Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Xiao-yin, Zhou; Fukuyama, Hisashi; Okita, Yoichi; Kanda, Hiroyuki; Yamamoto, Yuki; Araki, Takashi; Gomi, Fumi

doi:10.1167/iovs.63.10.2

Cited by 7 publications

(10 citation statements)

References 42 publications

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“…The pupillary response can therefore provide a sensitive, inexpensive, and non-invasive measure that reflects the ANS pathways. The response has been utilized to assess diseases, various cognitive tasks, and autonomic activation ( Reddy et al, 2018 ; Zhou X. et al, 2022 ). By comparing the results of the participants’ pupillary light reflex in MS induced by the rotary chair and before, we found that the PCV and PMD in both of the participants’ eyes were significantly reduced, which may be related to the changes in the autonomic nervous function.…”

Section: Discussionmentioning

confidence: 99%

Hypoxic acclimatization training improves the resistance to motion sickness

Wang,

Yan,

Tie

et al. 2023

Front. Neurosci.

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ObjectiveVestibular provocation is one of the main causes of flight illusions, and its occurrence is closely related to the susceptibility of motion sickness (MS). However, existing training programs have limited effect in improving the resistance to motion sickness. In this study, we investigated the effects of hypoxia acclimatization training (HAT) on the resistance to motion sickness.MethodsHealthy military college students were identified as subjects according to the criteria. MS model was induced by a rotary chair. Experimental groups included control, HAT, 3D roller training (3DRT), and combined training.ResultsThe Graybiel scores were decreased in the HAT group and the 3DRT group and further decreased in the combined training group in MS induced by the rotary chair. Participants had a significant increase in blood pressure after the rotary chair test and a significant increase in the heart rate during the rotary chair test, but these changes disappeared in all three training groups. Additionally, LFn was increased, HFn was decreased, and LF/HF was increased accordingly during the rotary chair test in the control group, but the changes of these three parameters were completely opposite in the three training groups during the rotary chair test. Compared with the control group, the decreasing changes in pupillary contraction velocity (PCV) and pupillary minimum diameter (PMD) of the three training groups were smaller. In particular, the binocular PCV changes were further attenuated in the combined training group.ConclusionOur research provides a possible candidate solution for training military pilots in the resistance to motion sickness.

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Section: Discussionmentioning

confidence: 99%

Hypoxic acclimatization training improves the resistance to motion sickness

Wang,

Yan,

Tie

et al. 2023

Front. Neurosci.

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“…Our previous study compared healthy subjects and patients with CSC regarding pupillary responses and HRV, but not anatomic or imaging characteristics. 5 Combining PLR data from this previous study with more recent cases and cases in which HRV measurements failed, the current cases were collected from April 2020 to September 2022. Participants were recruited from the Department of Ophthalmology at the Hyogo Medical University (Japan) after providing written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…A detailed description of this device and the experimental process were given in our previous study. 5 The experiment was conducted between 12:00 and 15:00. Patients were provided with detailed instructions before the commencement of the PLR task.…”

Section: Methodsmentioning

confidence: 99%

“…The synchronization of stimuli and pupil recordings by the eye tracker facilitated the following PLR metrics 5 evaluation ( Fig. 1 A): (1) pupil diameters: 1-second baseline pupil diameter (BPD) before the flash onset; (2) constriction phase (parasympathetic nervous system innervation): minimum pupil diameter (MIN), AMP (BPD − MIN), the ratio of AMP to BPD (AMP%) as the relative amplitude, maximum constriction velocity and acceleration (MCV and MCA, respectively); time from flash onset to the minimum pupil diameter (T1) and maximum velocity (T2); and (3) re-dilation phase (SNS innervation): pupil diameter (D1) at 5.5 seconds (3.5 seconds after light offset) and the ratio of D1 to the BPD as the re-dilation ratio (D1%).…”

Section: Methodsmentioning

confidence: 99%

“…Our previous study discovered that patients with CSC had sympathetic activation, parasympathetic inhibition, a higher total mood disturbance, and more negative mood scores than healthy volunteers, as examined by a combination of pupillary responses, heart rate variability (HRV), and the Profile of Mood States questionnaire. 5 …”

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Pupillary Light Reflex and Multimodal Imaging in Patients With Central Serous Chorioretinopathy

Zhou,

Fukuyama,

Sugisawa

et al. 2023

Invest. Ophthalmol. Vis. Sci.

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Purpose The purpose of this study was to investigate and compare the corresponding alterations of the pupillary response between acute and chronic central serous chorioretinopathy (CSC) and between different disease categories. Methods We recruited patients with unilateral acute and chronic CSC. An eye tracker was applied to determine the pupillary light reflex (PLR) and evaluate the following PLR metrics in healthy eyes: pupil diameter, diameter changes, including relative constriction amplitude (AMP%), and re-dilation ratio (D1%). Baseline optical coherence tomography (OCT), and fluorescein and indocyanine green angiography (FA/ICGA) were performed to analyze the relationship between pupillary response and retinal/choroidal architecture. Results In total, 52 patients were enrolled, including 25 with acute CSC and 27 with chronic CSC. Compared to the chronic CSC group, the acute CSC group displayed a significantly larger baseline pupil diameter (BPD; of 5.51 mm, P = 0.015), lower AMP% (34.40%, P = 0.004), and higher D1% (93.01%, P = 0.002), indicating sympathetic overactivity. On OCT, the total macular volume was positively correlated with the D1% ( r = 0.48, P = 0.005) and negatively with AMP ( r = −0.47, P = 0.007). On ICGA, the intense choroidal vascular hyperpermeability (CVH) group displayed a greater BPD than the nonintense CVH group. Additionally, 9 cases with later recurrent episodes following therapy showed a lower AMP% and higher D1% than the nonrecurrent group. Conclusions The PLR revealed sympathetic excitation in patients with acute CSC. The stronger D1% was significantly associated with greater total macular volume, and it may be a potential biomarker for predicting the later recurrence of CSC.

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The choroidal nervous system: a link between mineralocorticoid receptor and pachychoroid

Leclercq,

Weiner,

Zola

et al. 2023

Acta Neuropathol

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Central serous chorioretinopathy (CSCR) belongs to the pachychoroid spectrum, a pathological phenotype of the choroidal vasculature, in which blood flow is under the choroidal nervous system (ChNS) regulation. The pathogenesis of CSCR is multifactorial, with the most recognised risk factor being intake of glucocorticoids, which activate both the gluco- and the mineralocorticoid (MR) receptors. As MR over-activation is pathogenic in the retina and choroid, it could mediate the pathogenic effects of glucocorticoids in CSCR. But the role of MR signalling in pachychoroid is unknown and whether it affects the ChNS has not been explored. Using anatomo-neurochemical characterisation of the ChNS in rodents and humans, we discovered that beside innervation of arteries, choroidal veins and choriocapillaris are also innervated, suggesting that the entire choroidal vasculature is under neural control. The numerous synapses together with calcitonin gene-related peptide (CGRP) vesicles juxtaposed to choroidal macrophages indicate a neuro-immune crosstalk. Using ultrastructural approaches, we show that transgenic mice overexpressing human MR, display a pachychoroid-like phenotype, with signs of choroidal neuropathy including myelin abnormalities, accumulation and enlargement of mitochondria and nerves vacuolization. Transcriptomic analysis of the RPE/choroid complex in the transgenic mice reveals regulation of corticoids target genes, known to intervene in nerve pathophysiology, such as Lcn2, rdas1/dexras1, S100a8 and S100a9, rabphilin 3a (Rph3a), secretogranin (Scg2) and Kinesin Family Member 5A (Kif5a). Genes belonging to pathways related to vasculature development, hypoxia, epithelial cell apoptosis, epithelial mesenchymal transition, and inflammation, support the pachychoroid phenotype and highlight downstream molecular targets. Hypotheses on the imaging phenotype of pachychoroid in humans are put forward in the light of these new data. Our results provide evidence that MR overactivation causes a choroidal neuropathy that could explain the pachychoroid phenotype found in transgenic mice overexpressing human MR. In patients with pachychoroid and CSCR in which systemic dysautonomia has been demonstrated, MR-induced choroidal neuropathy could be the missing link between corticoids and pachychoroid.

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Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

Cited by 7 publications

References 42 publications

Hypoxic acclimatization training improves the resistance to motion sickness

Hypoxic acclimatization training improves the resistance to motion sickness

Pupillary Light Reflex and Multimodal Imaging in Patients With Central Serous Chorioretinopathy

The choroidal nervous system: a link between mineralocorticoid receptor and pachychoroid

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