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Philibert M, Milea D. Basics, benefits, and pitfalls of pupillometers assessing visual function. Eye (Lond) 2024; 38:2415-2421. [PMID: 38802485 PMCID: PMC11306737 DOI: 10.1038/s41433-024-03151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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, Sabeti F, van Kleef JP, Carle CF, Rohan EMF, Essex RW, Barry RC, Maddess T. Comparing 2-dimensional macular pigment optical density with objective and subjective perimetry and visual acuity in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:2449-2459. [PMID: 38483610 PMCID: PMC11271426 DOI: 10.1007/s00417-024-06437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/01/2024] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To compare diagnostic power for different severities of age-related macular degeneration (AMD) of two-dimensional macular pigment optical densities (2D-MPOD) and spatially matched objective perimetry, with standard perimetry and best-corrected visual acuity (BCVA). METHODS The ObjectiveField Analyser (OFA) provided objective perimetry, and a Heidelberg Spectralis optical coherence tomography (OCT) measured 2D-MPOD in AMD patients, both completed twice over 0.99 ± 0.16 years. From each 2D-MPOD image, we extracted 20 regions/macula, matched to the 20 OFA stimuli/macula. For each region, we calculated 7 measures from the 2D-MPOD pixel values and correlated those with OFA sensitivities and delays. We quantified 2D-MPOD changes, the ability of 2D-MPOD and OFA to discriminate AMD stages, and the discriminatory power of Matrix perimetry and BCVA using percentage area under receiver operator characteristic plots (%AUROC). RESULTS In 58 eyes of 29 subjects (71.6 ± 6.3 years, 22 females), we found significant correlations between 2D-MPOD and OFA sensitivities for Age-Related Eye Disease Studies (AREDS)-3 and AREDS-4 severities. Delays showed significant correlations with AREDS-2. For AREDS-4, correlations extended across all eccentricities. Regression associated with the Bland-Altman plots showed significant changes in 2D-MPOD over the study period, especially variability measures. MPOD per-region medians discriminated AREDS-1 from AREDS-3 eyes at a %AUROC of 80.0 ± 6.3%, outperforming OFA, Matrix perimetry, and BCVA. CONCLUSIONS MPOD changes correlated with central functional changes and significant correlations extended peripherally in later-stage AMD. Good diagnostic power for earlier-stage AMD and significant change over the study suggest that 2D-MPOD and OFA may provide effective biomarkers.
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Affiliation(s)
- Bhim B Rai
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia.
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia
- Faculty of Health, School of Optometry, University of Canberra, Canberra, ACT, Australia
| | - Joshua P van Kleef
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia
| | - Corinne F Carle
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia
| | - Emilie M F Rohan
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia
| | - Rohan W Essex
- Department of Ophthalmology, Canberra Hospital, Canberra, ACT, Australia
| | | | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Canberra, ACT, 2601, Australia
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Carle CF, Chain AYH, Kolic M, Maddess T. The structure-function relationship between multifocal pupil perimetry and retinal nerve fibre layer in glaucoma. BMC Ophthalmol 2024; 24:159. [PMID: 38600474 PMCID: PMC11008001 DOI: 10.1186/s12886-024-03402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Multifocal pupillographic objective perimetry (mfPOP) is a novel method for assessing functional change in diseases like glaucoma. Previous research has suggested that, in contrast to the pretectally-mediated melanopsin response of intrinsically photosensitive retinal ganglion cells, mfPOP responses to transient onset stimuli involve the extrastriate cortex, and thus the main visual pathway. We therefore investigate the correlation between peripapillary retinal nerve fibre layer (pRNFL) thickness and glaucomatous visual field changes detected using mfPOP. Parallel analyses are undertaken using white on white standard automated perimetry (SAP) for comparison. METHODS Twenty-five glaucoma patients and 24 normal subjects were tested using SAP, 3 mfPOP variants, and optical coherence tomography (OCT). Arcuate clusters of the SAP and mfPOP deviations were weighted according to their contribution to published arcuate divisions of the retinal nerve fibre layer. Structure-function correlation coefficients (r) were computed between pRNFL clock-hour sector thickness measurements, and the local visual field sensitivities from both SAP and mfPOP. RESULTS The strongest correlation was observed in the superior-superotemporal disc sector in patients with worst eye SAP MD < -12 dB: r = 0.93 for the mfPOP LumBal test (p < 0.001). Correlations across all disc-sectors were strongest in these same patients in both SAP and mfPOP: SAP r = 0.54, mfPOP LumBal r = 0.55 (p < 0.001). In patients with SAP MD ≥ -6 dB in both eyes, SAP correlations across all sectors were higher than mfPOP; mfPOP correlations however, were higher than SAP in more advanced disease, and in normal subjects. CONCLUSIONS For both methods the largest correlations with pRNFL thickness corresponded to the inferior nasal field of more severely damaged eyes. Head-to-head comparison of mfPOP and SAP showed similar structure-function relationships. This agrees with our recent reports that mfPOP primarily stimulates the cortical drive to the pupils.
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Affiliation(s)
- Corinne F Carle
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia.
| | - Allan Y H Chain
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia
| | - Maria Kolic
- CERA Retinal Gene Therapy Unit, University of Melbourne, Melbourne Vic, Australia
| | - Ted Maddess
- Neuroscience, The John Curtin School of Medical Research, Australian National University, Building 131 Garran Road, Canberra ACT, 2601, Australia
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Sabeti F, van Kleef JP, Iyer RM, Carle CF, Nolan CJ, Chia RH, Maddess T. Discriminating early-stage diabetic retinopathy with subjective and objective perimetry. Front Endocrinol (Lausanne) 2024; 14:1333826. [PMID: 38264290 PMCID: PMC10804944 DOI: 10.3389/fendo.2023.1333826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction To prevent progression of early-stage diabetic retinopathy, we need functional tests that can distinguish multiple levels of neural damage before classical vasculopathy. To that end, we compared multifocal pupillographic objective perimetry (mfPOP), and two types of subjective automated perimetry (SAP), in persons with type 2 diabetes (PwT2D) with either no retinopathy (noDR) or mild to-moderate non-proliferative retinopathy (mmDR). Methods Both eyes were assessed by two mfPOP test methods that present stimuli within either the central ±15° (OFA15) or ±30° (OFA30), each producing per-region sensitivities and response delays. The SAP tests were 24-2 Short Wavelength Automated Perimetry and 24-2 Matrix perimetry. Results Five of eight mfPOP global indices were significantly different between noDR and mmDR eyes, but none of the equivalent measures differed for SAP. Per-region mfPOP identified significant hypersensitivity and longer delays in the peripheral visual field, verifying earlier findings. Diagnostic power for discrimination of noDR vs. mmDR, and normal controls vs. PwT2D, was much higher for mfPOP than SAP. The mfPOP per-region delays provided the best discrimination. The presence of localized rather than global changes in delay ruled out iris neuropathy as a major factor. Discussion mfPOP response delays may provide new surrogate endpoints for studies of interventions for early-stage diabetic eye damage.
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Affiliation(s)
- Faran Sabeti
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
- Discipline of Optometry, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Joshua P. van Kleef
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Rakesh M. Iyer
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
| | - Corinne F. Carle
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Christopher J. Nolan
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | - Rong Hui Chia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Ted Maddess
- Eccles Institute for Neuroscience, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
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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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Sabeti F, Rai BB, van Kleef JP, Rohan EMF, Carle CF, Barry RC, Essex RW, Nolan CJ, Maddess T. Objective perimetry identifies regional functional progression and recovery in mild Diabetic Macular Oedema. PLoS One 2023; 18:e0287319. [PMID: 37319294 PMCID: PMC10270604 DOI: 10.1371/journal.pone.0287319] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Retinal function beyond foveal vision is not routinely examined in the clinical screening and management of diabetic retinopathy although growing evidence suggests it may precede structural changes. In this study we compare optical coherence tomography (OCT) based macular structure with function measured objectively with the ObjectiveFIELD Analyzer (OFA), and with Matrix perimetry. We did that longitudinally in Type 2 diabetes (T2D) patients with mild Diabetic Macular Oedema (DMO) with good vision and a similar number of T2D patients without DMO, to evaluate changes in retinal function more peripherally over the natural course of retinopathy. METHODS Both eyes of 16 T2D patients (65.0 ± 10.1, 10 females), 10 with baseline DMO, were followed for up longitudinally for 27 months providing 94 data sets. Vasculopathy was assessed by fundus photography. Retinopathy was graded using to Early Treatment of Diabetic Retinopathy Study (ETDRS) guidelines. Posterior-pole OCT quantified a 64-region/eye thickness grid. Retinal function was measured with 10-2 Matrix perimetry, and the FDA-cleared OFA. Two multifocal pupillographic objective perimetry (mfPOP) variants presented 44 stimuli/eye within either the central 30° or 60° of the visual field, providing sensitivities and delays for each test-region. OCT, Matrix and 30° OFA data were mapped to a common 44 region/eye grid allowing change over time to be compared at the same retinal regions. RESULTS In eyes that presented with DMO at baseline, mean retinal thickness reduced from 237 ± 25 μm to 234.2 ± 26.7 μm, while the initially non-DMO eyes significantly increased their mean thickness from 250.7 ± 24.4 μm to 255.7 ± 20.6 μm (both p<0.05). Eyes that reduced in retinal thickness over time recovered to more normal OFA sensitivities and delays (all p<0.021). Matrix perimetry quantified fewer regions that changed significantly over the 27 months, mostly presenting in the central 8 degrees. CONCLUSIONS Changes in retinal function measured by OFA possibly offer greater power to monitor DMO over time than Matrix perimetry data.
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Affiliation(s)
- Faran Sabeti
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- Faculty of Health, School of Optometry, University of Canberra, Bruce, Canberra, Australia
| | - Bhim B. Rai
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Josh P. van Kleef
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Emilie M. F. Rohan
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Corinne F. Carle
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Richard C. Barry
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- Blink Eye Clinic, Canberra, ACT, Australia
| | - Rohan W. Essex
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Christopher J. Nolan
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Ted Maddess
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
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Rapid, non-contact multifocal visual assessment in multiple sclerosis. Neurol Sci 2023; 44:273-279. [PMID: 36098887 PMCID: PMC9816274 DOI: 10.1007/s10072-022-06387-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Previous work on temporally sparse multifocal methods suggests that the results are correlated with disability and progression in people with multiple sclerosis (PwMS). Here, we assess the diagnostic power of three cortically mediated sparse multifocal pupillographic objective perimetry (mfPOP) methods that quantified response-delay and light-sensitivity at up to 44 regions of both visual fields concurrently. METHODS One high-spatial-resolution mfPOP method, P129, and two rapid medium-resolution methods, W12 and W20, were tested on 44 PwMS and controls. W12 and W20 took 82 s to test both visual fields concurrently, providing response delay and sensitivity at each field location, while P129 took 7 min. Diagnostic power was assessed using areas under the receiver operating characteristic (AUROC) curves and effect-size (Hedges' g). Linear models examined significance. Concurrent testing of both eyes permitted assessment of between-eye asymmetries. RESULTS Per-region response delays and asymmetries achieved AUROCs of 86.6% ± 4.72% (mean ± SE) in relapsing-remitting MS, and 96.5% ± 2.30% in progressive MS. Performance increased with increasing disability scores, with even moderate EDSS 2 to 4.5 PwMS producing AUROCs of 82.1 to 89.8%, Hedge's g values up to 2.06, and p = 4.0e - 13. All tests performed well regardless of any history of optic neuritis. W12 and W20 performed as well or better than P129. CONCLUSION Overall, the 82-s tests (W12 and W20) performed better than P129. The results suggest that mfPOP assesses a correlate of disease severity rather than a history of inflammation, and that it may be useful in the clinical management of PwMS.
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Maddess T, Carle CF, Rohan EM, Baird-Gunning J, van Kleef JP, Lueck CJ. Objective perimetry and progression of multiple sclerosis. eNeurologicalSci 2022; 29:100430. [PMID: 36254171 PMCID: PMC9568864 DOI: 10.1016/j.ensci.2022.100430] [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] [Received: 07/19/2022] [Revised: 09/07/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction We re-examined the per-region response amplitudes and delays obtained from multifocal pupillographic objective perimetry (mfPOP) after 10 years in 44 persons living with multiple sclerosis (PwMS), both to examine which parts of the visual field had progressed in terms of response properties and to examine if the baseline data could predict the overall progression of disease. Methods Expanded Disability Status Scale (EDSS) scores were assessed in 2009 and 2019. Both eyes of each participant were concurrently tested at 44 locations/eye on both occasions. Several measures of clinical progression were examined, using logistic regression to determine the odds of progression. Results At the second examination the 44 PwMS (31 females) were aged 61.0 ± 12.2 y. Mean EDSS had not changed significantly (3.69 ± 1.23 in 2009, 3.81 ± 2.00 in 2019). mfPOP delay increased progressively from inferior to superior regions of the visual fields while amplitudes demonstrated a temporal to nasal gradient. The mean of the 3 most delayed visual field regions was correlated with progression of MS by 2019 (p = 0.023). Logistic regression indicated a significant association between delay and odds of progression (p = 0.045): an individual with 3 regions at least 1 SD (40 ms) slower than the mean in 2009 had 2.05× (±SE: 1.43× to 2.95×) the odds of progression by 2019. A 1 SD shorter delay was associated with 2.05× lower odds of progression. Amplitude changes were not predictive of progression. Significance mfPOP may provide a rapid, convenient method of monitoring and predicting MS progression.
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Affiliation(s)
- Ted Maddess
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Corinne F. Carle
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Emilie M.F. Rohan
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | | | - Josh P. van Kleef
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Christian J. Lueck
- Department of Neurology, the Canberra Hospital, Canberra, ACT, Australia
- Australian National University Medical School, Acton, ACT, Australia
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Portengen BL, Porro GL, Imhof SM, Naber M. Comparison of unifocal, flicker, and multifocal pupil perimetry methods in healthy adults. J Vis 2022; 22:7. [PMID: 35998063 PMCID: PMC9424968 DOI: 10.1167/jov.22.9.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
To this day, the most popular method of choice for testing visual field defects (VFDs) is subjective standard automated perimetry. However, a need has arisen for an objective, and less time-consuming method. Pupil perimetry (PP), which uses pupil responses to onsets of bright stimuli as indications of visual sensitivity, fulfills these requirements. It is currently unclear which PP method most accurately detects VFDs. Hence, the purpose of this study is to compare three PP methods for measuring pupil responsiveness. Unifocal (UPP), flicker (FPP), and multifocal PP (MPP) were compared by monocularly testing the inner 60 degrees of vision at 44 wedge-shaped locations. The visual field (VF) sensitivity of 18 healthy adult participants (mean age and SD 23.7 ± 3.0 years) was assessed, each under three different artificially simulated scotomas for approximately 4.5 minutes each (i.e. stimulus was not or only partially present) conditions: quadrantanopia, a 20-, and 10-degree diameter scotoma. Stimuli that were fully present on the screen evoked strongest, partially present stimuli evoked weaker, and absent stimuli evoked the weakest pupil responses in all methods. However, the pupil responses in FPP showed stronger discriminative power for present versus absent trials (median d-prime = 6.26 ± 2.49, area under the curve [AUC] = 1.0 ± 0) and MPP performed better for fully present versus partially present trials (median d-prime = 1.19 ± 0.62, AUC = 0.80 ± 0.11). We conducted the first in-depth comparison of three PP methods. Gaze-contingent FPP had best discriminative power for large (absolute) scotomas, whereas MPP performed slightly better with small (relative) scotomas.
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Affiliation(s)
- Brendan L Portengen
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands.,
| | - Giorgio L Porro
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,
| | - Saskia M Imhof
- Ophthalmology Department, University Medical Center Utrecht, The Netherlands.,
| | - Marnix Naber
- Experimental Psychology, Helmholtz Institute, Utrecht University, The Netherlands.,
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Rapid Objective Testing of Visual Function Matched to the ETDRS Grid and Its Diagnostic Power in Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2022; 2:100143. [PMID: 36249701 PMCID: PMC9559873 DOI: 10.1016/j.xops.2022.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 03/14/2022] [Indexed: 11/21/2022]
Abstract
Purpose To study the power of an 80-second multifocal pupillographic objective perimetry (mfPOP) test tailored to the ETDRS grid to diagnose age-related macular degeneration (AMD) by Age-Related Eye Disease Study (AREDS) severity grade. Design Evaluation of a diagnostic technology. Methods We compared diagnostic power of acuity, ETDRS grid retinal thickness data, new 80-second M18 mfPOP test, and two wider-field 6-minute mfPOP tests (Macular-P131, Widefield-P129). The M18 stimuli match the size and shape of bifurcated ETDRS grid regions, allowing easy structure–function comparisons. M18, P129, and P131 stimuli test both eyes concurrently. We recruited 34 patients with early-stage AMD with a mean ± standard deviation (SD) age of 72.6 ± 7.06 years. The M18 and P129 plus P131 stimuli had 26 and 51 control participants, respectively with mean ± SD ages of 73.1 ± 8.17 years and 72.1 ± 5.83 years, respectively. Multifocal pupillographic objective perimetry testing used the Food and Drug Administration-cleared Objective FIELD Analyzer (OFA; Konan Medical USA). Main Outcome Measures Percentage area under the receiver operator characteristic curve (AUC) and Hedge’s g effect size. Results Acuity and OCT ETDRS grid thickness and volume produced reasonable diagnostic power (percentage AUC) for AREDS grade 4 eyes at 83.9 ± 9.98% and 90.2 ± 6.32% (mean ± standard error), respectively, but not for eyes with less severe disease. By contrast, M18 stimuli produced percentage AUCs from 72.8 ± 6.65% (AREDS grade 2) to 92.9 ± 3.93% (AREDS grade 4), and 82.9 ± 3.71% for all eyes. Hedge’s g effect sizes ranged from 0.84 to 2.32 (large to huge). Percentage AUC for P131 stimuli performed similarly and for P129 performed somewhat less well. Conclusions The rapid and objective M18 test provided diagnostic power comparable with that of wider-field 6-minute mfPOP tests. Unlike acuity or OCT ETDRS grid data, OFA tests produced reasonable diagnostic power in AREDS grade 1 to 3 eyes.
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Multifocal pupillographic objective perimetry for assessment of early diabetic retinopathy and generalised diabetes-related tissue injury in persons with type 1 diabetes. BMC Ophthalmol 2022; 22:166. [PMID: 35418088 PMCID: PMC9008936 DOI: 10.1186/s12886-022-02382-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/28/2022] [Indexed: 12/01/2022] Open
Abstract
Background To examine the potential utility of five multifocal pupillographic objective perimetry (mfPOP) protocols, in the assessment of early diabetic retinopathy (DR) and generalised diabetes-related tissue injury in subjects with type 1 diabetes (T1D). Methods Twenty-five T1D subjects (age 41.8 ± 12.1 (SD) years, 13 male) with either no DR (n = 13) or non-proliferative DR (n = 12), and 23 age and gender-matched control subjects (age 39.7 ± 12.9 years, 9 male) were examined by mfPOP using five different stimulus methods differing in visual field eccentricity (central 30° and 60°), and colour (blue, yellow or green test-stimuli presented on, respectively, a blue, yellow or red background), each assessing 44 test-locations per eye. In the T1D subjects, we assessed 16 metabolic status and diabetes complications variables. These were summarised as three principal component analysis (PCA) factors. DR severity was assessed using Early Treatment of Diabetic Retinopathy Study (ETDRS) scores. Area under the curve (AUC) from receiver operator characteristic analyses quantified the diagnostic power of mfPOP response sensitivity and delay deviations for differentiating: (i) T1D subjects from control subjects, (ii) T1D subjects according to three levels of the identified PCA-factors from control subjects, and (iii) TID subjects with from those without non-proliferative DR. Results The two largest PCA-factors describing the T1D subjects were associated with metabolic variables (e.g. body mass index, HbA1c), and tissue-injury variables (e.g. serum creatinine, vibration perception). Linear models showed that mfPOP per-region response delays were more strongly associated than sensitivities with the metabolic PCA-factor and ETDRS scores. Combined mfPOP amplitude and delay measures produced AUCs of 90.4 ± 8.9% (mean ± SE) for discriminating T1D subjects with DR from control subjects, and T1D subjects with DR from those without of 85.9 ± 8.8%. The yellow and green stimuli performed better than blue on most measures. Conclusions/interpretation In T1D subjects, mfPOP testing was able to identify localised visual field functional abnormalities (retinal/neural reflex) in the absence or presence of mild DR. mfPOP responses were also associated with T1D metabolic status, but less so with early stages of non-ophthalmic diabetes complications.
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Carle CF, James AC, Sabeti F, Kolic M, Essex RW, Shean C, Jeans R, Saikal A, Licinio A, Maddess T. Clustered Volleys Stimulus Presentation for Multifocal Objective Perimetry. Transl Vis Sci Technol 2022; 11:5. [PMID: 35113130 PMCID: PMC8819283 DOI: 10.1167/tvst.11.2.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Multifocal pupillographic objective perimetry (mfPOP) is being developed as an alternative to subjective threshold perimetry for the management of visual and neurological disorders. Here, we evaluate, in normal subjects, differences in signal quality between the original mfPOP method of spatially sparse Continuous stimulus presentation and the new Clustered Volleys (CVs) method. We hypothesized that the CVs method would lead to increased signal-to-noise ratios (SNRs) over the original method due to the stabilization of gain within the pupillary system. Methods Data were collected from six separate studies where otherwise-identical pairs of mfPOP tests using either the original Continuous stimulus presentation method or the new CVs method were undertaken; 440 6-minute tests from 96 normal subjects of varying ages were included. Per-region SNRs were compared between the two methods. Results Mean SNRs for the CVs mfPOP variants were between 35% and 57% larger than the original Continuous mfPOP variants (P < 0.001 in five of six studies). Similarly, the goodness-of-fit measure (r2) demonstrated large and significant fold increases of between 2.3× and 3.4× over the original method (all P < 0.001). Significant improvements in SNRs were present in all of the 88 test regions (44/eye), ranging between 8.4% and 93.7%; mean SNRs were significantly larger in 98% of test subjects. Conclusions The CVs mfPOP stimulus presentation method produced substantial increases in signal quality over the original method. This is likely due to the stabilization of pupillary gain during stimulus presentation. Translational Relevance These improvements increase diagnostic accuracy and have enabled shorter, 80-second mfPOP tests to be developed.
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Affiliation(s)
- Corinne F Carle
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Andrew C James
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Maria Kolic
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Rohan W Essex
- John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Canberra Hospital, Canberra, Australia
| | - Chris Shean
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Rhiannon Jeans
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Aiasha Saikal
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Alice Licinio
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
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Rai BB, Essex RW, Sabeti F, Maddess T, Rohan EMF, van Kleef JP, Carle CF. An Objective Perimetry Study of Central Versus Peripheral Sensitivities and Delays in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:24. [PMID: 34932115 PMCID: PMC8711003 DOI: 10.1167/tvst.10.14.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to compare central versus peripheral retinal sensitivities and delays in neovascular age-related macular degeneration (nAMD) using US Food and Drug Administration (FDA)-cleared multifocal pupillographic objective perimetry (mfPOP). Methods We recruited 18 patients with nAMD and commenced Pro re nata intravitreal anti- vascular endothelial growth factor (VEGF) injection. We compared macular (±15 degrees) and wide-field (±30 degrees) mfPOP variants. We examined temporal correlations between treated and untreated fellow eyes. We fitted linear models to selected treatment patterns, and compared the ability of central versus peripheral responses to predict the need for treatment. Results Central sensitivity decreased by -2.23 ± 0.051 dB/month (P < 0.0002) in treated eyes, and -0.17 ± 0.07 dB/month (P = 0.033) in untreated eyes. Treated eyes showed quicker central responses by 13.08 ± 3.77 ms than untreated eyes (P = 0.001). Based on peripheral responses, we identified two eye-types. Among positive-eyes peripheral sensitivity increased by 9.88 ± 4.41 dB (P = 0.042) before treatment; delays increased by 3.49 ± 1.75 ms/month (P = 0.049). For negative-eyes peripheral delays were shorter a month before treatment by 9.38 ± 3.59 ms (P = 0.013). Correlations between treatment and peripheral sensitivities or delays peaked at 1 to 2 months post-treatment. Peripheral data significantly determined treatment frequency and final acuity (all P < 0.044). Conclusions Peripheral macular function of treated and untreated eyes divided eyes into positive and negative groups. Those peripheral responses determined outcomes; changes preceding active disease by 1 to 3 months. Overall, mfPOP may provide potential biomarkers to assist nAMD management. Translational Relevance Objective perimetry may identify the requirement for treatment in nAMD that accords with the decision of a skilled clinician based on optical coherence tomography (OCT) and clinical findings.
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Affiliation(s)
- Bhim B Rai
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
| | - Rohan W Essex
- Academic Unit, ANU Medical School, ANU, Canberra, Australia Capital Territory, Australia
- Department of Ophthalmology, The Canberra Hospital, ACT Health, Canberra, ACT, Australia
| | - Faran Sabeti
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
- School of Optometry, University of Canberra, Bruce, Canberra, Australia Capital Territory, Australia
| | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
| | - Emilie M F Rohan
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
| | - Joshua P van Kleef
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
| | - Corinne F Carle
- John Curtin School of Medical Research, Australian National University, Australia Capital Territory, Australia
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14
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Effect of central and peripheral cone- and rod-specific stimulation on the pupillary light reflex. Int Ophthalmol 2021; 42:1427-1436. [PMID: 34826023 PMCID: PMC9123028 DOI: 10.1007/s10792-021-02132-1] [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] [Received: 06/14/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
Purpose To assess the effect of central and peripheral stimulation on the pupillary light reflex. The aim was to detect possible differences between cone- and rod-driven reactions. Methods Relative maximal pupil constriction amplitude (relMCA) and latency to constriction onset (latency) to cone- and rod-specific stimuli of 30 healthy participants (24 ± 5 years (standard deviation)) were measured using chromatic pupil campimetry. Cone- and rod-specific stimuli had different intensities and wavelengths according to the Standards in Pupillography. Five filled circles with radii of 3°, 5°, 10°, 20° and 40° and four rings with a constant outer radius of 40° and inner radii of 3°, 5°, 10° and 20° were used as stimuli. Results For cone-and rod-specific stimuli, relMCA increased with the stimulus area for both, circles and rings. However, increasing the area of a cone-specific ring by minimizing its inner radius with constant outer radius increased relMCA significantly stronger than the same did for a rod-specific ring. For cones and rods, a circle stimulus with a radius of 40° created a lower relMCA than the summation of the relMCAs to the corresponding ring and circle stimuli which combined create a 40° circle-stimulus. Latency was longer for rods than for cones. It decreased with increasing stimulus area for circle stimuli while it stayed nearly constant with increasing ring stimulus area for cone- and rod-specific stimuli. Conclusion The effect of central stimulation on relMCA is more dominant for cone-specific stimuli than for rod-specific stimuli while latency dynamics are similar for both conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-021-02132-1.
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Rai BB, Maddess T, Carle CF, Rohan EMF, van Kleef JP, Barry RC, Essex RW, Nolan CJ, Sabeti F. Comparing Objective Perimetry, Matrix Perimetry, and Regional Retinal Thickness in Mild Diabetic Macular Edema. Transl Vis Sci Technol 2021; 10:32. [PMID: 34842920 PMCID: PMC8631055 DOI: 10.1167/tvst.10.13.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/31/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose To compare per-region macular sensitivity and delay from objective perimetry with Matrix perimetry and retinal thickness in mild diabetic macular edema (DMO). Methods Thirty-three patients with type 2 diabetes (T2D) aged 59.2 ± 10.5 years participated in a longitudinal study. Macular thickness, sensitivities and delays from the objectiveFIELD Analyzer (OFA), and Matrix perimeter sensitivities were mapped onto a common spatial layout to compute per-region correlations between structure/function measures. A generalized linear mixed-effects logistic regression model determined which variables contributed to clinical diagnosis of DMO. Results For OFA, the mean sensitivity differences compared with normal in patients with T2D were negative and the mean delay differences positive, indicating lowered sensitivities and prolonged delays, both increasing with diabetes duration. Shorter diabetes duration could produce either localized peripheral hypersensitivities or shorter delays. Functional change could occur when retinal thickness was stable. Peripheral macular thickness correlated with central and peripheral OFA sensitivity and delay, all P < 0.0012 in DMO and a median of P = 0.001 without DMO; this was not true for Matrix sensitivities. The logistic model determined that peripheral thickness, OFA sensitivity (P = 0.043), and time in the study (P = 0.001) contribute independently to the odds of DMO versus no DMO. Conclusions Mean sensitivities decreased and mean delays increased with duration of diabetes. Peripheral macular thickness correlated significantly with central and peripheral macular OFA sensitivity and delay. Peripheral macular thickness and functional measures may provide sensitive prognostic data. Translational Relevance Functional loss can precede structural change in DMO, so including such functional assessment for deciding on treatment may be beneficial.
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Affiliation(s)
- Bhim B. Rai
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Ted Maddess
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Corinne F. Carle
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Emilie M. F. Rohan
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Josh P. van Kleef
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Richard C. Barry
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- Blink Eye Clinic, Canberra, ACT, Australia
| | - Rohan W. Essex
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Christopher J. Nolan
- The Canberra Hospital, ACT Health, Garran, Canberra, ACT, Australia
- ANU Medical School, Australian National University, Canberra, ACT, Australia
| | - Faran Sabeti
- The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- University of Canberra, School of Optometry, Faculty of Health, Bruce, Canberra, ACT, Australia
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Ali EN, Carle CF, Lueck CJ, Kolic M, Maddess T. Assessing migraine patients with multifocal pupillographic objective perimetry. BMC Neurol 2021; 21:211. [PMID: 34039302 PMCID: PMC8152334 DOI: 10.1186/s12883-021-02239-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background To establish the effects of stimulating intrinsically-photosensitive retinal ganglion cells (ipRGCs) on migraine severity, and to determine if migraine produces objectively-measured visual field defects. Methods A randomized, open labelled, crossover study tested migraineurs and normal controls using multifocal pupillographic objective perimetry (mfPOP) with 44 test-regions/eye. A slow blue protocol (BP) stimulated ipRGCs, and a fast yellow protocol (YP) stimulated luminance channels. Migraine diaries assessed migraine severity. Per-region responses were analyzed according to response amplitude and time-to-peak. Results Thirty-eight migraineurs (42.0 ± 16.5 years, 23 females) and 24 normal controls (39.2 ± 15.2 years, 14 females) were tested. The proportion of subjects developing a migraine did not differ after either protocol, either during the 1st day (odds ratio 1.0; 95% confidence interval 0.2–4.4, p = 0.48) or during the first 3 days after testing (odds ratio 0.8; 95% confidence interval 0.3–2.1, p = 0.68). Migraine days/week did not increase following testing with either protocol in comparison to the baseline week (1.4 ± 1.6 pre-testing (mean ± SD), 1.3 ± 1.4 post-BP, and 1.3 ± 1.2 post-YP; p = 0.96), neither did other measures of severity. Migraine occurring up to 2 weeks before testing significantly lowered amplitudes, − 0.64 ± 0.14 dB (mean ± SE), while triptan use increased amplitudes by 0.45 ± 0.10 dB, both at p < 0.001. Conclusions Stimulating ipRGCs did not affect migraine occurrence or severity. Pupillary response characteristics were influenced by the occurrence of a recent migraine attack and a history of triptan use.
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Affiliation(s)
- Eman N Ali
- Eccles Institute of Neuroscience, the John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia.,Department of Neuroscience, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Corinne F Carle
- Eccles Institute of Neuroscience, the John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Christian J Lueck
- Australian National University Medical School, Acton, ACT, Australia.,Department of Neurology, The Canberra Hospital, Canberra, ACT, Australia
| | - Maria Kolic
- Eccles Institute of Neuroscience, the John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
| | - Ted Maddess
- Eccles Institute of Neuroscience, the John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia.
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Carle CF, James AC, Rosli Y, Maddess T. Localization of Neuronal Gain Control in the Pupillary Response. Front Neurol 2019; 10:203. [PMID: 30930833 PMCID: PMC6423807 DOI: 10.3389/fneur.2019.00203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 02/18/2019] [Indexed: 11/27/2022] Open
Abstract
Multifocal pupillographic objective perimetry (mfPOP) is being developed as an alternative to standard visual perimetry. In mfPOP, pupil responses to sparse multifocal luminance stimuli are extracted from the overall composite response. These individual test-region responses are subject to gain-control which is dependent on the temporal and spatial density of stimuli. This study aimed to localize this gain within the pupil pathway. Pupil constriction amplitudes of 8 subjects (41.5 ±12.7 y, 4 male) were measured using a series of 14 mfPOP stimulus variants. The temporal density of stimulus signal at the levels of retina, pretectal olivary nuclei (PON), and Edinger-Westphal nuclei (EWN) were controlled using a combination of manipulation of the mean interval between stimulus presentations (3 or 6 stimuli/s/hemiretina) and the restriction of stimuli to specific subsets of the 24 visual field test-regions per eye (left or right eye, left or right hemifield, or nasal or temporal hemifield). No significant difference was observed between mfPOP variants with differing signal density at the retina or PON but matched density at the other levels. In contrast, where signal density differed at the EWN but was the same at the retinal and PON levels e.g., between 3 stim/s homonymous hemifield and all test-region variants, significant reductions in constriction amplitudes were observed [t(30) = −2.07 to −2.50, all p < 0.05]. Similar, although more variable, relationships were seen using nasal, and temporal hemifield stimuli. Results suggest that the majority of gain-control in the subcortical pupillary pathway occurs at the level of the EWN.
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Affiliation(s)
- Corinne Frances Carle
- John Curtin School of Medical Research, Eccles Institute of Neuroscience, The Australian National University, Canberra, ACT, Australia.,ANU Medical School, The Australian National University, Canberra, ACT, Australia
| | - Andrew Charles James
- John Curtin School of Medical Research, Eccles Institute of Neuroscience, The Australian National University, Canberra, ACT, Australia
| | - Yanti Rosli
- Diagnostic and Applied Health Sciences, Biomedical Science Program, Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ted Maddess
- John Curtin School of Medical Research, Eccles Institute of Neuroscience, The Australian National University, Canberra, ACT, Australia
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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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Rosli Y, Carle CF, Ho Y, James AC, Kolic M, Rohan EMF, Maddess T. Retinotopic effects of visual attention revealed by dichoptic multifocal pupillography. Sci Rep 2018; 8:2991. [PMID: 29445236 PMCID: PMC5813021 DOI: 10.1038/s41598-018-21196-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/31/2018] [Indexed: 01/10/2023] Open
Abstract
Multifocal pupillographic objective perimetry (mfPOP) has recently been shown to be able to measure cortical function. Here we assessed 44 regions of the central 60 degrees of the visual fields of each eye concurrently in 7 minutes/test. We examined how foveally- and peripherally-directed attention changed response sensitivity and delay across the 44 visual field locations/eye. Four experiments were completed comparing white, yellow and blue stimulus arrays. Experiments 1 to 4 tested 16, 23, 9 and 6 subjects, 49/54 being unique. Experiment 1, Experiments 2 and 3, and Experiment 4 used three variants of the mfPOP method that provided increasingly improved signal quality. Experiments 1 to 3 examined centrally directed attention, and Experiment 4 compared effects of attention directed to different peripheral targets. Attention reduced the sensitivity of the peripheral locations in Experiment 1, but only for the white stimuli not yellow. Experiment 2 confirmed that result. Experiment 3 showed that blue stimuli behaved like white. Peripheral attention showed increased sensitivity around the attentional targets. The results are discussed in terms of the cortical inputs to the pupillary system. The results agree with those from multifocal and other fMRI and VEP studies. mfPOP may be a useful adjunct to those methods.
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Affiliation(s)
- Yanti Rosli
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
- Biomedical Science Program, Diagnostic & Applied Health Sciences, Faculty of Health Science, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Corinne Frances Carle
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Yiling Ho
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Andrew Charles James
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Maria Kolic
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia
| | - Emilie Marie Françoise Rohan
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Ted Maddess
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia.
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Maddess T, Daria VR. To BCVA, or not to BCVA, that is the question. Clin Exp Ophthalmol 2017; 45:437-439. [PMID: 28710867 DOI: 10.1111/ceo.12984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ted Maddess
- Diagnostics for Eye Diseases, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Vincent R Daria
- Neurophotonics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
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22
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Sabeti F, James AC, Carle CF, Essex RW, Bell A, Maddess T. Comparing multifocal pupillographic objective perimetry (mfPOP) and multifocal visual evoked potentials (mfVEP) in retinal diseases. Sci Rep 2017; 7:45847. [PMID: 28368051 PMCID: PMC5377468 DOI: 10.1038/srep45847] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/03/2017] [Indexed: 11/09/2022] Open
Abstract
Multifocal pupillographic objective perimetry (mfPOP) shows regions of slight hypersensitivity away from retinal regions damaged by diabetes or age-related macular degeneration (AMD). This study examines if such results also appear in multifocal visual evoked potentials (mfVEPs) recorded on the same day in the same patients. The pupil control system receives input from the extra-striate cortex, so we also examined evidence for such input. We recruited subjects with early type 2 diabetes (T2D) with no retinopathy, and patients with unilateral exudative AMD. Population average responses of the diabetes patients, and the normal fellow eyes of AMD patients, showed multiple regions of significant hypersensitivity (p < 0.05) on both mfPOP and mfVEPs. For mfVEPs the occipital electrodes showed fewer hypersensitive regions than the surrounding electrodes. More advanced AMD showed regions of suppression becoming centrally concentrated in the exudative AMD areas. Thus, mfVEP electrodes biased towards extra-striate cortical responses (surround electrodes) appeared to show similar hypersensitive visual field locations to mfPOP in early stage diabetic and AMD damage. Our findings suggest that hypersensitive regions may be a potential biomarker for future development of AMD or non-proliferative diabetic retinopathy, and may be more informative than visual acuity which remains largely undisturbed during early disease.
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Affiliation(s)
- Faran Sabeti
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Department of Ophthalmology, The Canberra Hospital, Canberra, Australia
| | - Andrew C James
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Corinne F Carle
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Rohan W Essex
- Department of Ophthalmology, The Canberra Hospital, Canberra, Australia.,Medical School, Australian National University, Canberra, Australia
| | - Andrew Bell
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Ted Maddess
- Eccles Institute of Neuroscience, John Curtin School of Medical Research, Australian National University, Canberra, Australia
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Park JC, Chen YF, Blair NP, Chau FY, Lim JI, Leiderman YI, Shahidi M, McAnany JJ. Pupillary responses in non-proliferative diabetic retinopathy. Sci Rep 2017; 7:44987. [PMID: 28332564 PMCID: PMC5362954 DOI: 10.1038/srep44987] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/17/2017] [Indexed: 01/24/2023] Open
Abstract
The goal of this study was to determine the extent of rod-, cone-, and melanopsin-mediated pupillary light reflex (PLR) abnormalities in diabetic patients who have non-proliferative diabetic retinopathy (NPDR). Fifty diabetic subjects who have different stages of NPDR and 25 age-equivalent, non-diabetic controls participated. PLRs were measured in response to full-field, brief-flash stimuli under conditions that target the rod, cone, and intrinsically-photosensitive (melanopsin) retinal ganglion cell pathways. Pupil responses were compared among the subjects groups using age-corrected linear mixed models. Compared to control, the mean baseline pupil diameters were significantly smaller for all patient groups in the dark (all p < 0.001) and for the moderate-severe NPDR group in the light (p = 0.003). Pairwise comparisons indicated: (1) the mean melanopsin-mediated PLR was significantly reduced in the mild and moderate-severe groups (both p < 0.001); (2) the mean cone-mediated PLR was reduced significantly in the moderate-severe group (p = 0.008); (3) no significant differences in the mean rod-mediated responses. The data indicate abnormalities in NPDR patients under conditions that separately assess pupil function driven by different photoreceptor classes. The results provide evidence for compromised neural function in these patients and provide a promising approach for quantifying their neural abnormalities.
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Affiliation(s)
- Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Sciences, University of Illinois at Chicago, 914 S Wood Street, Chicago, IL 60612, USA
| | - Norman P Blair
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
| | - Felix Y Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
| | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
| | - Yannek I Leiderman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, 1450 San Pablo St, Los Angeles, CA 90033, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W. Taylor St., Chicago, IL 60612, USA
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24
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Binda P, Murray SO. Keeping a large-pupilled eye on high-level visual processing. Trends Cogn Sci 2014; 19:1-3. [PMID: 25467128 DOI: 10.1016/j.tics.2014.11.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/12/2014] [Accepted: 11/02/2014] [Indexed: 11/27/2022]
Abstract
The pupillary light response has long been considered an elementary reflex. However, evidence now shows that it integrates information from such complex phenomena as attention, contextual processing, and imagery. These discoveries make pupillometry a promising tool for an entirely new application: the study of high-level vision.
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Affiliation(s)
- Paola Binda
- University of Pisa, Department of Translational Research on New Technologies in Medicine and Surgery, via San Zeno 31, 56126 Pisa, Italy; University of Washington, Department of Psychology, Seattle, WA 98195-1525, USA.
| | - Scott O Murray
- University of Washington, Department of Psychology, Seattle, WA 98195-1525, USA
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25
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