Minor effect of inaccurate fixation on VEP-based acuity estimates

Purpose VEP-based estimation of visual acuity may be used in cases of suspected malingering to objectify subjective complaints. In such an application, a lack of cooperation needs to be expected. The same may apply to young children with suspected functional impairments. In the present study, we assessed how inaccurate fixation affects the acuity estimates obtained with a VEP technique. Methods VEP-based acuity estimates were obtained by stimulating with a series of different check sizes using a 'stepwise sweep' protocol. Sixteen participants were tested with normal and degraded vision under five different fixation conditions (central fixation and eccentric fixation at top, bottom, right, and left edge of the stimulus area). Results The majority of individual acuity estimates with eccentric fixation differed by less than 0.1 logMAR from central fixation, and almost all estimates differed by less than 0.3 logMAR. Median estimates with eccentric fixation differed only slightly (up to 0.08 logMAR) and, except for top fixation with normal vision, non-significantly. However, data quality was lower with eccentric fixation, which increased the probability that no acuity estimate could be derived from the recording. Conclusion VEP-based acuity estimates are relatively insensitive to eccentric fixation. Unnoticed deviations from central fixation in routine applications will probably be smaller than in the present study and will have even less impact on the outcome.