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VERIS ™ by Electro-Diagnostic Imaging, Inc. Redwood City, California, USA Complete integrated System for Visual Electrophysiology First in Multifocal Electrophysiology Comprehensive Visual Electrodiagnostic Testing Traditional (ISCEV Standard) Testing • EOG, Full-Field ERG & Flash VEP, Pattern ERG & VEP Multifocal Testing • mfERG, mfVEP • Automated Ring Ratio Analysis • Optic Nervehead Component (Global Flash Paradigm) ...and more • • • • M-Sequence Full-Field ERG, Pattern VEP, Pattern ERG Full Kernel Analysis ./ Synthesis capability User-Defined Custom Recording and Analysis Protocols Customizable Reports Apple OS X Platform • Exceptionally stable • VERIS data can be stored automatically to any local, network, or Internet-accessible storage device • Choice of open or password-protected file locking of data, analysis settings, and recording settings files • Easy creation of pdf copies of reports for electronic medical records or email communications without additional (3rd party) software • Easy to learn and fun to use! FG1 FMS IV VERIS Platform Available Stimulators: • FMS IV • EMS IV (not shown) • Fresnel Ganzfeld 1 (FG1) • Flat panel displays • Ganzfeld II (not shown) Grass Amplifier Mac Pro VERIS ™ 6 Software Four Levels 1. Traditional • Traditional ISCEV protocols only 2. CLINIC • All Pre-programmed tests • Creating and editing reports 3. SCIENCE • • • • All Pre-programmed tests, Creating and editing reports Creation of new stimulation modes Creation of new analysis schemes 4. PRO • All functions of SCIENCE • Advanced kernel synthesis and modeling ability Real-time Internet support from EDI • Available to all VERIS users by appointment • Real-time monitoring and control of your VERIS system from our California office for training and troubleshooting at your location • Fully encrypted with security controls to ensure privacy of medical information • Requires Internet connection The Conventional Flash ERG Response Response of the retina to a full-field flash derived by means of an electrode placed on or near the cornea of the eye. The basic stimulator used for the derivation of this response is The Ganzfeld Stimulator ISCEV Standard Ganzfeld Protocols • • • • The EDI Ganzfeld 2 Full-Size Ganzfeld Stimulator Flash ERG Flicker ERG Flash VEP EOG The Fresnel Ganzfeld FG1 Supports all Ganzfeld functions FG 1 in handheld use FG 1 is the only handheld Ganzfeld stimulator for binocular recording The retina is not homogeneous in its anatomy and physiology. The distribution of dysfunction is often characteristic for the disease and helpful for diagnosis and disease management. Response Mapping with Multifocal Electrophysiology mfVEP mfERG Hexagon array Monitor screen 120 scaled sectors stimulated with contrast reversing check patterns ~ 40° Corneal Electrode Amplifie r Typical electrode placement Computer Minimum 2 channels: 1 midline 1 lateral Trace array Inion 120 focal VEPs Right eye red Left eye blue Response density Inter-ocular differences Fundus Monitoring Stimulator FMS IV Permits monitoring the patient’s fixation during stimulation Single know spherical refraction with range > 20 diopteer For PERG PVEP mfERG mfVEP Stimulator unit includes: • High resolution color display • Eye camera for patient alignment • IR fundus camera for fixation monitoring Eye Monitoring Stimulator EMS IV Permits monitoring the patient’s eye during stimulation Single know spherical refraction with range > 20 diopters For PERG PVEP mfERG mfVEP Stimulator unit includes: • High resolution color display • Eye camera for patient alignment Clinical recording of multifocal ERGs takes 2 to 7 minutes per eye. The time depends on • The spatial resolution (Veris offers up to 509 stimulus areas within the central 45 deg) • The electrode technique Example from the Clinic: Hydroxychloroquine Toxicity Hydroxychloroquine Retinopathy • A small percentage of patients who take this drug for autoimmune disease develop a bullseye retinopathy. • This retinopathy is, at best, only partially reversible when the patient is taken off the drug. • For disease prevention, the mfERG is now often used for patient screening. Para-central depression Relative sparing of center P1 implicit times are within normal range! Plot is automatically generated red area between outside 30 Divided by total red area Ring aveerages The Multifocal VEP (mfVEP) Placing recording electrodes on the scalp over the visual cortex A sensitive test in unilateral and asymmetric diseases Normal mfVEP 200 nV 0 200 ms Traces from the two eyes match well! Red traces : right eye Blue traces : left eye Example from the Clinic: Optic Neuritis Optic Neuritis on right eye acute phase Record Dated: 03-26-2007 Red traces : right eye Blue traces : left eye Right eye amplitudes severely depressed in central area. Optic Neuritis Recovery 1 Record Dated: 05-19-2007 Red traces : right eye Blue traces : left eye Right eye amplitudes recovered but delayed in central area. Optic Neuritis Recovery 2 Record Dated: 07-23-2007 Red traces : right eye Blue traces : left eye Recovery of delays suggests re-myelination of fibers.