Practical Visual Electrophysiological Examination

This book includes the concept, general summary and the equipment of the visual electrophysiological examination. It also covers the clinical application scope, diagnosis protocol, standardized operation steps, clinical report samples, and the key points of reading reports, etc. of visual evoked potential (VEP), electroretinogram (ERG), electrooculogram (EOG), multifocal VEP, multifocal ERG and other commonly used visual electrophysiological examinations. Typical clinical report examples of normal and abnormal waveforms are specially added, which is a highlight of this book and can help clinical technicians quickly grasp the key points of electrophysiological report reading. Preface Contents About the Authors List of Abbreviations 1: Visual Electrophysiology Summary 1.1 Visual Electrophysiology Basic Mechanism and Features 1.1.1 Basic Principle 1.1.2 Clinical Importance 1.2 Classification of Visual Electrophysiology 1.2.1 Basic Classification 1.2.2 Classification of Traditional Visual Electrophysiology 1.2.3 Classification of Multifocal Visual Electrophysiology 1.3 Visual Electrophysiology Clinical Application Principles 1.3.1 Overall Check 1.3.2 Combined with Other Clinical Results 1.3.3 Binocular Contrast 1.4 Visual Electrophysiology International Standards 1.4.1 ISCEV Standards 1.4.2 Revision of the ISCEV Standards 1.4.3 The Relation Between the Book and ISCEV Standards 2: Visual Electrophysiology Examination Equipment 2.1 Visual Electrophysiology Hardware Compositions 2.2 Visual Electrophysiology Stimulators 2.2.1 Stimulator Classification 2.2.2 Full-Field Ganzfeld 2.2.3 Graphic Stimulator 2.2.3.1 CRT Graphic Stimulator 2.2.3.2 LED Graphic Stimulator 2.2.3.3 LCD Graphic Stimulator 2.2.3.4 SLO Graphic Stimulator 2.2.4 Stimulators for Infants 2.2.4.1 The Stimulator Used for Infants and Bedridden Patients 2.2.4.2 Handheld Graphic Stimulator 2.2.4.3 Instant Control Babyflash Stimulator 2.2.4.4 Mini-Ganzfeld Handheld Flash Stimulator 2.3 Visual Electrophysiology Electrodes 2.3.1 Skin Electrode 2.3.1.1 Gold Cup Electrode or Silver Cup Electrode 2.3.1.2 Infant Skin Electrode 2.3.1.3 Ear Clip Gold or Silver Cup Electrode 2.3.2 Corneal Electrode 2.3.2.1 ERG-Jet Corneal Contact Lens Electrode 2.3.2.2 DTL (Dawson, Trick, and Litzkow) Electrode 2.3.2.2.1 DTL Conductive Fiber Electrode 2.3.2.2.2 Roll-Type DTL Electrode 2.3.2.3 Gold Foil Electrode 2.3.2.4 HK (Hawlina, Konec) Conductive Metal Ring Electrode 2.3.2.5 Burian Allen Electrode (B-A Electrode) 2.3.2.6 Kooyman Electrode 3: Visual Electrophysiology Result Reading Key Points 3.1 Visual Electrophysiology Result Reading Principles 3.1.1 The Form, Influencing Factors, and Characteristics of Visual Electrophysiological Examination Results 3.1.1.1 The Results Presentation Form 3.1.1.2 Factors Influencing Visual Electrophysiological Examination 3.1.1.3 Characteristics of Visual Electrophysiological Examination 3.1.1.3.1 Variation Between the Examination Rooms 3.1.1.3.2 Variation with Age 3.1.1.3.3 Variation Among Individuals 3.1.2 Result Reading Key Points of Visual Electrophysiological Examination 3.2 VEP Basic Features and Report Reading Key Points 3.2.1 VEP and EEG 3.2.2 Role and Classification of VEP 3.2.3 VEP Application Range and Stimulation Mode 3.2.3.1 PVEP Application Range and Stimulation Mode 3.2.3.2 PVEP Application Range and Stimulation Mode 3.2.4 PVEP Versus FVEP 3.2.5 VEP Scope of Application 3.2.5.1 Optic Neuropathy 3.2.5.2 Unexplained Loss of Vision 3.2.5.3 Glaucoma 3.2.5.4 Amblyopia 3.2.5.5 Refracting Media Opacity 3.2.6 Examples of VEP Clinical Reports and Key Points of Reading Diagrams 3.2.6.1 Normal PVEP 3.2.6.2 Abnormal PVEP 3.2.6.3 Normal FVEP 3.2.6.4 Abnormal FVEP 3.3 ffERG Basic Features and Report Reading Key Points 3.3.1 ffERG Basic Process and Signal Origin 3.3.2 ffERG Active Electrode Selection 3.3.3 ffERG Basic Waveform 3.3.4 ffERG New International Standard Changes 3.3.5 ffERG Normal and Abnormal Waveform Contrast 3.3.5.1 Dark-Adapted 0.01 ERG Normal Versus Abnormal Waveforms 3.3.5.2 Dark-Adapted 3.0 ERG Normal and Abnormal Waveform Contrast 3.3.5.3 Dark-Adapted 3.0 Oscillation Potential Normal and Abnormal Waveform Contrast 3.3.5.4 Light Adapted 3.0 ERG Normal and Abnormal Waveform Contrast 3.3.5.5 Light Adapted 30 Hz Flicker ERG Normal and Abnormal Waveform Contrast 3.3.6 ffERG Clinical Features 3.3.7 ffERG Scope of Application 3.3.7.1 Hereditary Retinopathy 3.3.7.2 Retinal Vascular Diseases 3.3.7.3 Preoperative Cataract Examination 3.3.7.4 Assessment of Retinal Function in Infants 3.3.7.5 Retinal Toxicity Drug Monitoring 3.3.8 Examples of Normal ffERG Clinical Report and Key Points of Reading the Diagram 3.3.9 Examples of Abnormal ffERG Clinical Report and Key Points of Reading the Diagram 3.4 PERG Basic Features and Report Reading Key Points 3.4.1 PERG Basic Process and Its Clinical Significance 3.4.2 PERG Waveform 3.4.3 PERG Scope of Application 3.4.3.1 Macular Disease 3.4.3.2 Hereditary Retinopathy and Retinal Vascular Diseases 3.4.3.3 Optic Nerve Disease (e.g., Glaucoma) 3.4.3.4 Lesion Localization 3.4.4 Examples of Normal PERG Clinical Reports and Key Points of Reports Reading 3.4.5 Examples of Abnormal PERG Clinical Report and Key Points of Reading the Diagram 3.5 mfERG Basic Features and Report Reading Key Points 3.5.1 mfERG Basic Concept 3.5.2 Three ERGs Comparisons 3.5.3 Scope of Application for mfERG 3.5.3.1 Quantitative Evaluation of the Therapeutic Effect of Fundus Diseases 3.5.3.2 Hereditary Retinopathy 3.5.3.3 Macular Degeneration 3.5.3.4 Retinal Vasculopathy 3.5.3.5 Retinal Toxicity Drug Monitoring 3.5.3.6 Preoperative Assessment of Retinal Function for Cataract 3.5.4 Examples of Normal mfERG Clinical Reports and Key Points of Reading 3.5.5 Examples of Clinical Reports of mfERG Abnormalities and Key Points of Image Reading 3.6 EOG Basic Features and Report Reading Key Points 3.6.1 EOG Recording Process and New Changes in International Standards 3.6.2 Application Scope of EOG 3.6.2.1 Best Disease (Vitelliform Macular Dystrophy) 3.6.2.2 Pigment Epithelial Lesion 3.6.2.3 Choroid Lesions 3.6.3 Examples of Normal EOG Clinical Reports and Key Points of Reading 3.6.4 Examples of Abnormal EOG Clinical Reports and Key Points of Reading 4: Visual Electrophysiology Clinical Cases 4.1 Visual Electrophysiology Examination Selections and Application Scope 4.1.1 Visual Electrophysiology Examination Selections Protocol 4.1.2 Application Scope of Visual Electrophysiology 4.2 Optic Neuropathy 4.2.1 Optic Nerve Demyelination 4.2.2 Degeneration of the Optic Nerve 4.3 ROP 4.4 Inherited Retinopathy 4.4.1 Stargardt’s Disease 4.4.2 Bull’s Eye Maculopathy 4.4.3 Best Vitelliform Macular Dystrophy 4.4.4 Congenital Stationary Night Blindness 4.4.5 X-Linked Juvenile Retinoschisis 4.4.6 Retinitis Pigmentosa 4.4.7 Occult Macular Dystrophy 4.5 Acquired Retinopathy 4.5.1 Diabetic Retinopathy 4.5.2 Central Retinal Artery Occlusion 4.5.3 Central Retinal Vein Occlusion 4.5.4 Macular Hole 4.5.5 Age-Related Macular Degeneration 4.5.6 Acute Zonal Occult Outer Retinopathy 4.6 Toxic Retinopathy 4.7 Refractive Media Opacity 4.8 Glaucoma 4.8.1 Glaucoma Steady-State PERG 4.8.2 Glaucoma Transient-State PERG 4.8.3 Glaucoma PhNR ERG 4.9 Amblyopia 4.10 Eye Diseases Judicial Expertise 4.11 Eye Diseases Visual Electrophysiological Examinations Selection 5: Visual Electrophysiology Equipment Install and Operation 5.1 Visual Electrophysiology Equipment Install 5.1.1 Installation of Ground Wires 5.1.2 Inspection Room Requirements and Layout 5.2 PVEP Operation Steps and Key Points 5.2.1 PVEP Examination for Adult 5.2.1.1 Examination of Environmental Requirements 5.2.1.2 Preexamination Preparation 5.2.1.2.1 Patient Preparation 5.2.1.2.2 Examination Distance 5.2.1.3 PVEP Examination Operation Steps 5.2.1.3.1 Open PVEP Program 5.2.1.3.2 Input Patient Information 5.2.1.3.3 Electrodes Placement 5.2.1.3.3.1 Determine the Positions of Electrodes Placement 5.2.1.3.3.2 Clean the Skin 5.2.1.3.3.3 Connect the Electrode to the Amplifier 5.2.1.3.3.4 Electrodes Placement 5.2.1.3.4 Impedance Measurement 5.2.1.3.5 Electrode Fastened 5.2.1.3.6 Monocular Cover 5.2.1.3.7 Refractive Correct 5.2.1.3.8 PVEP Examination 5.2.1.3.8.1 PVEP Examination of Right Eye 5.2.1.3.8.2 PVEP Examination of Left Eye 5.2.1.3.9 Results Analyses 5.2.2 PVEP Examination for Children 5.2.2.1 Special Stimulator 5.2.2.1.1 Cartoon Fixation Pattern Suitable for Children 5.2.2.1.2 Handheld Graphic Stimulator 5.2.2.2 Special Skin Electrode 5.3 FVEP Operation Steps and Key Points 5.3.1 FVEP Examinations for Adult 5.3.2 FVEP Examinations for Infant and Young Children 5.3.2.1 Handheld Controlled Infant Flash Stimulator 5.3.2.2 Flat Full-Field Ganzfeld Stimulator 5.3.2.3 Mini-Ganzfeld Handheld Flash Stimulator 5.3.2.4 Eye Mask Stimulator 5.3.2.5 Kooyman Electrode Stimulator 5.4 ffERG Operation Steps and Key Points 5.4.1 ffERG Electrode Operation Points and Notes 5.4.2 Prepare Before ffERG Examination 5.4.3 ffERG Examination Operation Steps 5.4.4 ffERG Result Analysis and Marker Adjustment 5.4.5 ffERG Examination for Infants and Young Children 5.4.5.1 Examination Characteristics 5.4.5.2 Anesthesia 5.4.5.3 Electrode 5.4.5.4 Repeating Time 5.4.5.5 Stimulators 5.5 PERG Operation Steps and Key Points 5.5.1 Prepare Before PERG Examination 5.5.2 PERG Electrode Operation Key Points 5.5.2.1 Electrodes and Positions 5.5.2.2 Fiber Electrode 5.5.2.3 Gold Foil Electrode 5.5.2.4 HK-Loop Ring Electrode 5.5.2.5 Others 5.5.3 PERG Examination Stimulus Conditions 5.5.4 PERG Examination Operation Steps 5.5.5 PERG Examination for Children 5.6 mfERG Operation Steps and Key Points 5.6.1 Prepare Before mfERG Examination 5.6.2 mfERG Electrode Requirements 5.6.3 mfERG Operating Essentials 5.6.4 mfERG Steps 5.7 EOG Operation Steps and Key Points 5.7.1 Preparation Before EOG Examination 5.7.2 EOG Electrode Requirements 5.7.3 EOG Operation Steps 5.8 Visual Electrophysiological Examinations Operation Key Points Comparing 5.9 Different ERG Electrodes Comparing 6: ISCEV Extended Visual Electrophysiological Examinations 6.1 Objective Visual Acuity-VEP SF Limit 6.2 ON/OFF PVEP 6.3 Three Channels PVEP 6.4 Three Channels FVEP 6.5 S-Cone ERG 6.6 PhNR ERG 6.7 The Stimulus-Response Series for the Dark-Adapted ffERG 6.8 ON/OFF ERG 6.9 PERG+PVEP Simultaneous Examination 6.10 Multifocal Visual Evoked Potential 7: Visual Electrophysiological in Animal Experiments 7.1 Hardware for Animal Visual Electrophysiological Examinations 7.2 Animal VEP 7.2.1 Animal PVEP Examination 7.2.2 Animal FVEP Examination 7.3 Animal ERG 7.3.1 Animal Serial Dark Adaptation ffERG Response Examination 7.3.2 Animals Light Adaptation ffERG Examination 7.3.3 Animals PERG Examination 7.3.4 Animals mfERG Examination 7.4 Animal Examination SOP 7.4.1 Animal FVEP Examination SOP [15, 16] 7.4.2 Animal ffERG Examination SOP [17, 18] 7.4.3 Animal mfERG Examination SOP [19] References