Standards in Pupillography

Kelbsch, Carina; Straßer, Torsten; Chen, Yanjun; Feigl, Beatrix; Gamlin, Paul D.; Kardon, Randy H.; Peters, Tobias; Roecklein, Kathryn A.; Steinhauer, Stuart R.; Szabadi, E.; Zele, Andrew J.; Wilhelm, Helmut; Wilhelm, Barbara

doi:10.3389/fneur.2019.00129

Cited by 146 publications

(191 citation statements)

References 240 publications

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“…Anisocoria has been clinically defined as asymmetry of 1 mm or greater [4,5]. Interstimulus interval between eyes has been shown to affect measurement of pupillary light response amplitudes if the pupil has not returned to its resting diameter, and the necessary interval is shorter in scotopic conditions [18]. Order of eye measurement, thus, could affect anisocoria data if the interstimulus interval is not appropriate.…”

Section: Discussionmentioning

confidence: 99%

Establishing a normative database for quantitative pupillometry in the pediatric population

et al. 2020

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Background: Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting. Methods: Pupillometry was obtained prospectively for consecutive, normal patients < 18 years old being evaluated by Lurie Children's Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark. Results: 196 eyes of 101 participants (42.6% male, ages 1-17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1-8.1 mm 95% CI); MIN was 4.7 mm (3.1-6.1 mm 95% CI); CON was 30% (17-42 95% CI); LAT was 230 milliseconds (160-300 ms 95% CI); ACV was 3.70 mm/sec (2.21-5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38-1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2 and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤ 1.0 mm, respectively. Conclusions: Quantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON.

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Section: Discussionmentioning

confidence: 99%

Establishing a normative database for quantitative pupillometry in the pediatric population

et al. 2020

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“…Moreover, AD patients performed neuropsychological evaluation and the MMSE corrected (MMSEc score) was obtained for all of them. We also collected all the clinical information available, including concomitant medications potentially impacting on pupil function (Chougule et al, 2019;Kelbsch et al, 2019), for both controls and AD patients.…”

Section: Study Participantsmentioning

confidence: 99%

Chromatic Pupillometry Findings in Alzheimer’s Disease

et al. 2020

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Intrinsically photosensitive melanopsin retinal ganglion cells (mRGCs) are crucial for nonimage forming functions of the eye, including the photoentrainment of circadian rhythms and the regulation of the pupillary light reflex (PLR). Chromatic pupillometry, using light stimuli at different wavelengths, makes possible the isolation of the contribution of rods, cones, and mRGCs to the PLR. In particular, post-illumination pupil response (PIPR) is the most reliable pupil metric of mRGC function. We have previously described, in post-mortem investigations of AD retinas, a loss of mRGCs, and in the remaining mRGCs, we demonstrated extensive morphological abnormalities. We noted dendrite varicosities, patchy distribution of melanopsin, and reduced dendrite arborization. In this study, we evaluated, with chromatic pupillometry, the PLR in a cohort of mildmoderate AD patients compared to controls. AD and controls also underwent an extensive ophthalmological evaluation. In our AD cohort, PIPR did not significantly differ from controls, even though we observed a higher variability in the AD group and 5/26 showed PIPR values outside the 2 SD from the control mean values. Moreover, we found a significant difference between AD and controls in terms of rod-mediated transient PLR amplitude. These results suggest that in the early stage of AD there are PLR abnormalities that may reflect a pathology affecting mRGC dendrites before involving the mRGC cell body. Further studies, including AD cases with more severe and longer disease duration, are needed to further explore this hypothesis.

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“…30,31,36,37 All pupil measurements and analysis metrics were completed in accordance with the standards in pupillography. 38…”

Section: Pupillometrymentioning

confidence: 99%

Outer Retinal Structure and Function Deficits Contribute to Circadian Disruption in Patients With Type 2 Diabetes

Dumpala

Zele

Feigl

2019

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Light transmitted by retinal photoreceptors provides the input for circadian photoentrainment. In diabetes, there is a high prevalence of circadian and sleep disruption but the underlying causes are not well understood. Patients with diabetes can exhibit dysfunctional photoreceptors but their role in circadian health is not known. Here we quantify photoreceptor function and contributions to circadian health and sleep in patients with diabetes without diabetic retinopathy and healthy controls. METHODS. Rod, cone, and melanopsin function was derived using chromatic pupillometry in 47 participants including 23 patients with type 2 diabetes and 24 age-matched healthy controls after an ophthalmic examination including retinal thickness assessment using optical coherence tomography. Circadian health was determined using dim light melatonin onset (DLMO) and sleep questionnaires; light exposure was measured using actigraphy. RESULTS. Compared with the control group, the patients with diabetes had a significantly earlier DLMO (1 hour) (P ¼ 0.008), higher subjective sleep scores (P < 0.05), a reduction in pupil constriction amplitude for red stimuli (P ¼ 0.039) and for the early postillumination pupil response (PIPR) for blue (P ¼ 0.024) stimuli. There were no between-group differences in the light exposure pattern, activity levels, and intrinsic melanopsin-mediated PIPR amplitude (P > 0.05). A significant correlation was evident between outer retinal thickness and DLMO (r ¼ À0.65, P ¼ 0.03) and the pupil constriction amplitude (r ¼ 0.63, P ¼ 0.03); patients with thinner retina had earlier DLMO and lower pupil amplitudes. CONCLUSIONS. We infer that the observed changes in circadian function in patients with no diabetic retinopathy are due to structural and functional outer retinal rod photoreceptor deficits at early stage of diabetic eye disease.

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Standards in Pupillography

Cited by 146 publications

References 240 publications

Establishing a normative database for quantitative pupillometry in the pediatric population

Establishing a normative database for quantitative pupillometry in the pediatric population

Chromatic Pupillometry Findings in Alzheimer’s Disease

Outer Retinal Structure and Function Deficits Contribute to Circadian Disruption in Patients With Type 2 Diabetes

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