A comparison of CRT and digital stimulus delivery methods in the multifocal ERG

Comparison of CRT and LCD monitors for objective estimation of visual acuity using the sweep VEP

Purpose

To investigate the applicability of liquid crystal displays (LCD) as suitable replacement for cathode ray tube monitors (CRT) as stimulator for the sweep VEP for estimating visual acuity.

Methods

In a first experiment, sweep VEPs were recorded in 13 healthy volunteers with best-corrected visual acuity with an LCD and a CRT monitor, respectively. Time-to-peak after stimulus and peak-to-trough amplitudes as well as the visual acuity, estimated using a second-order polynomial and the modified Ricker model, were compared between both monitor types. In a second experiment, sweep VEPs were recorded in six healthy volunteers with two levels of stimulus contrast using artificially reduced visual acuities as well as best-corrected with the same monitors as in the first experiment and additionally, a modern LCD gaming monitor with a response time of 1 ms. Time-to-peak after stimulus and peak-to-trough amplitudes were compared between the different combinations of monitors and contrasts. Finally, visual acuities estimated using the modified Ricker model were compared to subjective visual acuities determined using the Freiburg Visual Acuity and Contrast Test (FrACT).

Results

In the first experiment, the time-to-peak after stimulus presentation was statistically significantly delayed for LCD displays (mean difference [confidence interval]: 60.0 [54.0, 65.9] ms; t(516) = 19.7096, p < 0.0001). Likewise, peak-to-trough amplitudes were statistically significantly smaller for the LCD stimulator, however, not clinically relevant (mean difference [confidence interval]: − 0.89 [– 1.59, − 0.20] µV; t(516) =  − 2.5351, p = 0.0115). No statistically significant effect of the monitor type on the estimated visual acuity was found for neither method, second-order polynomial, nor the modified Ricker model. In the second experiment, statistically significant delays of the time-to-peak after stimulus onset were found for all combinations of monitor and contrast compared to the CRT monitor. A statistically significant, but not clinically relevant, difference of the peak-to-trough amplitudes was only found between the CRT monitor and the LCD gaming monitor (mean difference [confidence interval]: 2.6 [1.2, 4.0] µV; t(814) = 4.66, p < 0.0001). Visual acuities estimated from LCD stimulation significantly underestimated the subjective visual acuity up to 0.2 logMAR using the conversion formula of the first experiment. No statistically significant difference was found when using conversion formulas adjusted for each combination of monitor and contrast.

Conclusions

Based on the results of this study, LCD monitors may substitute CRT monitors for presenting the stimuli for the sweep VEP to objectively estimate visual acuity. Nevertheless, it is advisable to perform a calibration and to collect normative data of healthy volunteers using best-corrected and artificially reduced visual acuity for establishing a conversion formula between sweep VEP outcome and the subjective visual acuity before replacing a CRT with an LCD stimulator.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10633-022-09883-x.

Comparison of cathode ray tube and liquid crystal display stimulators for use in multifocal VEP

PURPOSE

To compare the modified signal-to-noise ratio (SNR*) of multifocal visual evoked potential (mfVEP) responses elicited by a cathode ray tube (CRT) and liquid crystal display (LCD) monitor in normal subjects.

METHODS

An LCD monitor and CRT monitor were luminance and contrast matched. Luminance stability and the effect of viewing angle on luminance and contrast was measured for both screens. The SNR* of mfVEP responses from 15 normal subjects was compared between the stimulators using repeated measures analysis of variance.

RESULTS

The CRT monitor took 10 min from switch on to reach the desired luminance compared to 60 min for the LCD monitor. LCD luminance was sensitive to variations in ambient temperature, fluctuating by 10 cd/m(-2) over approximately 20-27 °C, whereas CRT luminance was stable. Luminance variation from the centre to the edge of the CRT screen was 8 % when viewed perpendicularly and 28 % when viewed at an angle of 25°, compared to 24 and 46 %, respectively, for the LCD screen. Contrast was >94 % and varied by <3 % across both monitors for both viewing conditions. There was no significant difference in SNR* between responses elicited by the two stimulators (p = 0.76).

CONCLUSIONS

CRT and LCD stimulators elicited mfVEP responses with similar SNR* in normal subjects. This study highlighted practical issues with the use of LCD monitors as visual stimulators, particularly with regard to warm-up time, luminance stability and luminance uniformity.

Achieving precise display timing in visual neuroscience experiments

In experimental visual neuroscience brief presentations of visual stimuli are often required. Accurate knowledge of the durations of visual stimuli and their signal shapes is important in psychophysical experiments with humans and in neuronal recordings with animals. In this study we measure and analyze the changes in luminance of visual stimuli on standard computer monitors. Signal properties of the two most frequently used monitor technologies, cathode ray tube (CRT) and liquid crystal display (LCD) monitors, are compared, and the effects of the signal shapes on the stated durations of visual stimuli are analyzed. The fundamental differences between CRT and LCD signals require different methods for the specification of durations, especially for brief stimulus presentations. In addition, stimulus durations on LCD monitors vary over different monitor models and are not even homogeneous with respect to different luminance levels on a single monitor. The use of LCD technology for brief stimulus presentation requires extensive display measurements prior to the experiment.

A comparison of the suitability of cathode ray tube (CRT) and liquid crystal display (LCD) monitors as visual stimulators in mfERG diagnostics

The aim of this study was to determine up to which extent the specific characteristics of cathode ray tube (CRT) and liquid crystal display (LCD) monitors influence the retinal biosignal when used as stimulators in ocular electrophysiology. In a conventional CRT monitor, each pixel lights up only for a duration of a few milliseconds during each frame. In contrast, liquid crystal displays are quasi-static, i.e. each pixel has a constant luminance during the whole length of the frame, but lights up only with a certain delay after the trigger. These different display characteristics may affect the mfERG signal. The temporal and spatial luminance distributions of a CRT and an LCD monitor were measured in white flashes. The total amount of emitted light was calculated by integration of the intensity versus time curves. By means of an mfERG recording system (RETIsystem, Roland Consult, Brandenburg, Germany) first-order kernel (FOK) mfERG signals were computed and then analysed using customized MATLAB (TheMathWorks, Natick, MA, USA) software. With the two stimulator monitors, differences in the mfERG signal were observed. The latencies of mfERG responses recorded with the LCD monitor were significantly increased by 7.1 ms for N1 and 9.5 ms for P1 compared to the CRT. Due to a higher luminance, the N1 amplitude was significantly higher by approx. 2 dB in measurements with the LCD monitor while no significant difference could be detected with regard to the more contrast sensitive P1 amplitude. When using LCD monitors as stimulators the increase in latencies and differences in the luminance versus time profile must be taken into account. Prior to clinical application, the establishment of guidelines for the use of LCD monitors is recommended.

A method for investigating the temporal dynamics of local neuroretinal responses

Visual sensitivity improves with prolonged exposure to light. Global neuroretinal responses increase, but little is known about the dynamics of local retinal responses over brief time intervals after changes in light level. This study applies the time-slice multifocal electroretinogram (TS mfERG) paradigm for the measurement of local electrical responses of the human eye over brief time intervals. Sixty-one, localised retinal areas were assessed over 25 degrees of the visual field. Cone-mediated contributions to the time-slice waveform were established. The time-slice mfERG waveforms were similar in shape and timing for pre- and post-photopigment bleach conditions after saturation of rod-mediated responses, suggesting there was no rod-mediated intrusion in the waveform. The temporal dynamics of the mfERG components show that N1P1 amplitudes decrease with each successive time-slice probe, with larger amplitude responses in the central retina compared to nasal and temporal retina. The time-slice mfERG waveform is a technique for assessing the temporal dynamics of cone-generated neural responses over time. The data are interpreted in terms of the vascular supplies and lower-level visual adaptation mechanisms.

The clinical applications of multifocal electroretinography: a systematic review

Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40-50 degrees of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.

Cathode-ray-tube monitor artefacts in neurophysiology

We demonstrate that cathode-ray-tube (CRT) monitors commonly used as stimulus generators in visual neuroscience produce signal artefacts. This arises from two factors, one being the finite time needed for the raster scan of the CRT to cross the receptive field being stimulated, and the other being the restraint imposed by the impulse response of the phosphor itself. Together these factors result in smearing or blurring that manifests as high frequency noise, distorting the desired signal applied by the investigator. Our analysis identifies those conditions that promote these artefacts and we describe methods for their minimisation. We suggest that a monitor frame rate >/=100 Hz provides a reasonable trade-off between refresh and the generators of high frequency noise.

The ON/OFF-response in Retinopathy of Prematurity Subjects with Myopia

Retinopathy of prematurity (ROP) is often associated with myopia. Electrophysiological findings have shown that an imbalance of the ON- and OFF-response in subjects with ROP is associated with their refractive status. Nevertheless, the extent of these functional changes is still unclear. The aim of this study was to determine the extent of the ON- and OFF-response attenuation in ROP subjects with myopia. Fast and slow m-sequence multifocal electroretinogram were recorded on 14 eyes in 8 subjects with various degrees of myopia using the VERIS system. The spherical equivalent of refractive error ranged from -0.25 to -13.50 D. All ERG recordings were made using DTL electrodes with dilated pupils. A 19 retinally scaled hexagon stimulus was used. The findings showed that the ON- and OFF-response are reduced differently in ROP subjects with myopia. The ON-response attenuation is dependant on the severity of myopia, whereas, the OFF-response attenuation is influenced by retinal eccentricity as well as the degree of myopia. The contributions of these findings toward the understanding of retinal mechanisms controlling ocular growth need to be further explored.

The multifocal ERG: unmasked by selective cross-correlation

The purpose of this paper is to provide the reader with a better insight into the mechanisms of multifocal ERG (mfERG) recording. The construction of the first and second order mfERG responses were examined by recovering the response to specific pulse trains embedded in the m-sequence.A custom built pc based multifocal system driving a LED stimulator was used to record a 61 element mfERG and a global ERG. The global ERG recording was used to enable the recovery of different pulse trains embedded in the m-sequence. Summation of these individual pulse trains was performed and the results compared with the standard full cross-correlation. An isolated pulse response is defined as a flash of light that has no other flashes within two m-sequence base periods before or after the flash. This isolated pulse response was recovered from the raw data and this response input into a simple superposition model to predict the waveform shape for specific pulse trains. The superposition model was compared with the actual selective cross-correlation for a particular pulse train. The summations of the selective cross-correlation components give identical responses to the full cross-correlation. The superposition model also predicts the waveform shapes recovered by the selective cross-correlation procedure. The mfERG response is a complex composite response from a number of different pulse trains. Examination of the individual waveform shapes provides some insight into the origin of the mfERG waveform. The main contributions to the P1 component are the same as for an isolated response and as with the standard ERG this component is likely to be dominated by the mid retina. The N1 component is also likely to have similar origins to that of the isolated response but the amplitude is dominated by contributions from pulse trains where there is no change of state and therefore includes a component from the interaction between two consecutive stimuli. The N2 component is a composite response dominated by the interaction between two successive stimuli two base periods apart and the P1 component of a second stimulus delayed one frame from the first stimulus.