Invited review International Federation of Clinical Neurophysiology: Recommendations for visual system testing Graham E. Holder a, * , Gastone G. Celesia b , Yozo Miyake c , Shozo Tobimatsu d , Richard G. Weleber e , for the International Federation of Clinical Neurophysiology a Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK b 3016 Heritage Oak Lane, Oak Brook, IL 60523, USA c Aichi Medical University, Nagakute-Cho, Aichi-Gun, Aichi 480-1195, Japan d Neurological Institute, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan e Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239-4197, USA article info Article history: Accepted 3 April 2010 Available online 16 June 2010 Keywords: Visual evoked potential Electroretinography Pattern electroretinography Multi-focal ERG Retina Macula Optic nerve abstract This document presents recommendations and guidelines for the use of visual electrophysiological test- ing in the clinical assessment of visual pathway function. Ó 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. Contents 1. Introduction ........................................................................................................ 1394 2. The anatomy and physiology of the visual system ......................................................................... 1394 3. The tests, waveforms and component nomenclature........................................................................ 1395 3.1. The electroretinogram (ERG) ..................................................................................... 1395 3.1.1. Normal waveforms of scotopic ERG ........................................................................ 1396 3.1.2. Normal waveforms of photopic ERG ........................................................................ 1396 3.2. Pattern electroretinogram (PERG) ................................................................................. 1396 3.3. Multi-focal ERG (mfERG) ........................................................................................ 1396 3.4. Electrooculogram (EOG) ......................................................................................... 1396 3.5. Visual evoked potentials (VEPs) ................................................................................... 1396 3.5.1. Importance of stimulus selection .......................................................................... 1397 3.5.2. Pattern reversal VEPs .................................................................................... 1398 3.5.3. Pattern onset VEPs ...................................................................................... 1398 4. Recommended standard protocols ...................................................................................... 1398 4.1. The electroretinogram (ERG) ..................................................................................... 1398 4.1.1. Electrodes ............................................................................................. 1398 4.1.2. Stimulus .............................................................................................. 1399 4.1.3. Response nomenclature .................................................................................. 1399 4.1.4. Recording ............................................................................................. 1399 4.1.5. Adaptation............................................................................................. 1399 4.1.6. Fixation ............................................................................................... 1400 1388-2457/$36.00 Ó 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.clinph.2010.04.010 * Corresponding author. Address: Moorfields Eye Hospital, 162 City Road, London EC1V 2PD, UK. Tel.: +44 20 7566 2120; fax: +44 20 7566 2556. E-mail address: graham.holder@moorfields.nhs.uk (G.E. Holder). Clinical Neurophysiology 121 (2010) 1393–1409 Contents lists available at ScienceDirect Clinical Neurophysiology journal homepage: www.elsevier.com/locate/clinph