Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.ophtha.2015.06.002
Title: Pupillary Responses to High-Irradiance Blue Light Correlate with Glaucoma Severity
Authors: RUKMINI, ANNADATA V 
MILEA, DAN 
BASKARAN, MANI 
HOW, ALICIA C 
PERERA, SHAMIRA A 
AUNG, TIN 
GOOLEY, JOSHUA J 
Keywords: Science & Technology
Life Sciences & Biomedicine
Ophthalmology
RETINAL GANGLION-CELLS
MELANOPSIN
ROD
MODEL
CONE
MICE
PHOTORECEPTORS
DISEASE
PUPILLOGRAPHY
EXPOSURE
Issue Date: 1-Sep-2015
Publisher: ELSEVIER SCIENCE INC
Citation: RUKMINI, ANNADATA V, MILEA, DAN, BASKARAN, MANI, HOW, ALICIA C, PERERA, SHAMIRA A, AUNG, TIN, GOOLEY, JOSHUA J (2015-09-01). Pupillary Responses to High-Irradiance Blue Light Correlate with Glaucoma Severity. OPHTHALMOLOGY 122 (9) : 1777-1785. ScholarBank@NUS Repository. https://doi.org/10.1016/j.ophtha.2015.06.002
Abstract: © 2015 American Academy of Ophthalmology. Purpose To evaluate whether a chromatic pupillometry test can be used to detect impaired function of intrinsically photosensitive retinal ganglion cells (ipRGCs) in patients with primary open-angle glaucoma (POAG) and to determine if pupillary responses correlate with optic nerve damage and visual loss. Design Cross-sectional study. Participants One hundred sixty-one healthy controls recruited from a community polyclinic (55 men; 151 ethnic Chinese) and 40 POAG patients recruited from a glaucoma clinic (22 men; 35 ethnic Chinese) 50 years of age or older. Methods Subjects underwent monocular exposure to narrowband blue light (469 nm) or red light (631 nm) using a modified Ganzfeld dome. Each light stimulus was increased gradually over 2 minutes to activate sequentially the rods, cones, and ipRGCs that mediate the pupillary light reflex. Pupil diameter was recorded using an infrared pupillography system. Main Outcome Measures Pupillary responses to blue light and red light were compared between control subjects and those with POAG by constructing dose-response curves across a wide range of corneal irradiances (7-14 log photons/cm2 per second). In patients with POAG, pupillary responses were evaluated relative to standard automated perimetry testing (Humphrey Visual Field [HVF]; Carl Zeiss Meditec, Dublin, CA) and scanning laser ophthalmoscopy parameters (Heidelberg Retinal Tomography [HRT]; Heidelberg Engineering, Heidelberg, Germany). Results The pupillary light reflex was reduced in patients with POAG only at higher irradiance levels, corresponding to the range of activation of ipRGCs. Pupillary responses to high-irradiance blue light associated more strongly with disease severity compared with responses to red light, with a significant linear correlation observed between pupil diameter and HVF mean deviation (r = -0.44; P = 0.005) as well as HRT linear cup-to-disc ratio (r = 0.61; P < 0.001) and several other optic nerve head parameters. Conclusions In glaucomatous eyes, reduced pupillary responses to high-irradiance blue light were associated with greater visual field loss and optic disc cupping. In POAG, a short chromatic pupillometry test that evaluates the function of ipRGCs can be used to estimate the degree of damage to retinal ganglion cells that mediate image-forming vision. This approach could prove useful in detecting glaucoma.
Source Title: OPHTHALMOLOGY
URI: https://scholarbank.nus.edu.sg/handle/10635/155341
ISSN: 01616420
15494713
DOI: 10.1016/j.ophtha.2015.06.002
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