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Biomedical subjects

Jeffrey G Odel

Publications and source records attributed to Jeffrey G Odel.

5 recordsLinked to original sources

Simultaneous occurrence of neuroretinitis and optic perineuritis in a single eye.

A 52-year-old woman presented with pain, decreased visual acuity, decreased color vision, and visual field loss in the OD. Fundus examination revealed optic disc edema and later a macular star figure consistent with neuroretinitis. Magnetic resonance imaging showed enhancement of the orbital optic nerve sheath and perineural fat suggestive of optic perineuritis. The patient was not treated. At 11 months, visual function and fundus examination had returned to normal. This unusual simultaneous occurrence of neuroretinitis and optic perineuritis suggests that these two entities may have a similar pathogenesis.

Female↗

The multifocal electroretinogram.

The multifocal electroretinogram (mfERG) technique allows local ERG responses to be recorded simultaneously from many regions of the retina. As in the case of the full-field ERG, the ganglion cells contribute relatively little to the response, which originates largely from the outer retina. The mfERG is particularly valuable in cases in which the fundus appears normal, and it is difficult to distinguish between diseases of the outer retina and diseases of the ganglion cells and/or optic nerve. The mfERG can also help to differentiate among outer retinal diseases, to follow the progression of retinal diseases, and, with the addition of the mfVEP, to differentiate between organic and nonorganic causes of visual loss. However, because the difficulties encountered in recording and analyzing mfERG responses are greater than those involved in full-field ERG testing, mfERG testing is best left to centers with an electrophysiologist familiar with the mfERG test. Although this technique is relatively new and standards are still being developed, centers capable of recording reliable mfERG responses can be found in hundreds of locations around the world.

Electroretinography↗

The multifocal visual evoked potential.

With the multifocal technique, visual evoked potentials (VEPs) can be recorded simultaneously from many regions of the visual field. For the multifocal VEP (mfVEP), the patient views a display that typically contains 60 sectors, each with a checkerboard pattern. The display covers about the same retinal area as the 24-2 Humphrey visual field (HVF). However, due to the scaling of the sectors of the mfVEP display, the fields are sampled differently by the mfVEP and HVF. To assess local defects in the visual field, the mfVEP responses must be compared with normal controls. These comparisons require relatively sophisticated analyses and software. Whereas the mfVEP can be recorded relatively easily with the same equipment used to record multifocal electroretinograms (mfERGs), the software needed to perform the analysis is not yet widely available. The mfVEP is valuable for ruling out non-organic visual loss, diagnosing and following patients with optic neuritis/multiple sclerosis, evaluating patients with unreliable or questionable HVFs, and following disease progression. When combined with the mfERG, diseases of the outer retina (before the retinal ganglion cells) can be distinguished from diseases of the ganglion cells and/or optic nerve. The difficulties encountered in recording and analyzing mfVEP responses are greater than those involved in full-field VEP testing. Thus, in its current form, the mfVEP is best recorded and interpreted by ophthalmologists and electrophysiologists experienced with the technique. However, this technique is developing rapidly; advances in commercial hardware and software are expected in the near future.

Electroretinography↗

Visual field defects and multifocal visual evoked potentials: evidence of a linear relationship.

OBJECTIVE: To determine the relationship between spatially localized multifocal visual evoked potentials (mfVEPs) and Humphrey visual fields (HVFs) in patients with unilateral field defects. METHODS: Humphrey visual fields and mfVEPs were obtained from 20 patients with unilateral field losses due to either ischemic optic neuropathy or glaucoma. Monocular mfVEPs were obtained for each eye. The amplitude of the mfVEP responses was calculated using root-mean-square and signal-noise ratio measures. Estimates of the HVF loss in the same regions of the field used for the mfVEP were obtained by interpolating the 24-2 HVF data. RESULTS: Monocular mfVEP amplitude decreased with HVF loss, although small mfVEP signals were not uniquely associated with poor fields. On average, the monocular mfVEP was indistinguishable from noise for field losses between -5 and -10 dB, and good monocular mfVEP amplitudes were never associated with extensive visual field loss. The interocular ratio of the mfVEP amplitudes correlated well with the difference between the HVF values of the 2 eyes, and this correlation improved with increased signal-noise ratio. CONCLUSIONS: The monocular and interocular results were consistent with a linear relationship between the amplitude of the signal portion of the mfVEP response and linear HVF loss. One way to produce this relationship would be if both the signal in the mfVEP and linear HVF loss were linearly related to the percentage of local ganglion cells lost. The clinical limitations of the mfVEP technique can be understood by taking the signal-noise ratio, and the linear model proposed herein, into consideration.

Adult↗