The technique, validity and clinical use of the sweep VEP

Rhythmic visual stimulation as a window into early brain development: A systematic review

Rhythmic visual stimulation (RVS), the periodic presentation of visual stimuli to elicit a rhythmic brain response, is increasingly applied to reveal insights into early neurocognitive development. Our systematic review identified 69 studies applying RVS in 0- to 6-year-olds. RVS has long been used to study the development of the visual system and applications have more recently been expanded to uncover higher cognitive functions in the developing brain, including overt and covert attention, face and object perception, numeral cognition, and predictive processing. These insights are owed to the unique benefits of RVS, such as the targeted frequency and stimulus-specific neural responses, as well as a remarkable signal-to-noise ratio. Yet, neural mechanisms underlying the RVS response are still poorly understood. We discuss critical challenges and avenues for future research, and the unique potentials the method holds. With this review, we provide a resource for researchers interested in the breadth of developmental RVS research and hope to inspire the future use of this cutting-edge method in developmental cognitive neuroscience.

A multilevel investigation of sensory sensitivity and responsivity in autistic adults

Atypical sensory processing is a core symptom of autism spectrum disorders (ASD). We aimed at better characterizing visual sensitivity and responsivity in ASD at the self-reported, behavioral and neural levels, and at describing the relationships between these levels. We refer to sensory sensitivity as the ability to detect sensory stimuli and to sensory responsivity as an affective response to sensory stimuli. Participants were 25 neurotypical and 24 autistic adults. At the self-reported level, autistic participants had higher scores of sensory sensitivity and responsivity than neurotypicals. The behavioral and neural tasks involved contrast-reversing gratings which became progressively (in)visible as their contrast or spatial frequency evolved. At the behavioral level, autistic participants had higher detection and responsivity thresholds when gratings varied in spatial frequency, but their thresholds did not differ from neurotypicals when gratings varied in contrast. At the neural level, we used fast periodic visual stimulations and electroencephalography to implicitly assess detection thresholds for contrast and spatial frequency, and did not reveal any group difference. Higher self-reported responsivity was associated with higher behavioral responsivity, more intolerance of uncertainty and anxiety, in particular in ASD. At the self-reported level, higher sensitivity was associated with more responsivity in both groups, contrary to the behavioral level where these relationships were not found. These heterogeneous results suggest that sensitivity and responsivity per se are not simply increased in ASD, but may be modulated by other factors such as environmental predictability. Multi-level approaches can shed light on the mechanisms underlying sensory issues in ASD.

The power of rhythms: how steady-state evoked responses reveal early neurocognitive development

Electroencephalography (EEG) is a non-invasive and painless recording of cerebral activity, particularly well-suited for studying young infants, allowing the inspection of cerebral responses in a constellation of different ways. Of particular interest for developmental cognitive neuroscientists is the use of rhythmic stimulation, and the analysis of steady-state evoked potentials (SS-EPs) - an approach also known as frequency tagging. In this paper we rely on the existing SS-EP early developmental literature to illustrate the important advantages of SS-EPs for studying the developing brain. We argue that (1) the technique is both objective and predictive: the response is expected at the stimulation frequency (and/or higher harmonics), (2) its high spectral specificity makes the computed responses particularly robust to artifacts, and (3) the technique allows for short and efficient recordings, compatible with infants' limited attentional spans. We additionally provide an overview of some recent inspiring use of the SS-EP technique in adult research, in order to argue that (4) the SS-EP approach can be implemented creatively to target a wide range of cognitive and neural processes. For all these reasons, we expect SS-EPs to play an increasing role in the understanding of early cognitive processes. Finally, we provide practical guidelines for implementing and analyzing SS-EP studies.

EEG Measurement for Suppression in Refractive Amblyopia and Push-pull Perception Efficacy

In order to evaluate refractive amblyopia suppression and understand the neural mechanism of amblyopia suppression and push-pull perception training, we recorded the EEG of refractive amblyopia children before, during, and after push-pull perception training. We compared the brain activity in different states through the steady-state visual evoked potentials (SSVEPs) response and power topography and compared them with normal children. We found that amblyopic and fellow eyes have different performances in fundamental and harmonic frequency responses. They also show different characteristics when be masked. Push-pull perception training improved the SSVEP performance of amblyopia children by reducing the SSVEP response difference between eyes and improving the intermodulation frequency response. The result of topography showed that push-pull perception reduced the alpha power of occipital and temporal lobes, which was conducive to improving binocular function. The changes of intermodulation response and occipital alpha power were significantly correlated with the clinical indicator. Thus, EEG is a potential method to measure amblyopia suppression and the efficacy of push-pull perception.

Cerebral visual impairment in CDKL5 deficiency disorder: vision as an outcome measure

AIM

To characterize the neuro-ophthalmological phenotype of cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder (CDD) and assess visual acuity as a reproducible, quantitative outcome measure.

METHOD

We retrospectively analyzed clinical data from patients with CDD. Complete neuro-ophthalmological assessments, including visual acuity, were evaluated.

RESULTS

Of 26 patients (22 females, four males; median age 4y, interquartile range 2y 1mo-7y 10mo), cerebral visual impairment (CVI), defined as visual dysfunction in the absence of ocular or anterior visual pathway abnormalities, was diagnosed in all those over 2 years of age. Ophthalmological examinations revealed nystagmus in 10 patients and strabismus in 24 patients. Visual acuity was measured in 24 patients, by preferential looking in all and by sweep visual evoked potential in 13. Visual acuities were lower than age expectations and demonstrated improvement in the first 3 years. Adjusting for age and sex, average preferential looking visual acuity after 2 years of age was higher in patients with intact mobility than in those who were non-mobile.

INTERPRETATION

CVI was observed in patients with CDD. Visual acuity improved over time and correlated with mobility. Visual acuity, as a quantifiable measure of visual function, should be considered as an outcome measure in pre-clinical and clinical studies for CDD. What this paper adds Cerebral visual impairment is highly prevalent in cyclin-dependent kinase-like 5 deficiency disorder (CDD). Visual acuity is a measurable quantitative outcome measure in CDD. Visual acuity in CDD correlates with gross motor ability.

The Clinical Use of Vernier Acuity: Resolution of the Visual Cortex Is More Than Meets the Eye

Vernier acuity measures the ability to detect a misalignment or positional offset between visual stimuli, for example between two vertical lines when reading a vernier scale. It is considered a form of visual hyperacuity due to its detectable thresholds being considerably smaller than the diameter of a foveal cone receptor, which limits the spatial resolution of classical visual acuity. Vernier acuity relies heavily on cortical processing and is minimally affected by optical media factors, making it a useful indicator of cortical visual function. Vernier acuity can be measured, usually in seconds of arc, by freely available automated online tools as well as via analysis of steady state visual-evoked potentials, which allows measurement in non- or pre-verbal subjects such as infants. Although not routinely measured in clinical practice, vernier acuity is known to be reduced in amblyopia, glaucoma and retinitis pigmentosa, and has been explored as a measure of retinal or neural visual function in the presence of optical media opacities. Current clinical utility includes a home-based vernier acuity tool, preferential hyperacuity perimetry, which is used for screening for choroidal neovascularisation in age-related macular degeneration. This review will discuss the measurement of vernier acuity, provide a current understanding of its neuro-ophthalmic mechanisms, and finally explore its utility through a clinical lens, along with our recommendations for best practice.

Real-time, precise, rapid and objective visual acuity assessment by self-adaptive step SSVEPs

Objective. This study aimed to explore an online, real-time, and precise method to assess steady-state visual evoked potential (SSVEP)-based visual acuity more rapidly and objectively with self-adaptive spatial frequency steps.Approach. Taking the vertical sinusoidal reversal gratings with different spatial frequencies and temporal frequencies as the visual stimuli, according to the psychometric function for visual acuity assessment, a self-adaptive procedure, the best parameter estimation by sequential testing algorithm, was used to calculate the spatial frequency sequence based on all the previous spatial frequencies and their significance of the SSVEP response. Simultaneously, the canonical correlation analysis (CCA) method with a signal-to-noise ratio (SNR) significance detection criterion was used to judge the significance of the SSVEP response.Main results.After 18 iterative trails, the spatial frequency to be presented converged to a value, which was exactly defined as the SSVEP visual acuity threshold. Our results indicated that this SSVEP acuity had a good agreement and correlation with subjective Freiburg Visual Acuity and Contrast Test acuity, and the test-retest repeatability was also good.Significance. The self-adaptive step SSVEP procedure combined with the CCA method and SNR significance detection criterion appears to be an alternative method in the real-time SSVEP acuity test to obtain objective visual acuity more rapidly and precisely.

Meridian-Specific and Post-Optical Deficits of Spatial Vision in Human Astigmatism: Evidences From Psycho-Physical and EEG Scalings

Previous studies have demonstrated that orientation-specific deprivation in early life can lead to neural deficits of spatial vision in certain space, and can even result in meridional amblyopia (MA). Individuals with astigmatism are the optimal and natural models for exploring this asymmetric development of spatial vision in the human visual system. This study aims to assess the contrast sensitivity function (CSF) and EEG signals along two principal meridians in participants with regular astigmatism when being optimal optical corrected. Twelve participants with astigmatism (AST group, 20 eyes) and thirteen participants with (MA group, 19 eyes) were recruited in the current study. CSFs and spatial sweep visual evoked potentials (sVEP) were measured with vertical and horizontal sinewave gratings along two principal meridians monocularly. Area under log CSF (AULCSF), spatial frequency threshold corresponding to 80% contrast gratings (SF threshold at 80% ctr), and CSF acuity were calculated from CSF test. In addition, sVEP amplitudes and thresholds were calculated with the recursive least square method. Participants with astigmatism exhibited marked vertical-horizontal resolution disparities even after they were corrected with optimal optical corrections. CSF tests showed that AULCSF along weak meridian (measured with horizontal gratings) was lower than that along strong meridian (measured with vertical gratings) in both groups. Significant meridional disparity of CSF acuity was also found in both groups. In addition, the MA group showed larger meridional disparity compared to the AST group. Spatial sVEP thresholds also supported the existence of marked meridional disparity. Our results suggest that meridian-specific partial deprivation in early life might lead to monocularly asymmetric development of spatial vision in the human visual system. In terms of application, we tested the feasibility and reliability of adopting psychophysical and EEG scalings to investigate the asymmetric development of spatial vision related to astigmatism. These paradigms are potentially applicable to reduce and even eliminate the meridional disparity in the primary visual cortex by adopting perceptual learning or other vision-related interventions.

Electrophysiology in neuro-ophthalmology

This chapter reviews common applications of visual electrophysiology relevant to neuro-ophthalmology practice. The use of standard tests and extended protocols are described including the cortical visual evoked potential and pattern and full-field electroretinogram (PERG; ERG) methods, the latter including the photopic negative response. Abnormalities of these recordings are rarely specific but provide valuable diagnostic guidance and an objective measure of visual pathway function, difficult or impossible to infer by other methods. The electrophysiological phenotypes associated with Leber hereditary optic neuropathy, OPA1- and SSBP1-associated dominant optic atrophy, and WFS1-related syndromes are described. Typical changes in retinal and optic nerve function tests associated with acquired disease are highlighted, including those related to demyelination, ischemic, compressive, nutritional and toxic, and nonorganic etiologies. The importance of complementary testing using different electrophysiological techniques is emphasized, for the purposes of differential diagnosis and in disorders that may masquerade as optic nerve pathology.

A robust electrophysiological marker of spontaneous numerical discrimination

Humans have a Number Sense that enables them to represent and manipulate numerical quantities. Behavioral data suggest that the acuity of numerical discrimination is predictively associated with math ability-especially in children-but some authors argued that its assessment is problematic. In the present study, we used frequency-tagged electroencephalography to objectively measure spontaneous numerical discrimination during passive viewing of dot or picture arrays in healthy adults. During 1-min sequences, we introduced periodic numerosity changes and we progressively increased the magnitude of such changes every ten seconds. We found significant brain synchronization to the periodic numerosity changes from the 1.2 ratio over medial occipital regions, and amplitude strength increased with the numerical ratio. Brain responses were reliable across both stimulus formats. Interestingly, electrophysiological responses also mirrored performances on a number comparison task and seemed to be linked to math fluency. In sum, we present a neural marker of numerical acuity that is passively evaluated in short sequences, independent of stimulus format and that reflects behavioural performances on explicit number comparison tasks.

Assessment of Human Visual Acuity Using Visual Evoked Potential: A Review

Visual evoked potential (VEP) has been used as an alternative method to assess visual acuity objectively, especially in non-verbal infants and adults with low intellectual abilities or malingering. By sweeping the spatial frequency of visual stimuli and recording the corresponding VEP, VEP acuity can be defined by analyzing electroencephalography (EEG) signals. This paper presents a review on the VEP-based visual acuity assessment technique, including a brief overview of the technique, the effects of the parameters of visual stimuli, and signal acquisition and analysis of the VEP acuity test, and a summary of the current clinical applications of the technique. Finally, we discuss the current problems in this research domain and potential future work, which may enable this technique to be used more widely and quickly, deepening the VEP and even electrophysiology research on the detection and diagnosis of visual function.

The Influence of the Stimulus Design on the Harmonic Components of the Steady-State Visual Evoked Potential

Steady-state visual evoked potentials (ssVEPs) are commonly used for functional objective diagnostics. In general, the main response at the stimulation frequency is used. However, some studies reported the main response at the second harmonic of the stimulation frequency. The aim of our study was to analyze the influence of the stimulus design on the harmonic components of ssVEPs. We studied 22 subjects (8 males, mean age ± SD = 27 ± 4.8 years) using a circular layout (r₁ = 0–1.6°, r₂ = 1.6–3.5°, r₃ = 3.5–6.4°, r₄ = 6.4–10.9°, and r₅ = 10.9–18°). At a given eccentricity, the stimulus was presented according to a 7.5 Hz square wave with 50% duty cycle. To analyze the influence of the stimulus eccentricity, a background luminance of 30 cd/m² was added to suppress foveal stray light effects; to analyze the influence of simultaneous foveal and peripheral stimulations, stimulations are performed without stray light suppression. For statistical analysis, medians M of the amplitude ratios for amplitudes at the second harmonic to the first harmonic and the probability of the occurrence of the main response at the second harmonic P(MCSH) are calculated. For stimulations with foveal stray light suppression, the medians were M_0–1.6° = 0.45, M_1.6–3.5° = 0.45, M_3.5–6.4° = 0.76, M_6.4–10.9° = 0.72, and M_10.9–18° = 0.48, and the probabilities were P_0–1.6°(MCSH) = 0.05, P_1.6–3.5°(MCSH) = 0.05, P_3.5–6.4°(MCSH) = 0.32, P_6.4–10.9°(MCSH) = 0.29, and P_10.9–18°(MCSH) = 0.30. For stimulations without foveal stray light suppression, the medians M were M_0–1.6° = 0.29, M_1.6–3.5° = 0.37, M_3.5–6.4° = 0.98, M_6.4–10.9° = 1.08, and M_10.9–18° = 1.24, and the probabilities were P_0–1.6°(MCSH) = 0.09, P_1.6–3.5°(MCSH) = 0.05, P_3.5–6.4°(MCSH) = 0.50, P_6.4–10.9°(MCSH) = 0.55, and P_10.9–18°(MCSH) = 0.55. In conclusion, the stimulus design has an influence on the harmonic components of ssVEPs. An increase in stimulation eccentricity during extrafoveal stimulation leads to a transition of the main response to the second harmonic. The effect is enhanced by a simultaneous foveal stimulation.

The Validity of Steady-State Visual Evoked Potentials as Attention Tags and Input Signals: A Critical Perspective of Frequency Allocation and Number of Stimuli

Steady-state visual evoked potential (SSVEP) is a periodic response to a repetitive visual stimulus at a specific frequency. Currently, SSVEP is widely treated as an attention tag in cognitive activities and is used as an input signal for brain-computer interfaces (BCIs). However, whether SSVEP can be used as a reliable indicator has been a controversial issue. We focused on the independence of SSVEP from frequency allocation and number of stimuli. First, a cue-target paradigm was adopted to examine the interaction between SSVEPs evoked by two stimuli with different frequency allocations under different attention conditions. Second, we explored whether signal strength and the performance of SSVEP-based BCIs were affected by the number of stimuli. The results revealed that no significant interaction of SSVEP responses appeared between attended and unattended stimuli under various frequency allocations, regardless of their appearance in the fundamental or second-order harmonic. The amplitude of SSVEP suffered no significant gain or loss under different numbers of stimuli, but the performance of SSVEP-based BCIs varied along with duration of stimuli; that is, the recognition rate was not affected by the number of stimuli when the duration of stimuli was long enough, while the information transfer rate (ITR) presented the opposite trend. It can be concluded that SSVEP is a reliable tool for marking and monitoring multiple stimuli simultaneously in cognitive studies, but much caution should be taken when choosing a suitable duration and the number of stimuli, in order to achieve optimal utility of BCIs in the future.

Anti-fatigue Performance in SSVEP-Based Visual Acuity Assessment: A Comparison of Six Stimulus Paradigms

Purpose

The occurrence of mental fatigue when users stare at stimuli is a critical problem in the implementation of steady-state visual evoked potential (SSVEP)-based visual acuity assessment, which may weaken the SSVEP amplitude and signal-to-noise ratio (SNR) and subsequently affect the results of visual acuity assessment. This study aimed to explore the anti-fatigue performance of six stimulus paradigms (reverse vertical sinusoidal gratings, reverse horizontal sinusoidal gratings, reverse vertical square-wave gratings, brief-onset vertical sinusoidal gratings, reversal checkerboards, and oscillating expansion–contraction concentric rings) in SSVEP acuity assessment.

Methods

Based on four indices of α + θ index, pupil diameter, National Aeronautics and Space Administration Task Load Index (NASA-TLX), and amplitude and SNR of SSVEPs, this study quantitatively evaluated mental fatigue in six SSVEP visual attention runs corresponding to six paradigms with 12 subjects.

Results

These indices of mental fatigue showed a good agreement. The results showed that the paradigm of motion expansion–contraction concentric rings had a superior anti-fatigue efficacy than the other five paradigms of conventional onset mode or pattern reversal mode during prolonged SSVEP experiment. The paradigm of brief-onset mode showed the lowest anti-fatigue efficacy, and the other paradigms of pattern reversal SSVEP paradigms showed a similar anti-fatigue efficacy, which was between motion expansion–contraction mode and onset mode.

Conclusion

This study recommended the paradigm of oscillating expansion–contraction concentric rings as the stimulation paradigm in SSVEP visual acuity because of its superior anti-fatigue efficacy.

Developments in non-invasive visual electrophysiology

To study the physiology of the primate visual system, non-invasive electrophysiological techniques are of major importance. Two main techniques are available: the electroretinogram (ERG), a mass potential originating in the retina, and the visual evoked potential (VEP), which reflects activity in the primary visual cortex. In this overview, the history and the state of the art of these techniques are briefly presented as an introduction to the special issue "New Developments in non-invasive visual electrophysiology". The overview and the special issue can be used as the starting point for exciting new developments in the electrophysiology of primate and mammalian vision.

Comparison of the performance of six stimulus paradigms in visual acuity assessment based on steady-state visual evoked potentials

PURPOSE

There are several stimulus paradigms used in objective visual acuity assessment based on steady-state visual evoked potentials (SSVEPs). The aim of this study was to explore the difference and performance of common used six stimulus paradigms (reverse vertical sinusoidal gratings, reverse horizontal sinusoidal gratings, reverse vertical square-wave gratings, brief-onset vertical sinusoidal gratings, reversal checkerboards and oscillating expansion-contraction concentric-rings) of SSVEP acuity assessment.

METHODS

We tested subjective visual acuity both by tumbling E and Freiburg Visual Acuity and Contrast Test (FrACT) in 11 subjects. SSVEPs were induced by 11 spatial frequencies for each paradigm, and then a threshold determination criterion was used to define the objective SSVEP visual acuity.

RESULTS

After SSVEP signal analysis, we found there was difference in SSVEP response of harmonic components and no difference in sensitive electrode placement for the six paradigms. We selected six electrodes (PO3, POz, PO4, O1, Oz and O2) as the sensitive electrodes to use in data processing for each paradigm. The results showed that except for brief-onset vertical sinusoidal gratings, the correlation and agreement between objective SSVEP and subjective FrACT acuity were all quite good, demonstrating good performance in acuity detection for the rest five paradigms.

CONCLUSION

Except for brief-onset vertical sinusoidal gratings, all the five stimulus paradigms of reverse vertical sinusoidal gratings, reverse horizontal sinusoidal gratings, reverse vertical square-wave gratings, reversal checkerboards and oscillating expansion-contraction concentric-rings performed quite well in objective SSVEP visual acuity assessment.

Differential visual acuity - A new approach to measuring visual acuity

BACKGROUND

A novel type of acuity measurement, which we refer to as 'differential acuity', requires the observer to identify one unique target among three others which are identical. This is a proof of concept study aimed to determine if differential acuity is equivalent to standard measures of recognition acuity.

METHODS

To create a range of visual acuity, vision was optically blurred in sixteen adults with normal visual acuity. Visual acuity was then measured with the differential acuity targets in both crowded and uncrowded format, and compared with standard ETDRS acuity or with singly presented letters and uncrowded letters were analysed separately.

RESULTS

The visual acuity results for crowded and uncrowded letters were analysed separately. Repeated measures analysis of variance showed that when a crowded Sloan C had to be differentiated from three crowded Os (CvsO), the results were not significantly different from ETDRS acuity or from naming one of four letters presented centrally (Name4) (p<0.05). Similar results were found for uncrowded letters - the C versus O and Name4 gave similar visual acuity. The 95% limits of agreement between the naming and C versus O differential acuity measures were between 0.17 and 0.27 logMAR.

CONCLUSION

From this proof of concept study we conclude that differential acuity gives similar results to the ETDRS chart in adults. We infer that the comparable but cognitively simpler differential visual acuity task could be applied in clinical settings for young children or patients with developmental delay who cannot respond by naming or matching.

Evaluation of the “Freiburg Acuity VEP” on Commercial Equipment

Purpose

To assess the implementation and outcome quality of the Freiburg Acuity VEP methodology (Bach et al. in Br J Ophthalmol 92:396–403, 2008) on the Diagnosys Espion Profile and E3 electrophysiology systems.

Methods

We recorded visual evoked potentials (VEPs) from both eyes of 24 participants, where visual acuity (VA) was either full or reduced with scatter foils to approximately 0.5 and 0.8 LogMAR, resulting in a total of 144 recordings. Behavioral VA was measured in each case under the same conditions using the Freiburg Acuity Test (FrACT); VEP-based acuity was assessed with the “heuristic algorithm,” which automatically selects points for regression to zero amplitude.

Results

Behavioral VA ranged from − 0.2 to 1.0 LogMAR. The fully automatic heuristic VEP algorithm resulted in 8 of 144 recordings (6%) that were scored as “no result.” The other 136 recordings (94%) had an outcome of − 0.20 to 1.3 LogMAR (which corresponds to a range of 20/12.5–20/400, or 6/3.8–6/120, in Snellen ratios; or 1.6–0.1 in decimal acuity). The heuristic VEP algorithm agreed with the behavioral VA to within ± 0.31 LogMAR (95% limits of agreement), which is equivalent to approximately three lines on a VA chart.

Conclusions

The successful implementation of the Freiburg Acuity VEP “heuristic algorithm” on a commercial system makes this capability available to a wider group of users. The limits of agreement of ± 0.31 LogMAR are close to the original implementation at the University of Freiburg and we believe are clinically acceptable for a fully automatic, largely objective assessment of visual acuity.

Can VEP-based acuity estimates in one eye be improved by applying knowledge from the other eye?

PURPOSE

It is desirable to make VEP-based acuity estimates match standard subjective acuity numerically, as the latter is familiar to ophthalmologists and optometrists. This is achieved by applying an empirical conversion factor, and previous studies found the resulting values to be within ±1 octave of subjective acuity. This leaves room for improvement. In the present study, we tested for the case of a monocular acuity deficit whether the known difference between subjective and objective acuity in the trusted fellow eye can be used to get a more precise objective estimate in the eye of which the acuity is to be estimated. In other words, we tested whether it would make sense to determine a patient-specific conversion factor.

METHODS

In 19 subjects, we obtained monocular objective and subjective acuity estimates with both eyes. Normal vision and artificially degraded vision were tested. Subjective acuity was taken as the veridical value. We computed the differences between objective and subjective acuity and reasoned that if these were correlated between eyes and acuity levels, the valid information from the trusted healthy eye could be used to improve the precision of the acuity estimate in the other, potentially impaired, eye.

RESULTS

The difference between objective and subjective acuity values was neither correlated significantly between eyes, nor was it correlated significantly between acuity levels.

CONCLUSIONS

Knowledge about the discrepancy between objective and subjective acuity values in one eye does not help improving the accuracy of acuity estimates in the other eye. The lack of a significant correlation between eyes even at the same acuity level suggests that a major part of the discrepancies between subjective acuity and VEP-based acuity is not the result of factors that would equally apply to both eyes, such as cortical morphology.

Objective assessment of visual acuity: a refined model for analyzing the sweep VEP

PURPOSE

The aim of this study was to develop a simple and reliable method for the objective assessment of visual acuity by optimizing the stimulus used in commercially available systems and by improving the methods of evaluation using a nonlinear function, the modified Ricker model.

METHODS

Subjective visual acuity in the normal subjects was measured with Snellen targets, best-corrected, and in some cases also uncorrected and with plus lenses (+ 1 D, + 2 D, + 3 D). In patients, subjective visual acuity was measured best-corrected using the Freiburg Visual Acuity Test. Sweep VEP recordings to 11 spatial frequencies, with check sizes in logarithmically equidistant steps (0.6, 0.9, 1.4, 2.1, 3.3, 4.9, 7.3, 10.4, 18.2, 24.4, and 36.5 cpd), were obtained from 56 healthy subjects aged between 17 and 69 years (mean 42.5 ± 15.3 SD years) and 20 patients with diseases of the lens (n = 6), retina (n = 8) or optic nerve (n = 6). The results were fit by a multiple linear regression (2nd-order polynomial) or a nonlinear regression (modified Ricker model) and parameters compared (limiting spatial frequency (sf_limiting) and the spatial frequency of the vertex (sf_vertex) of the parabola for the 2nd-order polynomial fitting, and the maximal spatial frequency (sf_max), and the spatial frequency where the amplitude is 2 dB higher than the level of noise (sf_threshold) for the modified Ricker model.

RESULTS

Recording with 11 spatial frequencies allows a more accurate determination of acuities above 1.0 logMAR. Tuning curves fitted to the results show that compared to the normal 2nd-order polynomial analysis, the modified Ricker model is able to describe closely the amplitudes of the sweep VEP in relation to the spatial frequencies of the presented checkerboards. In patients with a visual acuity better than about 0.5 (decimal), the predicted acuities based on the different parameters show a good match of the predicted visual acuities based on the models established in healthy volunteers to the subjective visual acuities. However, for lower visual acuities, both models tend to overestimate the visual acuity (up to ~ 0.4 logMAR), especially in patients suffering from AMD.

CONCLUSIONS

Both models, the 2nd-order polynomial and the modified Ricker model performed equally well in the prediction of the visual acuity based on the amplitudes recorded using the sweep VEP. However, the modified Ricker model does not require the exclusion of data points from the fit, as necessary when fitting the 2nd-order polynomial model making it more reliable and robust against outliers, and, in addition, provides a measure for the noise of the recorded results.

Similarities and differences between behavioral and electrophysiological visual acuity thresholds in healthy infants during the second half of the first year of life

PURPOSE

Behavioral and electrophysiological methods for visual acuity estimation typically correlate well in children and adult populations, but this relationship remains unclear in infants, particularly during the second half of the first year of life. It has been suggested that the agreement between both methods mostly relies on age and/or subjective acuity factors. The present study aimed at comparing acuity thresholds obtained with both approaches in a sample of healthy infants in a relatively narrow age range, that is 6-10 months old.

METHODS

Acuity thresholds were assessed in 61 healthy infants aged between 6 and 10 months using the Teller acuity cards (TAC) and sweep visual evoked potentials (sVEP). The TAC stimuli (stationary vertical gratings displayed on laminated cards) ranged from 0.31 to 38 cycles per degree (cpd). The TAC acuity threshold was estimated according to the highest spatial frequency scored by the experimenter as seen by the infant. The sVEP stimuli (high-contrast vertical gratings counter-phased at 12 reversals/s) ranged from 13.5 to 1 cpd. sVEP were recorded at Oz and acuity threshold was estimated using regression linear fitting.

RESULTS

Considering the entire sample, sVEP acuity thresholds (8.97 ± 2.52 cpd) were significantly better than TAC scores (5.58 ± 2.95 cpd), although the difference was within 1 octave for 64% of the infants. Neither Pearson nor intra-class correlations between the two methods were significant (0.18 and 0.03, respectively). While age at assessment was not related to any dependent variable (TAC, sVEP, sVEP-TAC difference score), subjective (behavioral) acuity was found to underlie the difference between the two methods. The difference between sVEP and TAC scores decreased as a function of subjective acuity, and at the highest subjective acuity level (>10 cpd), TAC acuity slightly exceeded sVEP acuity.

CONCLUSIONS

The superiority of sVEP acuity often reported in the literature was evident in our infant sample when subjective acuity (TAC) was low or moderate, but not when it was high (>10 cpd). The relationship between the two estimation methods was not dependent on age, but on subjective acuity.

Imitating the effect of amblyopia on VEP-based acuity estimates

PURPOSE

Acuity testing based on visual evoked potentials (VEPs) overestimates acuity in patients with amblyopia. We hypothesized that distortion and fragmentation of the stimulus in amblyopia impede recognition of optotypes, while it leaves the pattern onset response in the VEP mostly unaffected, resulting in overestimation of acuity.

METHODS

Acuity VEPs were recorded in visually normal participants with the stimulus degraded by patterned polymethyl methacrylate panes, which induce distortion and fragmentation. For comparison, frosted panes were used to induce blur through wide-angle scattering. Standard psychophysical optotype acuity was recorded under the same conditions.

RESULTS

With the distorted and fragmented stimuli, the VEP consistently overestimated acuity relative to psychophysical optotype acuity. With blurred stimuli, both measures were in good agreement.

CONCLUSIONS

The data support the assumption that stimulus distortion and fragmentation leave VEP-based measures of acuity relatively unaffected, resulting in a discrepancy between measures of acuity that are based on checkerboard VEPs on one hand and psychophysical optotype recognition on the other hand. The technique of stimulus degradation described here provides a simple and efficient way of imitating effects that are known from amblyopia and may thus serve as a tool in the evaluation of vision tests.

Restoration of visual performance by d-serine in models of inner and outer retinal dysfunction assessed using sweep VEP measurements in the conscious rat and rabbit

The NMDA subtype of glutamate receptor and its co-agonist d-serine play a key role in synaptic function in the central nervous system (CNS), including visual cortex and retina. In retinal diseases such as glaucoma and macular degeneration, a loss of vision arises from malfunction of retinal cells, resulting in a glutamate hypofunctional state along the visual pathway in the affected parts of the visual field. An effective strategy to remedy this loss of function might be to increase extracellular levels of d-serine and thereby boost synaptic NMDA receptor-mediated visual transmission and/or plasticity to compensate for the impairment. We tested this idea in brain slices of visual cortex exhibiting long-term potentiation, and in rodent models of visual dysfunction caused by retinal insults at a time when the injury had stabilized to look for neuroenhancement effects. An essential aspect of the in vivo studies involved adapting sweep VEP technology to conscious rats and rabbits and combining it with intracortical recording while the animals were actively attending to visual information. Using this technology allowed us to establish complete contrast sensitivity function curves. We found that systemic d-serine dose-dependently rescued the contrast sensitivity impairment in rats with blue light-induced visual dysfunction. In rabbits with inner retinal dysfunction, both systemic and intravitreal routes of d-serine provided a rescue of visual function. In sum, we show that co-agonist stimulation of the NMDA receptor via administration of exogenous d-serine might be an effective therapeutic strategy to enhance visual performance and compensate for the loss of vision resulting from retinal disease.

Objective measurement of visual resolution using the P300 to self-facial images

OBJECTIVE

To assess visual acuity objectively "beyond V1", the P300 event-related potential is a promising candidate and closely associated with conscious perception. However, the P300 can be willfully modulated, a disadvantage for objective visual acuity estimation. Faces are very salient stimuli and difficult to ignore. Here, we present a P300-type paradigm to assess visual acuity with faces.

METHODS

Gray-scale portraits of the respective subject served as oddball stimuli (probability 1/7), scrambled versions of these as the standard stimuli (probability 6/7). Furthermore, stimuli were spatially high-pass filtered (at 0, 2.2, 4.2 and 8.3 cpd), making them recognizable only with sufficient acuity. Acuity was systematically reduced by dioptric blur, chosen individually to render faces unrecognizable when high-passed at ≥ 4.2 cpd. EEG was recorded from 11 subjects at 32 scalp positions and re-referenced to the average of TP9 and TP10. One of the rare face variants was designated as target, for which a button had to be pressed.

RESULTS

The event-related potential was dominated by the P300 at 300-800 ms. All subjects had a significant (P < 0.05) P300 for 0- to 8.3-cpd filtering. When vision was blurred, the fraction of significant P300 responses to 8.3-cpd filtered faces dropped to 18%, but stayed at 100% for 4.2 cpd. Another component, the vertex positive potential (VPP) at 170 ms, was undetectable in most participants with blur and all levels of filtering, even when the images were recognizable.

CONCLUSIONS

The study demonstrates the feasibility of a face-based P300 approach to objectively assess visual acuity. The sensitivity to stimulus degradation was comparable to that of a grating-based approach as previously reported. An unexpected finding was the differing behavior of the P300 and the VPP. The VPP was quite sensitive to high-pass filtering, while the P300 sustained stronger filtering, although for its generation, the faces must also be discriminated from scrambled faces.

Contribution of sVEP visual acuity testing in comparison with subjective visual acuity

AIMS

Visual acuity determination is an important task in ophthalmology and optometry practices. Visual acuity can be examined objectively or subjectively. The objective examination method, sVEP, allows for quick objective measurements of patient's visual acuity. Previous studies have not demonstrated the repeatability of this objective sVEP method. This study aims to evaluate the sVEP method and compare it to a subjective method.

METHODS AND RESULTS

The sample was divided into two groups. For the first group, visual acuity was measured with sVEP and Snellen methods on only one patient twelve times. In the second group, visual acuity was measured twice with sVEP followed twice with the Snellen method with Landolt's rings and logMAR modification on 32 non-pathological patients. Results showed significant differences between average values of visual acuity obtained with both methods (sVEP and Snellen) in both samples (T-test, P < 0.01; Wilcoxon test, P = 0.02 in second group). In the second group, significant correlations between repeated sVEP measurements (Spearman test, P < 0.05, r = 0.69) were found but no significant correlation between average sVEP measurement and average Snellen measurement (Spearman test, P > 0.05, r = 0.15) was found.

CONCLUSION

Objective measurement of visual acuity with sVEP is a valid and reliable method, but is recommended only when it is not possible to use a subjective method for measuring visual acuity, e.g. children, patients with mental retardation or simulating/dissimulating patients.

Maximally reliable spatial filtering of steady state visual evoked potentials

Due to their high signal-to-noise ratio (SNR) and robustness to artifacts, steady state visual evoked potentials (SSVEPs) are a popular technique for studying neural processing in the human visual system. SSVEPs are conventionally analyzed at individual electrodes or linear combinations of electrodes which maximize some variant of the SNR. Here we exploit the fundamental assumption of evoked responses--reproducibility across trials--to develop a technique that extracts a small number of high SNR, maximally reliable SSVEP components. This novel spatial filtering method operates on an array of Fourier coefficients and projects the data into a low-dimensional space in which the trial-to-trial spectral covariance is maximized. When applied to two sample data sets, the resulting technique recovers physiologically plausible components (i.e., the recovered topographies match the lead fields of the underlying sources) while drastically reducing the dimensionality of the data (i.e., more than 90% of the trial-to-trial reliability is captured in the first four components). Moreover, the proposed technique achieves a higher SNR than that of the single-best electrode or the Principal Components. We provide a freely-available MATLAB implementation of the proposed technique, herein termed "Reliable Components Analysis".

The steady-state visual evoked potential in vision research: A review

Periodic visual stimulation and analysis of the resulting steady-state visual evoked potentials were first introduced over 80 years ago as a means to study visual sensation and perception. From the first single-channel recording of responses to modulated light to the present use of sophisticated digital displays composed of complex visual stimuli and high-density recording arrays, steady-state methods have been applied in a broad range of scientific and applied settings.The purpose of this article is to describe the fundamental stimulation paradigms for steady-state visual evoked potentials and to illustrate these principles through research findings across a range of applications in vision science.

Understanding individual face discrimination by means of fast periodic visual stimulation

This paper reviews a fast periodic visual stimulation (FPVS) approach developed recently to make significant progress in understanding visual discrimination of individual faces. Displaying pictures of faces at a periodic frequency rate leads to a high signal-to-noise ratio (SNR) response in the human electroencephalogram, at the exact frequency of stimulation, a so-called steady-state visual evoked potential (SSVEP, Regan in Electroencephalogr Clin Neurophysiol 20:238-248, 1966). For fast periodic frequency rates, i.e., between 3 and 9 Hz, this response is reduced if the exact same face identity is repeated compared to the presentation of different face identities, the largest difference being observed over the right occipito-temporal cortex. A 6-Hz stimulation rate (cycle duration of ~170 ms) provides the largest difference between different and repeated faces, as also evidenced in face-selective areas of the ventral occipito-temporal cortex in functional magnetic resonance imaging. This high-level discrimination response is reduced following inversion and contrast-reversal of the faces and can be isolated without subtraction thanks to a fast periodic oddball paradigm. Overall, FPVS provides a response that is objective (i.e., at an experimentally defined frequency), implicit, has a high SNR and is directly quantifiable in a short amount of time. Although the approach is particularly appealing for understanding face perception, it can be generalized to study visual discrimination of complex visual patterns such as objects and visual scenes. The advantages of the approach make it also particularly well-suited to investigate these functions in populations who cannot provide overt behavioral responses and can only be tested for short durations, such as infants, young children and clinical populations.

Sweep visually evoked potentials and visual findings in children with West syndrome

BACKGROUND

West syndrome (WS) is a type of early childhood epilepsy characterized by progressive neurological development deterioration that includes vision.

AIM

To demonstrate the clinical importance of grating visual acuity thresholds (GVA) measurement by sweep visually evoked potentials technique (sweep-VEP) as a reliable tool for evaluation of the visual cortex status in WS children.

METHODS

This is a retrospective study of the best-corrected binocular GVA and ophthalmological features of WS children referred for the Laboratory of Clinical Electrophysiology of Vision of UNIFESP from 1998 to 2012 (Committee on Ethics in Research of UNIFESP n° 0349/08). The GVA deficit was calculated by subtracting binocular GVA score (logMAR units) of each patient from the median values of age norms from our own lab and classified as mild (0.1-0.39 logMAR), moderate (0.40-0.80 logMAR) or severe (>0.81 logMAR). Associated ophthalmological features were also described.

RESULTS

Data from 30 WS children (age from 6 to 108 months, median = 14.5 months, mean ± SD = 22.0 ± 22.1 months; 19 male) were analyzed. The majority presented severe GVA deficit (0.15-1.44 logMAR; mean ± SD = 0.82 ± 0.32 logMAR; median = 0.82 logMAR), poor visual behavior, high prevalence of strabismus and great variability in ocular positioning. The GVA deficit did not vary according to gender (P = .8022), WS type (P = .908), birth age (P = .2881), perinatal oxygenation (P = .7692), visual behavior (P = .8789), ocular motility (P = .1821), nystagmus (P = .2868), risk of drug-induced retinopathy (P = .4632) and participation in early visual stimulation therapy (P = .9010).

CONCLUSIONS

The sweep-VEP technique is a reliable tool to classify visual system impairment in WS children, in agreement with the poor visual behavior exhibited by them.

An objective method for measuring face detection thresholds using the sweep steady-state visual evoked response

We introduce a sensitive method for measuring face detection thresholds rapidly, objectively, and independently of low-level visual cues. The method is based on the swept parameter steady-state visual evoked potential (ssVEP), in which a stimulus is presented at a specific temporal frequency while parametrically varying ("sweeping") the detectability of the stimulus. Here, the visibility of a face image was increased by progressive derandomization of the phase spectra of the image in a series of equally spaced steps. Alternations between face and fully randomized images at a constant rate (3/s) elicit a robust first harmonic response at 3 Hz specific to the structure of the face. High-density EEG was recorded from 10 human adult participants, who were asked to respond with a button-press as soon as they detected a face. The majority of participants produced an evoked response at the first harmonic (3 Hz) that emerged abruptly between 30% and 35% phase-coherence of the face, which was most prominent on right occipito-temporal sites. Thresholds for face detection were estimated reliably in single participants from 15 trials, or on each of the 15 individual face trials. The ssVEP-derived thresholds correlated with the concurrently measured perceptual face detection thresholds. This first application of the sweep VEP approach to high-level vision provides a sensitive and objective method that could be used to measure and compare visual perception thresholds for various object shapes and levels of categorization in different human populations, including infants and individuals with developmental delay.

Keep your eyes on development: the behavioral and neurophysiological development of visual mechanisms underlying form processing

Visual form perception is essential for correct interpretation of, and interaction with, our environment. Form perception depends on visual acuity and processing of specific form characteristics, such as luminance contrast, spatial frequency, color, orientation, depth, and even motion information. As other cognitive processes, form perception matures with age. This paper aims at providing a concise overview of our current understanding of the typical development, from birth to adulthood, of form-characteristic processing, as measured both behaviorally and neurophysiologically. Two main conclusions can be drawn. First, the current literature conveys that for most reviewed characteristics a developmental pattern is apparent. These trajectories are discussed in relation to the organization of the visual system. The second conclusion is that significant gaps in the literature exist for several age-ranges. To complete our understanding of the typical and, by consequence, atypical development of visual mechanisms underlying form processing, future research should uncover these missing segments.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

"Cognitive" visual acuity estimation based on the event-related potential P300 component

OBJECTIVE

An objective assessment of sensory and sensuo-cognitive function, based on physiological signals rather than on the behavioral response of a patient, is often advisable, albeit challenging. Evoked potentials are frequently used as an objective measure, but usually fail to detect defects beyond primary sensory areas, including those of psychogenic origin. Here we assess whether the event-related P300 component may be used to measure "cognitive" visual acuity.

METHODS

A visual oddball paradigm was used to elicit P300 responses in subjects with normal or artificially blurred vision. Probe stimuli consisted of infrequently presented gratings with spatial frequencies in the range of 2.2-16.2 cycles per degree, which could be either target or non-target stimuli depending on their orientation. Frequent stimuli were homogeneously grey fields.

RESULTS

Without blur, rare stimuli of all spatial frequencies produced reliable P300 responses. Blur abolished the P300 to fine gratings consistently in 10 of 11 subjects. The drop in P300 amplitude was steep, rather than gradual, between visible and invisible gratings.

CONCLUSION

The P300 is sensitive to identify the resolution threshold and thus may serve as a tool for estimating acuity in cases of visual impairments.

SIGNIFICANCE

The study presents a tool for the objective assessment of acuity in cases of higher-level visual impairments. The concept can most likely be extended to other sensory modalities.

Threshold determination in sweep VEP and the effects of criterion

In order to develop criteria for the range of data points used for regression line fitting in sweep visually evoked potential (sVEP), which would be objective, clearly specified and give good repeatability and validity, and in order to investigate the effect of luminance on sVEP measurement, visual acuity (VA) and contrast sensitivity (CS) were measured with sVEP in adults aged 17-30 years and children aged 6-8 years. Six to ten participants took part in each experiment. Five criteria (C0-C4) for fitting the regression line were implemented. Test-retest repeatability and validity against psychophysical thresholds at three luminance levels were considered for thresholds and the number of acceptable readings. There were significant effects of criteria (repeated measures ANOVAs, P < 0.05). The criteria, C2 and C3 (based on the range over which the signal-to-noise ratio >or=1), consistently gave better VA and CS, more viable readings, better agreement with psychophysical thresholds in adults and better repeatability than the other criteria. In the case of adults, C2 gave thresholds that were not significantly different from the psychophysical thresholds (P > 0.05). There was little effect of luminance over the 25-100 cd/m(2) range used. Overall, C2 performed the best and would be the criterion of choice, giving better repeatability, better validity and more viable plots.