ELECTRO-OCULOGRAPHY

BY L.S.N SRINIVAS 09NG1A0439

DEFINITION
The clinical electro-oculogram is an electrophysiological test of function of the outer retina and retinal pigment epithelium in which the change in the electrical potential between the cornea and the fundus is recorded during successive periods of dark and light adaptation.

HISTORY
Emil du Bois-Reymond (1848) observed that the cornea of the eye is electrically positive relative to the back of the eye.

Elwin Marg named the electrooculogram in 1951 and Geoffrey Arden (Arden et al. 1962) developed the first clinical application

The Control of Eye Movements

Eye movements are used to fixate objects so that they fall on the fovea of the eye Occipital and frontal cortices are involved in eye fixation The eye muscles are innervated by the 3rd (oculomotor), 4th (trochlear), and 6th (abducens) cranial nerves Three sets of muscles are used to move the eyes:
Superior and inferior rectus Lateral and medial rectus Superior and inferior obliques

Eye Movements and the EOG

Types of Eye Movements

Saccadic- movements from one fixation point to the next
Saccade variables:
Saccade latency- time between presentation of stimulus and fixation Saccade amplitude- distance covered by eye during saccade Direction of movement- whether it is horizontal or vertical movement Velocity- speed of the saccade Fixation pause time- occurs between fixations

Types of Eye Movements

Smooth Pursuit- movement the eyes make when following a moving object
- Example: following a bird in the sky

Smooth Compensatory- this movement corrects for differences in head tilt so that the image remains upright

Types of Eye Movements

Nystagmoid- abnormal oscillations of the eye

Causes:
1. Eye defects 2. Impairment of vestibular (balance) system 3. Impairment of visual or vestibular pathways in the CNS

Rapid Eye Movements (REM):

Occur during sleep Last anywhere from a few minutes to more than a half-hour

Eye Blinks: (3 types)

3 Types of Eye Blinks

1. Voluntary blink: consciously close the eyes 2. Blink Reflex: when the eyes blink to act as a defense mechanism in response to a potentially harmful stimulus 3. Keeps the cornea healthy by keeping the surface moist
Occurs about 15,000 times/day (about 15-20 times/min in relaxed state)

Voluntary vs. Involuntary Eye Fixations

Voluntary Fixations: when the eye focuses on an object of choice
Example: reading Controlled by the prefrontal cortex

Involuntary Fixations: constantly occuring

Controlled by the occipital cortex

Recording Eye Movements/Blinks

Four methods:
1. 2. 3. 4. Contact-lens method Corneal reflection method Television camera scanning Electrooculogram (EOG)

Electrooculogram (EOG)
Records the movements (and direction) of the eyes by electrodes placed over the muscles that move the eye Can have binocular or monocular set-up (binocular more reliable) Head must be kept still so the center of the visual field is constant Ideal impedance of the electrodes is under 2,000 ohms (we have been dealing with impedances under 50 Kohms)

The EOG Can Record:

Saccadic movements Smooth pursuit movements Nystagmus Convergence and divergence of the eye REM during sleep

EOG Complications
3 problems to be cautious of:
1.Small magnitude of EOG signal 2.Skin potential that are the same frequency as the EOG signal 3.Slow drift- steady deflection of recording in one direction
Caused by unclean electrodes and poor contact with the skin

Binocular Electrode Placement

Electrodes A & B are used to measure horizontal eye movements Electrodes C & D measure vertical eye movements Electrode E is the ground

EOG Recording

Channel 1: one second timer; Channel 2: horizontal unipolar reading; Channel 3: horizontal bipolar reading; Channel 4: marking channel with artifact noise

CLINICAL ELECTRO OCULOGRAM

The clinical electro-oculogram (EOG) makes an indirect measurement of the minimum amplitude of the standing potential in the dark and then again at its peak after the light rise. This is usually expressed as a ratio of light peak to dark trough and referred to as the Arden ratio.

Measurement of the clinical EOG

The calibration of the signal may be achieved by having the patient look consecutively at two different fixation points located a known angle apart and recording the concomitant EOGs . By attaching skin electrodes on both sides of an eye the potential can be measured by having the subject move his or her eyes horizontally a set distance . Typical signal magnitudes range from 5-20 V/.

 A ground electrode is attached usually to either the forehead or earlobe. Either inside a Ganzfeld, or on a screen in front of the patient, small red fixation lights are place 30 degrees apart . The distance the lights are separated is not critical for routine testing.

 The patient should be light adapted such as in an well-illuminated room, and their eyes dilated The patient keeps his or her head still while moving the eyes back and forth alternating between the two red lights. The movement of the eyes produces a voltage swing of approximately 5 milli volts between the electrodes on each side of the eye, which is charted on graph paper or stored in the memory of a computer.

The standard method

After training the patient in the eye movements, the lights are turned off. About every minute a sample of eye movement is taken as the patient is asked to look back and forth between the two lights . After 15 minutes the lights are turned on and the patient is again asked about once a minute to move his or her eyes back and forth for about 10 seconds.

The standard method

Typically the voltage becomes a little smaller in the dark reaching its lowest potential after about 8-12 minutes, the so-called dark trough. When the lights are turned on the potential rises, the light rise, reaching its peak in about 10 minutes. When the size of the "light peak" is compared to the "dark trough" the relative size should be about 2:1 or greater . A light/dark ratio of less than about 1.7 is considered abnormal.

APPLICATIONS
The light response is affected in: - diffuse disorders of the RPE and the photoreceptor layer of the retina including some characterized by rod dysfunction - chorio-retinal atrophic and inflammatory diseases

In most of these there is correlation with the electroretinogram (ERG), except notably in the case of Bests vitelliform maculopathy, in which the clinical EOG is usually highly abnormal in the presence of a normal ERG May be an early indicator of Chloroquine toxicity

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