Ординатура / Офтальмология / Английские материалы / Electrophysiology of Vision_Lam_2005
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ISBN: 0-8247-4068-8
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Preface
This book was written to provide the clinician with practical information of visual electrophysiologic tests in an accessible and understandable format. Personnel involved in electrophysiologic testing and ophthalmic trainees may also find this book beneficial. The book is organized into two sections keeping in mind that the majority of clinical users of visual electrophysiologic tests do not perform the tests themselves. The first section consists of six chapters that discuss clinical recording techniques and physiologic origins of electroretinogram (ERG), electro-oculogram (EOG), and visual evoked potential (VEP); the section ends with a chapter that focuses on the effects of maturation and aging on these tests as well as electrophysiologic testing in infants. The second section consists of 11 chapters dealing with the clinical applications of ERG, EOG, and VEP testing. The first chapter of this section is an overview from a clinical perspective. The electrophysiologic findings of specific clinical conditions are discussed in subsequent chapters with an emphasis on when and why a specific test should be considered. The clinician
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Preface |
will find the second section particularly useful in everyday patient care.
ACKNOWLEDGMENTS
The completion of the book wouldn’t have been possible without the support of my family and colleagues. Dr. Mu Liu assisted immensely in many of the figures and tables. Rick Stratton helped substantially in the preparation of figures. Ailin Rodriguez provided excellent secretarial support. Dr. Sheridan Lam reviewed drafts and gave valuable advice.
I wish to thank my family for their support and encouragement during the writing of this book. In particular, I deeply appreciate Diane, my lifetime soul mate and best friend, for her loving sustenance. The book is dedicated to my family.
Byron L. Lam
Contents
Preface . . . . iii
I. Clinical Recording Techniques
1.Full-Field Electroretinogram . . . . . . . . . . . . . . . . 1
Clinical Use of Full-Field ERG . . . . 1 Retinal Electrical Responses . . . . 6 Clinical Recording of Full-Field ERG . . . . 6
Physiologic Origin of the Full-Field ERG . . . . 20
ERG Fluctuation Related to Circadian Rhythm . . . . 24 Negative ERG—Selective Reduction
of b-Wave . . . . 24
Advanced Clinical Full-Field ERG Topics . . . . 25 Specialized ERG Recordings and Waveforms . . . . 38 Basic Retinal Anatomy and Physiology as
Related to ERG . . . . 47
2. Focal and Multifocal Electroretinogram . . . . . 65
Focal Electroretinogram . . . . 67
Multifocal Electroretinogram . . . . 68
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Contents |
Multifocal ERG Recording Environment and Patient Set-Up . . . . 70
Multifocal ERG Stimulus . . . . 71
Recording Multifocal ERG . . . . 71
First-Order ‘‘Response’’ of Multifocal ERG . . . . 74 Displaying Multifocal ERG Results . . . . 78 Physiologic Blind Spot in Multifocal ERG . . . . 79 Second-Order ‘‘Response’’ of the Multifocal ERG . . . . 81 Specialized Multifocal ERG Techniques and
Waveforms . . . . 83
3.Pattern Electroretinogram . . . . . . . . . . . . . . . . . 91
Clinical Utility of Pattern ERG . . . . 91 Basic Concepts and Physiologic Origins of
Pattern ERG . . . . 93
Clinical Recording of Pattern ERG . . . . 98 Reporting Pattern ERG Results . . . . 101
4.Electro-oculogram . . . . . . . . . . . . . . . . . . . . . . . . 105
Physiologic Origins and Characteristics of EOG . . . . 105
Clinical EOG Recording—Patient Set-Up . . . . 111 Obtaining Light Peak and Dark Trough
EOG Amplitudes . . . . 114
EOG Amplitude Ratio—Arden Ratio . . . . 116 Alternative EOG Method: Light-Peak to Dark-Adapted
Baseline Amplitude Ratio . . . . 117 Reporting the EOG Result . . . . 117 Non-photic EOG Responses . . . . 118 Fast Oscillations of the EOG . . . . 118
5.Visual Evoked Potential . . . . . . . . . . . . . . . . . . . 123
Clinical Utility of VEP . . . . 123 Specialized VEP Techniques . . . . 139
6.Maturation, Aging, and Testing in Infants . . . . 151
Maturation . . . . 152
Delayed Visual Maturation . . . . 156 Electrophysiologic Testing in Infants . . . . 156
Contents |
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Estimating Visual Acuity in Infants . . . . 159
Amblyopia . . . . 165
Aging . . . . 167
Gender . . . . 172
II. Clinical Applications
7.Overview: Clinical Indications and
Disease Classification . . . . . . . . . . . . . . . . . . . . . 185
Clinical Indications of Visual Electrophysiologic Tests . . . . 185
Disease Classification . . . . 188
8.Retinitis Pigmentosa and Pigmentary Retinopathies . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Retinitis Pigmentosa (Rod–Cone Dystrophy) . . . . 192 Leber Congenital Amaurosis . . . . 203
Usher Syndrome . . . . 204 Bardet–Biedl Syndrome . . . . 206 Refsum Syndrome . . . . 208 Abetalipoproteinemia (Bassen–Kornzweig
Syndrome) . . . . 209
Neuronal Ceroid Lipofuscinosis . . . . 210 Kearns–Sayre Syndrome: Mitochondrial
Retinopathy . . . . 213 Rubella Retinopathy . . . . 214 Syphilitic Retinopathy . . . . 214
Enhanced S-Cone Syndrome . . . . 215 Goldmann–Favre Syndrome . . . . 218
Dominant Late-Onset Retinal Degeneration . . . . 219 Cone–Rod Dystrophy . . . . 219
Alstro¨m Syndrome . . . . 223
9.Stationary Night Blindness and Stationary Cone Dysfunction Disorders . . . . . . . . . . . . . . . . . . . . 243
Stationary Night Blindness Disorders . . . . 244 Stationary Cone Dysfunction Disorders . . . . 261
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Contents |
10.Macular Disorders . . . . . . . . . . . . . . . . . . . . . . . 277
Age-Related Macular Degeneration . . . . 278 Macular Degeneration—Autosomal Dominant,
Recessive . . . . 279
Central Serous Chorioretinopathy . . . . 280 Doyne Honeycomb Retinal Dystrophy=
Malattia Leventinese . . . . 283 Stargardt Macular Dystrophy—
Fundus Flavimaculatus . . . . 284
Best Vitelliform Macular Dystrophy . . . . 290 Cone Dystrophy . . . . 293
Central Cone Dystrophy (Occult Macular Dystrophy) . . . . 295
Peripheral Cone Dystrophy . . . . 297 Cone Dystrophy with Supernormal and Delayed Rod ERG (Supernormal and
Delayed Rod ERG Syndrome) . . . . 297 Sorsby Fundus Dystrophy . . . . 298 Pattern Dystrophy . . . . 302
X-Linked Retinoschisis . . . . 303
Central Areolar Choroidal Dystrophy . . . . 307 North Carolina Macular Dystrophy
(Central Areolar Pigment Epithelial Dystrophy) . . . . 308
Progressive Bifocal Chorioretinal Atrophy . . . . 309 Fenestrated Sheen Macular Dystrophy . . . . 309 Familial Internal Limiting Membrane
Dystrophy . . . . 310
11.Chorioretinal Disorders . . . . . . . . . . . . . . . . . . 331
Choroideremia . . . . 331 Gyrate Atrophy . . . . 334
Hereditary Choroidal Atrophy . . . . 336 Helicoid Peripapillary Chorioretinal
Degeneration . . . . 337
Pigmented Paravenous Retinochoroidal Atrophy . . . . 339
Contents |
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12.Vitreoretinal Disorders . . . . . . . . . . . . . . . . . . . 343
Stickler Syndrome . . . . 344 Wagner Vitreoretinopathy . . . . 345
Familial Exudative Vitreoretinopathy . . . . 346 Autosomal Dominant
Vitreoretinochoroidopathy . . . . 347 Autosomal Dominant Neovascular Inflammatory
Vitreoretinopathy . . . . 347
13.Inflammatory and Immune-Related Ocular Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Inflammatory Retinal Disorders . . . . 352 Zonal Inflammatory Retinal Disorders . . . . 360 Paraneoplastic and Immune-Related
Retinopathies . . . . 367
14.Ocular Vascular Disorders . . . . . . . . . . . . . . . . 377
Vascular Occlusions . . . . 379
Other Proliferative Neovascular Disorders . . . . 392 Other Ocular Vascular Disorders . . . . 397
15.Nutritional, Toxic, and Pharmacologic
Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Vitamin A Deficiency . . . . 408 Nutritional Optic Neuropathy . . . . 410 Metallic Intraocular Foreign Bodies—
Ocular Siderosis . . . . 411 Methanol Poisoning . . . . 414
Synthetic Retinoids—Isotretinoin (Accutane ) . . . . 415 Chloroquine=Hydroxychloroquine . . . . 415 Thioridazine (Mellaril ), Chlorpromazine, and
Other Phenothiazines . . . . 419 Quinine . . . . 421
Deferoxamine (Desferrioxamine) . . . . 425 Vigabatrin . . . . 428
Sildenafil (Viagra ) . . . . 431 Gentamicin . . . . 432 Ethambutol . . . . 433