Contrast and spatial frequency modulation for diagnosis of amblyopia: An electrophysiological approach

Background and Aim : Amblyopia is a developmental disorder of central visual pathways and occurs when an amblyogenic factor affects the visual system of a growing child and diminishes the normal development of the visual nervous system.In this study, we evaluated the diagnostic value of Visual Evoked Potentials and compared it with psychophysical contrast sensitivity measurements to introduce an electrophysiological protocol for diagnosis of amblyopia and to find out which test setting has the most sensitivity and specificity for amblyopia diagnosis.Methods : Thirty-three adult anisometropic amblyopes were intended in this study and were tested for visual evoked potentials with different stimulus conditions including three spatial frequencies [1, 2, and 4-cycles-per-degree (cpd)] at four contrast levels (100, 50, 25, and 5%). We also tested psychophysical contrast sensitivity and compared the results with electrophysiological ones. We plotted Receiver Operating Characteristic (ROC) curve for each VEP recording and psychophysical contrast sensitivity to evaluate the area under the curve, sensitivity, specificity, and cut-point value of each test stimulus for detecting amblyopic eyes.Results : Thirty-three amblyopic and 33 non-amblyopic eyes were examined for psychophysical contrast sensitivity and VEPs. Area under the ROC curve (AURC) findings showed that VEP with different stimulus settings can significantly detect amblyopic eyes, as well as psychophysical contrast sensitivity test. We found that P100 amplitudes had the largest AURC in response to stimuli of 2-cpd spatial frequency at 50 (P < 0.001) and 25% (P < 0.001) contrast levels, respectively. Cut-off amplitudes for these stimuli were 8.65 and 4.50 μV, which had a sensitivity of 0.758 and 0.697 and a specificity of 0.788 and 0.848, respectively. The sensitivity and specificity of VEP P100 amplitude in response to the stimuli with 2 cpd spatial frequency and 50 and 25% contrast were greater than the findings obtained from psychophysical contrast sensitivity test.Conclusion : According to our findings, assessment of VEP amplitudes in response to stimuli of 2-cpd spatial frequency at 50 and 25% contrast levels can best detect amblyopia with highest sensitivity and specificity and thus, are the protocols of choice for detection of amblyopic eyes.