Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.ophtha.2018.02.024
Title: Pupillary Responses to Full-Field Chromatic Stimuli Are Reduced in Patients with Early-Stage Primary Open-Angle Glaucoma
Authors: NAJJAR, RAYMOND P 
SHARMA, SOURABH
ATALAY, ERAY
RUKMINI, ANNADATA V 
SUN, CHRISTOPHER
LOCK, JING ZHAN
BASKARAN, MANI 
PERERA, SHAMIRA A 
HUSAIN, RAHAT 
LAMOUREUX, ECOSSE 
GOOLEY, JOSHUA J 
AUNG, TIN 
MILEA, DAN 
Keywords: Science & Technology
Life Sciences & Biomedicine
Ophthalmology
RETINAL GANGLION-CELLS
FIBER LAYER THICKNESS
LIGHT REFLEX
MELANOPSIN
PHOTORECEPTORS
PROJECTIONS
PREVALENCE
IRRADIANCE
DRIVEN
OUTER
Issue Date: 1-Sep-2018
Publisher: ELSEVIER SCIENCE INC
Citation: NAJJAR, RAYMOND P, SHARMA, SOURABH, ATALAY, ERAY, RUKMINI, ANNADATA V, SUN, CHRISTOPHER, LOCK, JING ZHAN, BASKARAN, MANI, PERERA, SHAMIRA A, HUSAIN, RAHAT, LAMOUREUX, ECOSSE, GOOLEY, JOSHUA J, AUNG, TIN, MILEA, DAN (2018-09-01). Pupillary Responses to Full-Field Chromatic Stimuli Are Reduced in Patients with Early-Stage Primary Open-Angle Glaucoma. OPHTHALMOLOGY 125 (9) : 1362-1371. ScholarBank@NUS Repository. https://doi.org/10.1016/j.ophtha.2018.02.024
Abstract: © 2018 American Academy of Ophthalmology Purpose: To evaluate the ability of chromatic pupillometry to reveal abnormal pupillary responses to light in patients with early-stage primary open-angle glaucoma (POAG) and to test whether the degree of pupillometric impairment correlates with structural hallmarks of optic nerve damage in the disease. Design: Cross-sectional study. Participants: Forty-six patients with early-stage POAG (63.4±8.3 years, 63% male, 87% ethnic-Chinese) and 90 age-matched healthy controls (61.4±8.6 years, 34% male, 89% ethnic-Chinese). Patients with POAG had a visual field mean deviation (VFMD) of −6 decibels or better on automated perimetry. Methods: Each participant underwent a monocular 2-minute exposure to blue light (462 nm) followed by another 2-minute exposure to red light (638 nm) using a modified Ganzfeld dome equipped with a light-emitting diode lighting system. The light stimuli intensity was increased logarithmically to evaluate the combined extrinsic and intrinsic response of intrinsically photosensitive retinal ganglion cells (ipRGCs). Light-induced changes in horizontal pupil diameter were assessed monocularly using infrared pupillography. Main Outcome Measures: Baseline-adjusted, light-induced pupillary constriction amplitudes were calculated, and individual irradiance-response curves were constructed for each stimulus. Pupillary constriction amplitudes were compared between groups and across light intensities using a linear mixed model analysis. The linear relationship between pupillometric parameters and different structural and functional features of glaucoma was assessed using Pearson's correlation analysis. Results: Light-induced pupillary constriction was reduced in patients with early-stage POAG compared with controls at moderate to high irradiances (≥11 Log photons/cm2/s) of blue (P = 0.003) and red (P < 0.001) light. Maximal pupillary constriction amplitude was correlated with retinal nerve fiber layer thickness (RNFL) thickness (blue: r = 0.51, P < 0.001; red: r = 0.45, P = 0.002) in patients with POAG but not in controls. Conversely, pupillometric parameters were not correlated with visual field scores in patients with early-stage POAG. Conclusions: Patients with early-stage POAG exhibit reduced pupillary responses to moderate and high irradiances of blue and red lights. This wavelength-independent functional alteration correlates with structural thinning of the RNFL and could be the consequence of dysfunction or loss of melanopsin expressing ipRGCs in the early stages of the disease.
Source Title: OPHTHALMOLOGY
URI: https://scholarbank.nus.edu.sg/handle/10635/155338
ISSN: 01616420
15494713
DOI: 10.1016/j.ophtha.2018.02.024
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