Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

Link, Barbara; Jünemann, Anselm; Rix, R.; Sembritzki, O.; Brenning, Alexander; Korth, Matthias; Horn, Folkert K.

doi:10.1167/iovs.06-0021

Cited by 24 publications

(18 citation statements)

References 44 publications

(39 reference statements)

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“…31,33–37 The findings of these studies are as follows: (1) RAPD is more likely to be present in patients with glaucoma than in controls. 33–35 (2) Patients with glaucoma have greater asymmetry in the IVP between the 2 eyes (as measured by pupil area ratio) 4,32 and greater differences in response to light between the superior and inferior visual field within the same eye. 29,30 (3) Eyes with glaucoma have smaller amplitude, slower velocity, and slower acceleration of pupil constriction than control eyes.…”

Section: Resultsmentioning

confidence: 99%

“…29,30 (3) Eyes with glaucoma have smaller amplitude, slower velocity, and slower acceleration of pupil constriction than control eyes. 32,34,38 (4) Glaucomatous eyes have smaller sustained constriction of PLR after cessation of blue light stimuli compared with controls. 27,28 …”

Section: Resultsmentioning

confidence: 99%

“…Studies have confirmed that patients with glaucoma have lower amplitude, slower velocity, and acceleration of pupil constriction than control subjects. 30,32,34 Determining the exact onset and peak contraction of the pupil is a major challenge when trying to determine whether single eye pupillary responses are abnormal. The action of the smooth iris sphincter muscle does not always cause an abrupt change in the pupil tracing.…”

Section: Discussionmentioning

confidence: 99%

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Accuracy of Pupil Assessment for the Detection of Glaucoma

Chang

Boland

et al. 2013

Ophthalmology

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Objective To assess the accuracy of using pupillary light reflex (PLR) in detecting glaucoma. Clinical Relevance Glaucoma is a specific disease of the optic nerve and is often more severe in 1 eye. When large enough, this asymmetry in disease severity can cause a relative afferent pupillary defect (RAPD). Better detection of RAPDs may be one way to identify persons with glaucoma. Methods We searched Medline and Embase through June 2012 and searched bibliographies for relevant studies for additional references. Two authors independently reviewed all articles and selected studies that assessed PLRs in patients with glaucoma. We analyzed data using mixed-effect bivariate summary receiver operating characteristic meta-analysis models. Results A total of 30 studies were included in this review. An RAPD was observed in 9% to 82% of patients with glaucoma. Eleven studies with a total of 7271 participants were included in the analysis, and the pooled estimate corresponded to a sensitivity of 0.63 (95% confidence interval [CI], 0.43–0.80) and a specificity of 0.93 (95% CI, 0.85–0.97). After excluding 2 studies that used the swinging flashlight test, the sensitivity increased to 0.74 (95% CI, 0.59–0.85) with a specificity of 0.85 (95% CI, 0.77–0.90). Study designs and different pupil measurement techniques explained part of the heterogeneity between studies. Conclusions Patients with glaucoma frequently have an abnormal PLR and comparing the responses between the 2 eyes can in part distinguish between those with glaucoma and those without the disease. Newer instruments and analytic approaches to assess pupil function may improve the performance of pupil screening.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Accuracy of Pupil Assessment for the Detection of Glaucoma

Chang

Boland

et al. 2013

Ophthalmology

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“…[25,30] Similarly, in eyes with optic neuritis or multiple sclerosis, amplitude is decreased and latency is prolonged. In the present study involving eyes with AMD, Loc in AMD did not differ significantly from that in normal eyes; this indicates that the speed of the impulse from the eye to the midbrain, and from the midbrain to the pupil, is almost the same in both eyes.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional pupillographic evaluation of relative afferent pupillary defect in age-related macular degeneration

Takayama

Ito²,

Kaneko³

et al. 2016

Medicine

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To evaluate, using pupillography, the difference between eyes affected by age-related macular degeneration and their contralateral normal eyes with regard to the mean relative afferent pupillary defect (RAPD) score. Also, to ascertain any correlations between this difference in RAPD score and differences in visual acuity or age-related macular degeneration (AMD) dimensions. Measurements were made using the RAPDx pupillographer (Konan Medical, Nishinomiya, Japan), which analyzes pupil response to light stimulation. Both best corrected visual acuity (converted to logMAR) and greatest linear dimension (GLD; calculated on the basis of fluorescence angiography images) were measured. The correlations between RAPD difference and logMAR difference, and GLD difference were then analyzed. The study included 32 patients (18 men, 14 women; mean age = 74.8 ± 9.7 years) who had AMD in 1 eye and a normal fundus in the contralateral eye. Mean resting pupil diameter, mean latency onset of constriction, mean velocity of constriction, and recovery were not significantly different in AMD eyes compared with normal eyes. The mean amplitude of constriction was smaller (P = 0.028), and the mean latency of maximum constriction was shorter (P = 0.0013) in AMD eyes than in normal eyes. Regarding RAPD scores, there was a significant correlation between visual acuity difference and RAPD score differences of both amplitude (P < 0.001, r = 0.53) and latency (P = 0.034, r = 0.33). GLD difference was also significantly correlated with differences in both amplitude (P = 0.021, r = 0.36) and latency (P = 0.033, r = 0.33) scores. RAPD outcomes were correlated with visual acuity and AMD dimension. Automated pupillography may be a useful tool in monitoring the progression of AMD and assessing changes in retinal function that result from novel interventions.

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“…12,13 This is similar to the glaucoma hemifield test, which also tests for asymmetry between the superior and inferior visual fields. 14 In addition, it is likely that pupil responses in glaucoma may be generally diminished when compared to normal subjects, 15 which can also help with detection.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of an Associative Model for the Detection of Glaucoma Using Pupillography

Chang¹,

Arora²,

Boland³

et al. 2013

American Journal of Ophthalmology

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Purpose To develop and validate an associative model using pupillography that best discriminates those with and without glaucoma. Design A prospective case-control study. Methods 148 patients with glaucoma (mean age 67±11) and 71 controls (mean age 60±10) were enrolled in a clinical setting. This prototype pupillometer is designed to record and analyze pupillary responses at multiple, controlled stimulus intensities, while using varied stimulus patterns and colors. We evaluated three approaches: 1) comparing the responses between the two eyes, 2) comparing responses to stimuli between the superonasal and inferonasal fields within each eye, and 3) calculating the absolute pupil response of each individual eye. Associative models were developed using stepwise regression or forward selection with Akaike information criterion and validated with 5-fold cross validation. We assessed the associative model using sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC). Results Persons with glaucoma had a more asymmetric pupil response between the two eyes (p<0.001), between superonasal and inferonasal visual field within the same eye (p=0.014), and also had a smaller amplitude, slower velocity and longer latency of pupil response compared to controls (all p<0.001). A model including age and these three components resulted in an AUROC of 0.87 (95% CI 0.83 to 0.92) with 80% sensitivity and specificity in detecting glaucoma. This result remained robust after cross-validation. Conclusions Using pupillography, we were able to discriminate persons with glaucoma from those with normal eye exams. With refinement, pupil testing may provide a simple approach for glaucoma screening.

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Pupillographic Measurements with Pattern Stimulation: The Pupil’s Response in Normal Subjects and First Measurements in Glaucoma Patients

Cited by 24 publications

References 44 publications

Accuracy of Pupil Assessment for the Detection of Glaucoma

Accuracy of Pupil Assessment for the Detection of Glaucoma

Cross-sectional pupillographic evaluation of relative afferent pupillary defect in age-related macular degeneration

Development and Validation of an Associative Model for the Detection of Glaucoma Using Pupillography

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