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Editors Selection IGR 12-1

Diagnostic Methods: Electrophysiology: The place of multifocal VEP in clinical management of glaucoma

Comment by Vittorio Porciatti on:

50190 Clinical use of multifocal visual-evoked potentials in a glaucoma practice: a prospective study, De Moraes CG; Liebmann JM; Ritch R et al., Documenta Ophthalmologica, 2012; 125: 1-9

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The multifocal visual-evoked potential (mfVEP) is a technology that is primarily used as an objective method for topographical assessment of the visual field in glaucoma. mfVEP is reported to have similar sensitivity and specificity as Standard Automated Perimetry (SAP), even though it may disagree with SAP in about 20% of cases. Dr. De Moraes and collaborators tested the usefulness of mfVEP in real-world clinical setting, where many cases may have inconclusive SAP and disk exams, unreliable/inconsistent SAP tests, or SAP tests requiring confirmation. They examined 210 patients over two years in a non-randomized, prospective study. All patients (52 glaucoma suspects; 43 ocular hypertension; 33 normaltension glaucoma; 82 unconfirmed SAP defects) were referred by a single glaucoma specialist. De Moraes and collaborators found, in agreement with preliminary reports of the same group, that the mfVEP may be valuable in categorizing patients with unreliable, unconfirmed, or excessively subjective SAP defects, and documented how mfVEP occasionally helped to change treatment based on the congruency of functional defects with clinical examination of the optic nerve and RNFL. The authors propose an interesting flow chart as a guiding framework for the clinician, in which mfVEP interact with SAP and optic disk/RNFL findings to eventually identify high-risk patients needing treatment, confirm/modify treatment schedules in patients with manifest disease, and ruling out early damage. This study lends further support to the applicability of the mfVEP technique in a clinical scenario, and provide guidelines on how mfVEP may influence the clinical management of glaucoma.

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