Evaluation of visual evoked potentials in dysthyroid optic neuropathy

Orbit. 2022 Sep 21;1-6. doi: 10.1080/01676830.2022.2123929. Online ahead of print.


Purpose: To evaluate the findings of visual evoked potentials (VEP) in patients with dysthyroid optic neuropathy (DON).

Methods: In this observational, cross-sectional study 40 eyes (22 patients) with a diagnosis of DON were included.

Results: We discovered that in 16 out of 37 eyes with pattern-VEP (p-VEP), the latency of P100 wave was normal in spite of having a diagnosis of DON. The same pattern was also observed in the measurement of the amplitude of P100 wave: in 28 out of 37 eyes with p-VEP the amplitudes were observed as normal. In 3 eyes of 3 patients p-VEP showed no response, therefore a flash-VEP (f-VEP) was performed. Flash-VEPs of those patients indicated a prolonged P100 latency with a reduced amplitude. The sensitivity of abnormal P100 latency was 56.8% (95%CI 39.5-72.9%); and that of reduced P100 amplitude was 24.3% (95%CI 11.8-41.2%). Also, in 40 eyes color vision test by Arden was performed. In 36 eyes (20 patients) the tritan value was pathological (based on a threshold of ≥8%).

Conclusion: According our data, VEP seems to have a limited potential especially in patients with a good best-corrected visual acuity (BCVA ≤0.2 LogMAR) for identifying the optic nerve involvement. The fact that P100 latency and amplitude were normal even in cases with an optic nerve swelling makes us question the usefulness of the VEP for diagnosing cases of DON in daily clinical life.

Keywords: Compressive optic neuropathy; dysthyroid optic neuropathy; thyroid eye disease; visual evoked potentials.