Sweep VEP (Visual Evoked Potential)

 

Ai-Hou Wang, M.D., Ph.D.

 

 

§Ú1990®L¨ì1991®L¦bª÷¤sThe Smith-Kettlewell Eye Research Institute (SKERI)¶i­×¤p¨à²´¬ì¤Î±×µø(Fellowship of Pediatric Ophthalmology and Strabismus)ªº¤@¦~¸Ì¡A¦³©¯±µÄ²¨ì¨â®M¹q¥Í²zªº³]­p¡A¨ä¤@¬ODr. Erich Sutterªº¦hµJºô½¤¹q¹Ï(Multifocal ERG)¡A¨ä¤G¬ODr. Anthony Norcia©MDr. Christopher Tylerªº±½±°µø»¤µo¹q¦ì(Sweep VEP)¡C¥Ø«e°ê»ÚÁ{§ÉµøÄ±¹q¥Í²z¾Ç·|(International Society for Clinical Electrophysiology of Vision, ISCEV)¤w¸g¦³¦hµJºô½¤¹q¹Ïªº¼Ð·Ç(https://iscev.wildapricot.org/standards)¡A±½±°µø»¤µo¹q¦ìªº¼Ð·ÇÁÙ¨S¦³¦C¤J¡C°£¤FÁ{§É¨Ï¥Î¤§¥~¡A³o¨â¶µ¤u¨ã¤]¬OµøÄ±ªº°ò¦¬ì¾Ç¬ã¨sªº§Q¾¹¡C

 

During my year-long Fellowship of Pediatric Ophthalmology and Strabismus at The Smith-Kettlewell Eye Research Institute (SKERI) in San Francisco from the summer of 1990 to the summer of 1991, I had the opportunity to learn about two electrophysiological designs: Dr. Erich Sutter's multifocal electroretinography (ERG) and Dr. Anthony Norcia and Dr. Christopher Tyler's sweep visual evoked potentials (Sweep VEP). Currently, the International Society for Clinical Electrophysiology of Vision (ISCEV) has standards for multifocal ERG (https://iscev.wildapricot.org/standards), but standards for sweep visual evoked potentials have not yet been included. Besides clinical use, these two tools are also invaluable for basic scientific research in vision.

 

 

    

Dr. Anthony Norcia    Dr. Christopher Tyler

 

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Clinically, pattern visual evoked potentials (PDPs) are performed using checkerboard reversal, with each eye tested separately. Each eye tests four different grid sizes ¡V 16, 32, 64, and 128 squares per side (see figure), with grid sizes of 1¢X, 1/2¢X, 1/4¢X, and 1/8¢X. In rigorous laboratory settings, each scenario is tested twice, with the waveforms superimposed to demonstrate the stability and reproducibility of the experiment.

 

 

      

 

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Transient visual evoked potentials (VEPs) are typically performed, with 3.7 reversals per second (see figure). The average of 100 brainwaves is summed to improve the signal-to-noise ratio (SNR) by ¡Ô100 = 10 times. This requires at least 27 seconds (3.7 reversals/sec „³ 27 sec/100 reversals). Infants and young children typically cannot stare at such a boring image for an extended period.

 

This is a patient with amblyopia in the left eye and excellent vision in the right eye. Even the smallest square at 1/8¢X still evoked a large potential; as the squares decreased, the peak-to-trough potentials gradually lengthened. In the left eye with amblyopia, the NPN waveform in the second square at 1/2¢X was no longer clearly visible.

 

 

 

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To rapidly assess visual function using electrophysiological methods, Dr. Christopher Tyler and Dr. Anthony Norcia developed the sweep visual evoked potential (SEP) system in the 1970s and 1980s to estimate the development of visual acuity, contrast sensitivity, and vernier acuity in children. This system, developed from the 1970s and 80s to the present day, is called PowerDiva.

 

 

 

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Only 10 seconds of brainwave recording are needed. Steady-state visual evoked potentials are generated, with image parameters changing every half second, displaying 20 different sizes over 10 seconds.

 

Visual acuity is assessed using a sinusoidal grating, sweeping across 20 widths linearly according to spatial frequency, from wide to narrow (see figure).

 

 

Sweep Spatial Frequecy (Size) (Visual Acuity)

Linearly from Low to High Spatial Frequency (From Large to Small size)

 

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To assess contrast sensitivity, a sinusoidal grating of fixed width was used, with contrasts ranging from small to large, sweeping across 20 contrasts in logarithmic proportions (see figure).

 

 

Sweep Contrast (Contrast Sensitivity)

Logarithmically from Low to High Contrast

 

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To assess vernier vision, a square wave grating is used, with offsets ranging from narrow to wide, sweeping across 20 different widths in logarithmic proportions according to spatial frequency (see figure).

 

 

Sweep Offset (Vernier Acuity)

Logarithmically from Small to Large Offset

 

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The entire 10-second brainwave was divided into 2-second blocks ¡V 0 to 2 seconds, 0.5 to 2.5 seconds, 1 to 3 seconds, ... 7.5 to 9.5 seconds, 8 to 10 seconds, for a total of 17 blocks. If the visual acuity grating reverses at 6 Hz (12 reversals/sec), there are 24 reversals in a 2-second block. The amplitude and phase of the 24th harmonic of this 2-second brainwave were extracted. Simultaneously, the amplitudes of the 23rd and 25th harmonics were extracted from each block, and the average of these two was taken as noise. A low signal-to-noise ratio indicates that the potential at the 24th harmonic was indeed induced (see figure).

 

 

 

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The following diagram plots the 17 amplitudes and 17 phases obtained from 17 2-second blocks, along with the noise from each block (see figure). As the inversion grating gradually narrows, the evoked potential amplitude gradually decreases, and the phase gradually shifts (equivalent to the potential value of the transient visual evoked potential gradually increasing). These three values ​​are combined to estimate the visual acuity threshold, that is, how fine the grating needs to become before the subject can no longer see the inversion.

 

1. Extrapolate the amplitude at high spatial frequencies (red line); the spatial frequency at 0 potential is used as the visual acuity estimate.

 

2. Gradually shift the phase; if the shift trend reverses or becomes disordered, the spatial frequency at that point is used as the visual acuity estimate.

 

3. Gradually increase the noise/signal ratio; the spatial frequency at the point where it increases significantly and rapidly is used as the visual acuity estimate. (See figure)

 

 

 

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This system allows for the modification of many parameters. The analysis method primarily uses Fourier transform to extract the amplitude and phase of certain frequencies, which seems straightforward to implement.

 

To determine the visual threshold for a specific parameter, the standard setting of this system is to change the visual stimulus pattern every half second, scanning 20 patterns in 10 seconds. The pattern can gradually transition from relatively clear to relatively unclear; this system scans for visual acuity, or spatial frequency, moving from large stripes to small stripes. Conversely, it can scan for contrast and vernier acuity, gradually transitioning from relatively unclear to relatively clear (see figure).

 

The manner and speed of change of the 20 patterns must also be considered: the spatial frequency of the grating used for visual acuity scanning changes linearly. The unit of spatial frequency is cycles per degree of visual field (FIN), which is the reciprocal of the FIN, equivalent to Snellen visual acuity, unlike the logMAR visual acuity charts used today. Sweeping contrast, from weak to strong, increases logarithmically at each step. The unit of contrast is usually (highest brightness - lowest brightness) / average brightness. Sweeping vernier vision, although similar to grating vision in that it is a concept of spatial size, involves the vernier grating misalignment increasing logarithmically from small to large (see figure).

 

 

    

 

   

 

Tyler CWApkarian PLevi DMNakayama K. Rapid assessment of visual function: an electronic sweep technique for the pattern visual evoked potential. Invest Ophthalmol Vis Sci. 1979 Jul;18(7):703-13.

Norcia AM, Tyler CW, Hamer RD. Development of contrast sensitivity in the human infant. Vision Res. 1990;30(10):1475-86.

Skoczenski AM, Norcia AM. Development of VEP Vernier Acuity and Grating Acuity in Human Infants. Invest Ophthalmol Vis Sci. 1999;40:2411¡V2417.

Hou C, Good WV, Norcia AM. Detection of amblyopia using sweep VEP Vernier and grating acuity. Invest Ophthalmol Vis Sci. 2018;59:1435¡V1442.

 

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The Fourier analysis described earlier uses a 2-second block size with a 0.5-second interval between adjacent blocks, resulting in 17 blocks in 10 seconds. However, as shown in the diagram, if the analyzed blocks are 1 second long with a 0.5-second interval, there will be 19 blocks in 10 seconds. The block length and the interval between adjacent blocks can be arbitrarily changed, which also determines the total number of blocks in 10 seconds. For example, if the block length is 3 seconds and the block interval is 1 second, the total number of blocks is 8.

 

 

 

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If the visual stimulus frequency is 3.75 Hz and the block length is 2 seconds, then there are 7.5 cycles in 2 seconds. Fourier analysis shows that the 7.5th harmonic is the fundamental frequency (1f), and the 15th harmonic is the second harmonic (2f).

 

If the pattern doesn't change for 10 seconds, it's not called a swept visual evoked potential, but Fourier analysis of this system can still be used. Extending the original 2-second block to 10 seconds results in only one block throughout. Similar to the "kinesthetic/optico-nystagmus nasotemporal asymmetric visual evoked potential" described in the article "Steady-state vs. Transient VEP," if the jittering grating vibrates at 6 Hz, it vibrates for a total of 60 cycles in 10 seconds. In a 10-second brainwave, the amplitude and phase of the 60th harmonic frequency extracted by Fourier analysis are the fundamental frequency (1f), and the amplitude and phase of the 120th harmonic frequency are the 2nd harmonic frequency (2f).

 

 

 

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Regarding visual evoked potentials (VAPs), most computer screens display approximately 60 images per second, or 60 frames. Rapid image transitions, where calculations are completed and new images are displayed before the next frame appears, represent a "real-time" threshold in computer screen display functionality.

 

Visual evoked potentials (VAPs) display images on a computer screen at 60 frames per second, similar to the 24 frames per second of film. In cases where image 1/image 2 alternates (e.g., in chessboard reversal, chessboard 1 and chessboard 2 alternate), if each image stays on one frame, each cycle is 2 frames, resulting in 30 cycles (Hz) or 60 reversals per second. If each image stays on four frames, it's 7.5 Hz with 15 reversals; if each image stays on three frames, it's 10 Hz with 20 reversals, and so on. In short, the frequency must be an integer, divisible by 60.

 

In visual experiments, 3Hz and 6Hz inversion are often used as low temporal frequencies, while 5Hz and 10Hz inversion are often used as high temporal frequencies. Fourier analysis extracts the fundamental frequency (1f) by extracting the 3rd or 5th harmonic per second of brainwaves; extracting the 2nd harmonic (2f) involves extracting the 6th or 10th harmonic per second of brainwaves.

 

If the computer program's image presentation is not synchronized with the screen, or if the number of images per second is not a divisor of 60, the dynamic images on the screen will appear discontinuous, and the visual stimulation received by the subject will be outside the range designed and controlled.

 

 

 

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Besides grazing visual acuity, contrast, and vernier visual acuity, the thresholds for color vision, binocular vision, and any other visual field can, in principle, be designed to record grazing visual evoked potentials (VEPs) using gradually changing images. These are electrophysiological thresholds, which can be compared and referenced with thresholds obtained from psychophysical experiments. Modern multielectrode EEG/evoked potential recordings can then be used to study the brain localization of these visual parameter changes.

 

In infants and young children, the estimated values ​​of visual evoked potentials are much higher than those estimated by preferred looking, reaching 1.0 visual acuity around one year of age, which doesn't quite match clinical experience. Until recently, there has been ongoing research suggesting that grazing visual evoked potentials based on vernier visual acuity or grating visual acuity are closer to the clinical assessment of amblyopia (Hou, 2018). The sweep parameters can be adjusted to sweep from small stripes to large stripes, or vice versa; to change the size linearly or logarithmically; to reverse the pattern or to make the pattern appear/disappear; to analyze the fundamental frequency (1f) or the double frequency (2f)...

 

 

Hou C, Good WV, Norcia AM. Detection of amblyopia using sweep VEP Vernier and grating acuity. Invest Ophthalmol Vis Sci. 2018;59:1435¡V1442.

 

 

¥ý¤Ñ¤º±×µø¯f¤Hªº¹B°Êı/µø°Ê²´¾_¬O»óù®°¼¤£¹ïºÙªº¡A·|±N¤ÏÂà¬]¯¾¬Ý¦¨¦V¥ª©Î¦V¥k²¾°Êªº¬]¯¾¡A¨Ã¤Þµoµø°Ê²´¾_(optokinetic nystagmus)¡C±½±°¬]¯¾µø¤O(grating acuity)©ó¬O§ï¥Î¬]¯¾©M¥­§¡«G«×ªºªÅ¥Õµe­±¥æ´À¥X²{(grating onset/offset)(¨£¹Ï)¡C³o¼Ëªº¸Ü¡A³Å¥ß¸­¤ÀªRÀ³¸Ó­n¤ÀªR°òÀW(1f)¦Ó¤£¬O2­¿ÀW²v(2f)¤F¡C

 

In patients with congenital esotropia, the kinesthetic/optico-nystagmus is asymmetrical on the nasotemporal side, causing them to perceive inverted grating lines as moving to the left or right, thus triggering optokinetic nystagmus. Grazing acuity is then achieved by alternating between grating lines and blank areas of average brightness (grating onset/offset) (see figure). Therefore, Fourier analysis should analyze the fundamental frequency (1f) instead of its second harmonic (2f).

 

 

 

 

PowerDiva 1980¦~¥Nªº­ì«¬¬O¼g¦bApple-II¹q¸£¤Wªº¡A¦~»´¤H¤w¸g¨Sªk·Q¹³¨º¬O¦h»ò­ì©lªº¹q¸£¤F¡A°O¾ÐÅé(RAM)¥u¦³64KB¡I¦b¨º¼ËÁ}§xªºÀô¹Ò¤U¡A±o¾a°ª¶Wªºµ{¦¡§Þ³N¨Ó¸É¨¬¡C°O±o®ý¤j°Æ±Ð±Â­ð´ü·í®É¤]¦bTonyªº¹êÅç«Ç³]­pµ{¦¡¡A³]ªk§ï¶i»¤µo¹q¦ì©â¨ú«H¸¹ªº³t«×©M®Ä²v¡C

 

10¬í°O¿ý¤§«e¡A³q±`¦³´X¬íªº¥ý¸m¾AÀ³(adaptation)µe­±¡A´ú¸ÕªÌ½T©w¥®¨àªº±Mª`¤O¨Ó¨ì¿Ã¹õ¤W¤F¡A¤~«ö¶s±Ò°Ê¥¿¦¡ªºµø¨ë¿E±½±°µe­±¡C

 

§Y«K¥u»Ý­n10¬íÄÁª`µø¿Ã¹õ¡A³\¦h¥®¨àÁÙ¬O¨Sªk¤@¦¸§¹¦¨¡C´ú¸ÕªÌµo²{¥Lªºµø½u²¾¶}¿Ã¹õ®É¡A¥ß§Y«ö¶s¼È°±°O¿ý¸£ªi¡Fµ¥±N¥Lªºª`·N¤O§l¤Þ¦^¿Ã¹õ¤§«á¡A¦A«ö¶s¶}©l°O¿ý¡C­«±Òªº°O¿ý·|­«½Æ³¡¤À¼È°±«eªºµø¨ë¿E¡A¤§«á±N´X¬q¸£ªiµô´î¡B³s±µ°_¨Ó¡A±o¨ì¥¿¦n10¬íÄÁªº¸£ªi¶i¦æ¤ÀªR¡C(¨£¹Ï¡A¦A¬Ý¤@¦¸¥®¨àµø»¤µo¹q¦ìªºÀˬdµe­±)

 

The PowerDiva prototype from the 1980s was programmed into an Apple II computer¡Xa very primitive computer for modern people to imagine, with only 64KB of RAM! In such a challenging environment, advanced programming technology was needed to compensate. I remember Tang Yu, an associate professor at Zhejiang University, was designing programs in Tony's lab at the time, trying to improve the speed and efficiency of evoked potential signal extraction.

 

Before the 10-second recording, there were usually a few seconds of adaptation screen. The tester confirmed that the child's attention was on the screen before pressing the button to start the formal visual stimulus sweep.

 

Even though only 10 seconds of screen focus was required, many children couldn't complete it in one go. When the tester noticed the child's gaze leave the screen, they immediately paused the brainwave recording; after drawing the child's attention back to the screen, they resumed recording. The restarted recording repeated parts of the visual stimulus before the pause, and then the brainwave segments were trimmed and connected to obtain exactly 10 seconds of brainwave data for analysis. (See the image; view the examination footage of visual evoked potentials in young children again.)

 

 

 

¥Ø«ePowerDiva³o®M¨t²Î¦b¬ü°ê³\¦hÂå¾Ç¤¤¤ß¡BµøÄ±¬ã¨s¤¤¤ß¨Ï¥Î¤¤¡C

 

¥t¤@®M¥]§t±½±°µø»¤µo¹q¦ìªº¨t²Î«h¬ODiopsys Enfant® Pediatric Visual Evoked Potential Module (¨£¹Ï)

 

The PowerDiva system is currently used in many medical centers and vision research centers in the United States.

 

Another system that includes grazing visual evoked potentials is the Diopsys Enfant® Pediatric Visual Evoked Potential Module (see figure).

 

 

 

 

¥ú¹qºÞ(photocell)§@¬°µø»¤µo¹q¦ì¹êÅç«Çªº¼Ò«¬²´ ¡V ´ú¸Õ¨t²Îªº¥¿½T©Ê

 

¤§«e»s§@ªº¹êÅé§ä¤£¨ì¤F¡Aºô¸ô¤W§ä¨Ç§÷®Æ¹Ï¨Ó¸Ñ»¡¡C

 

¥DÅé¬O¨ºÁû¥ú¹qªý(photoresistor)¡A²k¦bBNC®y¤W¡A©T©w¦b©³¤ù²°©³¡Cµø»¤µo¹q¦ì¥Îªº¸£ªi©ñ¤j¾¹(amplifier)³q±`©ñ¤j100,000¡Ñ¡A¥ú¹qºÞª½±µ±µ¤W¥h¹q¤Ó¤j¡A¨Ã³s¤@­Ó¹qªý(BNC terminator)´N­è¦n¡C

 

A photocell serves as the model eye in a visual evoked potential (VAP) lab ¡V testing the system's correctness.

 

The original physical model is lost, so I'm using material diagrams found online for explanation.

 

The main component is the photoresistor, soldered to a BNC connector and fixed to the bottom of the film holder. The EEG amplifier used for VEP typically amplifies by 100,000¡Ñ; directly connecting the photocell would result in too much voltage, so connecting a resistor (BNC terminator) is just right.

 

 

 

³o¬O§Ú­Ì¥H¥ú¹qºÞ´À¥N¤H²´¡A´ú¸Õ¦Û¤v¶}µoªº±½±°µø»¤µo¹q¦ìªº¹q¸£µ{¦¡»P¨t²Î¡C®¶´T(amplitude)©M¬Û¦ì(phase)³£¤Q¤À§¹¬ü¡C

 

This is our computer program and system for testing our self-developed swept visual evoked potentials, using phototubes instead of the human eye. The amplitude and phase are both perfect.

 

 

 

¦pªG¦Û¦æ¶}µo¦hµJºô½¤¹q¹Ï/µø»¤µo¹q¦ì(Multifocal ERG/VEP)¹q¸£¨t²Î¡A¤@¼Ë¥i¥H¥Î¥ú¹qºÞ´À¥N¤H²´¡A´ú¸Õ¨Ã°»¿ù¨t²Î¬O§_¥¿½T¡C

 

If a multifocal ERG/VEP computer system is developed in-house, phototubes can be used to replace the human eye to test and detect whether the system is correct.

 

 

 

ªþ°O ¡V ¼Æ¦ì³Å¥ß¸­¤ÀªR (Digital Fourier Analysis)

 

ªþ¤W²µuªºBASIC»y¨¥µ{¦¡¡G

¾î¶bh­ÓÂI

©â¨úm­¿ÀW(mth harmonic)

 

[«D§Ö³t³Å¥ß¸­¶Ç´«(Fast Fourier Transform, FFT)]

 

Postscript ¡V Digital Fourier Analysis

 

A short BASIC program is attached: Horizontal axis: h points Decimate by m harmonics

 

[Non-Fast Fourier Transform (FFT)]

 

 

    real = 0: imag = 0

 

    FOR i = 0 TO h - 1

        real = real + y(i) * COS(2 * pi * i * m / h)

        imag = imag + y(i) * SIN(2 * pi * i * m / h)

    NEXT

 

    amp = (real ^ 2 + imag ^ 2) ^ .5 / h * 2

 

    IF real = 0 AND imag > 0 THEN

        phase = .5 * pi

    ELSEIF real = 0 AND imag < 0 THEN

        phase = 1.5 * pi

    ELSE

        phase = ATN(imag / real)

        IF real < 0 THEN phase = phase + pi

        IF real > 0 AND imag < 0 THEN phase = phase + 2 * pi

    END IF

    IF phase >= 2 * pi THEN phase = phase - 2 * pi

phase = phase / pi