National Journal of Medical Research & Yoga Science; Jan 2015: Vol.-1, Issue- 3, P.

37-39

ISSN 2395-2911
Original article

Effect of Refractive error on VEP in Myopic Boys and

Girls
*Vinodha.R1,
1Professor

Shanmugapriya.C2

& Head, 2Assistant Professor, Department of Physiology, Thanjavur Medical College, Thanjavur,
author email: vinodhadr@gmail.com

*Corresponding

Date of submission: 8th May 2015; Date of Publication: 31st July 2015
ABSTRACT
Introduction: Visual evoked potentials (VEPs) are summated electrical signals generated by occipital regions of the Cortex in
response to visual stimuli & recorded from human scalp. It tests the function of visual pathway from retina to occipital cortex and
more sensitive to changes in the visual stimuli. It is very useful when causes of poor vision are uncertain. VEP amplitude and
latencies are affected by multiple variables like age, gender, eye dominance, eye movement, visual acuity and refractive errors. To
determine the influence of refractive error on VEP this study was done in myopic boys and girls. Methods: 40 controls, 17 boys, 23
girls were selected.40 myopic subjects, 17 boys, 23 girls with refractive error in a range of 1to 8.5 Dioptres were participated. All
were aged between 17-21.Refractive error was measured by auto refractometry. VEPs were performed by checkerboard reversal
stimuli system. Results: Statistical analysis showed significant prolongation of P100 latency [P100L] in myopic subjects with a P
value of < 0.0001. Reduction in P100 amplitude was found and it was significant at P< 0.1 .The results were also compared
separately for boys and girls.P100L was significant with a P value of < 0.0001 for boys and it was significant with a P value of
0.0007 for girls. With regard to amplitude, reduction in amplitude was observed with a significant P value of 0.0369 for boys and
insignificant reduction in amplitude with a P value of 0.4103 for girls. Pearsons correlation study revealed negative correlation for
VEP-L and weak positive correlation for VEP-amplitude. Conclusion: During VEP recording, the subject is advised to wear
corrective lenses and this study can be used to prevent misinterpretation of VEP findings.
Keywords: Refractive error, Myopia, VEP amplitude, Latency.

INTRODUCTION
VEPs are electrical potentials evoked from visual stimuli and
recorded from the human scalp [1]. Electrophysiological
recording of visual evoked potentials are non invasive and
has been very useful in assessing the visual function [1, 2]. It
depends on the functional integrity of the visual pathway [3].
They are summated electrical signals generated by occipital
areas 17, 18, 19 in response to visual stimuli [1, 4].Since this
technique has a high quality of temporal resolution (in the
range of milliseconds), the study of dynamic changes
occurring in the nervous system is possible[5,6].Multiple
variables such as age, gender, eye dominance, eye movement,
visual acuity and refractive errors may affect VEP. [1] Studies
revealed that the latency of P100 remains normal in spite of
visual acuity as low as 20/120; however, the p100 amplitude
decreases [4]
A common cause of low visual acuity is refractive error
(ametropia). Normal refractive state is referred to as
emmetropia. Too high refractive error (in relation to the
length of eyeball) is the cause of myopia (near sight) and too
low refractive error is the cause of hyperopia (far sight).[7]
uncorrected refractive errors may affect the amplitude and
latency of the VEP[8]
Shorter latency and larger amplitude of VEPs have been
observed in normal females. [9,10] The reason for long
latency in males may be due to larger head size and lower
core body temperature.[4,11]Even though the cause for larger

Vinodha et al.,

amplitude in females is unclear, hormonal influences have

been suggested[9,10]
The present study was conducted to determine the effect of
refractive error on P100Latency (P100L) and P100Amplitude
in myopic boys and girls.

MATERIALS AND METHODS

The study was done at physiology research laboratory,

Thanjavur Medical College, Thanjavur from February 2011 to
July 2014. We tested 40 myopic subjects, 17boys and 23 girls
with refractive error in a range of 1 to 8.5D. 40controls, 17
Boys & 23Girls were selected. All were aged between 17 to
21.This study was conducted as a case control study.
Refractive error was measured by auto refractometry in each
subject. VEPs were performed by checkerboard pattern
reversal stimuli system. Analysis was done with corrected
lenses. Subjects with amblyopia, corneal opacity, squint, and
colour blindness, history of ophthalmic surgery, history of
ptosis, glaucoma, significant retinal pathology, those on
miotics or mydriatics, neuromuscular disorder or other
diseases that might affect visual acuity were excluded.
Informed written consent was obtained from all the
participants and experimental protocol was approved by the
college ethical committee.
VEP Pre test instructions [4, 12]
1. about the procedure of the test and got informed consent.
2. To avoid hair spray or oil after the last hair wash.

37

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3. The room parameters should be maintained constant

throughout the experiment.
4. Not to use any eye drops (miotic/ mydriatics) 12 hrs before
the test.
The study was done with 4 channels Digital Polygraph. Digital
colour monitor, model- no: IT-173SB.
VEP- Experimental Design and Recording:
VEPs were performed by checkerboard pattern reversal
displayed on a TV monitor at a viewing distance of 90cm.
Electrode placement and recording parameters were carried
out according to the standard of the International Society for
Clinical Electrophysiology of Vision (ISCEV) [3].
Standard disc EEG electrodes were placed at the Oz position
(active electrode) and reference electrode was placed at FpZ
position & ground electrode on the patients vertex (Cz).The
subject was instructed to fix his gaze at the center of the
screen. The latency of P100 and amplitude were measured.
Statistical Analysis: Spherical equivalent refraction between
Right and Left eye was analysed by students pairedt test and
the spherical equivalent(SE) between boys and girls were
analysed by unpaired t test. P100 amplitude and latency of
control group with myopic subjects were analysed by
unpaired test. VEP-L and amplitude were correlated with SE
refraction by Pearsons correlation coefficient. Graph pad
statistical software was used for data analysis.

RESULTS

The mean age for the study and control group was 18.05,
17.98 respectively.
The mean SE was -2.5375 in the Right, -2.5188 in the Left eye.
There was no significant difference in the SE between Right &
Left eye. P=0.8304 (Paired test Table 1).
There was no significant difference in Spherical Equivalent
Refraction between boys & Girls P= 0.7799(Unpaired ttest
Table 2).
Table 1: Spherical Equivalent in Right & Left eye (n=40)

SE Dioptres (D)
MeanSD
Right
-2.53751.9868
Left
-2.51881.9767

significant difference with control in p100 latency with a

significant P value of < 0.0001. Reduction in amplitude was
found with a P value of 0.0541 and it was significant at p<0.1
(Table3).The results were also compared separately for boys
and girls.P100L was extremely significant for boys and girls
with a P value of less than 0.0001 ,0.0007 respectively.
Reduction in amplitude was observed with a significant P
value of 0.0369(P<0.05)for boys and insignificant reduction
was found for girls with a P value of 0.4103. (Table4).When
SE was correlated with VEP-L and amplitude in whole group,
VEP-L showed negative correlation at P <0.001, and
amplitude showed weak positive correlation and it was
insignificant. When correlation was done separately in males,
we found negative correlation at P< 0.05 for latency and
amplitude was insignificant. In females latency showed
negative correlation at P <0.01and amplitude was
insignificant. (Table 5).
Table 3: P100 latency & Amplitude in Myopia and Control
Parameters
Mean
SD
P
P100 Latency(ms)
Control n=40
100.519 4.129
<0.0001
Myopia n=40
103.850 3.587
P100
Amplitude
(v)
Control n=40
10.8901 3.6281
0.0541
Myopia n=40
9.7513
3.7949
Table 4: P100 latency & Amplitude in Myopic Boys & Girls
with control

Parameters

P100 Latency(ms)
Boys(control)
n=17

Boys (myopia)
n=17
Girls(control)
n=23

Girls(myopia)
n=23

0.8304

Table 2: Spherical Equivalent of Boys & Girls

SE Dioptres (D)
Boys
Girls

MeanSD

-2.45591.7249
-2.58152.1493

P100Amplitudev
Boys(control)n=17

Boys(myopia)n=17

0.7799

Girls(control)n=23

The mean and SD of VEP latency & amplitude of myopic

subjects and control were compared. Longer latency was
observed in myopic subjects. They showed extremely
Table 5: Pearsons correlation

waves

Whole group
(n=40)SE

VEP L(ms)

-0.5248

VEPamp(v)

Vinodha et al.,

Pearsons
Correlation[r]
0.1288

P value

0.000508
0.428315

Boys(n=17)
SE

Girls(myopia)n=23

Pearsons
correlation[r]
-0.5622
0.1076

P value

0.018824
0.681035

Mean

SD

101.250

3.542

99.891

4.523

105.118

3.501

102.804

3.385

10.6547

2.8284

11.0641

4.1436

8.8738

10.3978
Girls(n=23)
SE
Pearsons
correlation
-0.6081
0.0546

3.9704
3.5606

<0.0001

0.0007

0.0396
0.4103

P value

0.002081
0.804572

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38

DISCUSSION
Certain studies revealed that the P100L remains normal in
spite of visual acuity as low as 20/120; however the
amplitude decreases if the visual acuity reduces further.[4]
Lee et al tried to evaluate the P100 latency in myopia and
found significant negative correlation between refraction and
P100 latency. They suggested that during VEP study, we
should
consider
the
refraction
and
visual
acuity.[13].Reduction in amplitude of the VEP was reported
by Ludlam et al they observed that visual evoked response
(VER) amplitude decreased by approximately 25% per
dioptre of defocus, and the effect was recognizable for
0.25D.[14]
Small but indistinguishable latency changes were noticed by
Collins DW et al in patients with refractive errors. [8] Ruchi
Kothari et al studied the effect of myopia and hyperopia on
VEP and found that the p100 latency was increased and
amplitude decreased with and without correction of
refractive error. [15]
In this study p100 amplitude and latency were compared
between myopia and control to know the influence of
refractive error on the VEP responses and found that P100
latency was extremely longer and significant differences also
exists in relation to amplitude. Since shorter latency and
larger amplitude of VEP have been observed in normal
females [9, 10], the results were compared separately for
males and females.P100L was longer and extremely
significant in myopic boys and girls, whereas with regard to
amplitude significant reduction in amplitude was observed in
myopic boys, and it was insignificantly reduced in myopic
girls when compared with control. Pearsons correlation
study revealed, negative correlation for VEP-L and weak
positive correlation for amplitude.
VEP is more sensitive to minimal changes in refractive errors
than (ERG) electroretinogram, because VEP is more focussed
on foveal region, whereas ERG represents the entire stimulus
field. The relationship between the degree of myopia and the
VEP responses remains unclear. It was presumed that
refractive error causes defocus which may affect the VEP
responses.
CONCLUSION
During VEP recording, the subject is advised to wear
corrective lenses to prevent misinterpretation of VEP
findings. Further studies can be carried out on a larger sample
of myopia and hyperopia with and without corrective lenses
to confirm the relation between retinal defocus and VEP
responses.

2. Celesia GG: Evoked Potential techniques in the evaluation

of Visual Function. J.Clin Neurophysiol. 1984Jan;1(1):5576

3. J.Varnon Odom Michael Bach Mitchell Brigell Graham E.

Holder Dapnne L. MC Culloch. ISCEV Standard for Clinical

Visual evoked Potential. Doc Ophthal 2010; 120:111-19.

4. UK Misra, J Kalita Clinical Neurophysiology 2nd

ed.2006:311-16.

5. Regan D. Human Brain Electrophysiology. Evoked

Potentials & Evoked Magnetic fields in Science &
Medicine. Elsvier; Newyork 1989:453

6. Churchland PS, Sejnowski TJ: Perspectives on cognitive

neuroscience. Science;1988; 242; 741,

7. Cline D; Hofs tetter HW, Griffin JR. Dictionary of visual

science 4th ed. Bulter worth Heinemann Boston
1997;7506-95

8. Collins DW, Carroll WM, Black JL, Walsh M. Effect of

refractive error on Visual evoked response. Br.Med J
1979; 1:231 2.

9. Celesia GG, Kaufman D, Cone S: Effects of age & sex on

Pattern electroretinograms & Visual evoked Potentials.
Electroencephalogr Clin NeuroPhysiol,1987;68:161-71

10. La Marche JA, Dobson WR, Cohn NB et al: Amplitudes of

Visually evoked Potentials to Patterned Stimuli: age &
sex comparisons. Electroencephaogr clin NeuroPhysiol,
1986; 65:81.

11. Stockard JJ, Hughes JR, Sharvough FW. Visually evoked

Potentials to electronic Pattern reversal: Latency

variations with gender, age & tenchincal factors. Am JEEG
Technol 1979;19:171

12. GK Pal Practical Manual, Text book of Practical

Physiology. 3rd edition, 2010.

13. Lee SM, Kims, Ann JK. The Change of Visual evoked

Potential in Patients with myopia in Correction of

Refraction. J Korean Acad Rehabil Med.2002 Dec; 26(6):
734 38. Korean.

14. Ludlam WM, Meyers RR. The use of visual evoked

responses in objective refraction. Trans NY Acad Sci

1973; 34:154-70.

15. Kothari Ruchi, Bokariya Pradeep. Singh Ramji, Sing

Smita. Influence of Refractory error on the Pattern

Reversal VEPs of myopes & Hypermetropes.
International Journal of Physiology 2013; 1:57-61

ACKNOWLEDGEMENT

We thank Dr.P.Ravishankar, M.D., former Dean, Thanjavur

Medical College, Thanjavur, and Dr.P.G.Sankara narayanan,
M.S., present Dean, Thanjavur Medical College.

Conflict of Interest: NIL

REFERENCES

1. Michael J.Aminoff. Electro diagnosis in clinical Neurology

5th ed. 2005;455

Vinodha et al.,

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