaluated.

[Long-term study of nipradilol ophthalmic solution in patients with normal-tension glaucoma].

PURPOSE: We investigated the long-term clinical effects of a nipradilol ophthalmic solution on normal-tension glaucoma. METHODS: Among normal tension glaucoma patients who consulted the Nara Medical University Hospital or 2 affiliated hospitals between November 2001 and August 2002, we prospectively examined intraocular pressure-decreasing effects, the deterioration of visual field defects, and the appearance of side effects in 46 patients who underwent single therapy with a nipradilol ophthalmic solution. We evaluated intraocular pressure at 6-month intervals. The deterioration of visual field defects was assessed based on a 3-dB or more decrease in the mean deviation measured using the Humphrey Field Analyzer 30-2 program. RESULTS: The 60 months intraocular pressure value after administration of nipradilol ophthalmic solution was significantly lower than the pretreatment value. The deterioration of visual field defects was examined using the Kaplan-Meier life table. The survival rate after 60 months was 82.4%. In 4 of the 46 patients, administration of the nipradilol ophthalmic solution was discontinued due to side effects. CONCLUSION: Long-term therapy with a nipradilol ophthalmic solution may be useful for treating normal-tension glaucoma.

Objective visual field evaluation using multifocal visual evoked potentials in patients with intracranial disease complicated by mental disorders.

OBJECTIVES: We investigated whether visual field defects can be objectively evaluated using multifocal visual evoked potentials (mfVEPs) in patients with intracranial disease complicated by mental disorders. PATIENTS AND METHODS: First, to determine the normal pattern of mfVEPs, recordings were performed using a VERIS Junior Science recording apparatus (Mayo, Aichi, Japan) in 40 healthy subjects. Responses from 8 sites in each subject were divided into 4 quadrants (superior and inferior temporal quadrants and superior and inferior nasal quadrants). In each quadrant, two response waves were grouped and averaged, and the peak latency and amplitude were used for assessment. mfVEP recordings were also performed in 3 patients with intracranial disease complicated by mental disorders, in whom dynamic or static perimetry was impossible, or in whom reliable data could not be obtained, and quadrants showing abnormalities were compared with the sites of intracranial lesions observed by imaging techniques. RESULTS: In the 40 normal subjects, no significant differences were observed in the peak latency among the 4 quadrants, but the amplitude was significantly higher in the inferior than in the superior semi-field. mfVEPs in the 3 patients revealed abnormal waves, which corresponded to the lesions observed by imaging techniques. CONCLUSION: The objective evaluation of visual field defects using mfVEPs may be useful in patients with intracranial disease complicated by mental disorders, in whom kinetic/static perimetry as a subjective examination is difficult.

Usefulness of multifocal VEP in a child requiring perimetry.

We examined the reliability of multifocal visual evoked potentials for evaluating visual-field defects in a child with epilepsy and an arachnoid cyst. Multifocal visual evoked potentials were measured both when perimetry was difficult and several years later, when kinetic perimetry became possible in a child with epilepsy and homonymous hemianopia, as suggested by computed tomography of the brain. The peak latency and amplitude of response waves were used for assessment. The recordings of multifocal visual evoked potentials at both times revealed marked decreases in amplitude in the left visual hemifield. This area of decreased amplitude corresponded to the location of the lesion observed with imaging techniques, and was consistent with the left homonymous hemianopia observed via kinetic perimetry. The objective evaluation of visual-field defects through multifocal visual evoked potentials may be useful in children in whom conventional perimetry is difficult.