Multifocal Pupillography Identifies Changes in Visual Sensitivity According to Severity of Diabetic Retinopathy in Type 2 Diabetes

Sabeti, Faran; Nolan, Christopher; James, Andrew; Jenkins, Alicia J.; Maddess, Ted

doi:10.1167/iovs.15-16712

Cited by 26 publications

(41 citation statements)

References 49 publications

(82 reference statements)

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“…Note that asymmetry adds the effects of hyper- and hypo-sensitivity across congruent regions in the two eyes. Asymmetries provided perfect performance (AUC = 1.0) for eyes with mild to moderate retinopathy25.…”

Section: Discussionmentioning

confidence: 97%

“…We did not have and T2D subjects in this cohort who had mild/moderate non-proliferative retinopathy to determine if similar results are replicated. However other mfPOP studies from our lab have demonstrated sensitivity loss and response delays with progression to mild/moderate NPDR25. That study explicitly compared the diagnostic power of regions of sensitivity loss, hypersensitive regions, and the asymmetry between regions.…”

Section: Discussionmentioning

confidence: 99%

“…This is driven by a combination of visual field regions showing both sensitivity reductions and moderate sensitivity increases, and is assisted by the two eyes being tested simultaneously, providing a within subject control. In the earliest stages of diabetes the localised sensitivity increases measured by mfPOP can provide better sensitivity and specificity than sensitivity losses25.…”

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confidence: 99%

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Comparing multifocal pupillographic objective perimetry (mfPOP) and multifocal visual evoked potentials (mfVEP) in retinal diseases

Sabeti

James

Carle

et al. 2017

Sci Rep

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Multifocal pupillographic objective perimetry (mfPOP) shows regions of slight hypersensitivity away from retinal regions damaged by diabetes or age-related macular degeneration (AMD). This study examines if such results also appear in multifocal visual evoked potentials (mfVEPs) recorded on the same day in the same patients. The pupil control system receives input from the extra-striate cortex, so we also examined evidence for such input. We recruited subjects with early type 2 diabetes (T2D) with no retinopathy, and patients with unilateral exudative AMD. Population average responses of the diabetes patients, and the normal fellow eyes of AMD patients, showed multiple regions of significant hypersensitivity (p < 0.05) on both mfPOP and mfVEPs. For mfVEPs the occipital electrodes showed fewer hypersensitive regions than the surrounding electrodes. More advanced AMD showed regions of suppression becoming centrally concentrated in the exudative AMD areas. Thus, mfVEP electrodes biased towards extra-striate cortical responses (surround electrodes) appeared to show similar hypersensitive visual field locations to mfPOP in early stage diabetic and AMD damage. Our findings suggest that hypersensitive regions may be a potential biomarker for future development of AMD or non-proliferative diabetic retinopathy, and may be more informative than visual acuity which remains largely undisturbed during early disease.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparing multifocal pupillographic objective perimetry (mfPOP) and multifocal visual evoked potentials (mfVEP) in retinal diseases

Sabeti

James

Carle

et al. 2017

Sci Rep

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“…Relatively recent advances in the understanding of the neural mechanisms that mediate the pupil response have greatly renewed interest in pupillometry as a tool for assessing retinal function in patients with acquired91011 and inherited12131415 retinal disease. That is, the afferent limb of the pupillary response to light is now thought to be driven primarily by intrinsically photosensitive retinal ganglion cells (ipRGCs) that contain the photopigment melanopsin1617.…”

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confidence: 99%

Pupillary responses in non-proliferative diabetic retinopathy

Park

Chen

Blair

et al. 2017

Sci Rep

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The goal of this study was to determine the extent of rod-, cone-, and melanopsin-mediated pupillary light reflex (PLR) abnormalities in diabetic patients who have non-proliferative diabetic retinopathy (NPDR). Fifty diabetic subjects who have different stages of NPDR and 25 age-equivalent, non-diabetic controls participated. PLRs were measured in response to full-field, brief-flash stimuli under conditions that target the rod, cone, and intrinsically-photosensitive (melanopsin) retinal ganglion cell pathways. Pupil responses were compared among the subjects groups using age-corrected linear mixed models. Compared to control, the mean baseline pupil diameters were significantly smaller for all patient groups in the dark (all p < 0.001) and for the moderate-severe NPDR group in the light (p = 0.003). Pairwise comparisons indicated: (1) the mean melanopsin-mediated PLR was significantly reduced in the mild and moderate-severe groups (both p < 0.001); (2) the mean cone-mediated PLR was reduced significantly in the moderate-severe group (p = 0.008); (3) no significant differences in the mean rod-mediated responses. The data indicate abnormalities in NPDR patients under conditions that separately assess pupil function driven by different photoreceptor classes. The results provide evidence for compromised neural function in these patients and provide a promising approach for quantifying their neural abnormalities.

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“…It tests both eyes concurrently in under 7 min using responses of the pupils. Its design makes it tolerant of senescent pupils and the macular test has high diagnostic power in early stage diabetes and AMD . The presence of slight hypersensitivities within these fields seems to predict which Wet‐AMD patient response to anti‐VEGF treatment .…”

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confidence: 99%

To BCVA, or not to BCVA, that is the question

Maddess

Daria

2017

Clinical Exper Ophthalmology

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Multifocal Pupillography Identifies Changes in Visual Sensitivity According to Severity of Diabetic Retinopathy in Type 2 Diabetes

Abstract: Asymmetry in local response delays measured by mfPOP may provide useful information regarding the severity of diabetic retinopathy and may have clinical use as a rapid, noninvasive method for identifying functional loss even in the absence of NPDR.

Cited by 26 publications

References 49 publications

Comparing multifocal pupillographic objective perimetry (mfPOP) and multifocal visual evoked potentials (mfVEP) in retinal diseases

Comparing multifocal pupillographic objective perimetry (mfPOP) and multifocal visual evoked potentials (mfVEP) in retinal diseases

Pupillary responses in non-proliferative diabetic retinopathy

To BCVA, or not to BCVA, that is the question

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