Comparing isolated-check visual evoked potential, pattern visual evoked potential, and standard automated perimetry in dysthyroid optic neuropathy eyes

Xin Qi,Weikun Hu,Ban Luo,Boding Tong

doi:10.1038/s41433-020-01274-3

Abstract

ObjectiveTo determine the diagnostic ability of isolated-check visual evoked potential (icVEP), pattern visual evoked potential (pVEP), and standard automated perimetry (SAP) between dysthyroid optic neuropathy (DON) and thyroid-associated ophthalmopathy (TAO) without DON (non-DON).MethodsThis is a case-control study, 49 bilateral patients (26 DON and 23 non-DON) were included. icVEP, pVEP, and SAP were conducted in all the subjects, icVEP parameters compared were signal-to-noise ratios (SNRs) under 8, 16, and 32% depth of modulation (DOM). pVEP parameters compared were amplitude and latency. SAP parameters were mean deviation (MD) and pattern standard deviation (PSD). The area under the receiver operating characteristic (ROC) curve (AUC), net reclassification index (NRI), integrated discrimination index (IDI), and decision curve analysis (DCA) were applied for analysis.ResultsIn icVEP, values of SNR in DON were significantly smaller than non-DON (p < 0.05). In pVEP, P100 latent time in DON was significantly larger than non-DON (p = 0.0026). In SAP, value of PSD in DON was larger than non-DON (p = 0.0006), and value of MD in DON was smaller (p = 0.0007). AUC, NRI, and IDI among the three tests were not significantly different. DCA showed that SNR of icVEP under 8% DOM was the farthest from the two extreme curves.ConclusionsicVEP, pVEP, and SAP have equal diagnostic capabilities to discern between DON and non-DON. In addition, icVEP may represent a significant ancillary diagnostic approach to DON detection, with more clinical benefit.

Highlights

Dysthyroid optic neuropathy (DON) is a sight-threatening condition that occurs due to impaired optic nerve function secondary to thyroid-associated ophthalmopathy (TAO) [1, 2]
We found that the area under the ROC curve (AUC) (8% depth of modulation (DOM) vs pattern standard deviation (PSD), p = 0.664 > 0.05; 8% DOM vs P100 latent time, p = 0.434 > 0.05; PSD vs P100 latent time, p = 0.590 > 0.05), net reclassification index (NRI) (8% DOM vs PSD, −0.120, p = 0.477 > 0.05; 8% DOM vs P100 latent time, −0.077, p = 0.502 > 0.05; PSD vs P100 latent time, 0.004, p = 0.975 > 0.05), and integrated discrimination index (IDI) (8% DOM vs PSD, −0.120, p = 0.486 > 0.05; 8% DOM vs P100 latent time, −0.077, p = 0.511 > 0.05; PSD vs P100 latent time, 0.004, p = 0.975 > 0.05) among three presented no statistically difference, which indicates that isolated-check visual evoked potentials (VEPs) (icVEP), pattern visual evoked potential (pVEP), and standard automated perimetry (SAP) showed no significant difference in discriminating dysthyroid optic neuropathy (DON) and non-DON
PVEPs are mainly dominated by the central 10° of the visual field (VF) and will miss localised changes if they are in the periphery [15], which could be compensated by VF testing (e.g., SAP)

Summary

Introduction

Dysthyroid optic neuropathy (DON) is a sight-threatening condition that occurs due to impaired optic nerve function secondary to thyroid-associated ophthalmopathy (TAO) [1, 2]. It has an estimated incidence of 3–8.6% [2,3,4]. The majority of eyes with DON develop a central or paracentral scotoma and peripheral breakout patterns [3, 7]; visual field testing, such as SAP, could accurately detect this disease. Pattern VEP (pVEP) is widely used for DON screening; isolated-check VEP (icVEP) was designed based on known

Methods

Results

Conclusion