Simulated nystagmus reduces pattern-reversal more strongly than pattern-onset multifocal visual evoked potentials.

OBJECTIVE In patients with nystagmus conventional pattern-reversal visual evoked potentials are severely degraded, while sizeable pattern-onset VEPs can often still be obtained. We tested whether this differential effect of retinal image motion on pattern-reversal and pattern-onset responses also applies to multifocal VEPs (mfVEPs). METHODS In eight subjects with normal oculomotor behaviour and vision we recorded pattern-reversal and pattern-onset mfVEPs from an occipital electrode pair to 60 locations of a scaled dartboard-pattern, and to 64 locations of a uniform checkerboard-pattern. Subjects viewed the stimulus monocularly via a mirror, which was placed close to the eye and driven by a scanner with a 4 Hz sawtooth waveform at an amplitude of 2 degrees to simulate horizontal jerk nystagmus and of 0 degrees for the reference condition. RESULTS For the scaled dartboard-stimulus we observed an eccentricity-dependent effect of induced retinal image motion on mfVEP responses: in the central visual field (0-0.5 degrees), pattern-reversal and pattern-onset responses were reduced by 73 and 42%, respectively. In the periphery (10-16 degrees), only pattern-reversal responses were reduced (by 27%), while pattern-onset responses were enhanced by 39%. Pattern-onset responses to the uniform checkerboard stimulus were enhanced by 17%, while pattern-reversal responses were reduced by 27%. CONCLUSIONS Pattern-onset mfVEPs are more efficient than pattern-reversal mfVEPs, if retinal image motion is superimposed onto the stimulus. This is in close correspondence to previous reports on conventional VEPs. SIGNIFICANCE This study demonstrates a differential effect of retinal image motion on pattern-reversal and pattern-onset mfVEPs and thus suggests stimulus conditions to enhance the efficiency of mfVEP recordings in patients with moderate nystagmus.