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A Klistorner

Publications and source records attributed to A Klistorner.

13 recordsLinked to original sources
PubMed2000

Objective perimetry in glaucoma.

PURPOSE: Objective perimetry in glaucoma is described using the multifocal pattern visually evoked potential (VEP). A multichannel recording technique was used to improve signal detection in healthy volunteers and assess its ability to detect glaucoma and early changes in patients with suspected glaucoma. DESIGN: Prospective, case-control study. PARTICIPANTS: Thirty healthy volunteers, 30 patients with suspected glaucoma, and 30 patients with glaucomatous visual field defects were tested. METHOD: The VEP was recorded using cortically scaled, multifocal, pseudorandomly alternated pattern stimuli with the VERIS system (Electro-Diagnostic Imaging, Inc., San Francisco, CA). An array of four bipolar occipital electrodes provided four differently oriented channels for simultaneous recording. Signals were compared for different locations within the field up to 26 degrees of eccentricity. Healthy volunteers, patients with suspected glaucoma, and glaucoma patients with established visual field defects were tested, and results were compared with Humphrey visual fields (Humphrey Systems, Dublin, CA) performed on the same day. For reproducibility, five healthy volunteers were each tested on four separate days. The patients with suspected glaucoma and the established glaucoma patients were analyzed for intereye asymmetry of signals, and these data were compared with the asymmetry values of the healthy volunteers. RESULTS: Multiple recording channels significantly enhanced the recording of signals from parts of the visual field not reliably sampled with a single channel technique in all healthy volunteers, particularly along the horizontal meridian (P: < 0.001). Signal amplitude did not decline with age in healthy volunteers. Recordings showed good reproducibility within individuals. In all 30 glaucoma patients, the Humphrey visual field defects were well demonstrated by the VEP, and topographic location was strongly correlated (r(s) = 0.79). Despite large interindividual variations in amplitude, scotomas were well demonstrated when compared with normal values. In the patients with suspected glaucoma, smaller changes in signal amplitude could be identified in parts of the field still normal on perimetry using intereye asymmetry analysis. CONCLUSIONS: The multifocal, multichannel VEP can objectively detect glaucomatous visual field defects. The nasal step region can be more reliably tested using multiple channels. Asymmetry analysis has the potential to detect early defects. This technique represents a significant step toward the clinical application of objective perimetry in glaucoma.

Adult↗
PubMed1999

Objective perimetry in glaucoma: recent advances with multifocal stimuli.

The introduction of multifocal stimulus recording has enhanced our ability to examine the human visual field with electrophysiologic techniques. We have adapted the multifocal pattern visual evoked potential (PVEP) to detect visual field loss. In glaucoma patients we sought to determine the extent to which the PVEP amplitudes correlate with perimetric thresholds. Multifocal pseudorandomly alternated pattern stimuli, which were cortically scaled in size, were presented with use of the VERIS-Scientific system. Bipolar occipital straddle electrode positions were used. The visual field up to 25 degrees of eccentricity was investigated. Forty-three glaucoma patients with reproducible visual field defects were tested. The bipolar PVEP corresponded well with Humphrey visual field defects, showing loss of signal in the scotoma area. For Humphrey quadrant threshold totals and PVEP quadrant amplitudes, the correlation coefficient was strong (r = 0.49, P < 0.0001). The multifocal PVEP demonstrates good correspondence with the topography of the visual field. This technique represents the first practical application of the multifocal PVEP to objective detection of visual field defects in glaucoma.

Chronic Disease↗
PubMed1999

The diagnostic significance of the multifocal pattern visual evoked potential in glaucoma.

The concept of objective perimetry is an exciting one because it strives to assess glaucoma damage without relying on psychophysical testing. The recent introduction of multifocal stimulus recording has enhanced our ability to examine the human visual field using electrophysiology. A multifocal pattern visual evoked potential can now be recorded, testing up to 60 sites within the central 25 degrees. The test requires only that the subject fixate on a target, while a cortically scaled dartboard pattern stimulus undergoes pseudorandom alternation within each of the test segments. In its present configuration the test requires at least 8 minutes recording time per eye. Modified bipolar electrode positions are required to ensure that adequate signals are detected from all parts of the visual field. In glaucoma patients, pattern visual evoked potential amplitudes have been shown to reflect visual field loss with reduction of signal amplitude in the affected areas. This technique represents the first major step toward objective detection of visual field defects in glaucoma.

Evoked Potentials, Visual↗
PubMed1998

Temporal analysis of the topographic ERG: chromatic versus achromatic stimulation.

The topographic electroretinogram evoked by multi-focal exchange of black and white or red and green stimuli was analysed into linear and non-linear Wiener kernels. The first-order (temporally linear) response showed a biphasic waveform which inverted as the luminance ratio of the exchanged colours passed through unity (established both psychophysically and photometrically). A short latency non-linearity which was dependant on luminance contrast was observed in both chromatic and achromatic ERG. However, in the chromatic second-order response, a long-latency non-linearity, foveally prominent, with a distinct skew in power towards the nasal retina, appeared around the isoluminant point, between the points of silent substitution for the L and M-cone types. Modelling of the second-order responses showed that over a wide range of luminance ratios, the chromatic ERG is well described by a linear combination of the achromatic (contrast-dependent) component and the response at isoluminance. The difference in second-order response between coloured and black and white stimulation, at the same luminance contrast, showed that the long-latency non-linearity is recorded when the red and green cone types are operating out of phase and peaks in amplitude at a green/red luminance ratio of 0.8. This interpretation was confirmed by the lack of the long-latency non-linearity in colour-anomalous subjects (whether deficient in the L or the M-cone type). A marked similarity exists between the properties of the long-latency non-linearity and the frequency-doubled response generated in the ganglion cells of the magnocellular pathway.

Color Perception↗
PubMed1998

Temporal analysis of the chromatic flash VEP--separate colour and luminance contrast components.

Temporal analysis of the chromatic flash visual evoked potential (VEP) was studied in human subjects with normal and anomalous colour vision using a deterministic pseudo-random binary stimulus (VERIS). Five experiments were carried out on four normal subjects investigating heterochromatic red-green exchange and single colour/achromatic (either red/grey or green/grey) exchange over a wide range of luminance ratios for the two stimuli, the effects of lowered mean luminance on the chromatic VEP and the effects of colour desaturation at constant mean luminance and constant luminance contrast. Finally, the performance of three dichromats, a protanope and two deuteranopes, on heterochromatic exchange VEP and on colour desaturation were investigated. In contrast to the chromatic electroretinogram, which shows great symmetry with respect to luminance ratio on opposite sides of the isoluminant point, the chromatic VEP demonstrated a distinct asymmetry when the colours exchanged included red. On the red side of isoluminance (red more luminant than green), a wave with longer latency and altered waveform became dominant. The effects of green stimulation were indistinguishable from those of achromatic stimulation at the same luminance contrast over the whole range of chromatic contrast and for all levels of desaturation studied. Desaturation of red with constant luminance contrast (desaturated red/grey stimulation) resulted in a systematic alteration in the evoked waveform. Subtraction of the achromatic first- and second-order responses from responses recorded in the red desaturation series resulted in remarkably uniform waveforms, with peak amplitudes growing linearly with saturation. The absence of interaction between achromatic and coloured components for all (including the most intense colour) stimulus parameters used suggests that the generators of these components are separate. Recordings from the dichromats showed that the contrast response minimum shifted from the point of photopic isoluminance to the point of zero cone contrast (at the silent substitution point) for the remaining cone type. The waveforms recorded with a series of luminance ratios were much simpler than those recorded from trichromats and symmetrical with respect to their isoluminant points. Despite the indication of the presence of L cones of apparently normal spectral sensitivity in the deuteranopes (on the basis of flicker photometry), there was no evidence for a red-sensitive component in the desaturation or heterochromatic stimulation series. The results are discussed in terms of the possibility of separate generation of chromatic and achromatic contributions to the VEP.

Color Perception↗
PubMed1998

Electrophysiology: a review of signal origins and applications to investigating glaucoma.

Because different electrophysiological responses can be isolated to different retinal and cortical cell types and levels, the proportion in which the different signals are reduced can reflect the primary areas of damage. The knowledge of electrophysiology component sources can thus be applied when examining ophthalmic disorders. The present review covers the proposed origins and the usefulness of the conventional electrophysiological responses. Their application to glaucoma is discussed, with particular reference to the pattern electroretinogram. In the second part of the current review, we present some recent developments that relate to the use of multifocal pseudorandomly stimulated recording. This technique enables a new approach to the electrical assessment of visual responses. Analysis for temporal non-linearities and spatial distribution of the response throughout the visual field can be implemented. This type of recording has the potential to provide a method of objective visual field assessment in glaucoma and other disorders of the visual system.

Animals↗
PubMed1997

Separate magnocellular and parvocellular contributions from temporal analysis of the multifocal VEP.

Temporal analysis of the multifocal cortical visual evoked potential (VEP) was studied using pseudo-random (m-sequence) achromatic stimulation. The effects of variation of luminance contrast on the first-order response were complex. At low to mid contrasts (< 60%), a wave doublet (P100-N115) predominated. A second wave complex (N100-P120-N160) dominated at high contrasts. The second-order responses, however, showed an extremely simple variation with luminance contrast. Intrinsic differences in the adaptation time of the generators of these two components caused a distinct separation in the slices of the second-order response. A rapidly adapting nonlinearity saturating at low contrasts was only observable when measuring the responses from two consecutive flashes. Its latency coincided with the contrast saturating first-order response component. By comparison, the nonlinearity derived from the responses to the stimuli with longer interstimulus intervals (second and third slices) yielded a much more linear contrast response function with lower contrast gain and latencies, which clearly corresponded to the longer latency component of the first-order response. Thus, the second-order responses show a first slice which is predominantly driven by neural elements that have a latency and contrast function that mimic those of the magnocellular neurons of the primate LGN and a second slice which is dominated by a generator whose properties resemble primate parvocellular function. This division into magno and parvocellular contribution to the VEP is based on function (interaction time) as distinct from other currently available analyses, with potential for neural analysis of visual disease.

Adult↗