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The Prognostic Value of Pattern Visual Evoked Potentials in Age-related Macular Degeneration
Pojda S. M., Pojda-Wilczek D., Herba E., Zatorska B., Plech A. R., Makowiecka-Obidzinska K.,
Medical University of Silesia in Katowice, Department of Ophthalmology and Eye Division, Municipal Hospital No 1 (Bytom)
Purpose: Age-related macular degeneration (ARMD) and/or cataract are the most frequent reasons of decreased visual acuity in patients aged over 60 years. The aim of this study was to find out the usefulness of pattern visual evoked potentials (VEP) in the visual prognosis of patients with ARMD accompanied by early stage cataract, first of all to make a decision to perform cataract surgery.
Patients: 44 patients (25 women and 19 men, 88 eyes) aged from 55 to 88 (mean 72) years were examined. All the patients were good-cooperated. ARMD changes in various form were shown in the posterior pole in all eyes. Early stage cataract was found in 49 eyes, primary open angle glaucoma occurred in 9 eyes, strabismus and mild amblyopia in 3 eyes. The most common systemic problems of the patients were circulatory diseases (systemic hypertension - 11 patients, cardiac ischaemic disease - 9 patients, the history of brain stroke - 3 patients) and metabolic disorders (diabetes - 3 patients, hypercholesterolemy - 5 patients). Visual acuity varied from 5/5 to finger counting. In 14 eyes the cataract extraction with intraocular lens implantation was done.
Methods: Pattern VEP examination was performed according to ISCEV standard. The LKC (USA) equipment and UTAS E-2000 program were used. The active skin electrodes were situated on both sides of the head under the occipital region and the reference electrode was placed on the parietal region in the midline. The refractive errors were corrected to the distance of the examination. A few sizes of checks (210, 105, 52, 26, 13, 7 min arc.) were used. P100 latency and amplitude were calculated. The results were compared with our own normal values for various age groups.
Results: The VEP changes depended on checkerboard size used and on localization of the degenerative changes. The changes which were situated close to the fovea caused mostly abnormalities after stimulation by small checks (26, 13, 7 min arc.), while degenerations surrounding the macula disturbed the answers after big size stimulations (105, 52 min arc.). The P100 latency was significantly prolonged in responses obtained after stimulation of all eyes with ARMD and much more prolonged when cataract or glaucoma simultaneously occurred. Nuclear or capsular cataract did not lower P100 amplitude and the patients with good macular function confirmed by VEP had also good visual acuity after cataract extraction. Flat VEP after pattern stimulation was related to deep macular destruction and the patients definitely have lost their visual acuity.
Conclusions: Well preserved VEPs on small sizes checkerboards in spite of ARMD and relatively low vision have a good prognostic value. When P100 VEP amplitude is lower than expected from actual visual acuity, the cataract surgery most probably will not improve enough vision at all, or for a longer time.