Cortical potentials to pattern reversal and luminance onset under ramp stimulation conditions in glaucoma.

Stimulus quantities with a ramp-like temporal course evoke cortical potentials that are delayed and attenuated in comparison with responses evoked by a step-like course. This delay probably depends on temporal transfer characteristics of the activated precortical visual system. In a pilot study, luminance onset and pattern-reversal stimulation using this technique (light-emitting diode stimulator; transition time, 50 ms) were applied to 18 glaucomatous eyes with early visual field damage. The visual evoked cortical potential latency shifts between ramp and step mode were compared with visual field indices (mean defect, corrected loss variance). The pattern-reversal stimulation in ramp mode yielded a significant difference between the glaucoma group and normal subjects (p less than 0.004). The difference between groups with pattern-reversal stimulation in step mode was not significant (p = 0.15). From the determined visual field indices, only the mean defect showed a significant correlation to the measured visual evoked cortical potential latency shift, with both luminance-onset and pattern-reversal stimulation. In glaucoma with early malfunction, the precortical transmission and processing of lower and middle temporal frequencies, which are predominant in ramp-like temporal stimulus courses, are obviously more affected than the transmission of higher frequencies. The ramp stimulation technique for visual evoked cortical potentials might be of interest as a tool to detect early and specific functional defects in glaucoma.