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Biçer GY, Yılmaz Öztorun Z, Biçer KE, Zor KR. Analysis of pupillary responses in pediatric patients with vitamin D deficiency. Graefes Arch Clin Exp Ophthalmol 2024; 262:2625-2632. [PMID: 38416236 DOI: 10.1007/s00417-024-06428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE To evaluate the effects of vitamin D deficiency on pupillary responses in the pediatric population. METHODS The study was conducted using data from the right eyes of 52 children with vitamin D deficiency and 52 healthy children. Measurements were taken under static and dynamic conditions with automatic pupillometry. Static measurements were performed at scotopic, mesopic, and photopic light intensities. The mean pupil dilation speed was calculated by observing the changes in pupil dilation over time according to dynamic measurements. Differences between patient and control groups were analyzed for the static and dynamic measurements and the mean pupil dilation speed. RESULTS While the two groups were similar in terms of scotopic, mesopic, the first dynamic measurements, and the pupil dilation speed data (p > 0.05), a significant difference was found in the photopic conditions (p = 0.001). The mean pupil diameter of the patient group was 4.46 ± 0.928 mm and 3.95 ± 0.556 mm in the control group under photopic conditions. CONCLUSIONS Pediatric patients with vitamin D deficiency have significantly larger pupil diameters in photopic conditions than healthy children. These results suggest that there is an autonomic dysfunction in vitamin D deficiency in the pediatric population, especially pointing to the parasympathetic system.
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Affiliation(s)
- Gamze Yıldırım Biçer
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey.
| | - Zeynep Yılmaz Öztorun
- Department of Pediatrics, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey
| | - Kadir Eren Biçer
- Department of Orthopedics and Traumatology, Niğde Education and Research Hospital, Kumluca, Nigde, Turkey
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey
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Machalińska A, Kuligowska A, Ziontkowska-Wrzałek A, Stroynowska B, Pius-Sadowska E, Safranow K, Machaliński J, Mozolewska-Piotrowska K, Machaliński B. The Severity of Diabetic Retinopathy Corresponds with Corneal Nerve Alterations and Ocular Discomfort of the Patient. Int J Mol Sci 2024; 25:6072. [PMID: 38892258 PMCID: PMC11173272 DOI: 10.3390/ijms25116072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diabetic retinopathy (DR) remains the leading cause of blindness in the working-age population. Its progression causes gradual damage to corneal nerves, resulting in decreased corneal sensitivity (CS) and disruption of anterior-eye-surface homeostasis, which is clinically manifested by increased ocular discomfort and dry eye disease (DED). This study included 52 DR patients and 52 sex- and age-matched controls. Ocular Surface Disease Index (OSDI) survey, tear film-related parameters, CS, and in vivo corneal confocal microscopy (IVCM) of the subbasal plexus were performed. Furthermore, all patients underwent tear sampling for neurotrophin and cytokine analysis. OSDI scores were greater in DR patients than in controls (p = 0.00020). No differences in the Schirmer test score, noninvasive tear film-break-up time (NIBUT), tear meniscus or interferometry values, bulbar redness, severity of blepharitis or meibomian gland loss were found. In the DR group, both the CS (p < 0.001), and the scotopic pupil diameter (p = 0.00008) decreased. IVCM revealed reduced corneal nerve parameters in DR patients. The stage of DR was positively correlated with the OSDI (Rs = +0.51, 95% CI: + 0.35-+0.64, p < 0.001) and negatively correlated with IVCM corneal nerve parameters and scotopic pupillometry (Rs = -0.26, 95% CI: -0.44--0.06, p = 0.0097). We found negative correlations between the OSDI and IVCM corneal innervation parameters. The DR group showed lower tear film-brain-derived neurotrophic factor (BDNF) levels (p = 0.0001) and no differences in nerve growth factor (NGF)-β, neurotrophin (NT)-4, vascular endothelial growth factor (VEGF), interleukin (IL)-1β, IL-4, IL-5, IL-6, or IL-12 concentrations. Tumor necrosis factor (TNF)-α, IL-2, IL-8, IL-10, granulocyte macrophage colony-stimulating factor (GM-CSF), and interferon (IFN)-γ levels were decreased among patients with DR. Corneal innervation defects have a direct impact on patients' subjective feelings. The evolution of DR appears to be associated with corneal nerve alterations, emphasizing the importance of IVCM.
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Affiliation(s)
- Anna Machalińska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Agnieszka Kuligowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Alicja Ziontkowska-Wrzałek
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Beata Stroynowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Ewa Pius-Sadowska
- Department of General Pathology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (E.P.-S.); (B.M.)
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Jan Machaliński
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Katarzyna Mozolewska-Piotrowska
- First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (A.K.); (A.Z.-W.); (B.S.); (J.M.); (K.M.-P.)
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland; (E.P.-S.); (B.M.)
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Serbest Ceylanoglu K, Sen EM, Sekeroglu MA. Static and dynamic pupillary features in graves’ ophthalmopathy. Clin Exp Optom 2022:1-5. [DOI: 10.1080/08164622.2022.2059344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Emine Malkoc Sen
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Sekeroglu
- University of Health Sciences, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Yalim Z, Alan Yalim S, Eroğul Ö, Doğan M. The role of heart rate variability and heart rate turbulence in diabetic retinopathy. Minerva Endocrinol (Torino) 2022; 47:172-180. [PMID: 35142481 DOI: 10.23736/s2724-6507.20.03346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS The aim of this study was to evaluate the cardiac autonomic functions of individuals with asymptomatic diabetic retinopathy (DR) and no obvious heart disease by heart rate turbulence (HRT) and heart rate variability (HRV) analysis. METHODS A total of 72 patients with Type II Diabetes Mellitus: 20 non-retinopathic (NRDM), 26 non-proliferative retinopathic patients (NPDR) and 26 proliferative retinopathic patients (PDR) were enrolled in this cross-sectional study. RESULTS The HRV parameters of Standard deviation of NN intervals (SDNN) (119.8±11.7, 101.1±20.2, 100.6±17.04), Standard deviation of the average NN intervals (SDANN) (108.3±10.8, 91.2±17.5, 93.6±18.4), SDNN Index (49.5±5.1, 40.1±13.4, 38.6±12.7), Root mean square of successive RR interval differences (RMSSD) (28.3±5.1, 22.3±7.5, 26±9.2) and Triangular index (34.4±4.3, 29.7±8.8, 27.3±6.7) were significantly lower in the NPDR and PDR groups than in the NRDM group (for all p<0.05). Also, there was a statistically significant higher Turbulence Onset (-1.80±0.7, -1.1±0.9, -0.43±0.81) and lower Turbulence Slope (8.05±2.59, 5.82±3.39, 4.53±2.07) in HRT parameters in patients in the NPDR and PDR groups than in the NRDM group (respectively, NRDM, NPDM, PDM, for all p<0.001). CONCLUSIONS We found that HRV and HRT parameters had a significant deterioration in retinopathic individuals compared to the group without retinopathy. We think that HRV and HRT analysis can have an important role in the evaluation of these patients.
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Affiliation(s)
- Zafer Yalim
- Department of Cardiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey -
| | - Sümeyra Alan Yalim
- Department of İnternal Medicine, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Özgür Eroğul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
| | - Mustafa Doğan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University Hospital, Afyonkarahisar, Turkey
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Ava S, Hazar L, Karahan M, Erdem S, Dursun ME, Pekkolay Z, Keklikçi U. Quantitative Evaluation of Pupil Responses in Patients with Prolactinomas Being Treated with Dopamine Agonists. Neuroophthalmology 2022; 46:154-158. [PMID: 35574168 PMCID: PMC9103269 DOI: 10.1080/01658107.2021.2021247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The aim of this study was to determine whether the dopamine agonist (DA) drug cabergoline used in the treatment of prolactinoma causes autonomic dysfunction by measuring static and dynamic pupillary responses. The study included 25 eyes from 25 patients who were receiving DA for the treatment of prolactinoma and 25 eyes from 25 healthy individuals. Static and dynamic pupillary responses were measured by automatic quantitative pupillometry. The scotopic pupillary diameter was found to be significantly higher in patients receiving DA medication compared with the control group, while pupil contraction time and pupillary dilatation latency were significantly lower. DA drug use changes static and dynamic pupillary responses, probably by increasing sympathetic tone. Pupillometry can be used as a non-invasive method to provide information about changes in the autonomic nervous system in patients receiving such drug therapy.
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Affiliation(s)
- Sedat Ava
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Leyla Hazar
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey,CONTACT Leyla Hazar Department of Ophthalmology, Dicle University School of Medicine, Sur/Diyarbakır21280, Turkey
| | - Mine Karahan
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Seyfettin Erdem
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Mehmet Emin Dursun
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Zafer Pekkolay
- Department of Endocrinology and Metabolism, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
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Tan T, Finkelstein MT, Tan GSW, Tan ACS, Chan CM, Mathur R, Wong EYM, Cheung CMG, Wong TY, Milea D, Najjar RP. Retinal neural dysfunction in diabetes revealed with handheld chromatic pupillometry. Clin Exp Ophthalmol 2022; 50:745-756. [PMID: 35616273 PMCID: PMC9796882 DOI: 10.1111/ceo.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To evaluate the ability of handheld chromatic pupillometry to reveal and localise retinal neural dysfunction in diabetic patients with and without diabetic retinopathy (DR). METHODS This cross-sectional study included 82 diabetics (DM) and 93 controls (60.4 ± 8.4 years, 44.1% males). DM patients included those without (n = 25, 64.7 ± 6.3 years, 44.0% males) and with DR (n = 57, 60.3 ± 8.5 years, 64.9% males). Changes in horizontal pupil radius in response to blue (469 nm) and red (640 nm) light stimuli were assessed monocularly, in clinics, using a custom-built handheld pupillometer. Pupillometric parameters (phasic constriction amplitudes [predominantly from the outer retina], maximal constriction amplitudes [from the inner and outer retina] and post-illumination pupillary responses [PIPRs; predominantly from the inner retina]) were extracted from baseline-adjusted pupillary light response traces and compared between controls, DM without DR, and DR. Net PIPR was defined as the difference between blue and red PIPRs. RESULTS Phasic constriction amplitudes to blue and red lights were decreased in DR compared to controls (p < 0.001; p < 0.001). Maximal constriction amplitudes to blue and red lights were decreased in DR compared to DM without DR (p < 0.001; p = 0.02), and in DM without DR compared to controls (p < 0.001; p = 0.005). Net PIPR was decreased in both DR and DM without DR compared to controls (p = 0.02; p = 0.03), suggesting a wavelength-dependent (and hence retinal) pupillometric dysfunction in diabetic patients with or without DR. CONCLUSIONS Handheld chromatic pupillometry can reveal retinal neural dysfunction in diabetes, even without DR. Patients with DM but no DR displayed primarily inner retinal dysfunction, while patients with DR showed both inner and outer retinal dysfunction.
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Affiliation(s)
- Tien‐En Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Maxwell T. Finkelstein
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Anna Cheng Sim Tan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Choi Mun Chan
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Ranjana Mathur
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Dan Milea
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore
| | - Raymond P. Najjar
- Singapore Eye Research Institute, SingaporeSingapore National Eye CentreSingaporeSingapore,Duke‐National University of Singapore Medical SchoolSingaporeSingapore,Department of Ophthalmology, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
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Karpecki PM, Foster SA, Montaquila SM, Kannarr SR, Slonim CB, Meyer AR, Sooch MP, Jaber RM, Charizanis K, Yousif JE, Klapman SA, Amin AT, McDonald MB, Horn GD, Lazar ES, Pepose JS. Phentolamine Eye Drops Reverse Pharmacologically Induced Mydriasis in a Randomized Phase 2b Trial. Optom Vis Sci 2021; 98:234-242. [PMID: 33633016 DOI: 10.1097/opx.0000000000001656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE After a dilated eye examination, many patients experience symptoms of prolonged light sensitivity, blurred vision, and cycloplegia associated with pharmacological mydriasis. Phentolamine mesylate ophthalmic solution (PMOS) may expedite the reversal of mydriasis in patients, potentially facilitating return to functional vision and reducing barriers to obtaining dilated eye examinations. PURPOSE The protracted reversal time after pharmacologically induced pupil dilation impairs vision. We tested the hypothesis that PMOS rapidly reduces pupil diameter in this acute indication. METHODS In this double-masked placebo-controlled, randomized, two-arm crossover phase 2b trial, we evaluated the effects of one drop of 1% PMOS applied bilaterally in subjects who had their pupils dilated by one of two common mydriatic agents: 2.5% phenylephrine or 1% tropicamide. End points included change in pupil diameter, percent of subjects returning to baseline pupil diameter, and accommodative function at multiple time points. RESULTS Thirty-one subjects completed the study (15 dilated with phenylephrine and 16 with tropicamide). Change in pupil diameter from baseline at 2 hours after maximal dilation with 1% PMOS was -1.69 mm and was significantly greater in magnitude compared with placebo for every time point beyond 30 minutes (P < .05). At 2 hours, a greater percentage of study eyes given 1% PMOS returned to baseline pupil diameter compared with placebo (29 vs. 13%, P = .03), which was this also seen at 4 hours (P < .001). More subjects treated with PMOS in the tropicamide subgroup had at least one eye returning to baseline accommodative amplitude at 2 hours (63 vs. 38%, P = .01). There were no severe adverse events, with only mild to moderate conjunctival hyperemia that resolved in most patients by 6 hours. CONCLUSIONS Phentolamine mesylate ophthalmic solution at 1% reversed medically induced pupil dilation more rapidly than placebo treatment regardless of which mydriatic was used (adrenergic agonists and cholinergic blockers) with a tolerable safety profile.
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