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Reutrakul S, Park JC, McAnany JJ, Chau FY, Danielson KK, Prasad B, Cross A, Sintetas S, Law J, Pannain S, Pratuangtham S, Van Cauter E, Hanlon EC. Dysregulated 24 h melatonin secretion associated with intrinsically photosensitive retinal ganglion cell function in diabetic retinopathy: a cross-sectional study. Diabetologia 2024; 67:1114-1121. [PMID: 38413436 PMCID: PMC11195022 DOI: 10.1007/s00125-024-06118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to explore whether diabetic retinopathy is associated with alterations of the circadian system, and to examine the role of reduced intrinsically photosensitive retinal ganglion cell (ipRGC) function. METHODS Participants with type 2 diabetes, with diabetic retinopathy (n=14) and without diabetic retinopathy (n=9) underwent 24 h blood sampling for melatonin and cortisol under controlled laboratory conditions. ipRGC function was inferred from the post-illumination pupil response (PIPR). Habitual sleep duration, efficiency and variability were assessed by actigraphy. RESULTS Participants with diabetic retinopathy compared to participants without diabetic retinopathy had smaller PIPR (p=0.007), lower 24 h serum melatonin output (p=0.042) and greater day-to-day sleep variability (p=0.012). By contrast, 24 h cortisol profiles, sleep duration and efficiency were similar in both groups. Six individuals with diabetic retinopathy had no detectable dim-light melatonin onset. PIPR correlated with 24 h mean melatonin levels (r=0.555, p=0.007). CONCLUSIONS/INTERPRETATION ipRCG dysfunction in diabetic retinopathy is associated with disruptions of the 24 h melatonin rhythm, suggesting circadian dysregulation in diabetic retinopathy.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Jessie Brown Department of Veterans Affairs Hospital, Chicago, IL, USA
| | - Andrew Cross
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Stephanie Sintetas
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Julie Law
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarida Pratuangtham
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Eve Van Cauter
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Erin C Hanlon
- Section of Adult and Pediatric Endocrinology, Department of Medicine, University of Chicago, Chicago, IL, USA
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Philibert M, Milea D. Basics, benefits, and pitfalls of pupillometers assessing visual function. Eye (Lond) 2024:10.1038/s41433-024-03151-9. [PMID: 38802485 DOI: 10.1038/s41433-024-03151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024] Open
Abstract
Numerous commercially and non-commercially available pupillometers are nowadays able to assess various biological functions in humans, by evaluating pupils' dynamics in response to specific stimuli. However, the use of pupillometers for ophthalmic afferent evaluations (i.e., photoreceptoral responses) in real-world settings is relatively limited. Recent scientific and technological advances, coupled with artificial intelligence methods have improved the performance of such devices to objectively detect, quantify, and classify functional disturbances of the retina and the optic nerve. This review aims to summarize the scientific principles, indications, outcomes, and current limitations of pupillometry used for evaluation of afferent pathways in ophthalmic clinical settings.
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Affiliation(s)
| | - Dan Milea
- Rothschild Foundation Hospital, Paris, France.
- Copenhagen University Hospital, Copenhagen, Denmark.
- Singapore National Eye Centre, Singapore, Singapore.
- Angers University Hospital, Angers, France.
- Duke-NUS Medical School, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
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Rai BB, van Kleef JP, Sabeti F, Vlieger R, Suominen H, Maddess T. Early diabetic eye damage: Comparing detection methods using diagnostic power. Surv Ophthalmol 2024; 69:24-33. [PMID: 37797701 DOI: 10.1016/j.survophthal.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
It is now clear that retinal neuropathy precedes classical microvascular retinopathy in diabetes. Therefore, tests that underpin useful new endpoints must provide high diagnostic power well before the onset of moderate diabetic retinopathy. Hence, we compare detection methods of early diabetic eye damage. We reviewed data from a range of functional and structural studies of early diabetic eye disease and computed standardized effect size as a measure of diagnostic power, allowing the studies to be compared quantitatively. We then derived minimum performance criteria for tests to provide useful clinical endpoints. This included the criteria that tests should be rapid and easy so that children with type 1 diabetes can be followed into adulthood with the same tests. We also defined attributes that lend test data to further improve performance using Machine/Deep Learning. Data from a new form of objective perimetry suggested that the criteria are achievable.
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Affiliation(s)
- Bhim B Rai
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia.
| | - Joshua P van Kleef
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; School of Optometry, Faculty of Health, 2 University of Canberra, Canberra, ACT, Australia
| | - Robin Vlieger
- ANU School of Computing, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia; ANU School of Computing, Australian National University, Canberra, ACT, Australia; University of Turku, Turku, Finland
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; ANU Eccles Institute of Neuroscience, Australian National University, Canberra, ACT, Australia
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Quan Y, Duan H, Zhan Z, Shen Y, Lin R, Liu T, Zhang T, Wu J, Huang J, Zhai G, Song X, Zhou Y, Sun X. Evaluation of the Glaucomatous Macular Damage by Chromatic Pupillometry. Ophthalmol Ther 2023; 12:2133-2156. [PMID: 37284935 PMCID: PMC10287851 DOI: 10.1007/s40123-023-00738-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/16/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION This study aimed to examine the performance of binocular chromatic pupillometry for the objective and rapid detection of primary open-angle glaucoma (POAG), and to explore the association between pupillary light response (PLR) features and structural glaucomatous macular damage. METHODS Forty-six patients (mean age 41.00 ± 13.03 years) with POAG and 23 healthy controls (mean age 42.00 ± 11.08 years) were enrolled. All participants underwent sequenced PLR tests of full-field, superior/inferior quadrant-field chromatic stimuli using a binocular head-mounted pupillometer. The constricting amplitude, velocity, and time to max constriction/dilation, and the post-illumination pupil response (PIPR) were analyzed. The inner retina thickness and volume measurements were determined by spectral domain optical coherence tomography. RESULTS In the full-field stimulus experiment, time to pupil dilation was inversely correlated with perifoveal thickness (r = - 0.429, P < 0.001) and perifoveal volume (r = - 0.364, P < 0.001). Dilation time (AUC 0.833) showed good diagnostic performance, followed by the constriction amplitude (AUC 0.681) and PIPR (AUC 0.620). In the superior quadrant-field stimulus experiment, time of pupil dilation negatively correlated with inferior perifoveal thickness (r = - 0.451, P < 0.001) and inferior perifoveal volume (r = - 0.417, P < 0.001). The dilation time in response to the superior quadrant-field stimulus showed the best diagnostic performance (AUC 0.909). In the inferior quadrant-field stimulus experiment, time to pupil dilation (P < 0.001) correlated well with superior perifoveal thickness (r = - 0.299, P < 0.001) and superior perifoveal volume (r = - 0.304, P < 0.001). CONCLUSION The use of chromatic pupillometry offers a patient-friendly and objective approach to detect POAG, while the impairment of PLR features may serve as a potential indicator of structural macular damage.
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Affiliation(s)
- Yadan Quan
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Huiyu Duan
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zongyi Zhan
- Shenzhen Eye Hospital, Shenzhen, China
- Shenzhen Eye Institute, Shenzhen, China
- Shenzhen Eye Hospital Affiliated to Jinan University, Shenzhen, China
| | - Yuening Shen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
| | - Rui Lin
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Tingting Liu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Ting Zhang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Jihong Wu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Jing Huang
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xuefei Song
- Department of Ophthalmology, Ninth People's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yixiong Zhou
- Department of Ophthalmology, Ninth People's Hospital of Shanghai, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
- NHC and Chinese Academy of Medical Sciences Key Laboratory of Myopia, Fudan University, Shanghai, China.
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China.
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McAnany JJ, Park JC, Lim JI. Visual Field Abnormalities in Early-Stage Diabetic Retinopathy Assessed by Chromatic Perimetry. Invest Ophthalmol Vis Sci 2023; 64:8. [PMID: 36734963 PMCID: PMC9907378 DOI: 10.1167/iovs.64.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The purpose of this study was to define the nature and extent of sensitivity loss using chromatic perimetry in diabetics who have mild or no retinopathy. Methods Thirty-four individuals with type II diabetes mellitus who have mild nonproliferative diabetic retinopathy (MDR; N = 17) or no diabetic retinopathy (NDR; N = 17) and 15 visually normal, non-diabetic controls participated. Sensitivity was assessed along the horizontal visual field meridian using an Octopus 900 perimeter. Measurements were performed under light- and dark-adapted conditions using long-wavelength (red) and short-wavelength (blue) Goldmann III targets. Cumulative defect curves (CDCs) were constructed to determine whether field sensitivity loss was diffuse or localized. Results Sensitivity was reduced significantly under light-adapted conditions for both stimulus colors for the NDR (mean defect ± SEM = -2.1 dB ± 0.6) and MDR (mean defect ± SEM = -4.0 dB ± 0.7) groups. Sensitivity was also reduced under dark-adapted conditions for both stimulus colors for the NDR (mean defect ± SEM = -1.9 dB ± 0.7) and MDR (mean defect ± SEM = -4.5 ± 1.0 dB) groups. For both diabetic groups, field loss tended to be diffuse under light-adapted conditions (up to 6.9 dB loss) and localized under dark-adapted conditions (up to 15.4 dB loss). Conclusions Visual field sensitivity losses suggest neural abnormalities in early stage diabetic eye disease and the pattern of the sensitivity losses differed depending on the adaptation conditions. Chromatic perimetry may be useful for subtyping individuals who have mild or no diabetic retinopathy and for better understanding their neural dysfunction.
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Affiliation(s)
- J. Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Jason C. Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
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Decleva D, Vidal KS, Kreuz AC, de Menezes PAHL, Ventura DF. Alterations of color vision and pupillary light responses in age-related macular degeneration. Front Aging Neurosci 2023; 14:933453. [PMID: 36688155 PMCID: PMC9849391 DOI: 10.3389/fnagi.2022.933453] [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: 04/30/2022] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries and one of the leading causes of blindness. In this work, we evaluated color vision and the pupil light reflex (PLR) to assess visual function in patients with early and neovascular AMD (NVAMD) compared with the control group. Methods We recruited 34 early patients with dry AMD and classified them into two groups following AREDS: 13 patients with NVAMD and 24 healthy controls. Controls and patients with early dry AMD had visual acuity (VA) best or equal to 20/25 (0.098 logMAR). Color vision was assessed in controls and patients with early dry AMD using the Cambridge Color Test (CCT) 2.0 through the Trivector protocol. The PLR was evaluated using a Ganzfeld, controlled by the RETI-port system. The stimuli consisted of 1s blue (470 nm) and red (631 nm) light flashes presented alternately at 2-min intervals. To assess the cone contribution, we used a red flash at 2.4 log cd.m-2, with a blue background at 0.78 log cd.m-2. For rods, we used 470-nm flashes at -3 log cd.m-2, and for the melanopsin function of ipRGCs, we used 470 nm at 2.4 log cd.m-2. Results Patients with early dry AMD had reduced color discrimination in all three axes: protan (p = 0.0087), deutan (p = 0.0180), and tritan (p = 0.0095) when compared with the control group. The PLR has also been affected in patients with early dry AMD and patients with NVAMD. The amplitude for the melanopsin-driven response was smaller in patients with early dry AMD (p = 0.0485) and NVAMD (p = 0.0035) than in the control group. The melanopsin function was lower in patients with NVAMD (p = 0.0290) than the control group. For the rod-driven response, the latency was lower in the NVAMD group (p = 0.0041) than in the control group. No changes were found in cone-driven responses between the control and AMD groups. Conclusion Patients with early dry AMD present diffusely acquired color vision alteration detected by CCT. Rods and melanopsin contributions for PLR are affected in NVAMD. The CCT and the PLR may be considered sensitive tests to evaluate and monitor functional changes in patients with AMD.
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Affiliation(s)
- Diego Decleva
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil,Neuroscience and Behavior Graduate Studies Program, Institute of Psychology, University of São Paulo, São Paulo, Brazil,*Correspondence: Diego Decleva,
| | - Kallene Summer Vidal
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil,Prevent Senior Health Operator, São Paulo, Brazil,Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil,Young Medical Leadership Program of National Academy of Medicine in Brazil, Rio de Janeiro, Brazil
| | - Andre Carvalho Kreuz
- Neuroscience and Behavior Graduate Studies Program, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | | | - Dora Fix Ventura
- Department of Experimental Psychology, Institute of Psychology, University of São Paulo, São Paulo, Brazil,Neuroscience and Behavior Graduate Studies Program, Institute of Psychology, University of São Paulo, São Paulo, Brazil
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Öztürk Y, Yıldız MB, Bolaç R. Evaluation of Pupillometric Parameters in Patients with COVID-19. Ocul Immunol Inflamm 2023; 31:39-43. [PMID: 34637671 DOI: 10.1080/09273948.2021.1980811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the pupillary diameter and pupillary light response in patients who have recovered from the COVID-19. METHODS Thirty two eyes of 32 patients with a history of COVID-19 in the last two months and 32 eyes of 32 age and sex-matched healthy controls were included in this prospective study. All patients had neurological symptoms. Dynamic and static pupillometry measurements were performed with the Sirius (CSO, Italy) corneal topography device. RESULTS Patients with COVID-19 had higher mean scotopic, mesopic, and photopic pupil diameters compared to the controls (p = .01, p = .04, p = .02, respectively). In dynamic pupillometry analysis, 0th, 2th, 8th and 16th second pupil diameter measurements were higher in COVID-19 patients (p = .02, p = .04, p = .04, p = .04, respectively). There were no differences in the average speed of pupillary dilatation (p > .05). CONCLUSION Our findings suggest that the pupillary response, an indicator of autonomic nervous system activity, may be affected in COVID-19 patients with neurological symptoms.
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Affiliation(s)
- Yücel Öztürk
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Merve Beyza Yıldız
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | - Rüveyde Bolaç
- Haydarpaşa Numune Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
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Tripolone MC, Issolio LA, Agüero C, Lavaque A, Cao D, Barrionuevo PA. Comparing flickering and pulsed chromatic pupil light responses. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2022; 39:1505-1512. [PMID: 36215596 DOI: 10.1364/josaa.455619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/12/2022] [Indexed: 06/16/2023]
Abstract
The pupil light reflex (PLR) can serve as a biomarker of the photoreceptor function. Protocols for chromatic PLR consider mostly pulsed stimulation. A more sophisticated and promising technique is based on the PLR to flickering stimulation. Our aim was to compare flickering PLR (fPLR) and pulsed PLR (pPLR) parameters to validate the fPLR paradigm. Two different experiments were carried out in young participants to compare parameters of chromatic pupillary measurements under flickering and pulsed conditions. We found that the fPLR amplitude parameter was significantly associated with the pPLR transient constriction parameter. Also, for some conditions, pulse parameters can be identified directly in the fPLR recordings.
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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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Qin YJ, Xiao K, Zhong Z, Zhao Y, Zhang YL, Sun XF. Markers of the sympathetic, parasympathetic and sensory nervous system are altered in the human diabetic choroid. Peptides 2021; 146:170661. [PMID: 34571056 DOI: 10.1016/j.peptides.2021.170661] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND We sought to evaluate alterations in markers of the autonomic nervous system in human diabetic choroid. METHODS Eighteen eyeballs from subjects with diabetes and 22 eyeballs from subjects without diabetes were evaluated in this study. Synaptophysin, tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DβH), neuronal nitric oxide synthase (nNOS), choline acetyltransferase (ChAT), vesicular monoamine transporter II (VMAT-2), vesicular acetylcholine transporter (VAChT), vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), and calcitonin gene-related peptide (CGRP) levels were detected by western blot analysis and immunofluorescence was performed in some cases. Furthermore, differences in adrenergic (α1- and β2-subtypes) and cholinergic (M1 and M3) receptor levels between diabetic subjects and controls were noted. RESULTS Decreased synaptophysin levels were found in diabetic choroids by western blot analysis and a reduction of synaptophysin-immunoreactive nerves was also found by immunofluorescence. Furthermore, a decrease of the levels of the key enzyme (TH) and transporter (VMAT2) of norepinephrine was evident both by western blot analysis and immunofluorescence. Additionally, increased NPY, VAChT, nNOS, and CGRP levels were observed in diabetic choroids. The levels of adrenergic (β2 subtype) and acetylcholine (M1 subtype) receptors decreased in diabetic choroids, as shown by western blotting and although the differences in α1 and M3 were not significant, there was a downward trend. CONCLUSIONS In the diabetic choroid, the levels of neurotransmitters, enzymes, and receptors associated with choroidal blood flow regulation are altered. These changes may affect the regulation of choroidal blood flow and may be associated with impaired retinal function and retinal pathology.
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Affiliation(s)
- Yuan-Jun Qin
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Ke Xiao
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Zheng Zhong
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Yin Zhao
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Yao-Li Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
| | - Xu-Fang Sun
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie-fang Road, Wuhan, Hubei Province, People's Republic of China.
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11
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Maloca PM, Carvalho ER, Hasler PW, Balaskas K, Inglin N, Petzold A, Egan C, Tufail A, Scholl HPN, Valmaggia P. Dynamic volume-rendered optical coherence tomography pupillometry. Acta Ophthalmol 2021; 100:654-664. [PMID: 34750988 DOI: 10.1111/aos.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess intrapupillary space (IPS) changes in healthy subjects with regard to decreased iris motility in patients with pseudoexfoliation glaucoma (PEXG) or non-arteritic anterior ischaemic optic neuropathy (NAION) in a feasibility study in a clinical environment. METHODS Scotopic and photopic IPS measurements using three-dimensionally rendered swept-source optical coherence tomography (SS-OCT) data were obtained and compared for all subjects. Intrapupillary space (IPS) parameters were evaluated such as absolute volumetric differences, relative light response for volumetric ratios and pupillary ejection fraction (PEF) for functional contraction measurements. RESULTS From a total of 122 IPS from 66 subjects, 106 IPS were eligible for comparison providing values for 72 normal, 30 PEXG and 4 NAION eyes. In healthy, PEXG and NAION subjects, scotopic overall mean IPS was 8.90, 3.45 and 4.16 mm3 , and photopic overall mean IPS was 0.87, 0.74 and 1.13 mm3 , respectively. Three-dimensional contractility showed a mean absolute difference of 8.03 mm3 for normals (defined as 100% contractility), 2.72 mm3 for PEXG (33.88% of normal) and 3.03 mm3 for NAION (38.50% of normal) with a relative light response ratio between scotopic and photopic volumes of 10.26 (100%), 4.69 (45.70%) and 3.67 (35.78%), respectively. Pupillary ejection fraction (PEF) showed a contractile pupillary emptying of 88.11% for normals, 76.92% for PEXG and 70.91% for NAION patients. CONCLUSION This 3D pupillometry OCT assessment allows for quantitative measurements of pupil function, contractility and response to light. More specifically, PEF is presented as a potential (neuro)-pupillary outcome measure that could be useful in the monitoring of ophthalmic disorders that affect pupillary function.
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Affiliation(s)
- Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
- Moorfields Eye Hospital London UK
| | | | - Pascal W. Hasler
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | | | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
| | - Axel Petzold
- Moorfields Eye Hospital London UK
- National Hospital for Neurology and Neurosurgery UCLH & UCL Institute of Neurology Queen Square London UK
- Dutch Expertise Centre Neuro‐ophthalmology Amsterdam UMC The Netherlands
| | | | | | - Hendrik P. N. Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
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12
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Adhikari P, Pradhan A, Zele AJ, Feigl B. Supplemental light exposure improves sleep architecture in people with type 2 diabetes. Acta Diabetol 2021; 58:1201-1208. [PMID: 33851274 DOI: 10.1007/s00592-021-01712-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
AIMS People with type 2 diabetes (T2D) suffer from sleep disorders, with the mechanism not clearly understood. In T2D, the light transducing retinal photoreceptors that regulate sleep behaviours are dysfunctional; hence, we determine here whether supplemental light exposure ameliorates sleep quality and daytime sleepiness in T2D. METHODS Supplemental light (10,000 Lux, polychromatic) was self-administered for 30 min every morning for 14 days by ten participants with T2D with no diabetic retinopathy (DR). The effectiveness of supplemental light was assessed by comparing subjective sleep questionnaire (PSQI and ESS) scores and salivary dim light melatonin onset (DLMO) before and after the light exposure as well as with a self-maintained sleep diary during the light exposure. RESULTS Compared to the baseline, supplemental light significantly improved the excessive daytime sleepiness score (p = 0.004) and phase-advanced the DLMO on average by ~ 23 min. Sleep diary analyses showed that afternoon nap duration significantly shortened over the first week of supplemental light exposure (p = 0.019). Afternoon naps and midnight awakening were significantly longer in diabetic participants with thinner perifoveal retina. CONCLUSIONS In this case series, we provide initial evidence that supplemental bright light improves daytime sleepiness in T2D with no DR, with the critical period of light exposure showing a beneficial effect after one week. We infer that supplemental light augments photoreceptor signalling in T2D and therefore optimises circadian photoentrainment leading to improved sleep. Our findings inform the development of tailored light therapy protocols in future clinical trials for improving sleep architecture in diabetes.
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Affiliation(s)
- Prakash Adhikari
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Asik Pradhan
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Andrew J Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- Queensland Eye Institute, Brisbane, Australia.
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13
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Piaggio D, Namm G, Melillo P, Simonelli F, Iadanza E, Pecchia L. Pupillometry via smartphone for low-resource settings. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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14
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Using System Identification to Construct an Inherent Model of Pupillary Light Reflex to Explore Diabetic Neuropathy. Brain Sci 2021; 11:brainsci11070852. [PMID: 34202410 PMCID: PMC8301861 DOI: 10.3390/brainsci11070852] [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: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
This study proposed a pupillary light reflex (PLR) inherent model based on the system identification method to demonstrate the dynamic physiological mechanism of the PLR, in which pupillary constriction and dilation are controlled by the sympathetic and parasympathetic nervous system. This model was constructed and verified by comparing the simulated and predicted PLR response with that of healthy participants. The least root-mean-square error (RMSE) of simulated PLR response was less than 0.7% when stimulus duration was under 3 ms. The RMSE of predicted PLR response increased by approximately 6.76%/s from the stimulus duration of 1 ms to 3 s, when the model directly used the parameters extracted from the PLR at the stimulus duration of 10 ms. When model parameters were derived from the regression by the measured PLR response, the RMSE kept under 8.5%. The model was applied to explore the PLR abnormalities of the people with Diabetic Mellitus (DM) by extracting the model parameters from 42 people with DM and comparing these parameters with those of 42 healthy participants. The parameter in the first-order term of the elastic force of the participants with DM was significantly lower than that of the healthy participants (p < 0.05). The sympathetic force and sympathetic action delay of the participants with DM were significantly larger (p < 0.05) and longer (p < 0.0001) than that of the healthy ones, respectively. The reason might be that the sympathetic nervous system, which controls the dilator muscle, degenerated in diabetic patients.
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15
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Østergaard Madsen H, Hageman I, Kolko M, Lund-Andersen H, Martiny K, Ba-Ali S. Seasonal variation in neurohormones, mood and sleep in patients with primary open angle glaucoma - implications of the ipRGC-system. Chronobiol Int 2021; 38:1421-1431. [PMID: 34112046 DOI: 10.1080/07420528.2021.1931275] [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: 10/21/2022]
Abstract
Primary open angle glaucoma is associated with an increased risk of mood and sleep disorders. These adversities have been suggested to relate to a disrupted function of the intrinsically photosensitive retinal ganglion cells (ipRGCs). The ipRGCs are key components in the nonvisual photoreceptive system that mediates light effects on mood, sleep and circadian rhythm. We assessed the diurnal hormone levels, pupillary responses and mood and sleep under seasons with different photoperiods in 24 patients with glaucoma and 24 age- and sex-matched healthy controls to investigate responses to naturalistic seasonal changes in daylight. The patients had moderate-to-advanced glaucoma with substantial visual field defects and reductions in the ipRGC-mediated pupillary responses (p < .001). In winter, compared with summer, patients with glaucoma had higher daytime melatonin concentration (p < .001) and lower nighttime cortisol (p = .002). In winter, the daytime melatonin level was inversely correlated with the ipRGC-mediated pupillary responses in the control group (p = .04). In the control group, there were no significant changes in hormone levels between seasons or any correlations between neurohormone levels and the ipRGC-mediated responses. The two groups showed a similar response to season with lower depression scores in summer compared with winter. In between-group comparison, the nocturnal melatonin level (area under curve from 20:00 h to 08:00 h) in summer was lower in glaucoma compared with controls (p = .03). In winter, nocturnal cortisol (at 04:00 h) was lower (p = .004) and daytime cortisol (12:00 h and 16:00 h) was higher (p = .007) in glaucoma compared with controls. In conclusion, we found that patients with glaucoma displayed a seasonal variation in diurnal hormone levels that was not present in healthy controls. Such neurohormonal changes may contribute to the increased risk of mood and sleep disorders seen in patients with glaucoma.
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Affiliation(s)
| | - Ida Hageman
- Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
| | - Klaus Martiny
- Mental Health Center Copenhagen, Copenhagen, Denmark
| | - Shakoor Ba-Ali
- Department of Ophthalmology, Rigshospitalet-Glostrup Hospital, Copenhagen, Denmark
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16
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Pinheiro HM, da Costa RM. Pupillary light reflex as a diagnostic aid from computational viewpoint: A systematic literature review. J Biomed Inform 2021; 117:103757. [PMID: 33826949 DOI: 10.1016/j.jbi.2021.103757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 01/06/2023]
Abstract
This work presents a detailed and complete review of publications on pupillary light reflex (PLR) used to aid diagnoses. These are computational techniques used in the evaluation of pupillometry, as well as their application in computer-aided diagnoses (CAD) of pathologies or physiological conditions that can be studied by observing the movements of miosis and mydriasis of the human pupil. A careful survey was carried out of all studies published over the last 10 years which investigated, electronic devices, recording protocols, image treatment, computational algorithms and the pathologies related to PLR. We present the frontier of existing knowledge regarding methods and techniques used in this field of knowledge, which has been expanding due to the possibility of performing diagnoses with high precision, at a low cost and with a non-invasive method.
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17
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Abstract
SIGNIFICANCE Pupillometry protocols evaluating rod/cone- and melanopsin-driven responses often use mydriatics to ensure maximal stimulus exposure; however, retinal effects of mydriatics are not fully understood. We demonstrate that dilation with either atropine or phenylephrine results in similar enhancements of rod/cone- and melanopsin-driven pupil responses. PURPOSE The purposes of this study were to compare the effects of atropine, a muscarinic antagonist, and phenylephrine, an adrenergic agonist, on consensual pupil responses and to assess the repeatability of pupil metrics without mydriasis. METHODS Right eye pupil responses of 20 adults aged 21 to 42 years were recorded before and 45 minutes after instillation of 0.5% atropine or 2.5% phenylephrine in the left eye. Stimuli were presented to the left eye and included six alternating 1-second 651-nm "red" and 456-nm "blue" flashes. Metrics included baseline pupil diameter, maximal constriction, 6- and 30-second post-illumination pupil responses, and early (0 to 10 seconds) and late (10 to 30 seconds) areas under the curve. RESULTS Dilation of the stimulated eye with either mydriatic significantly increased the 6-second post-illumination pupil response and early and late areas under the curve for blue stimuli, and early area under the curve for red stimuli (P < .05 for all). Melanopsin-driven post-illumination pupil responses, achieved with either phenylephrine or atropine, did not significantly differ from each other (P > .05 for all). Without mydriasis, intersession intraclass correlation coefficients for pupil metrics were 0.63 and 0.50 (6- and 30-second post-illumination pupil responses, respectively) and 0.78 and 0.44 (early and late areas under the curve, respectively) for blue stimuli, with no significant difference between sessions (P > .05 for all). CONCLUSIONS Dilation with phenylephrine or atropine resulted in similar enhancements of the rod/cone- and melanopsin-driven pupil responses, despite differing mechanisms. Early pupil metrics without mydriasis demonstrated moderate to good intersession repeatability.
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18
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Higher choroidal thickness and lower choriocapillaris blood flow signal density based on optical coherence tomography angiography in diabetics. Sci Rep 2021; 11:5799. [PMID: 33707607 PMCID: PMC7952557 DOI: 10.1038/s41598-021-85065-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
Diabetes mellitus (DM) is one of the fastest growing chronic diseases in the world and one of the main causes of vision loss. Whether or not diabetic choroidopathy (DC) is involved in the initiation and progression of diabetic ocular complications needs to be explored. We included 54 diabetic eyes from 36 diabetic patients, and 54 healthy eyes from 32 control subjects after propensity scores matching. All of the subjects were given pupil light and dark adaptation examination and optical coherence tomography angiography (OCTA). Scotopic pupil diameter (SPD), pupil contraction amplitude, and velocity of pupil contraction of the diabetic group were significantly lower than that of the healthy control group (P < 0.05).Choroidal thickness at temporal quadrant (at 750 μm) and superior quadrant (at 1500 μm and 2250 μm) increased in diabetic group compared to control group(P < 0.05).In the diabetic group, choriocapillaris blood flow signal density (CCBFSD) in the macular area (diameter = 2000 μm) were significantly decreased compared with the healthy control group (P < 0.05). Apparent changes in pupil and choroidal blood flow were observed in the diabetic patients.
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19
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Kuze M, Negishi K, Koyasu T, Kondo M, Tsubota K, Ayaki M. Cataract type and pupillary response to blue and white light stimuli. Sci Rep 2021; 11:1828. [PMID: 33469062 PMCID: PMC7815835 DOI: 10.1038/s41598-020-79751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Abstract
We evaluated the pupil reaction to blue and white light stimulation in 70 eyes with cataract and in 38 eyes with a selective blue-light filtering intra-ocular lens. The diameter of the pupil before stimulation was set as baseline (BPD) and, after a stimulus duration of 1 s, the post-illumination pupillary response (PIPR) was measured using an electronic pupillometer. The BPD showed no significant difference among three grades of nuclear sclerosis (NS). In contrast, the PIPRs differed significantly among the NS grades eyes including with and without subcapsular cataract (SC) and IOL eyes for white light (p < 0.05, Kruskal-Wallis test), but not for blue light. Subcapsular opacity did not affect the BPD or PIPR in all cataract grades for either light stimulus. The tendency of larger PIPR in the pseudophakic eyes than the cataract eyes for both lights, however significant difference was found only for white light (p < 0.05 for white light, p > 0.05 for blue light). Our study demonstrates retention of the PIPR for blue light, but not for white light in cataract eyes. We also confirmed that the pupillary response in pseudohakic eyes with a selective blue light-filtering intra ocular lens was greater than that in cataractous eyes for white light.
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Affiliation(s)
- Manami Kuze
- Division of Ophthalmology, Matsusaka Central General Hospital, Matsusaka, Japan.
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
| | | | - Mineo Kondo
- Department of Ophthalmology, Mie University School of Medicine, Mie, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
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20
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Yan YJ, Tsai YC, Ko ML, Lee NC, Chiou JC, Ou-Yang M. Quantitative examination of early diabetes by light-emitting diodes light-induced pupillary light reflex. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2021; 92:014101. [PMID: 33514206 DOI: 10.1063/5.0030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the abnormal pupillary light reflex in patients with early diabetes mellitus (DM) without retinopathy by using a custom-made noninvasive portable pupilometer. The pupilometer recorded and analyzed the pupillary light reflex. Two light intensities, 0.2 cd and 1.2 cd, and four wavelengths of stimulus light-white (400 nm-800 nm), red (640 ± 5 nm), green (534 ± 5 nm), and blue (470 ± 5 nm)-were used to stimulate the pupil for 10 ms. The pupillary response was recorded for 15 s. A total of 40 healthy people and 40 people with DM without retinopathy participated in the experiment at the National Taiwan University Hospital. The mean and standard deviation of DM duration were 4.5 years and 3.9 years. Of the 16 indices, the duration that pupil restores from its minimum size to half of its resting size (DRP), maximum pupil restoration velocity (MRV), and average restoration velocity (ARV) exhibited the most significant differences between the healthy people and those with DM. Compared with healthy participants, DRP was 16.33% higher, and MRV and ARV were 17.45% and 4.58% lower, respectively, in those with DM. This might be attributable to the sympathetic nervous system (SNS) controlling the dilator muscle during the dark-adapted period and relaxing the pupil; the SNS had few degenerated nerve endings in people with DM. The three aforementioned indices might be used to evaluate the severity of autonomic neuropathy in early DM.
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Affiliation(s)
- Y J Yan
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - Y C Tsai
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M L Ko
- National Taiwan University Hospital Hsinchu Branch, Hsinchu 300, Taiwan
| | - N C Lee
- National Taiwan University Hospital, Taipei 100, Taiwan
| | - J C Chiou
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
| | - M Ou-Yang
- Institute of Electrical and Control Engineering, National Chiao Tung University, Hsinchu City 300, Taiwan
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21
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Bista Karki S, Coppell KJ, Mitchell LV, Ogbuehi KC. <p>Dynamic Pupillometry in Type 2 Diabetes: Pupillary Autonomic Dysfunction and the Severity of Diabetic Retinopathy</p>. Clin Ophthalmol 2020; 14:3923-3930. [PMID: 33244218 PMCID: PMC7683350 DOI: 10.2147/opth.s279872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/28/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
| | - Kirsten J Coppell
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin9054, New Zealand
| | - Logan V Mitchell
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin9054, New Zealand
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin9054, New Zealand
- Correspondence: Kelechi C Ogbuehi Department of Medicine, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin9054, New ZealandTel +64 3 474 0999 Ext 58308 Email
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22
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Pearce E, Sivaprasad S. A Review of Advancements and Evidence Gaps in Diabetic Retinopathy Screening Models. Clin Ophthalmol 2020; 14:3285-3296. [PMID: 33116380 PMCID: PMC7569040 DOI: 10.2147/opth.s267521] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 12/03/2022] Open
Abstract
Diabetic retinopathy (DR) is a microvascular complication of diabetes with a prevalence of ~35%, and is one of the leading causes of visual impairment in people of working age in most developed countries. The earliest stage of DR, non-proliferative DR (NPDR), may progress to sight-threatening DR (STDR). Thus, early detection of DR and active regular screening of patients with diabetes are necessary for earlier intervention to prevent sight loss. While some countries offer systematic DR screening, most nations are reliant on opportunistic screening or do not offer any screening owing to limited healthcare resources and infrastructure. Currently, retinal imaging approaches for DR screening include those with and without mydriasis, imaging in single or multiple fields, and the use of conventional or ultra-wide-field imaging. Advances in telescreening and automated detection facilitate screening in previously hard-to-reach communities. Despite the heterogeneity in approaches to fit local needs, an evidence base must be created for each model to inform practice. In this review, we appraise different aspects of DR screening, including technological advances, identify evidence gaps, and propose several studies to improve DR screening globally, with a view to identifying patients with moderate-to-severe NPDR who would benefit if a convenient treatment option to delay progression to STDR became available.
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Affiliation(s)
- Elizabeth Pearce
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK
| | - Sobha Sivaprasad
- Department of Ocular Biology, Institute of Ophthalmology, University College London, London, UK.,Medical Retina Department, NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
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23
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Bhatwadekar AD, Rameswara V. Circadian rhythms in diabetic retinopathy: an overview of pathogenesis and investigational drugs. Expert Opin Investig Drugs 2020; 29:1431-1442. [PMID: 33107770 DOI: 10.1080/13543784.2020.1842872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Circadian rhythm is a natural endogenous process occurring roughly every 24 hours. Circadian rhythm dysfunction is involved in diabetic retinopathy (DR) pathogenesis. Interestingly, there are investigational drugs that exhibit potential in the treatment of DR by targeting circadian rhythm dysfunction. AREAS COVERED We performed a literature search in June 2020 using PubMed's Medical Subject Heading (MeSH) terms 'circadian clock,' 'circadian rhythms,' and 'diabetic retinopathy.' This article offers an overview of the physiology of the biological clock and clock regulatory genes and presents an examination of the retinal clock. It discusses the pathogenic mechanisms of DR and emphasizes how circadian rhythm dysfunction at structural, physiological, metabolic and cellular levels, plays a critical role in the development of DR. The latter part of the paper sheds light on those investigational drugs (such as melatonin, tasimelteon and metformin) which exhibit potential in the treatment of DR by the targeting of circadian rhythm dysfunction. EXPERT OPINION An enhanced understanding of circadian rhythm and its role in DR could offer therapeutic potential by targeting of circadian rhythm dysfunction.
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Affiliation(s)
- Ashay D Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute , Indianapolis, IN, USA
| | - Varun Rameswara
- Indiana University School of Medicine. Indiana University , Indianapolis, IN, USA
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Kızıltoprak H, Tekin K, Sekeroglu MA, Yetkin E, Doguizi S, Yilmazbas P. Static and Dynamic Pupillary Responses in Patients with Different Stages of Diabetic Retinopathy. Neuroophthalmology 2020; 44:226-235. [PMID: 33012908 DOI: 10.1080/01658107.2019.1671465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study aimed to investigate pupillary involvement in patients with type 2 diabetes mellitus (DM) and to evaluate whether there is a relationship between severity of diabetic retinopathy (DR) and pupillary responses. The study included 133 individuals in four groups: proliferative DR, non-proliferative DR, DM group without retinal involvement and a control group. Static pupillometry measurements including scotopic pupil diameter (PD), mesopic PD, low photopic PD, high photopic PD, and dynamic pupillometry measurements, including resting diameter, amplitude, latency, velocity, duration of pupil contraction and latency, duration, and velocity of pupil dilatation were taken using an automated quantitative pupillometry system. The correlations between glycosylated haemoglobin values and duration of DM with these parameters were also investigated. The study showed that patients with DR may also have diabetic autonomic neuropathy and pupillometry can be a useful screening tool for detecting diabetic autonomic neuropathy.
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Affiliation(s)
- Hasan Kızıltoprak
- Ophthalmology Department, Bingol Women's Health and Children's Hospital, Bingol, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Mehmet Ali Sekeroglu
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Esat Yetkin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Sibel Doguizi
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pelin Yilmazbas
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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25
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Sleep variability, 6-sulfatoxymelatonin, and diabetic retinopathy. Sleep Breath 2020; 25:1069-1074. [PMID: 32951070 DOI: 10.1007/s11325-020-02165-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent evidence suggests that diabetic retinopathy (DR) is associated with abnormal melatonin regulation, possibly related to dysfunction of the melanopsin-expressing intrinsically photosensitive retinal ganglion cells. This study explored melatonin regulation in type 2 diabetes (T2D) patients with DR and its relation to sleep and circadian functioning. METHODS Thirty-five participants (10 non-diabetic controls, 10 T2D without DR, and 15 T2D with DR) were recruited. Overnight urine 6-sulfatoxymelatonin (aMT6s) and objective sleep and wrist activity (7-day actigraphy) were obtained. RESULTS After adjusting for covariates, having T2D with DR was significantly associated with lower urinary aMT6s (β = - 1.369, p = 0.004) compared with controls, while having T2D without DR was not (p = 0.418). T2D patients with DR reported poorer sleep quality (p = 0.014) and had greater variability of sleep duration (p = 0.017) than others, while no differences were found in sleep duration, efficiency, and rest-activity rhythm. After adjusting for covariates, lower nocturnal aMT6s was significantly associated with greater sleep variability. CONCLUSION T2D patients with DR exhibited low overnight production of aMT6s which likely contributed to sleep irregularities possibly due to weak circadian signaling. Whether or not melatonin supplementation could improve health in T2D patients with DR remains to be explored.
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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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Ba-Ali S, Brøndsted AE, Andersen HU, Jennum P, Lund-Andersen H. Pupillary light responses in type 1 and type 2 diabetics with and without retinopathy. Acta Ophthalmol 2020; 98:477-484. [PMID: 31943805 DOI: 10.1111/aos.14348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/20/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We assessed the function of rod/cones and melanopsin in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) with and without non-proliferative diabetic retinopathy (NPDR). METHODS We performed pupillometry on 22 healthy controls and four diabetic groups: 12 T1DM patients without NPDR and 12 with moderate NPDR, and 16 T2DM patients without NPDR and 12 with moderate NPDR. Monocular stimulations of 20 seconds with red (λ = 633 nm) and blue light (λ = 463 nm) at ~15 log quanta/cm2 /second were performed. The primary outcome was the melanopsin-mediated late redilation phase of postillumination pupillary light response (PIPRL ate ) to blue light. The secondary outcomes were the mixed rod/cone and melanopsin responses, that is maximal pupil constriction and the early redilation phase of PIPR (PIPRE arly ). RESULTS Late redilation phase of PIPR (PIPRL ate ) to blue and red light stimuli was not significantly different between healthy control and the four diabetic groups (n.s.). The maximal pupil contractions to blue light stimulus were significantly reduced in T1DM patients as well as in T2DM patients with NPDR (p ≤ 0.02), whereas for red light stimuli, the maximal pupil constriction was only reduced in T2DM with NPDR (p < 0.01). Early redilation phase of PIPR (PIPRE arly ) to blue and red light stimuli was not significantly different between healthy controls and diabetic patients (n.s.). CONCLUSION Neither the PIPRE arly nor the PIPRL ate was significantly reduced in diabetics with or without NPDR compared to healthy controls. The reduced maximal pupil constrictions in diabetics with NPDR indicate decreased mixed rod/cone and melanopsin responses.
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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
| | | | | | - Poul Jennum
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Centre for Sleep Medicine, Neurophysiology Clinic, Rigshospitalet, Glostrup, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Centre, Gentofte, Denmark
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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: 8] [Impact Index Per Article: 2.0] [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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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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Cankurtaran V, Ozates S, Ozler S. Association of pupil responses with severity of erectile dysfunction in diabetes mellitus. Indian J Ophthalmol 2019; 67:1314-1319. [PMID: 31332117 PMCID: PMC6677051 DOI: 10.4103/ijo.ijo_220_19] [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] [Indexed: 12/03/2022] Open
Abstract
Purpose: To investigate the relation between erectile dysfunction (ED) severity and pupillary functions in patients with diabetes mellitus (DM). Methods: This prospective and observational study included 90 patients with type 2 DM and ED. Patients divided into three subgroups according to severity of ED: (i) Mild ED, (ii) Moderate ED and (iii) Severe ED groups. Thirty age-matched healthy subjects formed the control group. Main outcome measures were pupil diameter and average speed of pupil dilation. Static and dynamic pupillometry analysis was performed using the Sirius Topographer (CSO, Firenze, Italy). Results: Mean pupil diameter during static and dynamic pupillometry analysis were significantly greater in the control group than in the all study groups (P < 0.05). Mean pupil diameter in static pupillometry analysis was significantly different in each study group and pupil was more miotic in the Severe ED group than in the both Moderate and Mild ED groups (P < 0.05 for each). Dynamic pupillometry analysis revealed that mean pupil diameter and mean average dilation speed were significantly different in each study group throughout measurement period and the highest speed was observed in the Mild ED group and the lowest speed was observed in the severe ED group (P < 0.005 for each). Conclusion: Our study results suggest that abnormal pupil functions due to diabetic autonomic neuropathy may indicate the associated ED in patients with DM.
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Affiliation(s)
- Veysel Cankurtaran
- Department of Ophthalmology, Medical School of Mustafa Kemal University, Hatay, Turkey
| | - Serdar Ozates
- Department of Ophthalmology, Kars Harakani State Hospital, Kars, Turkey
| | - Serkan Ozler
- Department of Urology, Medical School of Mustafa Kemal University, Hatay, Turkey
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31
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Kelbsch C, Stingl K, Kempf M, Strasser T, Jung R, Kuehlewein L, Wilhelm H, Peters T, Wilhelm B, Stingl K. Objective Measurement of Local Rod and Cone Function Using Gaze-Controlled Chromatic Pupil Campimetry in Healthy Subjects. Transl Vis Sci Technol 2019; 8:19. [PMID: 31788348 PMCID: PMC6871544 DOI: 10.1167/tvst.8.6.19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/02/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose We introduce a new approach for functional mapping of rod and cone activity by measuring pupillary responses to local stimulation via gaze-controlled chromatic pupil campimetry (CPC). Methods Pupillary constriction amplitude and latency to constriction onset to local photopic and scotopic light stimuli at different locations within the 30° central visual field were analyzed in 14 healthy subjects (4 males, 34 ± 11 years, mean ± standard deviation [SD]). All subjects were measured twice for evaluating the test–retest variability and reproducibility of the method. Results For the cone-favoring protocol (ConeProt), the relative maximal constriction amplitude was most pronounced in the center (26.8% ± 6.3%) with a hill-shaped decrease from the fovea to the periphery. For the rod-favoring protocol (RodProt), it was smaller (center, 13.5% ± 4.5%) with a profile lacking the central peak. Mean latency to constriction onset was faster for cones (277 ± 25 ms) than for rods (372 ± 13 ms). Mean intraclass correlation at the different stimulus locations was 0.84 ± 0.08 for RodProt and 0.75 ± 0.11 for ConeProt; mean coefficients of repeatability value of all stimulus locations was 5.9% ± 1.2% and 8.6% ± 1.7%, respectively. Conclusions CPC provides an objective evaluation of local rod and cone function within the central 30° visual field. It shows a photoreceptor-specific profile in healthy subjects. Due to its easy, noncontact, gaze-controlled character, it is a clinically applicable method and may fill the gap of functional diagnostics of rods and cones of the human retina. Translational Relevance Chromatic pupil campimetry provides information about the local rod and cone function of the human retina with distinct pattern of distributions in an objective manner.
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Affiliation(s)
- Carina Kelbsch
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Melanie Kempf
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Torsten Strasser
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Institute for Ophthalmic Research, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Ronja Jung
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Laura Kuehlewein
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Institute for Ophthalmic Research, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Wilhelm
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Tobias Peters
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Barbara Wilhelm
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Krunoslav Stingl
- Pupil Research Group, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
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Morjaria R, Alexander I, Purbrick RMJ, Safa R, Chong NV, Wulff K, Foster RG, Downes SM. Impact of Diabetic Retinopathy on Sleep, Mood, and Quality of Life. Invest Ophthalmol Vis Sci 2019; 60:2304-2310. [PMID: 31117122 PMCID: PMC6532697 DOI: 10.1167/iovs.18-26108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Diabetic retinopathy (DR) is associated with retinal neuronal and vascular damage. DR has previously been shown to affect the photosensitive retinal ganglion cells (pRGCs). PRGCs are essential for the entrainment of circadian rhythms; thus, DR progression could lead to worsening sleep quality and mood. We investigate the relationship between increasing DR severity, and its impact on sleep quality and mood. Methods A total of 430 participants with DR, and 303 healthy controls with no ocular disease or preexisting sleep disorders were recruited. DR severity was grouped as follows: 1, mild nonproliferative (NPDR); 2, moderate/severe NPDR; and 3, proliferative diabetic retinopathy (PDR). Sleep, mood, and quality of life were assessed using the Pittsburgh Sleep Quality Index (PSQI), quality of life (SF-36), and Hospital Anxiety and Depression Score (HADS) questionnaires. Data were analyzed by severity of DR, and correlated with sleep, QOL, and mood and compared to controls. Results No significant difference between PSQI scores in the DR group or the control group was identified despite severity of DR. Mean anxiety and depression scores were within the normal range for both groups. Despite a lower general health and physical function, the DR group had lower anxiety scores than controls. Conclusions These data show that even in severe DR, sleep quality is similar to controls. However, this could be explained by the majority of individuals in this study having good visual acuities in the better eye with a residual population of pRGCs remaining unaffected by DR.
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Affiliation(s)
- Rupal Morjaria
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom.,Oxford Eye Hospital, West Wing, Oxford University Hospitals NHS Trust, Headington, Oxford, United Kingdom.,University Hospital Birmingham NHS Trust, Mindelhson Way, Birmingham, United Kingdom
| | - Iona Alexander
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom
| | - Robert M J Purbrick
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom.,Oxford Eye Hospital, West Wing, Oxford University Hospitals NHS Trust, Headington, Oxford, United Kingdom.,Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, United Kingdom
| | - Rukhsana Safa
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom
| | - Ngaihang Victor Chong
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom
| | - Russell G Foster
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom
| | - Susan M Downes
- Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, South Parks Road, Oxford, United Kingdom.,Oxford Eye Hospital, West Wing, Oxford University Hospitals NHS Trust, Headington, Oxford, United Kingdom
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Thompson S, Blodi FR, Larson DR, Anderson MG, Stasheff SF. The Efemp1R345W Macular Dystrophy Mutation Causes Amplified Circadian and Photophobic Responses to Light in Mice. Invest Ophthalmol Vis Sci 2019; 60:2110-2117. [PMID: 31095679 PMCID: PMC6735810 DOI: 10.1167/iovs.19-26881] [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] [Indexed: 12/11/2022] Open
Abstract
Purpose The R345W mutation in EFEMP1 causes malattia leventinese, an autosomal dominant eye disease with pathogenesis similar to an early-onset age-related macular degeneration. In mice, Efemp1R345W does not cause detectable degeneration but small subretinal deposits do accumulate. The purpose of this study was to determine whether there were abnormal responses to light at this presymptomatic stage in Efemp1R345W mice. Methods Responses to light were assessed by visual water task, circadian phase shifting, and negative masking behavior. The mechanism of abnormal responses was investigated by anterior eye exam, electroretinogram, melanopsin cell quantification, and multielectrode recording of retinal ganglion cell activity. Results Visual acuity was not different in Efemp1R345W mice. However, amplitudes of circadian phase shifting (P = 0.016) and negative masking (P < 0.0001) were increased in Efemp1R345W mice. This phenotype was not explained by anterior eye defects or amplified outer retina responses. Instead, we identified increased melanopsin-generated responses to light in the ganglion cell layer of the retina (P < 0.01). Conclusions Efemp1R345W increases the sensitivity to light of behavioral responses driven by detection of irradiance. An amplified response to light in melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) is consistent with this phenotype. The major concern with this effect of the malattia leventinese mutation is the potential for abnormal regulation of physiology by light to negatively affect health.
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Affiliation(s)
- Stewart Thompson
- Department of Psychology, New Mexico Tech, Socorro, New Mexico, United States.,Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.,Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States
| | - Frederick R Blodi
- Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.,Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States.,Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States
| | - Demelza R Larson
- Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States.,Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, United States.,Biology Department, College of St. Benedict & St. John's University, Collegeville, Minnesota, United States
| | - Michael G Anderson
- Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.,Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States.,Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, United States.,VA Center for Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Steven F Stasheff
- Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States.,Pediatrics, University of Iowa, Iowa City, Iowa, United States.,Unit on Retinal Neurophysiology, National Eye Institute, Bethesda, Maryland, United States.,Center for Neurosciences and Behavioral Medicine, Children's National Medical Center, Washington, DC, United States.,George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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34
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Dumpala S, Zele AJ, Feigl B. Outer Retinal Structure and Function Deficits Contribute to Circadian Disruption in Patients With Type 2 Diabetes. Invest Ophthalmol Vis Sci 2019; 60:1870-1878. [PMID: 31042793 DOI: 10.1167/iovs.18-26297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Light transmitted by retinal photoreceptors provides the input for circadian photoentrainment. In diabetes, there is a high prevalence of circadian and sleep disruption but the underlying causes are not well understood. Patients with diabetes can exhibit dysfunctional photoreceptors but their role in circadian health is not known. Here we quantify photoreceptor function and contributions to circadian health and sleep in patients with diabetes without diabetic retinopathy and healthy controls. Methods Rod, cone, and melanopsin function was derived using chromatic pupillometry in 47 participants including 23 patients with type 2 diabetes and 24 age-matched healthy controls after an ophthalmic examination including retinal thickness assessment using optical coherence tomography. Circadian health was determined using dim light melatonin onset (DLMO) and sleep questionnaires; light exposure was measured using actigraphy. Results Compared with the control group, the patients with diabetes had a significantly earlier DLMO (1 hour) (P = 0.008), higher subjective sleep scores (P < 0.05), a reduction in pupil constriction amplitude for red stimuli (P = 0.039) and for the early postillumination pupil response (PIPR) for blue (P = 0.024) stimuli. There were no between-group differences in the light exposure pattern, activity levels, and intrinsic melanopsin-mediated PIPR amplitude (P > 0.05). A significant correlation was evident between outer retinal thickness and DLMO (r = -0.65, P = 0.03) and the pupil constriction amplitude (r = 0.63, P = 0.03); patients with thinner retina had earlier DLMO and lower pupil amplitudes. Conclusions We infer that the observed changes in circadian function in patients with no diabetic retinopathy are due to structural and functional outer retinal rod photoreceptor deficits at early stage of diabetic eye disease.
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Affiliation(s)
- Sunila Dumpala
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Australia
| | - Andrew J Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Australia
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Queensland Eye Institute, Brisbane, Australia
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McAnany JJ, Park JC. Cone Photoreceptor Dysfunction in Early-Stage Diabetic Retinopathy: Association Between the Activation Phase of Cone Phototransduction and the Flicker Electroretinogram. Invest Ophthalmol Vis Sci 2019; 60:64-72. [PMID: 30640972 PMCID: PMC6333111 DOI: 10.1167/iovs.18-25946] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose To define the nature and extent of cone photoreceptor abnormalities in diabetic individuals who have mild or no retinopathy by assessing the activation phase of cone phototransduction and the flicker ERG in these individuals. Methods Light-adapted single-flash and flicker ERGs were recorded from 20 diabetic individuals who have no clinically apparent retinopathy (NDR), 20 diabetic individuals who have mild nonproliferative diabetic retinopathy (NPDR), and 20 nondiabetic, age-equivalent controls. A-waves elicited by flashes of different retinal illuminance were fit with a delayed Gaussian model to derive Rmp3 (maximum amplitude of the massed photoreceptor response) and S (phototransduction sensitivity). Fundamental amplitude and phase of ERGs elicited by full-field sinusoidal flicker were obtained across a frequency range of 6 to 100 Hz. Results ANVOA indicated that both diabetic groups had significant S losses compared with the controls, whereas mean Rmp3 did not differ significantly among the groups. ANOVA also indicated significantly reduced flicker ERG amplitude for frequencies ≥56 Hz for both diabetic groups compared with the controls. Flicker ERG timing (phase) did not differ significantly among the groups. Log Rmp3 + log S was significantly correlated with the patients' high-frequency (62.5 Hz) flicker ERG amplitude loss (r = 0.69, P < 0.001). Conclusions The delayed Gaussian a-wave model is useful for characterizing abnormalities in the activation phase of cone phototransduction and can help explain flicker ERG abnormalities in early-stage diabetic retinopathy. Reduced cone sensitivity and attenuated high-frequency flicker ERGs provide evidence for impaired cone function in these individuals.
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Affiliation(s)
- J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States.,Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
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36
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Park JC, Chau FY, Lim JI, McAnany JJ. Electrophysiological and pupillometric measures of inner retina function in nonproliferative diabetic retinopathy. Doc Ophthalmol 2019; 139:99-111. [PMID: 31016437 DOI: 10.1007/s10633-019-09699-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate three measures of inner retina function, the pattern electroretinogram (pERG), the photopic negative response (PhNR), and the post-illumination pupil response (PIPR) in diabetics with and without nonproliferative diabetic retinopathy (NPDR). METHODS Fifteen non-diabetic control subjects and 45 type 2 diabetic subjects participated (15 have no clinically apparent retinopathy [NDR], 15 have mild NPDR, and 15 have moderate/severe NPDR). The pERG was elicited by a contrast-reversing checkerboard pattern, and the PhNR was measured in response to a full-field, long-wavelength flash presented against a short-wavelength adapting field. The PIPR was elicited by a full-field, 450 cd/m2, short-wavelength flash. All responses were recorded and analyzed using conventional techniques. One-way ANOVAs were performed to compare the pERG, PhNR, and PIPR among the control and diabetic groups. RESULTS ANOVA indicated statistically significant differences among the control and diabetic subjects for all three measures. Holm-Sidak post hoc comparisons indicated small, nonsignificant reductions in the pERG (8%), PhNR (8%), and PIPR (10%) for the NDR group compared to the controls (all p > 0.25). In contrast, there were significant reductions in the pERG (35), PhNR (34%), and PIPR (30%) for the mild NPDR group compared to the controls (all p < 0.01). Likewise, there were significant reductions in the pERG (40%), PhNR (32%), and PIPR (32%) for the moderate/severe NPDR group compared to the controls (all p < 0.01). CONCLUSION Abnormalities of the pERG, PhNR, and PIPR suggest inner retina neural dysfunction in diabetics who have clinically apparent vascular abnormalities. Taken together, these measures provide a noninvasive, objective approach to study neural dysfunction in these individuals.
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Affiliation(s)
- Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., MC/648, Chicago, IL, 60612, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., MC/648, Chicago, IL, 60612, USA
| | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., MC/648, Chicago, IL, 60612, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., MC/648, Chicago, IL, 60612, USA. .,Department of Bioengineering, University of Illinois at Chicago, 851 South Morgan St., Chicago, IL, 60607, USA.
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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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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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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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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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Ba-Ali S, Brøndsted AE, Andersen HU, Sander B, Jennum PJ, Lund-Andersen H. Assessment of diurnal melatonin, cortisol, activity, and sleep-wake cycle in patients with and without diabetic retinopathy. Sleep Med 2018; 54:35-42. [PMID: 30529775 DOI: 10.1016/j.sleep.2018.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the diurnal melatonin, cortisol, and activity/rest levels, as well as sleep quality, in patients with and without nonproliferative diabetic retinopathy (DR). METHODS We included 25 diabetic patients with DR and 29 without DR. A total of 21 healthy subjects constituted the control group. We assessed the circadian rhythm by actigraphy and diurnal salivary melatonin and cortisol measurements. Sleep quality was evaluated by actigraphy and the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. Light exposure was quantified by actigraphy. The primary outcome was peak salivary melatonin level. Secondary outcomes were mean melatonin and cortisol levels during dark hours, activity-rest rhythm, sleep quality, as well as level of white, red, green, and blue light exposure. RESULTS Peak melatonin concentration at 04:00 and mean nocturnal melatonin level were significantly reduced in all diabetic patients, regardless of retinopathy stage (p < 0.001). Levels of light exposures during dark hours were not significantly different in patients with and without DR and healthy controls. Only patients with DR showed increased intradaily variability in their activity-rest interval, indicating circadian misalignment (p = 0.04). Neither the objective actigraphic sleep quality parameters nor the subjective PSQI or ESS scores were significantly different between healthy controls and diabetic patients. CONCLUSIONS Reduced nocturnal melatonin concentration and increased fragmentation of activity-rest intervals revealed circadian rhythm disturbance in diabetic patients with DR.
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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.
| | | | | | - Birgit Sander
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Poul Jørgen Jennum
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Centre for Sleep Medicine, Neurophysiology Clinic, Rigshospitalet, Glostrup, Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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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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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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