Clinical Applications of Pupillography

Wilhelm, Helmut; Wilhelm, Barbara

doi:10.1097/00041327-200303000-00010

Cited by 102 publications

(89 citation statements)

References 29 publications

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“…Pupil responses are recognized to have large inter-and intra-subject variability (Wilhelm and Wilhelm, 2003). To assess the reliability of pupillometry in rabbits, we collected data weekly for seven consecutive weeks from five control rabbits.…”

Section: Reliability Of Pupillometry In Control Rabbitsmentioning

confidence: 99%

Dysfunction of the pupillary light reflex in experimental autoimmune autonomic ganglionopathy

Mukherjee¹,

Vernino²

2007

Autonomic Neuroscience

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Autoimmune autonomic ganglionopathy (AAG) is an antibody-mediated form of severe autonomic failure. AAG is associated with serum antibodies against ganglionic acetycholine receptors (AChR) and appears to result from impaired synaptic transmission in autonomic ganglia. The rabbit model of experimental AAG (EAAG), induced by immunization, reproduces the cardinal features of the human disease. Pupillary dysfunction is a prominent and defining feature in both AAG and EAAG. We adapted infrared computer-assisted video pupillometry to record direct pupil light responses in control and EAAG rabbits. Offline analysis algorithms were used to determine latency, velocity and amplitude of the constriction and redilation phases of the light reflex. Following immunization, pupillary abnormalities were the earliest sign of evolving autonomic failure. EAAG rabbits showed significant reduction in velocity and amplitude of pupil constriction while redilation parameters were only mildly affected. Fatigue in pupillary constriction, evidenced by premature redilation of the pupil prior to termination of the light stimulus, was observed only in seropositive rabbits. The severity of pupillary abnormalities was significantly correlated with ganglionic AChR antibody level. In chronic EAAG, treatment with pyridostigmine produced a partial recovery of pupil function. We conclude that pupillometry is a robust and sensitive diagnostic tool to assess autonomic dysfunction, distinguish AAG from other disorders, and assess responses to therapy. In EAAG, pupillary dysfunction is partially reversible, parasympathetic pupil function is more severely compromised than sympathetic function, and fatigue of pupillary constriction may be seen. These characteristic abnormalities of the pupillary light reflex may prove to have diagnostic value.

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Section: Reliability Of Pupillometry In Control Rabbitsmentioning

confidence: 99%

Dysfunction of the pupillary light reflex in experimental autoimmune autonomic ganglionopathy

Mukherjee¹,

Vernino²

2007

Autonomic Neuroscience

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“…Además, los desarrollos de la pupilometría por infrarrojos (IRPG), han propiciado una mayor precisión en el método de registro del reflejo pupilar, lo que permite un tratamiento más exhaustivo de la secuencia temporal y espacial de los cambios de los valores pupilares de tipo estático y dinámico (Wilhelm y Wilhelm, 2003).…”

Section: Recibido: Enero 2013 Aceptado: Marzo 2013unclassified

Utilidad de la pupilometría dinámica en el control de alcoholemia de los conductores

et al. 2013

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Resumen AbstractPupillometry is becoming a relevant tool in Vision Sciences. So far, only a few studies have explored the relationship between pupil reflex measures and drug consumption. The aim of this study was to assess the applicability of dynamic mesopic pupillometry as an objective measurement method for the detection of blood alcohol levels above the legal limit. In a quasiexperimental design, 19 volunteers were asked to participate in two conditions (before and after alcohol intake). In session with alcohol intake, participants were asked to consume 27.5 ml of alcohol in 60 minute intervals for four hours. Pupillometry records were conducted by means of the Power Refractor II, using four types of light stimulation: white (5600 K), blue (450 nm), green (510 nm) and red (600 nm). The basal diameter of the pupil increased significantly for alcohol concentrations equal to or greater than 0.25 mg/l in exhaled breath. Moreover, the value of the amplitude for red light constriction also provided significant differences between the two conditions. These results are promising in the search for new methods to detect illegal alcohol levels among drivers. This study demonstrates that basal pupil diameter increase and amplitude response could be used as an alcohol consumption level indicator. However, further studies are necessary to validate this and other diagnose methods complementary to breathalyzer and other drugs tests.

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“…Similarly, parasympathetic innervation causes contraction of the circular muscle of the iris, which affects amplitude of pupillary reaction and maximum constriction velocity after light exposure ( Figure 1). [11][12][13] PLR abnormalities precede CAT abnormalities and symptomatic neuropathy in diabetes but have not been evaluated in Chagas disease. 11,14,15 If PLRs could differentiate people with these diseases, they would be useful screening tools to identify patients who would benefit from intensified treatment.…”

Section: Introductionmentioning

confidence: 99%

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

Halperin

Pajuelo

Tornheim

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.

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Clinical Applications of Pupillography

Cited by 102 publications

References 29 publications

Dysfunction of the pupillary light reflex in experimental autoimmune autonomic ganglionopathy

Dysfunction of the pupillary light reflex in experimental autoimmune autonomic ganglionopathy

Utilidad de la pupilometría dinámica en el control de alcoholemia de los conductores

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

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