Static and dynamic pupil characteristics in pseudoexfoliation syndrome and glaucoma

Kemal Tekin, Hasan Kiziltoprak, Mehmet Ali Sekeroglu, Esat Yetkin, Serdar Bayraktar, Pelin Yilmazbas, Kemal Tekin, Hasan Kiziltoprak, Mehmet Ali Sekeroglu, Esat Yetkin, Serdar Bayraktar, Pelin Yilmazbas

Abstract

Background: To compare the static and dynamic pupillometry measurements in patients with pseudoexfoliation syndrome (PES), patients with pseudoexfoliation glaucoma (PEG) and age-matched healthy subjects using an automatic quantitative pupillometry system.

Methods: This prospective, cross-sectional study consisted of 40 patients with PES, 30 patients with PEG and 43 control subjects. Static pupillometry measurements including scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter were undertaken. Subsequently, dynamic pupillometry measurements including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation were undertaken. These measurements were compared between the groups.

Results: The scotopic, mesopic, and low photopic pupil diameter values were statistically significantly lower in patients with PES and PEG compared with controls (p < 0.001). However, these parameters were similar between the patients with PES and PEG (p > 0.05). The mean values of high photopic pupil diameter were similar within all groups (p = 0.54). The amplitude of pupil contraction values of the patients with PEG was statistically significantly lower than the patients with PES and the controls (p < 0.05). Patients with PES also had significantly lower amplitude of pupil contraction values compared with controls (p < 0.001). Additionally, the velocity of pupil contraction values was statistically significantly higher in control subjects when compared to the patients with PES and PEG (p < 0.05).

Conclusion: This study demonstrated that accumulation of pseudoexfoliative material can cause alterations in static and dynamic pupillary characteristics and the progression from PES to PEG may be associated with reduced amplitude of pupil contraction values.

Keywords: dynamic pupillometry; pseudoexfoliation glaucoma; pseudoexfoliation syndrome; pupil diameter; static pupillometry.

© 2019 Optometry Australia.

References

REFERENCES

    1. Anastasopoulos E, Founti P, Topouzis F. Update on pseudoexfoliation syndrome pathogenesis and associations with intraocular pressure, glaucoma and systemic diseases. Curr Opin Ophthalmol 2015; 26: 82-89.
    1. Naumann GO, Schlötzer-Schrehart U, Küchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist: intraocular and systemic manifestations. Ophthalmology 1998; 105: 951-968.
    1. Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019; 13: 453-464.
    1. Ritch R. Ocular and systemic manifestations of exfoliation syndrome. J Glaucoma 2014; 23: 1-8.
    1. Ritch R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. J Glaucoma 1994; 3: 176-177.
    1. Musch DC, Shimizu T, Niziol LM et al. Clinical characteristics of newly diagnosed primary, pigmentary and pseudoexfoliative open-angle glaucoma in the collaborative initial glaucoma treatment study. Br J Ophthalmol 2012; 96: 1180-1184.
    1. Kardon R. Pupillary light reflex. Curr Opin Ophthalmol 1995; 6: 20-26.
    1. Girkin CA. Evaluation of the pupillary light response as an objective measure of visual function. Ophthalmol Clin North Am 2003; 16: 143-153.
    1. Lowenstein O, Loewenfeld I. Electronic pupillography. Arch Ophthalmol 1958; 59: 352-363.
    1. Tekin K, Sekeroglu MA, Kiziltoprak H et al. Static and dynamic pupillometry data of healthy individuals. Clin Exp Optom 2018; 101: 659-665.
    1. Bootsma S, Tahzib N, Eggink F et al. Comparison of two pupillometers in determining pupil size for refractive surgery. Acta Ophthalmol Scand 2007; 85: 324-328.
    1. Kankipati L, Girkin CA, Gamlin PD. The post-illumination pupil response is reduced in glaucoma patients. Invest Ophthalmol Vis Sci 2011; 52: 2287-2292.
    1. Tatham AJ, Meira-Freitas D, Weinreb RN et al. Estimation of retinal ganglion cell loss in glaucomatous eyes with a relative afferent pupillary defect. Invest Ophthalmol Vis Sci 2014; 55: 513-522.
    1. Sarezky D, Volpe NJ, Park MS et al. Correlation between inter-eye difference in average retinal nerve fiber layer thickness and afferent pupillary response as measured by an automated pupillometer in glaucoma. J Glaucoma 2016; 25: 312-316.
    1. Yüksel N, Karabaş VL, Arslan A et al. Ocular hemodynamics in pseudoexfoliation syndrome and psedoexfoliation glaucoma. Ophthalmology 2001; 108: 1043-1049.
    1. Kesler A, Shemesh G, Rothkoff L et al. Effect of brimonidine tartrate 0.2% ophthalmic solution on pupil size. J Cataract Refract Surg 2004; 30: 1707-1710.
    1. Lie TC, Domino EF. Effects of tobacco smoking on the human pupil. Int J Clin Pharmacol Ther 1999; 37: 184-188.
    1. Erdem U, Gundogan FC, Dinc UA et al. Acute effect of cigarette smoking on pupil size and ocular aberrations: a pre- and post-smoking study. J Ophthalmol 2015; 2015: 625470.
    1. Zele AJ, Feigl B, Smith SS et al. The circadian response of intrinsically photosensitive retinal ganglion cells. PLoS One 2011; 6: 17860.
    1. Bergamin O, Zimmerman MB, Kardon RH. Pupil light reflex in normal and diseased eyes: diagnosis of visual dysfunction using waveform partitioning. Ophthalmology 2003; 110: 106-114.
    1. Portran P, Cour M, Hernu R et al. Pupillary abnormalities in non-selected critically ill patients: an observational study. J Thorac Dis 2017; 9: 2528-2533.
    1. Park JC, Moss HE, McAnany JJ. The pupillary light reflex in idiopathic intracranial hypertension. Invest Ophthalmol Vis Sci 2016; 57: 23-29.
    1. Schöder S, Chaschina E, Janunts E et al. Reproducibility and normal values of static pupil diameters. Eur J Ophthalmol 2018; 28: 150-156.
    1. Ulviye Y, Onur IU, Tufan AK et al. Assessment of pupil diameters in pseudoexfoliation syndrome under scotopic, mesopic, photopic and dynamic conditions using infrared pupillometer. Br J Med Med Res 2015; 7: 877-883.
    1. Yülek F, Konukseven OO, Cakmak HB et al. Comparison of the pupillometry during videonystagmography in asymmetric pseudoexfoliation patients. Curr Eye Res 2008; 33: 263-267.
    1. Tekin K, Sekeroglu MA, Kiziltoprak H et al. Static and dynamic pupillary characteristics in clinically unilateral pseudoexfoliation syndrome. J Glaucoma 2018; 27: 552-557.
    1. Park JW, Kang BH, Kwon JW et al. Analysis of various factors affecting pupil size in patients with glaucoma. BMC Ophthalmol 2017; 17: 168.
    1. Park HL, Jung SH, Park SH et al. Detecting autonomic dysfunction in patients with glaucoma using dynamic pupillometry. Medicine (Baltimore) 2019; 98: e14658.
    1. Grozdanic SD, Betts DM, Sakaguchi DS et al. Temporary elevation of the intraocular pressure by cauterization of vortex and episcleral veins in rats causes functional deficits in the retina and optic nerve. Exp Eye Res 2003; 77: 27-33.
    1. Feigl B, Mattes D, Thomas R et al. Intrinsically photosensitive (melanopsin) retinal ganglion cell function in glaucoma. Invest Ophthalmol Vis Sci 2011; 52: 4362-4367.
    1. Rukmini AV, Milea D, Baskaran M et al. Pupillary responses to high-irradiance blue light correlate with glaucoma severity. Ophthalmology 2015; 122: 1777-1785.
    1. Najjar RP, Sharma S, Atalay E et al. Pupillary responses to full-field chromatic stimuli are reduced in patients with early-stage primary open angle glaucoma. Ophthalmology 2018; 125: 1362-1371.
    1. Martucci A, Cesareo M, Napoli D et al. Evaluation of pupillary response to light in patients with glaucoma: a study using computerized pupillometry. Int Ophthalmol 2014; 34: 1241-1247.
    1. Link B, Jünemann A, Rix R et al. Pupillographic measurements with pattern stimulation: the pupil's response in normal subjects and first measurements in glaucoma patients. Invest Ophthalmol Vis Sci 2006; 47: 4947-4955.
    1. Adhikari P, Zele AJ, Thomas R et al. Quadrant field pupillometry detects melanopsin dysfunction in glaucoma suspects and early glaucoma. Sci Rep 2016; 6: 33373.
    1. Harwerth RS, Crawford ML, Frishman LJ et al. Visual field defects and neural losses from experimental glaucoma. Prog Retin Eye Res 2002; 21: 91-125.
    1. Gamlin PD, McDougal DH, Pokorny J et al. Human and macaque pupil responses driven by melanopsin-containing retinal ganglion cells. Vision Res 2007; 47: 946-954.
    1. Markwell EM, Feigl B, Zele AJ. Intrinsically photosensitive melanopsin retinal ganglion cell contributions to the pupillary light reflex and circadian rhythm. Clin Exp Optom 2010; 93: 137-149.
    1. Ba-Ali S, Sander B, Brøndsted AE, Lund-Andersen H. Effect of topical anti-glaucoma medications on late pupillary light reflex, as evaluated by pupillometry. Front Neurol 2015; 6: 93.

Source: PubMed

3
Subscribe