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Mutti DO, Mulvihill SP, Orr DJ, Shorter PD, Hartwick ATE. The Effect of Refractive Error on Melanopsin-Driven Pupillary Responses. Invest Ophthalmol Vis Sci 2020; 61:22. [PMID: 33091116 PMCID: PMC7594593 DOI: 10.1167/iovs.61.12.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Human and animal studies suggest that light-mediated dopamine release may underlie the protective effect of time outdoors on myopia development. Melanopsin-containing retinal ganglion cells may be involved in this process by integrating ambient light exposure and regulating retinal dopamine levels. The study evaluates this potential involvement by examining whether melanopsin-driven pupillary responses are associated with adult refractive error. Methods Subjects were 45 young adults (73% female, 24.1 ± 1.8 years) with refractive errors ranging from –6.33 D to +1.70 D. The RAPDx (Konan Medical) pupillometer measured normalized pupillary responses to three forms of square-wave light pulses alternating with darkness at 0.1 Hz: alternating long wavelength (red, peak at 608 nm) and short wavelength (blue, peak at 448 nm), followed by red only and then blue only. Results Non-myopic subjects displayed greater pupillary constriction in the blue-only condition and slower redilation following blue light offset than subjects with myopia (P = 0.011). Pupillary responses were not significantly different between myopic and non-myopic subjects in the red-only condition (P = 0.15). More hyperopic/less myopic refractive error as a continuous variable was linearly related to larger increases in pupillary constriction in response to blue-only stimuli (r = 0.48, P = 0.001). Conclusions Repeated light exposures to blue test stimuli resulted in an adaptation in the pupillary response (more constriction and slower redilation), presumably due to increased melanopsin-mediated input in more hyperopic/less myopic adults. This adaptive property supports a possible role for these ganglion cells in the protective effects of time outdoors on myopia development.
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Affiliation(s)
- Donald O Mutti
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | | | - Danielle J Orr
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Patrick D Shorter
- Optical Radiation Bioeffects Branch, Tri-Service Research Laboratory, Fort Sam Houston, Texas, United States
| | - Andrew T E Hartwick
- The Ohio State University College of Optometry, Columbus, Ohio, United States
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Park JC, Collison FT, Fishman GA, McAnany JJ. Electrophysiological and Pupillometric Abnormalities in PROM1 Cone-Rod Dystrophy. Transl Vis Sci Technol 2020; 9:26. [PMID: 32879782 PMCID: PMC7442873 DOI: 10.1167/tvst.9.9.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare electrophysiological and pupillometric responses in subjects with cone–rod dystrophy due to autosomal recessive (AR) PROM1 mutations. Methods Four subjects with AR PROM1 dystrophy and 10 visually normal, age-similar controls participated in this study. Full-field, light- and dark-adapted electroretinograms (ERGs) were obtained using conventional techniques. Full-field, light- and dark-adapted measures of the pupillary light reflex (PLR; pupil constriction elicited by a flash of light) were obtained across a range of stimulus luminance using long- and short-wavelength light. Pupil size as a function of stimulus luminance was described using Naka–Rushton functions to derive Pmax (maximum response) and s (pupil response sensitivity). Results Light-adapted ERGs were non-detectable in all four PROM1 subjects, whereas dark-adapted ERGs were non-detectable in three subjects and markedly attenuated in the fourth. By contrast, each PROM1 subject had light- and dark-adapted PLRs. Pmax ranged from normal to slightly attenuated under all conditions. Light-adapted s was generally normal, with the exception of two subjects who had abnormal s for the long-wavelength stimulus. Dark adapted s was abnormal for each PROM1 subject for the long-wavelength stimulus and ranged from the upper limit of normal to substantially abnormal for the short-wavelength stimulus. Conclusions ERG and PLR comparison showed an unanticipated dichotomy: ERGs were generally non-detectable, whereas PLRs were normal for all PROM1 subjects under select conditions. Differences between the measures may be attributed to distinct spatiotemporal summation/gain characteristics. Translational Relevance These data highlight the potential usefulness of pupillometry in cases where the ERG is non-detectable.
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Affiliation(s)
- Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Frederick T Collison
- The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | - Gerald A Fishman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.,The Pangere Center for Inherited Retinal Diseases, The Chicago Lighthouse, Chicago, IL, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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53
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Sher I, Tucker Y, Gurevich M, Hamburg A, Bubis E, Kfir J, Zorani S, Derazne E, Skaat A, Rotenstreich Y. Chromatic Pupilloperimetry Measures Correlate With Visual Acuity and Visual Field Defects in Retinitis Pigmentosa Patients. Transl Vis Sci Technol 2020; 9:10. [PMID: 32855857 PMCID: PMC7422758 DOI: 10.1167/tvst.9.8.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the ability of chromatic pupilloperimetry to identify visual field (VF) defects in patients with retinitis pigmentosa (RP) and to test the correlation between pupilloperimetry impairment and retinal structural and functional measures. Methods The pupil responses of 10 patients with RP (mean age, 41.3 ± 16.2 years) and 32 healthy age-similar controls (mean age, 50.7 ± 15.5 years) for 54 focal blue and red stimuli presented in a 24-2 VF were recorded. The pupilloperimetry measures were correlated with Humphrey VF mean deviation, best-corrected visual acuity, and ellipsoid zone area. Results Substantially lower percentage of pupil contraction and maximal pupil contraction velocity (MCV) were recorded in patients with RP throughout the VF in response to blue and red stimuli. The mean absolute deviation (MADEV) in the latency of MCV (LMCV) was significantly larger in patients compared with controls for blue and red stimuli (P = 1.0 × 10−7 and P = 1.0 × 10−6, respectively). The LMCV MADEV differentiated between patients and controls with high specificity and sensitivity (area under the receiver operating characteristic curve, 0.987 and 0.973 for blue and red, respectively). The MADEV of LMCV for blue stimuli correlated with best-corrected visual acuity (ρ = 0.938, P = 5.9 × 10−5) and ellipsoid zone area (ρ = −0.857; P = 0.002). The MADEV of LMCV for red stimuli correlated with Humphrey VF mean deviation (ρ = −0.709; P = 0.022). Minimizing the test to 15 targets maintained a diagnosis of retinal damage in patients with RP with high sensitivity and specificity (area under the receiver operating characteristic curve, 0.927). Conclusions The chromatic pupilloperimetry measures significantly correlated with retinal function and structure in patients with RP at various disease stages. Translational Relevance Chromatic pupilloperimetry may enable objective assessment of visual field defects and visual acuity in RP.
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Affiliation(s)
- Ifat Sher
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yisroel Tucker
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Maya Gurevich
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Hamburg
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ettel Bubis
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Kfir
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Zorani
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Skaat
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ygal Rotenstreich
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Romagnoli M, Stanzani Maserati M, De Matteis M, Capellari S, Carbonelli M, Amore G, Cantalupo G, Zenesini C, Liguori R, Sadun AA, Carelli V, Park JC, La Morgia C. Chromatic Pupillometry Findings in Alzheimer's Disease. Front Neurosci 2020; 14:780. [PMID: 32848556 PMCID: PMC7431959 DOI: 10.3389/fnins.2020.00780] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
Intrinsically photosensitive melanopsin retinal ganglion cells (mRGCs) are crucial for non-image 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 mild-moderate 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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Affiliation(s)
- Martina Romagnoli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy
| | | | - Maddalena De Matteis
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy
| | - Sabina Capellari
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Michele Carbonelli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy
| | - Giulia Amore
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gaetano Cantalupo
- Division of Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Corrado Zenesini
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alfredo A Sadun
- Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Valerio Carelli
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Chiara La Morgia
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Ospedale Bellaria, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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55
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McAnany JJ, Park JC, Fishman GA, Collison FT. Full-Field Electroretinography, Pupillometry, and Luminance Thresholds in X-Linked Retinoschisis. Invest Ophthalmol Vis Sci 2020; 61:53. [PMID: 32579680 PMCID: PMC7416904 DOI: 10.1167/iovs.61.6.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate the nature and extent of functional abnormality in X-linked retinoschisis (XLRS) by comparing three dark-adapted, full-field measures: the electroretinogram (ERG), pupillary light reflex (PLR), and luminance threshold. Methods ERGs, PLRs (pupil constriction due to light stimulation), and luminance thresholds were measured from seven XLRS subjects and from 10 normally sighted, age-similar controls. ERGs and PLRs were obtained for a range of flash strengths, and these data were fit with Naka–Rushton functions to derive the maximum saturated b-wave (Vmax) and PLR (Pmax) amplitudes. Additionally, semi-saturation constants were obtained for the b-wave (σ) and PLR (s). Values of 1/σ and 1/s provide sensitivity measures. Full-field, dark-adapted luminance thresholds were measured using 465-nm and 642-nm flash stimuli. Results Vmax and 1/σ were significantly reduced in XLRS compared to the controls (both t ≥ 5.33, P < 0.001). In comparison, Pmax was normal in the XLRS subjects (t = 1.39, P = 0.19), but 1/s was reduced (t = 7.84, P < 0.001). Luminance thresholds for the control and XLRS groups did not differ significantly (F = 3.57, P = 0.08). Comparisons among measures indicated that pupil sensitivity was correlated with luminance threshold for the long- and short-wavelength stimuli (both, r ≥ 0.77, P ≤ 0.04). Correlations among all other measures were not statistically significant. Conclusions The results indicate that the presumed bipolar cell dysfunction in XLRS, indicated by b-wave abnormalities, has complex downstream effects: Dark-adapted luminance threshold and maximum pupil responses are not significantly affected, but pupil sensitivity is reduced.
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56
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Hu X, Hisakata R, Kaneko H. Effects of stimulus size, eccentricity, luminance, and attention on pupillary light response examined by concentric stimulus. Vision Res 2020; 170:35-45. [PMID: 32244112 DOI: 10.1016/j.visres.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
Abstract
Previous studies show that the amplitude of pupillary light response (PLR) depends on the corneal flux density (CFD), which is the product of stimulus area by luminance. However, the contribution of CFD has been investigated only when the stimulus was centered on the fovea, whereas perceived luminance to pupillary response would reduce with stimulus eccentricity. Additionally, it has been shown recently that attentional state modulates pupillary response. In this study, we aimed to clarify the complete mechanisms of PLR by manipulating the stimulus size, eccentricity, luminance, and the participants' attentional states. We focused on four indices to examine PLR, that is, pupillary latency (PL), maximum constriction velocity (MCV), maximum constriction (MC), and mean pupil change (MPC). Results showed that PL was a function of CFD, whereas MCV, MC, and MPC were functions of both CFD and stimulus eccentricity. Furthermore, the magnitude of effect due to stimulus eccentricity for MCV and MC was different from that for MPC. These results provided new evidence that the different processing systems in PLR existed.
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Affiliation(s)
- Xiaofei Hu
- Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, 4259-G2-3 Nagatsuta-Cho, Midori-Ku, Yokohama 226-8502, Japan.
| | - Rumi Hisakata
- Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, 4259-G2-3 Nagatsuta-Cho, Midori-Ku, Yokohama 226-8502, Japan
| | - Hirohiko Kaneko
- Department of Information and Communications Engineering, School of Engineering, Tokyo Institute of Technology, 4259-G2-3 Nagatsuta-Cho, Midori-Ku, Yokohama 226-8502, Japan
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57
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Münch M, Wirz-Justice A, Brown SA, Kantermann T, Martiny K, Stefani O, Vetter C, Wright KP, Wulff K, Skene DJ. The Role of Daylight for Humans: Gaps in Current Knowledge. Clocks Sleep 2020; 2:61-85. [PMID: 33089192 PMCID: PMC7445840 DOI: 10.3390/clockssleep2010008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/21/2020] [Indexed: 01/04/2023] Open
Abstract
Daylight stems solely from direct, scattered and reflected sunlight, and undergoes dynamic changes in irradiance and spectral power composition due to latitude, time of day, time of year and the nature of the physical environment (reflections, buildings and vegetation). Humans and their ancestors evolved under these natural day/night cycles over millions of years. Electric light, a relatively recent invention, interacts and competes with the natural light-dark cycle to impact human biology. What are the consequences of living in industrialised urban areas with much less daylight and more use of electric light, throughout the day (and at night), on general health and quality of life? In this workshop report, we have classified key gaps of knowledge in daylight research into three main groups: (I) uncertainty as to daylight quantity and quality needed for "optimal" physiological and psychological functioning, (II) lack of consensus on practical measurement and assessment methods and tools for monitoring real (day) light exposure across multiple time scales, and (III) insufficient integration and exchange of daylight knowledge bases from different disciplines. Crucial short and long-term objectives to fill these gaps are proposed.
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Affiliation(s)
- Mirjam Münch
- Sleep/Wake Research Centre, Massey University Wellington, Wellington 6021, New Zealand
| | - Anna Wirz-Justice
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Steven A. Brown
- Chronobiology and Sleep Research Group, Institute of Pharmacology and Toxicology, University of Zürich, 8057 Zürich, Switzerland;
| | - Thomas Kantermann
- Faculty for Health and Social Affairs, University of Applied Sciences for Economics and Management (FOM), 45141 Essen, Germany;
- SynOpus, 44789 Bochum, Germany
| | - Klaus Martiny
- Psychiatric Center Copenhagen, University of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Oliver Stefani
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002 Basel, Switzerland; (A.W.-J.); (O.S.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences (MCN), University of Basel, 4002 Basel, Switzerland
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
| | - Kenneth P. Wright
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO 80309, USA; (C.V.); (K.P.W.J.)
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Katharina Wulff
- Departments of Radiation Sciences and Molecular Biology, Umeå University, 901 87 Umeå, Sweden;
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, 901 87 Umeå, Sweden
| | - Debra J. Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
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Krishnan AK, Jacobson SG, Roman AJ, Iyer BS, Garafalo AV, Héon E, Cideciyan AV. Transient pupillary light reflex in CEP290- or NPHP5-associated Leber congenital amaurosis: Latency as a potential outcome measure of cone function. Vision Res 2020; 168:53-63. [PMID: 32088401 PMCID: PMC7068155 DOI: 10.1016/j.visres.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/16/2022]
Abstract
Mutations in photoreceptor cilium genes CEP290 and NPHP5 cause a form of Leber congenital amaurosis (LCA) which typically lacks rods but retains central cones. The current study evaluated the transient pupillary light reflex (TPLR) as an objective outcome measure to assess efficacy of ongoing and future therapies. Eleven eyes of six patients selected for retained cone function were tested with TPLR using full-field stimuli in the dark-adapted state. Stimuli were red or blue with 1 s duration and spanned a 6-log unit dynamic range. TPLR response amplitude was quantified at fixed times of 0.9 and 2 s after stimulus onset and TPLR latency was defined as the time to reach 0.3 mm constriction. Full-field stimulus testing (FST) and static perimetry were used to correlate subjective perception with objective TPLR parameters. TPLR and FST thresholds with both red and blue stimuli were abnormally elevated in patients to near -1.25 log phot-cd·m-2 consistent with the lack of rods. TPLR latencies were delayed on average but showed some differences among patients. Remnant extrafoveal vision was correlated with faster TPLR latencies. Our results support the use of a short TPLR protocol with full-field red stimuli of 0.7 log phot-cd·m-2 or brighter as an objective and convenient outcome measure of cone function in CEP290- and NPHP5-LCA. The latency parameter of the TPLR would be expected to show a detectable change when an intervention modifies cone sensitivity in the extrafoveal region.
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Affiliation(s)
- Arun K Krishnan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Samuel G Jacobson
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Alejandro J Roman
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Bhavya S Iyer
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Alexandra V Garafalo
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Elise Héon
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Artur V Cideciyan
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
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59
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Reutrakul S, Crowley SJ, Park JC, Chau FY, Priyadarshini M, Hanlon EC, Danielson KK, Gerber BS, Baynard T, Yeh JJ, McAnany JJ. Relationship between Intrinsically Photosensitive Ganglion Cell Function and Circadian Regulation in Diabetic Retinopathy. Sci Rep 2020; 10:1560. [PMID: 32005914 PMCID: PMC6994721 DOI: 10.1038/s41598-020-58205-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/08/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intrinsically photosensitive retinal ganglion cells (ipRGCs) control non-visual light responses (e.g. pupillary light reflex and circadian entrainment). Patients with diabetic retinopathy (DR) show reduced ipRGC function, as inferred by abnormalities in the post illumination pupil response (PIPR). We explored whether ipRGC function in DR is associated with circadian outputs and sleep/wake behavior. METHODS Forty-five participants (15 without diabetes, 15 with type 2 diabetes (T2D) and no DR, 15 with T2D and DR) participated. ipRGC function was inferred from the PIPR (pupil size following stimulus offset). Circadian outputs were melatonin amplitude (overnight urinary 6-sulfatoxymelatonin (aMT6s)) and timing (dim light melatonin onset (DLMO)), and evening salivary cortisol levels. Sleep/wake patterns were measured with wrist actigraphy and insomnia symptoms were assessed subjectively. RESULTS Patients with T2D and DR had smaller PIPR and lower urinary aMT6s than other groups (p < 0.001). In adjusted regression models, smaller PIPR was associated with lower urinary aMT6s (β = 4.552, p = 0.005). Patients with DR were more likely to have no detectable DLMO (p = 0.049), higher evening salivary cortisol, greater insomnia symptoms and greater sleep variability compared to other groups. Sleep duration, efficiency and rest-activity rhythms were similar. CONCLUSION Reduced ipRGC function in DR is associated with circadian dysregulation and sleep disturbances, although a causal relationship cannot be established in this cross-sectional study. Prospective mechanistic and intervention studies examining circadian and sleep health in these patients are warranted.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Medha Priyadarshini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ben S Gerber
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Jade J Yeh
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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60
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Duque-Chica GL, Gracitelli CPB, Moura ALA, Nagy BV, Vidal KS, de Melo G, Paranhos A, Cahali MB, Ventura DF. Contributions of the Melanopsin-Expressing Ganglion Cells, Cones, and Rods to the Pupillary Light Response in Obstructive Sleep Apnea. Invest Ophthalmol Vis Sci 2019; 60:3002-3012. [PMID: 31310657 DOI: 10.1167/iovs.19-26944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the impact of obstructive sleep apnea (OSA) on the contribution of inner and outer retinal photoreceptors to the pupillary light response (PLR). Methods Ninety-three eyes from 27 patients with OSA and 25 healthy controls were tested. OSA severity was graded according to the apnea-hypopnea index. PLR was measured monocularly with an eye tracker in a Ganzfeld in response to 1-second blue (470 nm) and red (640 nm) flashes at -3, -2, -1, 0, 1, 2, and 2.4 log cd/m2. Peak pupil constriction amplitude, peak latency, and the postillumination pupil response were measured. The Cambridge Colour Test, standard automatic perimetry, spectral domain optical coherence tomography, polysomnography, and the Pittsburgh Sleep Quality Index were used. Results OSA patients have a significantly decreased peak pupil constriction amplitude for blue stimuli at -3, -2, -1, 1 log cd/m2 and at all red flash luminances (P < 0.050), revealing reduction of outer retina contributions to PLR. OSA patients showed reduced peak latency for blue (-2, 0, 2, 2.4 log cd/m2) and red stimuli (-2, 0 log cd/m2; P < 0.040). No significant difference was found in the melanopsin-mediated PLR. Conclusions This study is the first to evaluate the inner and outer retinal contributions to PLR in OSA patients. The results showed that the outer retinal photoreceptor contributions to PLR were affected in moderate and severe OSA patients. In contrast, the inner retina contributions to PLR are preserved.
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Affiliation(s)
- Gloria L Duque-Chica
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Psychology, University of Medellin, Medellin, Colombia
| | - Carolina P B Gracitelli
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Ana L A Moura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Balázs V Nagy
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Department of Mechatronics, Optics and Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Kallene S Vidal
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil.,Prevent Senior institute, Sao Paulo, Brazil
| | - Geraldine de Melo
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Augusto Paranhos
- Department of Ophthalmology and Visual Science, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Michel B Cahali
- Department of Otolaryngology, Hospital das Clínicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Dora F Ventura
- Experimental Psychology Department, Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
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Oh AJ, Amore G, Sultan W, Asanad S, Park JC, Romagnoli M, La Morgia C, Karanjia R, Harrington MG, Sadun AA. Pupillometry evaluation of melanopsin retinal ganglion cell function and sleep-wake activity in pre-symptomatic Alzheimer's disease. PLoS One 2019; 14:e0226197. [PMID: 31821378 PMCID: PMC6903762 DOI: 10.1371/journal.pone.0226197] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Melanopsin-expressing retinal ganglion cells (mRGCs), intrinsically photosensitive RGCs, mediate the light-based pupil response and the light entrainment of the body's circadian rhythms through their connection to the pretectal nucleus and hypothalamus, respectively. Increased awareness of circadian rhythm dysfunction in neurological conditions including Alzheimer's disease (AD), has led to a wave of research focusing on the role of mRGCs in these diseases. Postmortem retinal analyses in AD patients demonstrated a significant loss of mRGCs, and in vivo measurements of mRGC function with chromatic pupillometry may be a potential biomarker for early diagnosis and progression of AD. METHODS We performed a prospective case-control study in 20 cognitively healthy study participants: 10 individuals with pre-symptomatic AD pathology (pre-AD), identified by the presence of abnormal levels of amyloid β42 and total Tau proteins in the cerebrospinal fluid, and 10 age-matched controls with normal CSF amyloid β42 and Tau levels. To evaluate mRGC function, we used a standardized protocol of chromatic pupillometry on a Ganzfeld system using red (640 nm) and blue (450 nm) light stimuli and measured the pupillary light response (PLR). Non-invasive wrist actigraphy and standardized sleep questionnaires were also completed to evaluate rest-activity circadian rhythm. RESULTS Our results did not demonstrate a significant difference of the PLR between pre-AD and controls but showed a variability of the PLR in the pre-AD group compared with controls on chromatic pupillometry. Wrist actigraphy showed variable sleep-wake patterns and irregular circadian rhythms in the pre-AD group compared with controls. CONCLUSIONS The variability seen in measurements of mRGC function and sleep-wake cycle in the pre-AD group suggests that mRGC dysfunction occurs in the pre-symptomatic AD stages, preceding cognitive decline. Future longitudinal studies following progression of these participants can help in elucidating the relationship between mRGCs and circadian rhythm dysfunction in AD.
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Affiliation(s)
- Angela J. Oh
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
- * E-mail:
| | - Giulia Amore
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - William Sultan
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
| | - Samuel Asanad
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
| | - Jason C. Park
- Columbia University, Department of Psychology, New York, New York, United States of America
| | - Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Rustum Karanjia
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
- University of Ottawa Eye Institute, Department of Ophthalmology, Ottawa, Ontario, Canada
| | - Michael G. Harrington
- The Huntington Medical Research Institutes and Molecular Neurology Program, Pasadena, California, United States of America
| | - Alfredo A. Sadun
- Doheny Eye institute, UCLA Stein Eye Institute, University of California, Los Angeles, Department of Ophthalmology, Los Angeles, California, United States of America
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Palanca-Castan N, Harcha PA, Neira D, Palacios AG. Chromatic pupillometry for the characterization of the pupillary light reflex in Octodon degus. Exp Eye Res 2019; 190:107866. [PMID: 31682845 DOI: 10.1016/j.exer.2019.107866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/06/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Abstract
The common degu (Octodon degus) is an emerging model in biomedical science research due to its longevity and propensity to develop human-like conditions. However, there is a lack of standardized techniques for this non-traditional laboratory animal. In an effort to characterize the model, we developed a chromatic pupillometry setup and analysis protocol to characterize the pupillary light reflex (PLR) in our animals. The PLR is a biomarker to detect early signs for central nervous system deterioration. Chromatic pupillometry is a non-invasive and anesthesia-free method that can evaluate different aspects of the PLR, including the response of intrinsically photosensitive retinal ganglion cells (ipRGCs), the disfunction of which has been linked to various disorders. We studied the PLR of 12 degus between 6 and 48 months of age to characterize responses to LEDs of 390, 450, 500, 525 and 605 nm, and used 5 with overall better responses to establish a benchmark for healthy PLR (PLR+) and deteriorated PLR (PLR-). Degu pupils contracted up to 65% of their horizontal resting size before reaching saturation. The highest sensitivity was found at 500 nm, with similar sensitivities at lower tested intensities for 390 nm, coinciding with the medium wavelength and short wavelength cones of the degu. We also tested the post-illumination pupillary response (PIPR), which is driven exclusively by ipRGCs. PIPR was largest in response to 450 nm light, with the pupil preserving 48% of its maximum constriction 9 s after the stimulus, in contrast with 24% preserved in response to 525 nm, response driven mainly by cones. PLR- animals showed maximum constriction between 40% and 50% smaller than PLR+, and their PIPR almost disappeared, pointing to a disfunction of the iPRGCs rather than the retinal photoreceptors. Our method thus allows us to non-invasively estimate the condition of experimental animals before attempting other procedures.
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Affiliation(s)
- Nicolas Palanca-Castan
- Centro Interdisciplinario de Neurociencia de Valparaiso, Universidad de Valparaiso, Gran Bretaña 1111, Valparaiso, Chile.
| | - Paloma A Harcha
- Centro Interdisciplinario de Neurociencia de Valparaiso, Universidad de Valparaiso, Gran Bretaña 1111, Valparaiso, Chile
| | - David Neira
- Centro Interdisciplinario de Neurociencia de Valparaiso, Universidad de Valparaiso, Gran Bretaña 1111, Valparaiso, Chile
| | - Adrian G Palacios
- Centro Interdisciplinario de Neurociencia de Valparaiso, Universidad de Valparaiso, Gran Bretaña 1111, Valparaiso, Chile
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63
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Adhikari P, Feigl B, Zele AJ. The flicker Pupil Light Response (fPLR). Transl Vis Sci Technol 2019; 8:29. [PMID: 31637109 PMCID: PMC6798322 DOI: 10.1167/tvst.8.5.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The photoreceptor classes driving the flicker pupil light response (fPLR) to monochromatic sinusoidal temporal modulation are largely unknown. Here, we determine the photoreceptor inputs to the fPLR. METHODS The 0.5-Hz fPLR was measured in healthy observers using a Maxwellian view (41° diameter) pupillometer at five narrowband wavelengths (short: 409 nm; intermediate: 462, 507, 530 nm; and long: 592 nm) over ∼10 log units of irradiance spanning scotopic to photopic levels (5.6 to 15.6 log quanta·cm-2·s-1; -6.9 to 3.6 log cd·m-2). The relative photoreceptor contributions to the fPLR were then derived from these amplitude-irradiance functions using a criterion fPLR. RESULTS The fPLR amplitude is small (≤ 3.9 ± 3.1%; mean ± SEM) below 8.0 log quanta·cm-2·s-1 then increases with retinal irradiance in accordance with a Hill function that asymptotes between 13.0 to 15.0 log quanta·cm-2·s-1 (wavelength dependent). The Hill slope is steepest for the intermediate wavelengths. Further increases in irradiance (>15.0 log quanta·cm-2·s-1) produce a distinct suppression of the fPLR for the intermediate wavelengths. The fPLR phase delay shows a linear decrease with increasing irradiance. The spectral sensitivity of the fPLR is dominated by inner retinal melanopsin ganglion cell and outer retinal rod photoreceptor inputs to the afferent pupil control pathway; the relative melanopsin : rhodopsin weighting decreases with the transition from photopic to scotopic lighting. CONCLUSIONS The fPLR can be used as a marker of melanopsin and rod interactions during the flicker stimulation and to quantify their contributions to the post-illumination pupil response (PIPR). TRANSLATIONAL RELEVANCE These irradiance and wavelength responses will be useful in standardizing the measurements of the fPLR using chromatic pupillometry.
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Affiliation(s)
- Prakash Adhikari
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Australia
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
- Queensland Eye Institute, Brisbane, Australia
| | - Andrew J. Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Australia
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64
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Zele AJ, Adhikari P, Cao D, Feigl B. Melanopsin driven enhancement of cone-mediated visual processing. Vision Res 2019; 160:72-81. [DOI: 10.1016/j.visres.2019.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 12/13/2022]
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Chen Y, Pinto AA, Paulsen AJ, Schubert CR, Hancock LM, Klein BE, Klein R, Cruickshanks KJ. The Post-illumination Pupil Response (PIPR) Is Associated With Cognitive Function in an Epidemiologic Cohort Study. Front Neurol 2019; 10:682. [PMID: 31297083 PMCID: PMC6607919 DOI: 10.3389/fneur.2019.00682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
We conducted a cross-sectional study on 403 participants in the 10-year follow-up examination of the Beaver Dam Offspring Study. The participants included 172 male and 231 female, with age ranging from 33 to 81 years (mean ± SD, 60.7 ± 9.3). The post-illumination pupil response (PIPR) was recorded using binocular infrared pupillometer (Neur-Optics, Inc., Irvine, CA). Cognitive testing consisted of Trail Making Test (TMT) Parts A and B, Rey Auditory Verbal Learning Test (AVLT), Digit Symbol Substitution Test (DSST), and Verbal Fluency Test (VFT) (F, A, and S). Principal component analysis (PCA) was used to calculate an overall cognitive function score. There was a significant reduction in the mean baseline pupil diameter by 0.21 mm for every 5-year increase in age (95% CI: -0.25, -0.17). There was also a significant increase in the PCA cognitive score by 0.20 (linear regression, 95% CI: 0.08, 0.32) for every 0.1 unit increase in the PIPR. The association remained significant after adjusting for age, sex, education, medications, systemic and ocular disease, and short form-12 physical and mental component score. The results of this study demonstrated a modest association between the PIPR and cognitive function, warranting longitudinal studies to evaluate the role of the PIPR in predicting cognitive function in the middle-aged and older adults.
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Affiliation(s)
- Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Alex A. Pinto
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Adam J. Paulsen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Carla R. Schubert
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Laura M. Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Barbara E. Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ron Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Karen J. Cruickshanks
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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de Zeeuw J, Papakonstantinou A, Nowozin C, Stotz S, Zaleska M, Hädel S, Bes F, Münch M, Kunz D. Living in Biological Darkness: Objective Sleepiness and the Pupillary Light Responses Are Affected by Different Metameric Lighting Conditions during Daytime. J Biol Rhythms 2019; 34:410-431. [PMID: 31156018 PMCID: PMC6637815 DOI: 10.1177/0748730419847845] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Nighttime melatonin suppression is the most commonly used method to indirectly quantify acute nonvisual light effects. Since light is the principal zeitgeber in humans, there is a need to assess its strength during daytime as well. This is especially important since humans evolved under natural daylight but now often spend their time indoors under artificial light, resulting in a different quality and quantity of light. We tested whether the pupillary light response (PLR) could be used as a marker for nonvisual light effects during daytime. We also recorded the wake electroencephalogram to objectively determine changes in daytime sleepiness between different illuminance levels and/or spectral compositions of light. In total, 72 participants visited the laboratory 4 times for 3-h light exposures. All participants underwent a dim-light condition and either 3 metameric daytime light exposures with different spectral compositions of polychromatic white light (100 photopic lux, peak wavelengths at 435 nm or 480 nm, enriched with longer wavelengths of light) or 3 different illuminances (200, 600, and 1200 photopic lux) with 1 metameric lighting condition (peak wavelength at 435 nm or 480 nm; 24 participants each). The results show that the PLR was sensitive to both spectral differences between metameric lighting conditions and different illuminances in a dose-responsive manner, depending on melanopic irradiance. Objective sleepiness was significantly reduced, depending on melanopic irradiance, at low illuminance (100 lux) and showed fewer differences at higher illuminance. Since many people are exposed to such low illuminance for most of their day—living in biological darkness—our results imply that optimizing the light spectrum could be important to improve daytime alertness. Our results suggest the PLR as a noninvasive physiological marker for ambient light exposure effects during daytime. These findings may be applied to assess light-dependent zeitgeber strength and evaluate lighting improvements at workplaces, schools, hospitals, and homes.
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Affiliation(s)
- Jan de Zeeuw
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,Intellux GmbH, Berlin, Germany
| | - Alexandra Papakonstantinou
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin
| | - Claudia Nowozin
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin
| | - Sophia Stotz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin
| | | | - Sven Hädel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology
| | - Frederik Bes
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin
| | - Mirjam Münch
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Immunology, Laboratory of Chronobiology.,Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
| | - Dieter Kunz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Sleep Research & Clinical Chronobiology.,Intellux GmbH, Berlin, Germany.,St. Hedwig-Hospital, Clinic for Sleep & Chronomedicine, Berlin
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67
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Haj Yahia S, Hamburg A, Sher I, Ben Ner D, Yassin S, Chibel R, Mimouni M, Derazne E, Belkin M, Rotenstreich Y. Effect of Stimulus Intensity and Visual Field Location on Rod- and Cone-Mediated Pupil Response to Focal Light Stimuli. Invest Ophthalmol Vis Sci 2019; 59:6027-6035. [PMID: 30574657 DOI: 10.1167/iovs.18-23767] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the effect of stimulus intensity on rod- and cone-mediated pupil light reflex (PLR) to small stimuli presented at central and peripheral visual field (VF) locations. Methods The PLR to small (0.43°) chromatic stimuli was tested in the right eye of healthy subjects. Blue (485 ± 20 nm) and red (625 ± 15 nm) stimuli were presented at incremental light intensities (0.5-3.75 log cd/m2) at peripheral (21.21°) and central (4.24°) VF locations using a chromatic pupilloperimeter under mesopic or blue light adaptation conditions. The percentage of pupil contraction (PPC), maximal pupil contraction velocity (MCV), latency of MCV (LMCV) and the ratio of central to peripheral responses for PPC (QPPC value) were determined. Results Under mesopic light adaptation conditions, the mean PPC recorded in response to red stimuli was lower than blue stimuli in all VF locations and light intensities, and the QPPC values were higher in response to red compared with blue light stimuli across the light intensity range tested. With blue background light, the pupil responses for red and blue light stimuli were approximately the same in the peripheral VF. LMCV was nearly constant in all VF locations for blue and red stimuli, respectively. Conclusions The chromatic pupilloperimeter enables the assessment of rod- and cone- contribution to the PLR in different VF locations. The optimal light intensities determined here for the assessment of focal activation of the two photoreceptor systems may be used for clinical evaluation of photoreceptor health.
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Affiliation(s)
- Soad Haj Yahia
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Hamburg
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ifat Sher
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Daniel Ben Ner
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saeed Yassin
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ron Chibel
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Belkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ygal Rotenstreich
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Bowl W, Raoof S, Lorenz B, Holve K, Schweinfurth S, Stieger K, Andrassi-Darida M. Cone-Mediated Function Correlates to Altered Foveal Morphology in Preterm-Born Children at School Age. ACTA ACUST UNITED AC 2019; 60:1614-1620. [DOI: 10.1167/iovs.18-24892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Wadim Bowl
- Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany
| | - Sinan Raoof
- Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany
| | - Birgit Lorenz
- Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany
| | - Kerstin Holve
- Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany
| | | | - Knut Stieger
- Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany
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Chougule PS, Najjar RP, Finkelstein MT, Kandiah N, Milea D. Light-Induced Pupillary Responses in Alzheimer's Disease. Front Neurol 2019; 10:360. [PMID: 31031692 PMCID: PMC6473037 DOI: 10.3389/fneur.2019.00360] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/25/2019] [Indexed: 12/25/2022] Open
Abstract
The impact of Alzheimer's disease (AD) on the pupillary light response (PLR) is controversial, being dependent on the stage of the disease and on the experimental pupillometric protocols. The main hypothesis driving pupillometry research in AD is based on the concept that the AD-related neurodegeneration affects both the parasympathetic and the sympathetic arms of the PLR (cholinergic and noradrenergic theory), combined with additional alterations of the afferent limb, involving the melanopsin expressing retinal ganglion cells (mRGCs), subserving the PLR. Only a few studies have evaluated the value of pupillometry as a potential biomarker in AD, providing various results compatible with parasympathetic dysfunction, displaying increased latency of pupillary constriction to light, decreased constriction amplitude, faster redilation after light offset, decreased maximum velocity of constriction (MCV) and maximum constriction acceleration (MCA) compared to controls. Decreased MCV and MCA appeared to be the most accurate of all PLR parameters allowing differentiation between AD and healthy controls while increased post-illumination pupillary response was the most consistent feature, however, these results could not be replicated by more recent studies, focusing on early and pre-clinical stages of the disease. Whether static or dynamic pupillometry yields useful biomarkers for AD screening or diagnosis remains unclear. In this review, we synopsize the current knowledge on pupillometric features in AD and other neurodegenerative diseases, and discuss potential roles of pupillometry in AD detection, diagnosis and monitoring, alone or in combination with additional biomarkers.
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Affiliation(s)
- Pratik S Chougule
- Department of Visual Neurosciences, Singapore Eye Research Institute, Singapore, Singapore
| | - Raymond P Najjar
- Department of Visual Neurosciences, Singapore Eye Research Institute, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Maxwell T Finkelstein
- Department of Visual Neurosciences, Singapore Eye Research Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-National University of Singapore (NUS), Singapore, Singapore
| | - Dan Milea
- Department of Visual Neurosciences, Singapore Eye Research Institute, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore
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Abstract
PURPOSE To investigate receptor and post-receptor function in KCNV2 retinopathy [cone dystrophy with supernormal rod electroretinogram (ERG)], using the pupillary light reflex (PLR) and the ERG. METHODS Two unrelated patients (1 male and 1 female) with molecularly confirmed KCNV2 retinopathy underwent full-field two-color pupillometry testing in one eye, with monitoring of the stimulated eye by an infrared digital camera. Pupillometry stimuli consisted of 1-s duration, short-wavelength (465-nm, blue) and long-wavelength (642-nm, red) stimuli. Pupillometry intensity series were performed under both a dark-adapted condition and a light-adapted condition (on a 0.76-log cd m-2 blue background). The transient PLR, defined as the maximum constriction following flash onset, was measured under all conditions. The melanopsin-mediated sustained constriction was measured 5-7 s following flash offset for the highest flash luminance presented in the dark. Both patients were also tested in one eye with the full-field ERG, including a dark-adapted intensity series and ISCEV standard stimuli. RESULTS Dark-adapted PLRs were markedly attenuated or extinguished for low-luminance stimuli, but the responses to higher-luminance blue stimuli were within normal limits. Light-adapted PLRs to blue stimuli were generally within normal limits, exceeding the responses to photopically matched red stimuli. Thus, light-adapted responses were consistent with either rod or S-cone mediation of the PLR. Melanopsin-mediated sustained PLRs were within normal limits. ERG showed the characteristic findings previously reported in this condition. Cone-mediated ERG responses were markedly decreased in amplitude. Rod-mediated ERG responses were absent for low-luminance stimuli (- 3 log cd s m-2), but had normal amplitude for stimuli of - 2 log cd s m-2 and above (although none were "supernormal"). The b-wave for the dark-adapted ISCEV standard - 2 log cd s m-2 stimulus was markedly delayed, whereas the b-wave timing was generally normal for higher flash luminances. CONCLUSIONS The abnormalities measured by pupillometry have a similar pattern to the outer-retinal abnormalities measured by ERG in KCNV2 retinopathy. These findings as well as the normal sustained PLR suggest that inner-retinal function may be preserved in KCNV2 retinopathy and highlight the potential for therapies designed to restore outer-retinal function in these individuals.
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71
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Rukmini AV, Chew MC, Finkelstein MT, Atalay E, Baskaran M, Nongpiur ME, Gooley JJ, Aung T, Milea D, Najjar RP. Effects of low and moderate refractive errors on chromatic pupillometry. Sci Rep 2019; 9:4945. [PMID: 30894608 PMCID: PMC6426861 DOI: 10.1038/s41598-019-41296-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
Chromatic pupillometry is an emerging modality in the assessment of retinal and optic nerve disorders. Herein, we evaluate the effect of low and moderate refractive errors on pupillary responses to blue- and red-light stimuli in a healthy older population. This study included 139 participants (≥50 years) grouped by refractive error: moderate myopes (>−6.0D and ≤−3.0D, n = 24), low myopes (>−3.0D and <−0.5D, n = 30), emmetropes (≥−0.5D and ≤0.5D, n = 31) and hyperopes (>0.5D and <6.0D, n = 54). Participants were exposed to logarithmically ramping-up blue (462 nm) and red (638 nm) light stimuli, designed to sequentially activate rods, cones and intrinsically-photosensitive retinal ganglion cells. Pupil size was assessed monocularly using infra-red pupillography. Baseline pupil diameter correlated inversely with spherical equivalent (R = −0.26, P < 0.01), and positively with axial length (R = 0.37, P < 0.01) and anterior chamber depth (R = 0.43, P < 0.01). Baseline-adjusted pupillary constriction amplitudes to blue light did not differ between groups (P = 0.45), while constriction amplitudes to red light were greater in hyperopes compared to emmetropes (P = 0.04) at moderate to bright light intensities (12.25–14.0 Log photons/cm²/s). Our results demonstrate that low and moderate myopia do not alter pupillary responses to ramping-up blue- and red-light stimuli in healthy older individuals. Conversely, pupillary responses to red light should be interpreted cautiously in hyperopic eyes.
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Affiliation(s)
- A V Rukmini
- Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Eray Atalay
- Singapore Eye Research Institute, Singapore, Singapore.,Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore
| | - Joshua J Gooley
- Centre for Cognitive Neuroscience, Programme in Neuroscience and Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,The Ophthalmology & Visual Sciences ACP (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore, Singapore. .,The Ophthalmology & Visual Sciences ACP (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore.
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72
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Stingl K, Peters T, Strasser T, Kelbsch C, Richter P, Wilhelm H, Wilhelm B. Pupillographic campimetry: an objective method to measure the visual field. ACTA ACUST UNITED AC 2019; 63:729-734. [PMID: 29369809 DOI: 10.1515/bmt-2017-0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/21/2017] [Indexed: 11/15/2022]
Abstract
Pupillographic campimetry allows measuring the visual field objectively by analyzing the pupil response to perimetric stimuli. One of the drawbacks of this technique, similar to static perimetry, is the need of reliable fixation of the subject. By using stimulus sizes comparable to static perimetry and applying gaze tracking, we enable a retinotopic visual field examination regardless of fixation problems and with an increased stability and improved spatial resolution. Here, we present the results of applying the method in eight normal sighted subjects as well as in three patients suffering from diseases usually diagnosed by perimetry. The results in normal sighted subjects show a reduction in the amplitude of the pupil response with increasing eccentricity as expected. We also demonstrate that gaze-controlled campimetry is able to detect organic visual field defects objectively in a patient group and classify the visual field defects without an organic background. Moreover, we show that our method is able to evaluate the visual field sensitivity loss beyond classical perimetry in patients with late-stage retinitis pigmentosa. Thus, gaze-controlled pupil campimetry can be used in addition to classical perimetry, allowing for an objective monitoring of disease progression, rendering it as a biomarker for novel treatments.
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Affiliation(s)
- Krunoslav Stingl
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Tobias Peters
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Torsten Strasser
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany.,Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Carina Kelbsch
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Paul Richter
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Helmut Wilhelm
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group at the Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
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73
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Kelbsch C, Strasser T, Chen Y, Feigl B, Gamlin PD, Kardon R, Peters T, Roecklein KA, Steinhauer SR, Szabadi E, Zele AJ, Wilhelm H, Wilhelm BJ. Standards in Pupillography. Front Neurol 2019; 10:129. [PMID: 30853933 PMCID: PMC6395400 DOI: 10.3389/fneur.2019.00129] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/31/2019] [Indexed: 12/31/2022] Open
Abstract
The number of research groups studying the pupil is increasing, as is the number of publications. Consequently, new standards in pupillography are needed to formalize the methodology including recording conditions, stimulus characteristics, as well as suitable parameters of evaluation. Since the description of intrinsically photosensitive retinal ganglion cells (ipRGCs) there has been an increased interest and broader application of pupillography in ophthalmology as well as other fields including psychology and chronobiology. Color pupillography plays an important role not only in research but also in clinical observational and therapy studies like gene therapy of hereditary retinal degenerations and psychopathology. Stimuli can vary in size, brightness, duration, and wavelength. Stimulus paradigms determine whether rhodopsin-driven rod responses, opsin-driven cone responses, or melanopsin-driven ipRGC responses are primarily elicited. Background illumination, adaptation state, and instruction for the participants will furthermore influence the results. This standard recommends a minimum set of variables to be used for pupillography and specified in the publication methodologies. Initiated at the 32nd International Pupil Colloquium 2017 in Morges, Switzerland, the aim of this manuscript is to outline standards in pupillography based on current knowledge and experience of pupil experts in order to achieve greater comparability of pupillographic studies. Such standards will particularly facilitate the proper application of pupillography by researchers new to the field. First we describe general standards, followed by specific suggestions concerning the demands of different targets of pupil research: the afferent and efferent reflex arc, pharmacology, psychology, sleepiness-related research and animal studies.
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Affiliation(s)
- Carina Kelbsch
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Torsten Strasser
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Yanjun Chen
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, AL, United States
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Queensland Eye Institute, Brisbane, QLD, Australia
| | - Paul D. Gamlin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Randy Kardon
- Neuro-Ophthalmology Division, University of Iowa and Iowa City VA Healthcare System, Iowa City, LA, United States
| | - Tobias Peters
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Kathryn A. Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stuart R. Steinhauer
- VA Pittsburgh Healthcare System, VISN 4 MIRECC, University Drive C, Pittsburgh, PA, United States
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Elemer Szabadi
- Developmental Psychiatry, University of Nottingham, Nottingham, United Kingdom
| | - Andrew J. Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - Helmut Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
| | - Barbara J. Wilhelm
- Pupil Research Group, Centre for Ophthalmology, University Hospitals Tübingen, Tübingen, Germany
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Kircher N, Crippa SV, Martin C, Kawasaki A, Kostic C. Maturation of the Pupil Light Reflex Occurs Until Adulthood in Mice. Front Neurol 2019; 10:56. [PMID: 30778330 PMCID: PMC6369172 DOI: 10.3389/fneur.2019.00056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/16/2019] [Indexed: 11/13/2022] Open
Abstract
With respect to photoreceptor function, it is well known that electroretinogram (ERG) amplitudes decrease with age, but to our knowledge, studies describing age-related changes in the pupil light response (PLR) of mice are lacking. This study recorded the PLR and ERG in C57BL/6 and Sv129S6 wild-type mice at three different ages during early adulthood. Dark- and light-adapted PLR and ERG measurements were performed at 1, 2, and 4 months of age. For PLR measurements, we used either a red (622 nm) or blue (463 nm) light stimulus (500 ms) to stimulate one eye. We selected various light intensities ranging across almost 4 log units and subsequently classified them as low, medium, or high intensity. From the recorded PLR, we selected parameters to quantify the early and late phases of the response such as the baseline pupil size, the maximal constriction amplitude, the maximal velocity, the early partial dilation (area under the curve of the positive peak of the first derivative of PLR tracing), and the sustained constriction amplitude. For ERG measurements, both scotopic and photopic responses were recorded following stimulation with green light (520 nm) at preselected intensities. The amplitudes and latencies of the a-wave and the b-wave were also analyzed. In both strains, 1-month-old animals presented with a smaller baseline pupil diameter compared to that in 2- and 4-month-old mice. They also exhibited greater maximal constriction amplitude in response to red stimuli of medium intensity. Further, 1-month-old Sv129S6 mice responded with greater constriction amplitude to all other red and blue stimuli. One-month-old C57BL/6 mice also demonstrated faster early partial dilation and smaller sustained response to low blue stimuli. The ERG of 1-month-old C57BL/6 mice showed a greater scotopic a-wave amplitude compared to that of 2-month-old mice, whereas no significant differences were found in Sv129S6 mice. These results suggest that the functional maturation of the neuronal pathway that mediates the PLR continues after 1 month of age. In studies that measure PLR to determine retinal integrity in adult mice, it is thus important to determine normative values in animals of 2 months of age.
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Affiliation(s)
- Noémie Kircher
- Group for Retinal Disorder Research, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Sylvain V Crippa
- Group for Retinal Disorder Research, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland.,Neuro-Ophtalmology, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Catherine Martin
- Group for Retinal Disorder Research, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Aki Kawasaki
- Neuro-Ophtalmology, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
| | - Corinne Kostic
- Group for Retinal Disorder Research, Department of Ophthalmology, Hôpital Ophtalmique Jules Gonin, University of Lausanne, Lausanne, Switzerland
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75
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Rukmini AV, Milea D, Gooley JJ. Chromatic Pupillometry Methods for Assessing Photoreceptor Health in Retinal and Optic Nerve Diseases. Front Neurol 2019; 10:76. [PMID: 30809186 PMCID: PMC6379484 DOI: 10.3389/fneur.2019.00076] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/21/2019] [Indexed: 12/19/2022] Open
Abstract
The pupillary light reflex is mediated by melanopsin-containing intrinsically-photosensitive retinal ganglion cells (ipRGCs), which also receive input from rods and cones. Melanopsin-dependent pupillary light responses are short-wavelength sensitive, have a higher threshold of activation, and are much slower to activate and de-activate compared with rod/cone-mediated responses. Given that rod/cone photoreceptors and melanopsin differ in their response properties, light stimuli can be designed to stimulate preferentially each of the different photoreceptor types, providing a read-out of their function. This has given rise to chromatic pupillometry methods that aim to assess the health of outer retinal photoreceptors and ipRGCs by measuring pupillary responses to blue or red light stimuli. Here, we review different types of chromatic pupillometry protocols that have been tested in patients with retinal or optic nerve disease, including approaches that use short-duration light exposures or continuous exposure to light. Across different protocols, patients with outer retinal disease (e.g., retinitis pigmentosa or Leber congenital amaurosis) show reduced or absent pupillary responses to dim blue-light stimuli used to assess rod function, and reduced responses to moderately-bright red-light stimuli used to assess cone function. By comparison, patients with optic nerve disease (e.g., glaucoma or ischemic optic neuropathy, but not mitochondrial disease) show impaired pupillary responses during continuous exposure to bright blue-light stimuli, and a reduced post-illumination pupillary response after light offset, used to assess melanopsin function. These proof-of-concept studies demonstrate that chromatic pupillometry methods can be used to assess damage to rod/cone photoreceptors and ipRGCs. In future studies, it will be important to determine whether chromatic pupillometry methods can be used for screening and early detection of retinal and optic nerve diseases. Such methods may also prove useful for objectively evaluating the degree of recovery to ipRGC function in blind patients who undergo gene therapy or other treatments to restore vision.
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Affiliation(s)
- A V Rukmini
- Programme in Neuroscience and Behavioural Disorders, Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore, Singapore
| | - Dan Milea
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,The Ophthalmology and Visual Sciences Academic Clinical Programme (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore
| | - Joshua J Gooley
- Programme in Neuroscience and Behavioural Disorders, Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore, Singapore
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76
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Correlation between Transient Pupillary Light Reflex and Retinal Function Impairment in Patients with Retinitis Pigmentosa. J Ophthalmol 2019; 2018:2519375. [PMID: 30622818 PMCID: PMC6304905 DOI: 10.1155/2018/2519375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the relationship between transient pupillary light reflex (PLR) and visual function in patients with retinitis pigmentosa (RP). Methods A retrospective study was performed with 137 eyes of 73 patients with RP. Transient pupillary light reflex was measured by the vision monitor system (MonColor; Metrovision, France). Dark-adapted transient PLRs were elicited by four specific levels of stimulus luminance (−5, −3, −1, and 0 log cd/m2, blue or white light). Best-corrected visual acuity (BCVA) was recorded based on Early Treatment Diabetic Retinopathy Study (ETDRS) acuity charts. Fixation stability and retinal sensitivity of radial 10° areas were measured with microperimetry. The retinal sensitivity (RS) was divided into central RS (fovea and radial 1° areas) and peripheral RS (radial 3° and 5° areas from the fovea). The patients were further classified into 2 groups (P1 > 75% and P1 < 75%) according to fixation stability. Spearman's correlation was performed to identify significant associations between BCVA, fixation stability, RS, and PLR. Results Under the stimuli of the same color light, relative pupillary constriction (RPC), latency, or velocity of constriction in the same patients was statistically different in multiple luminance, respectively. Under the same luminance, blue light induced greater RPC and velocity (except for −3 log cd/m2) than white light. Most patients showed varying degrees of threshold elevation and visual function deficiency. Besides, there was a statistically significant difference in the distribution of BCVA, MRS, or fixation stability under different thresholds. The correlation between pupillary constrictive area (PCA) and retinal sensitivity was mainly determined by the peripheral region. Moreover, patients with stable fixation showed a greater correlation between PCA and RS. Conclusion PLR induced by specific colors and luminance may serve as a promising clinical approach for assessing and monitoring rod function in advanced RP patients.
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77
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Barrionuevo PA, McAnany JJ, Zele AJ, Cao D. Non-linearities in the Rod and Cone Photoreceptor Inputs to the Afferent Pupil Light Response. Front Neurol 2018; 9:1140. [PMID: 30622511 PMCID: PMC6308191 DOI: 10.3389/fneur.2018.01140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Purpose: To assess the nature and extent of non-linear processes in pupil responses using rod- and cone-isolating visual beat stimuli. Methods: A four-primary photostimulating method based on the principle of silent substitution was implemented to generate rod or cone isolating and combined sinusoidal stimuli at a single component frequency (1, 4, 5, 8, or 9 Hz) or a 1 Hz beat frequency (frequency pairs: 4 + 5, 8 + 9 Hz). The component frequencies were chosen to minimize the melanopsin photoresponse of intrinsically photosensitive retinal ganglion cells (ipRGCs) such that the pupil response was primarily driven by outer retinal photoreceptor inputs. Full-field (Ganzfeld) pupil responses and electroretinograms (ERGs) were recorded to the same stimuli at two mesopic light levels (−0.9 and 0 log cd/m2). Fourier analysis was used to derive the amplitudes and phases of the pupil and ERG responses. Results: For the beat frequency condition, when modulation was restricted to the same photoreceptor type at the higher mesopic level (0 log cd/m2), there was a pronounced pupil response to the 1 Hz beat frequency with the 4 + 5 Hz frequency pair and rare beat responses for the 8 + 9 Hz frequency pair. At the lower mesopic level there were few and inconsistent beat responses. When one component modulated the rod excitation and the other component modulated the cone excitation, responses to the beat frequency were rare and lower than the 1 Hz component frequency condition responses. These results were confirmed by ERG recordings. Conclusions: There is non-linearity in both the pupil response and electroretinogram to rod and cone inputs at mesopic light levels. The presence of a beat response for modulation components restricted to a single photoreceptor type, but not for components with cross-photoreceptor types, indicates that the location of a non-linear process in the pupil pathway occurs at a retinal site earlier than where the rod and cone signals are combined, that is, at the photoreceptor level.
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Affiliation(s)
- Pablo Alejandro Barrionuevo
- Instituto de Investigación en Luz, Ambiente y Visión, Consejo Nacional de Investigaciones Científicas y Técnicas-Universidad Nacional de Tucumán, San Miguel de Tucumán, Argentina
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Andrew J Zele
- Visual Science Laboratory, School of Optometry and Vision Science & Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
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78
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La Morgia C, Carelli V, Carbonelli M. Melanopsin Retinal Ganglion Cells and Pupil: Clinical Implications for Neuro-Ophthalmology. Front Neurol 2018; 9:1047. [PMID: 30581410 PMCID: PMC6292931 DOI: 10.3389/fneur.2018.01047] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023] Open
Abstract
Melanopsin retinal ganglion cells (mRGCs) are intrinsically photosensitive RGCs that mediate many relevant non-image forming functions of the eye, including the pupillary light reflex, through the projections to the olivary pretectal nucleus. In particular, the post-illumination pupil response (PIPR), as evaluated by chromatic pupillometry, can be used as a reliable marker of mRGC function in vivo. In the last years, pupillometry has become a promising tool to assess mRGC dysfunction in various neurological and neuro-ophthalmological conditions. In this review we will present the most relevant findings of pupillometric studies in glaucoma, hereditary optic neuropathies, ischemic optic neuropathies, idiopathic intracranial hypertension, multiple sclerosis, Parkinson's disease, and mood disorders. The use of PIPR as a marker for mRGC function is also proposed for other neurodegenerative disorders in which circadian dysfunction is documented.
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Affiliation(s)
- Chiara La Morgia
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Valerio Carelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Michele Carbonelli
- Unità Operativa Complessa Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
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79
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Bonmati-Carrion MA, Hild K, Isherwood CM, Sweeney SJ, Revell VL, Madrid JA, Rol MA, Skene DJ. Effect of Single and Combined Monochromatic Light on the Human Pupillary Light Response. Front Neurol 2018; 9:1019. [PMID: 30555403 PMCID: PMC6282540 DOI: 10.3389/fneur.2018.01019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/12/2018] [Indexed: 12/16/2022] Open
Abstract
The pupillary light reflex (PLR) is a neurological reflex driven by rods, cones, and melanopsin-containing retinal ganglion cells. Our aim was to achieve a more precise picture of the effects of 5-min duration monochromatic light stimuli, alone or in combination, on the human PLR, to determine its spectral sensitivity and to assess the importance of photon flux. Using pupillometry, the PLR was assessed in 13 participants (6 women) aged 27.2 ± 5.41 years (mean ± SD) during 5-min light stimuli of purple (437 nm), blue (479 nm), red (627 nm), and combinations of red+purple or red+blue light. In addition, nine 5-min, photon-matched light stimuli, ranging in 10 nm increments peaking between 420 and 500 nm were tested in 15 participants (8 women) aged 25.7 ± 8.90 years. Maximum pupil constriction, time to achieve this, constriction velocity, area under the curve (AUC) at short (0-60 s), and longer duration (240-300 s) light exposures, and 6-s post-illumination pupillary response (6-s PIPR) were assessed. Photoreceptor activation was estimated by mathematical modeling. The velocity of constriction was significantly faster with blue monochromatic light than with red or purple light. Within the blue light spectrum (between 420 and 500 nm), the velocity of constriction was significantly faster with the 480 nm light stimulus, while the slowest pupil constriction was observed with 430 nm light. Maximum pupil constriction was achieved with 470 nm light, and the greatest AUC0-60 and AUC240-300 was observed with 490 and 460 nm light, respectively. The 6-s PIPR was maximum after 490 nm light stimulus. Both the transient (AUC0-60) and sustained (AUC240-300) response was significantly correlated with melanopic activation. Higher photon fluxes for both purple and blue light produced greater amplitude sustained pupillary constriction. The findings confirm human PLR dependence on wavelength, monochromatic or bichromatic light and photon flux under 5-min duration light stimuli. Since the most rapid and high amplitude PLR occurred within the 460-490 nm light range (alone or combined), our results suggest that color discrimination should be studied under total or partial substitution of this blue light range (460-490 nm) by shorter wavelengths (~440 nm). Thus for nocturnal lighting, replacement of blue light with purple light might be a plausible solution to preserve color discrimination while minimizing melanopic activation.
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Affiliation(s)
- Maria A Bonmati-Carrion
- Chronobiology Laboratory, Department of Physiology, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Konstanze Hild
- Advanced Technology Institute and Department of Physics, University of Surrey, Guildford, United Kingdom
| | - Cheryl M Isherwood
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Stephen J Sweeney
- Advanced Technology Institute and Department of Physics, University of Surrey, Guildford, United Kingdom
| | - Victoria L Revell
- Surrey Clinical Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Juan A Madrid
- Chronobiology Laboratory, Department of Physiology, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Maria A Rol
- Chronobiology Laboratory, Department of Physiology, IMIB-Arrixaca, University of Murcia, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable, Madrid, Spain
| | - Debra J Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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80
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Kawasaki A, Wisniewski S, Healey B, Pattyn N, Kunz D, Basner M, Münch M. Impact of long-term daylight deprivation on retinal light sensitivity, circadian rhythms and sleep during the Antarctic winter. Sci Rep 2018; 8:16185. [PMID: 30385850 PMCID: PMC6212492 DOI: 10.1038/s41598-018-33450-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/27/2018] [Indexed: 11/12/2022] Open
Abstract
Long-term daylight deprivation such as during the Antarctic winter has been shown to lead to delayed sleep timing and sleep fragmentation. We aimed at testing whether retinal sensitivity, sleep and circadian rest-activity will change during long-term daylight deprivation on two Antarctic bases (Concordia and Halley VI) in a total of 25 healthy crew members (mean age: 34 ± 11y; 7f). The pupil responses to different light stimuli were used to assess retinal sensitivity changes. Rest-activity cycles were continuously monitored by activity watches. Overall, our data showed increased pupil responses under scotopic (mainly rod-dependent), photopic (mainly L-/M-cone dependent) as well as bright-blue light (mainly melanopsin-dependent) conditions during the time without direct sunlight. Circadian rhythm analysis revealed a significant decay of intra-daily stability, indicating more fragmented rest-activity rhythms during the dark period. Sleep and wake times (as assessed from rest-activity recordings) were significantly delayed after the first month without sunlight (p < 0.05). Our results suggest that during long-term daylight deprivation, retinal sensitivity to blue light increases, whereas circadian rhythm stability decreases and sleep-wake timing is delayed.
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Affiliation(s)
- A Kawasaki
- University of Lausanne, Hôpital Ophtalmique Jules-Gonin, Fondation Asile des aveugles, Lausanne, Switzerland
| | - S Wisniewski
- Charité Universitätsmedizin Berlin, Institute of Physiology, Berlin, Germany.,St. Hedwig-Krankenhaus, Berlin, Germany
| | - B Healey
- Centre Hospitalier Alps Léman, 74130, Contamine-sur-arve, France
| | - N Pattyn
- Vrije Universiteit Brussel, Department of Human Physiology & Royal Military Academy, VIPER Research Unit, Brussels, Belgium
| | - D Kunz
- Charité Universitätsmedizin Berlin, Institute of Physiology, Berlin, Germany.,St. Hedwig-Krankenhaus, Berlin, Germany.,Intellux GmbH, Berlin, Germany
| | - M Basner
- University of Pennsylvania, Department of Psychiatry, Perelman School of Medicine, Philadelphia, USA
| | - M Münch
- Charité Universitätsmedizin Berlin, Institute of Physiology, Berlin, Germany. .,St. Hedwig-Krankenhaus, Berlin, Germany. .,Charité Universitätsmedizin Berlin, Institute of Medical Immunology, Berlin, Germany.
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81
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McAdams H, Igdalova A, Spitschan M, Brainard DH, Aguirre GK. Pulses of Melanopsin-Directed Contrast Produce Highly Reproducible Pupil Responses That Are Insensitive to a Change in Background Radiance. Invest Ophthalmol Vis Sci 2018; 59:5615-5626. [PMID: 30481278 PMCID: PMC6262648 DOI: 10.1167/iovs.18-25219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose To measure the pupil response to pulses of melanopsin-directed contrast, and compare this response to those evoked by cone-directed contrast and spectrally narrowband stimuli. Methods Three-second unipolar pulses were used to elicit pupil responses in human subjects across three sessions. Thirty subjects were studied in session 1, and most returned for sessions 2 and 3. The stimuli of primary interest were "silent substitution" cone- and melanopsin-directed modulations. Red and blue narrowband pulses delivered using the post-illumination pupil response (PIPR) paradigm were also studied. Sessions 1 and 2 were identical, whereas session 3 involved modulations around higher radiance backgrounds. The pupil responses were fit by a model whose parameters described response amplitude and temporal shape. Results Group average pupil responses for all stimuli overlapped extensively across sessions 1 and 2, indicating high reproducibility. Model fits indicate that the response to melanopsin-directed contrast is prolonged relative to that elicited by cone-directed contrast. The group average cone- and melanopsin-directed pupil responses from session 3 were highly similar to those from sessions 1 and 2, suggesting that these responses are insensitive to background radiance over the range studied. The increase in radiance enhanced persistent pupil constriction to blue light. Conclusions The group average pupil response to stimuli designed through silent substitution provides a reliable probe of the function of a melanopsin-mediated system in humans. As disruption of the melanopsin system may relate to clinical pathology, the reproducibility of response suggests that silent substitution pupillometry can test if melanopsin signals differ between clinical groups.
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Affiliation(s)
- Harrison McAdams
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Aleksandra Igdalova
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Manuel Spitschan
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - David H. Brainard
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Geoffrey K. Aguirre
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
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82
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Zivcevska M, Blakeman A, Lei S, Goltz HC, Wong AMF. Binocular Summation in Postillumination Pupil Response Driven by Melanopsin-Containing Retinal Ganglion Cells. ACTA ACUST UNITED AC 2018; 59:4968-4977. [DOI: 10.1167/iovs.18-24639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Marija Zivcevska
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alan Blakeman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Shaobo Lei
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Herbert C. Goltz
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Agnes M. F. Wong
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- The Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
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83
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McAnany JJ, Smith BM, Garland A, Kagen SL. iPhone-based Pupillometry: A Novel Approach for Assessing the Pupillary Light Reflex. Optom Vis Sci 2018; 95:953-958. [PMID: 30234829 PMCID: PMC6166694 DOI: 10.1097/opx.0000000000001289] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The response of the pupil to a flash of light, the pupillary light reflex (PLR), is an important measure in optometry and in other fields of medicine that is typically evaluated by qualitative observation. Here we describe a simple, portable, iPhone-based pupillometer that quantifies the PLR in real time. PURPOSES The purposes of this study were to describe a novel application that records the PLR and to compare its technical capabilities with a laboratory-based infrared (IR) camera system. METHODS Pupil sizes were measured from 15 visually normal subjects (age, 19 to 65 years) using an IR camera system and the Sensitometer test. This test elicits pupillary constriction using the iPhone flash, records pupil size using the camera, and provides measurements in real time. Simultaneous recordings were obtained with the Sensitometer test and IR camera, and two measures were calculated: (1) dark-adapted steady-state pupil size and (2) minimum pupil size after the flash. The PLR was defined as the difference between these two measures. Pupil size was also recorded during the redilation phase after the flash. Bland-Altman analysis was used to assess the limits of agreement between the two methods. RESULTS Statistically significant correlations between the IR and Sensitometer test measures were found for the PLR (r = 0.91, P < .001) and redilation size (r = 0.65, P = .03). Bland-Altman analysis indicated a mean PLR difference of 6% between these two methods. The PLR limit of agreement was 14%, indicating that 95% of subjects are expected to have IR and Sensitometer test measurements that differ by 14% or less. Bland-Altman analysis indicated a mean redilation size difference of 1% between the two methods; the limit of agreement was 5%. CONCLUSIONS There is excellent agreement between pupil responses recorded using the Sensitometer test and IR camera. The Sensitometer test provides a highly promising approach for simple, portable, inexpensive pupillary measurements.
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Affiliation(s)
| | - Brandon M. Smith
- Department of Computer Sciences, University of Wisconsin–Madison, Madison, Wisconsin
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84
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Ostrin LA. The ipRGC-driven pupil response with light exposure and refractive error in children. Ophthalmic Physiol Opt 2018; 38:503-515. [PMID: 30259538 DOI: 10.1111/opo.12583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 09/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The intrinsically photosensitive retinal ganglion cells (ipRGCs) signal environmental light, control pupil size and entrain circadian rhythm. There is speculation that ipRGCs may be involved in the protective effects of light exposure in myopia. Here, the ipRGC-driven pupil response was evaluated in children and examined with light exposure and refractive error. METHODS Children ages 5-15 years participated. Subjects wore an actigraph device prior to the lab visit for objective measures of light exposure and sleep. For pupillometry, the left eye was dilated and presented with stimuli, and the consensual pupil response was measured in the right eye. Pupil measurements were preceded by 5 min dark adaptation. In Experiment 1 (n = 14), 1 s long wavelength light ('red,' 651 nm, 167 cd m-2 ) and 10 increasing intensities of 1 s short wavelength light ('blue,' 456 nm, 0.167-167 cd m-2 ) were presented with a 60 s interstimulus interval. A piecewise two-segment regression was fit to the stimulus response function to determine the functional melanopsin threshold. Pupil responses were analysed with light exposure over the previous 24 h. For Experiment 2 (n = 42), three 1 s red and three 1 s blue alternating stimuli were presented with a 60 s interstimulus interval. Following an additional 5-min dark adaption, the experiment was repeated. Pupil metrics included peak constriction, the 6 s and 30 s post-illumination response (PIPR), early and late area under the curve (AUC). Following pupil measurements, cycloplegic refractive error and axial length were measured. RESULTS For Experiment 1, PIPR metrics demonstrated a graded response to increasing intensity blue stimuli, with a mean functional melanopsin threshold of 6.2 ± 4.5 cd m-2 (range: 0.84-16.7 cd m-2 ). The 6 s PIPR and early AUC were associated with 24-h light exposure for high intensity stimuli (33.3 and 83.3 cd m-2 , p < 0.005 for both). For Experiment 2, there were no associations between pupil metrics and refractive error. The 6 s PIPR and early AUC to blue stimuli were significantly increased for Trial 2 compared to Trial 1. CONCLUSIONS The ipRGC-driven pupil responses in children were robust and similar to responses previously measured in an adult population. The 6 s PIPR and early AUC to high intensity blue stimuli were associated with previous light exposure. There were no associations between the ipRGC-driven pupil response and refractive status in this cohort.
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Affiliation(s)
- Lisa A Ostrin
- College of Optometry, University of Houston, Houston, USA
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85
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Najjar RP, Sharma S, Atalay E, Rukmini AV, Sun C, Lock JZ, Baskaran M, Perera SA, Husain R, Lamoureux E, Gooley JJ, Aung T, Milea D. Pupillary Responses to Full-Field Chromatic Stimuli Are Reduced in Patients with Early-Stage Primary Open-Angle Glaucoma. Ophthalmology 2018; 125:1362-1371. [DOI: 10.1016/j.ophtha.2018.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022] Open
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86
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Crippa SV, Pedrosa Domellöf F, Kawasaki A. Chromatic Pupillometry in Children. Front Neurol 2018; 9:669. [PMID: 30174642 PMCID: PMC6107754 DOI: 10.3389/fneur.2018.00669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/26/2018] [Indexed: 11/13/2022] Open
Abstract
Chromatic pupillometry is a technique that is increasingly used to assess retinal disorders. As age may be one of the various factors which can influence the pupillary light reaction, this study aimed to evaluate the pupil responses to colored light stimuli in the pediatric population. Fifty-three children with normal vision and without any history of ocular disorders were tested with a portable pupillometer. Four test sequences were used: five dim blue (470 nm) stimuli presented in half log steps ranging from −3.15 to −1.15 log cd/m2 after 3 min of dark adaptation, five red (622 nm) stimuli of −1.15, −0.7, −0.15, 0.3, and 0.85 log cd/m2 after 1 min light adaptation, one bright blue stimulus of 2.2 log cd/m2 and one bright red of 2 log cd/m2. The results were grouped by age: a younger group included 27 children aged from 3 to 10 years old and an older group included 26 from 10 and 1 month to 18 years old. The younger group had a smaller pupil diameter after dark adaptation compared with the older group. A linear regression defining the photopic threshold showed that younger subjects had a higher threshold, e.g., needed a brighter red stimulus to evoke a threshold pupil response comparable that of subjects. Age thus seems to influence outer retinal sensitivity at least as evaluated by the pupillary photopic threshold intensity. The post-illumination pupillary reaction was used as a marker of intrinsic melanopsin activity and did not show any difference between the two age groups.
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Affiliation(s)
- Sylvain V Crippa
- Neuro-Ophthalmology Unit, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.,Group for Retinal Disorder Research, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | | | - Aki Kawasaki
- Neuro-Ophthalmology Unit, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
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87
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Inner and Outer Retinal Contributions to Pupillary Light Response: Correlation to Functional and Morphologic Parameters in Glaucoma. J Glaucoma 2018; 27:723-732. [DOI: 10.1097/ijg.0000000000001003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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van der Meijden WP, Te Lindert BHW, Ramautar JR, Wei Y, Coppens JE, Kamermans M, Cajochen C, Bourgin P, Van Someren EJW. Sustained effects of prior red light on pupil diameter and vigilance during subsequent darkness. Proc Biol Sci 2018; 285:rspb.2018.0989. [PMID: 30051840 DOI: 10.1098/rspb.2018.0989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/26/2018] [Indexed: 11/12/2022] Open
Abstract
Environmental light can exert potent effects on physiology and behaviour, including pupil size, vigilance and sleep. Previous work showed that these non-image forming effects can last long beyond discontinuation of short-wavelength light exposure. The possible functional effects after switching off long-wavelength light, however, have been insufficiently characterized. In a series of controlled experiments in healthy adult volunteers, we evaluated the effects of five minutes of intense red light on physiology and performance during subsequent darkness. As compared to prior darkness, prior red light induced a subsequent sustained pupil dilation. Prior red light also increased subsequent heart rate and heart rate variability when subjects were asked to perform a sustained vigilance task during the dark exposure. While these changes suggest an increase in the mental effort required for the task, it could not prevent a post-red slowing of response speed. The suggestion that exposure to intense red light affects vigilance during subsequent darkness, was confirmed in a controlled polysomnographic study that indeed showed a post-red facilitation of sleep onset. Our findings suggest the possibility of using red light as a nightcap.
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Affiliation(s)
- Wisse P van der Meijden
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands .,Sleep Disorders Center, CHU and FMTS, CNRS-UPR 3212, Institute of Cellular and Integrative Neurosciences, University of Strasbourg, 67084 Strasbourg, France.,Center for Chronobiology, Psychiatric Hospital of the University of Basel, CH-4012 Basel, Switzerland
| | - Bart H W Te Lindert
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands
| | - Jennifer R Ramautar
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands
| | - Yishul Wei
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands
| | - Joris E Coppens
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands
| | - Maarten Kamermans
- Department of Retinal Signal Processing, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands.,Department of Neurogenetics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Christian Cajochen
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, CH-4012 Basel, Switzerland
| | - Patrice Bourgin
- Sleep Disorders Center, CHU and FMTS, CNRS-UPR 3212, Institute of Cellular and Integrative Neurosciences, University of Strasbourg, 67084 Strasbourg, France
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, 1081 HL Amsterdam, The Netherlands
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89
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Schroeder MM, Harrison KR, Jaeckel ER, Berger HN, Zhao X, Flannery MP, St Pierre EC, Pateqi N, Jachimska A, Chervenak AP, Wong KY. The Roles of Rods, Cones, and Melanopsin in Photoresponses of M4 Intrinsically Photosensitive Retinal Ganglion Cells (ipRGCs) and Optokinetic Visual Behavior. Front Cell Neurosci 2018; 12:203. [PMID: 30050414 PMCID: PMC6052130 DOI: 10.3389/fncel.2018.00203] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Intrinsically photosensitive retinal ganglion cells (ipRGCs) mediate not only image-forming vision like other ganglion cells, but also non-image-forming physiological responses to light such as pupil constriction and circadian photoentrainment. All ipRGCs respond to light through their endogenous photopigment melanopsin as well as rod/cone-driven synaptic inputs. A major knowledge gap is how melanopsin, rods, and cones differentially drive ipRGC photoresponses and image-forming vision. We whole-cell-recorded from M4-type ipRGCs lacking melanopsin, rod input, or cone input to dissect the roles of each component in ipRGCs' responses to steady and temporally modulated (≥0.3 Hz) lights. We also used a behavioral assay to determine how the elimination of melanopsin, rod, or cone function impacts the optokinetic visual behavior of mice. Results showed that the initial, transient peak in an M4 cell's responses to 10-s light steps arises from rod and cone inputs. Both the sustainability and poststimulus persistence of these light-step responses depend only on rod and/or cone inputs, which is unexpected because these ipRGC photoresponse properties have often been attributed primarily to melanopsin. For temporally varying stimuli, the enhancement of response sustainedness involves melanopsin, whereas stimulus tracking is mediated by rod and cone inputs. Finally, the behavioral assay showed that while all three photoreceptive systems are nearly equally important for contrast sensitivity, only cones and rods contribute to spatial acuity.
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Affiliation(s)
- Melanie M Schroeder
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Krystal R Harrison
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States.,Department of Molecular, Cellular & Developmental Biology, University of Michigan, Ann Arbor, MI, United States
| | - Elizabeth R Jaeckel
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Hunter N Berger
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Xiwu Zhao
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Michael P Flannery
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Emma C St Pierre
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Nancy Pateqi
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Agnieszka Jachimska
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Andrew P Chervenak
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Kwoon Y Wong
- Department of Ophthalmology & Visual Sciences, University of Michigan, Ann Arbor, MI, United States.,Department of Molecular, Cellular & Developmental Biology, University of Michigan, Ann Arbor, MI, United States
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90
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Joyce DS, Feigl B, Kerr G, Roeder L, Zele AJ. Melanopsin-mediated pupil function is impaired in Parkinson's disease. Sci Rep 2018; 8:7796. [PMID: 29773814 PMCID: PMC5958070 DOI: 10.1038/s41598-018-26078-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/30/2018] [Indexed: 01/16/2023] Open
Abstract
Parkinson's disease (PD) is characterised by non-motor symptoms including sleep and circadian disruption. Melanopsin-expressing intrinsically photosensitive Retinal Ganglion Cells (ipRGC) transmit light signals to brain areas controlling circadian rhythms and the pupil light reflex. To determine if non-motor symptoms observed in PD are linked to ipRGC dysfunction, we evaluated melanopsin and rod/cone contributions to the pupil response in medicated participants with PD (n = 17) and controls (n = 12). Autonomic tone was evaluated by measuring pupillary unrest in darkness. In the PD group, there is evidence for an attenuated post-illumination pupil response (PIPR) amplitude and reduced pupil constriction amplitude, and PIPR amplitudes did not correlate with measures of sleep quality, retinal nerve fibre layer thickness, disease severity, or medication dosage. Both groups exhibited similar pupillary unrest. We show that melanopsin- and the rod/cone-photoreceptor contributions to the pupil control pathway are impaired in people with early-stage PD who have no clinically observable ophthalmic abnormalities. Given that ipRGCs project to brain targets involved in arousal, sleep and circadian rhythms, ipRGC dysfunction may underpin some of the non-motor symptoms observed in PD.
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Affiliation(s)
- Daniel S Joyce
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- Visual Science Laboratory, School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Australia
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, USA
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- Medical Retina Laboratory, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Australia
- Queensland Eye Institute, Brisbane, Australia
| | - Graham Kerr
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- Movement Neuroscience Program, Queensland University of Technology (QUT), Brisbane, Australia
| | - Luisa Roeder
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia
- Movement Neuroscience Program, Queensland University of Technology (QUT), Brisbane, Australia
| | - Andrew J Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Australia.
- Visual Science Laboratory, School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Australia.
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91
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Truong JQ, Joshi NR, Ciuffreda KJ. Influence of refractive error on pupillary dynamics in the normal and mild traumatic brain injury (mTBI) populations. JOURNAL OF OPTOMETRY 2018; 11:93-102. [PMID: 28262507 PMCID: PMC5904777 DOI: 10.1016/j.optom.2016.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE There have been several studies investigating static, baseline pupil diameter in visually-normal individuals across refractive error. However, none have assessed the dynamic pupillary light reflex (PLR). In the present study, both static and dynamic pupillary parameters of the PLR were assessed in both the visually-normal (VN) and the mild traumatic brain injury (mTBI) populations and compared as a function of refractive error. METHODS The VN population comprised 40 adults (22-56 years of age), while the mTBI population comprised 32 adults (21-60 years of age) over a range of refractive errors (-9.00D to +1.25D). Seven pupillary parameters (baseline static diameter, latency, amplitude, and peak and average constriction and dilation velocities) were assessed and compared under four white-light stimulus conditions (dim pulse, dim step, bright pulse, and bright step). The Neuroptics, infrared, DP-2000 binocular pupillometer (30Hz sampling rate; 0.05mm resolution) was used in the monocular (right eye) stimulation mode. RESULTS For the majority of pupillary parameters and stimulus conditions, a Gaussian distribution best fit the data, with the apex centered in the low myopic range (-2.3 to -4.9D). Responsivity was reduced to either side of the apex. CONCLUSIONS Over a range of dynamic and static pupillary parameters, the PLR was influenced by refractive error in both populations. In cases of high refractive error, the PLR parameters may need to be compensated for this factor for proper categorization and diagnosis.
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Affiliation(s)
- James Q Truong
- SUNY College of Optometry, Department of Biological and Vision Sciences, 33 West 42(nd) Street, New York, NY 10036, USA
| | - Nabin R Joshi
- SUNY College of Optometry, Department of Biological and Vision Sciences, 33 West 42(nd) Street, New York, NY 10036, USA.
| | - Kenneth J Ciuffreda
- SUNY College of Optometry, Department of Biological and Vision Sciences, 33 West 42(nd) Street, New York, NY 10036, USA
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92
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Ba-Ali S, Jensen RH, Larsen LS, Lund-Andersen H, Hamann S. The Melanopsin-Mediated Pupillary Light Response Is Not Changed in Patients with Newly Diagnosed Idiopathic Intracranial Hypertension. Neuroophthalmology 2018; 42:65-72. [PMID: 29563950 DOI: 10.1080/01658107.2017.1344251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/07/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022] Open
Abstract
Previously, it has been reported that melanopsin-mediated pupillary light response (PLR), measured with pupillometry, is reduced in patients with idiopathic intracranial hypertension (IIH), indicating the clinical utility of the tool in the diagnosis of IIH. In the current study, the authors aimed to measure the PLR in 13 treatment-naive patients with new-onset IIH and 13 healthy controls. In contrast to the previous report, which was based on patients with longstanding IIH (n = 13), the authors found no significant difference in the melanopsin-mediated PLR (p = 0.48).
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Affiliation(s)
- Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rigmor Højland Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Line Sofie Larsen
- Department of Neurology, Danish Headache Center, Rigshospitalet, Glostrup, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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93
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Berman G, Muttuvelu D, Berman D, Larsen JI, Licht RW, Ledolter J, Kardon RH. Decreased retinal sensitivity in depressive disorder: a controlled study. Acta Psychiatr Scand 2018; 137:231-240. [PMID: 29336011 DOI: 10.1111/acps.12851] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare pupil responses in depressed patients with a seasonal pattern, depressed patients without a seasonal pattern and healthy controls as a function of daylight hours on the testing day. METHOD Patients suffering from a major depressive episode were included in wintertime. The pupil light reflex was measured at inclusion and in the following summer using a binocular pupillometer. A protocol of low (1 lux) and high (400 lux) intensity red and blue lights was used to assess rod, cone and melanopsin-containing intrinsic photosensitive retinal ganglion cell input to the pupil reflex. RESULTS The mean group pupil responses associated with a melanopsin-mediated sustained pupil response at 400 lux blue light were significantly reduced in the depressed subjects (N = 39) as compared to the healthy controls (N = 24) (P = 0.023). Across all groups, a reduction in number of daylight hours was significantly associated with a reduction in sustained pupil response (P = 0.007). All groups showed an equal effect of daylight hours on the melanopsin-mediated sustained pupil response. CONCLUSION The melanopsin-mediated sustained pupil contraction to offset of high-intensity blue light is reduced in depressed patients. These results further emphasize the interaction of light exposure with depression.
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Affiliation(s)
- G Berman
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - D Muttuvelu
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - D Berman
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - J I Larsen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - R W Licht
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J Ledolter
- Department of Veterans Affairs Hospital, Iowa City Veterans Affairs Center for Prevention of Visual Loss, Iowa City, IA, USA
| | - R H Kardon
- Department of Veterans Affairs Hospital, Iowa City Veterans Affairs Center for Prevention of Visual Loss, Iowa City, IA, USA.,Department of Ophthalmology and Visual Science, University of Iowa Hospitals and Clinics and Veterans Administration Hospitals, Iowa City, IA, USA
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94
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Bauer M, Glenn T, Monteith S, Gottlieb JF, Ritter PS, Geddes J, Whybrow PC. The potential influence of LED lighting on mental illness. World J Biol Psychiatry 2018; 19:59-73. [PMID: 29251065 DOI: 10.1080/15622975.2017.1417639] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two recent scientific breakthroughs may alter the treatment of mental illness, as discussed in this narrative review. The first was the invention of white light-emitting diodes (LEDs), which enabled an ongoing, rapid transition to energy-efficient LEDs for lighting, and the use of LEDs to backlight digital devices. The second was the discovery of melanopsin-expressing photosensitive retinal ganglion cells, which detect environmental irradiance and mediate non-image forming (NIF) functions including circadian entrainment, melatonin secretion, alertness, sleep regulation and the pupillary light reflex. These two breakthroughs are interrelated because unlike conventional lighting, white LEDs have a dominant spectral wavelength in the blue light range, near the peak sensitivity for the melanopsin system. METHODS Pertinent articles were identified. RESULTS Blue light exposure may suppress melatonin, increase alertness, and interfere with sleep in young, healthy volunteers and in animals. Areas of concern in mental illness include the influence of blue light on sleep, other circadian-mediated symptoms, prescribed treatments that target the circadian system, measurement using digital apps and devices, and adolescent sensitivity to blue light. CONCLUSIONS While knowledge in both fields is expanding rapidly, future developments must address the potential impact of blue light on NIF functions for healthy individuals and those with mental illness.
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Affiliation(s)
- Michael Bauer
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - Tasha Glenn
- b ChronoRecord Association, Inc , Fullerton , CA , USA
| | - Scott Monteith
- c Michigan State University College of Human Medicine, Traverse City Campus , Traverse City , MI , USA
| | - John F Gottlieb
- d Department of Psychiatry , Feinberg School of Medicine, Northwestern University , Chicago , IL , USA
| | - Philipp S Ritter
- a Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden , Dresden , Germany
| | - John Geddes
- e Department of Psychiatry , University of Oxford, Warneford Hospital , Oxford , UK
| | - Peter C Whybrow
- f Department of Psychiatry and Biobehavioral Sciences , Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA) , Los Angeles , CA , USA
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95
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Ba-Ali S, Lund-Andersen H, Ahmadi H, Brøndsted AE. Effect of Intermittent versus Continuous Light Exposure on Pupillary Light Response, As Evaluated by Pupillometry. Front Neurol 2018; 8:746. [PMID: 29387040 PMCID: PMC5775973 DOI: 10.3389/fneur.2017.00746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/26/2017] [Indexed: 12/11/2022] Open
Abstract
Objective Continuous and intermittent stimuli with green light affect the pupillary light response (PLR) differently. Since the majority of pupillometric studies use blue and red lights, we investigated the effect of continuous and intermittent stimulations on the PLR using red and blue lights. Methods Seventeen healthy subjects underwent continuous- and intermittent light stimuli, using red (643 nm) and blue light (463 nm). To avoid the influence of pupil size on the amount of light entering the eye, the procedures were repeated with the stimulus–eye in dilated condition. The maximal pupillary constriction and the early redilation phase of post-illumination pupillary response (PIPREarly) represented the mixed response of melanopsin and rod–cone photoreceptors. The late redilation phase of PIPR (PIPRLate) was the marker of melanopsin-containing retinal ganglion cells. Results Intermittent stimuli with blue light elicited significantly larger maximal contraction during dilated condition (P = 0.001), and larger sustained pupillary contraction under dilated as well as undilated condition (P < 0.001) compared to continuous light exposure. Except the PIPREarly during undilated condition, none of the PIPR metrics were significantly different between intermittent and continuous blue light stimuli. Intermittent red light stimuli elicited also a more sustained pupillary contraction regardless of mydriatic instillation (P ≤ 0.02). In addition, intermittent red light exposure resulted in a slightly larger PIPREarly under undilated condition (P = 0.02) and a slightly larger PIPRLate under dilated condition (P = 0.049). Except the PIPRLate to continuous red light stimulus, all PIPR parameters were larger when the light was presented after induction of unilateral mydriasis. Conclusion PLR parameters during and after light exposures depend on both the light stimulation mode and the entrance pupillary size.
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Affiliation(s)
- Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hamid Ahmadi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Adam Elias Brøndsted
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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96
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Abstract
OBJECTIVE The purpose of this study was to evaluate the pupil response to chromatic stimuli in patients with lesions in the dorsal midbrain and possibly gain new insights into the afferent pupillary pathways. METHODS Color pupillography was performed in 5 patients with dorsal midbrain syndrome (DMS), and their results were compared with those of 20 healthy control subjects. We used full-field red stimuli (605 nm) that primarily address the rod/cone system and blue stimuli (420 nm) that preferentially activate intrinsically photosensitive retinal ganglion cells (ipRGCs) directly, with a duration of 4 seconds and a stimulus intensity of 28 lx corneal illumination under mesopic conditions. One eye was stimulated, and the consensual pupil response was recorded and analyzed. RESULTS The pupillary light reflex in patients with DMS was reduced, differed in shape, and showed a prolonged latency time compared to normal subjects. The blue response was less affected than the red response: the mean maximal relative amplitude (M) was 15.8% (SD = 7.8) in patients with DMS compared with 43.0% (SD = 5.5) in normal subjects for red stimulation, and M = 40.8%, SD = 8.4 (DMS) with M = 58.3%, SD = 4.8 (normals) for blue stimulation. The reduction was 63% for red stimulation but only 30% for blue stimulation in patients with DMS. Moreover, there was a preserved postillumination pupil response to blue stimulation in DMS patients. CONCLUSIONS In DMS, the melanopsin-mediated ipRGC pathway appeared relatively preserved.
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97
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Ciuffreda KJ, Joshi NR, Truong JQ. Understanding the effects of mild traumatic brain injury on the pupillary light reflex. Concussion 2017; 2:CNC36. [PMID: 30202579 PMCID: PMC6094691 DOI: 10.2217/cnc-2016-0029] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/15/2017] [Indexed: 11/21/2022] Open
Abstract
The pupillary light reflex represents an optimal visual system to investigate and exploit in the mild traumatic brain injury (mTBI) population. Static and dynamic aspects of the pupillary light reflex were investigated objectively and quantitatively in the mTBI population. Pupillary responsivity was found to be significantly delayed, slowed and reduced, but symmetrical in nature, and with a smaller baseline diameter, as compared with normals. Several pupillary parameters also discriminated between those with versus without photosensitivity. Thus, dynamic pupillometry provides several objective biomarkers for the presence of mTBI and photosensitivity, gives insight into the global sites of neurological dysfunction and possible related mechanisms, and should result in improved patient care.
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Affiliation(s)
- Kenneth J Ciuffreda
- Brain Injury Research Clinic, SUNY/State College of Optometry, 33 West 42nd Street, New York City, NY 10036, USA
| | - Nabin R Joshi
- Brain Injury Research Clinic, SUNY/State College of Optometry, 33 West 42nd Street, New York City, NY 10036, USA
| | - James Q Truong
- Brain Injury Research Clinic, SUNY/State College of Optometry, 33 West 42nd Street, New York City, NY 10036, USA
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98
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Lee S, Muto N, Shimomura Y, Katsuura T. Human pupillary light reflex during successive irradiation with 1-ms blue- and green-pulsed light. J Physiol Anthropol 2017; 36:37. [PMID: 29041976 PMCID: PMC5646119 DOI: 10.1186/s40101-017-0153-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/10/2017] [Indexed: 11/16/2022] Open
Abstract
Background In the human retina, the contribution of intrinsically photosensitive retinal ganglion cells (ipRGCs) to the regulation of the pupillary response remains poorly understood. The objective of the current study was to determine the response dynamics of the pupillary light reflex to short, successive pulses of light. In order to better assess the roles of ipRGCs and cones, we used pulses of blue and green light. Methods Each participant was exposed to 1-ms blue (466 nm) and/or green (527 nm) light pulses simultaneously or separately, with inter-stimulus intervals (ISIs) of 0, 250, 500, 750, or 1000 ms. Pupil diameter was measured using an infrared camera system. Results We found that human pupillary light responses during simultaneous irradiation or successive irradiation with ISIs ≤ 250 ms were equivalent, though successive irradiation of blue- and green-pulsed light with ISIs ≥ 500 ms induced markedly increased pupillary constriction. Conclusions We propose that this result may be related to cell hyperpolarization that occurs in the retina just after the first light stimulus is turned off, with the threshold for this effect being between 250 and 500 ms in the human retina.
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Affiliation(s)
- Soomin Lee
- Center for Environment, Health and Field Sciences, Chiba University, 6-2-1, Kashiwanoha, Kashiwa, 277-0882, Japan.
| | - Naoko Muto
- Faculty of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
| | - Yoshihiro Shimomura
- Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
| | - Tetsuo Katsuura
- Graduate School of Engineering, Chiba University, 1-33, Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
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99
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Novotny P, Plischke H. Pupillary light reflex and circadian synchronization in the elderly. Psych J 2017; 6:292-293. [DOI: 10.1002/pchj.186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Philipp Novotny
- Department of Applied Sciences and Mechatronics; Munich University of Applied Sciences; Munich Germany
| | - Herbert Plischke
- Department of Applied Sciences and Mechatronics; Munich University of Applied Sciences; Munich Germany
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100
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Ostrin LA, Abbott KS, Queener HM. Attenuation of short wavelengths alters sleep and the ipRGC pupil response. Ophthalmic Physiol Opt 2017; 37:440-450. [PMID: 28656675 DOI: 10.1111/opo.12385] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Exposure to increasing amounts of artificial light during the night may contribute to the high prevalence of reported sleep dysfunction. Release of the sleep hormone melatonin is mediated by the intrinsically photosensitive retinal ganglion cells (ipRGCs). This study sought to investigate whether melatonin level and sleep quality can be modulated by decreasing night-time input to the ipRGCs. METHODS Subjects (ages 17-42, n = 21) wore short wavelength-blocking glasses prior to bedtime for 2 weeks. The ipRGC-mediated post illumination pupil response was measured before and after the experimental period. Stimulation was presented with a ganzfeld stimulator, including one-second and five-seconds of long and short wavelength light, and the pupil was imaged with an infrared camera. Pupil diameter was measured before, during and for 60 s following stimulation, and the six-second and 30 s post illumination pupil response and area under the curve following light offset were determined. Subjects wore an actigraph device for objective measurements of activity, light exposure, and sleep. Saliva samples were collected to assess melatonin content. The Pittsburgh Sleep Quality Index (PSQI) was administered to assess subjective sleep quality. RESULTS Subjects wore the blue-blocking glasses 3:57 ± 1:03 h each night. After the experimental period, the pupil showed a slower redilation phase, resulting in a significantly increased 30 s post illumination pupil response to one-second short wavelength light, and decreased area under the curve for one and five-second short wavelength light, when measured at the same time of day as baseline. Night time melatonin increased from 16.1 ± 7.5 pg mL-1 to 25.5 ± 10.7 pg mL-1 (P < 0.01). Objectively measured sleep duration increased 24 min, from 408.7 ± 44.9 to 431.5 ± 42.9 min (P < 0.001). Mean PSQI score improved from 5.6 ± 2.9 to 3.0 ± 2.2. CONCLUSIONS The use of short wavelength-blocking glasses at night increased subjectively measured sleep quality and objectively measured melatonin levels and sleep duration, presumably as a result of decreased night-time stimulation of ipRGCs. Alterations in the ipRGC-driven pupil response suggest a shift in circadian phase. Results suggest that minimising short wavelength light following sunset may help in regulating sleep patterns.
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Affiliation(s)
- Lisa A Ostrin
- University of Houston College of Optometry, Houston, USA
| | - Kaleb S Abbott
- University of Houston College of Optometry, Houston, USA
| | - Hope M Queener
- University of Houston College of Optometry, Houston, USA
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