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Title: Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma
Authors: Najjar Raymond 
Rukmini, AV
Finkelstein, Maxwell T
Nusinovici, Simon 
Mani, Baskaran 
Nongpiur, Monisha Esther
Perera, Shamira 
Husain, Rahat 
Aung, Tin 
Milea, D. 
Issue Date: 2021
Publisher: BMJ
Citation: Najjar Raymond, Rukmini, AV, Finkelstein, Maxwell T, Nusinovici, Simon, Mani, Baskaran, Nongpiur, Monisha Esther, Perera, Shamira, Husain, Rahat, Aung, Tin, Milea, D. (2021). Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma. British Journal of Ophthalmology. ScholarBank@NUS Repository.
Abstract: Background/aimsEarly detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.MethodsIn this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF).ResultsPupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT.ConclusionHCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.
Source Title: British Journal of Ophthalmology
ISSN: 00071161
DOI: 10.1136/bjophthalmol-2021-319938
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