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Biçer GY, Yılmaz Öztorun Z, Biçer KE, Zor KR. Analysis of pupillary responses in pediatric patients with vitamin D deficiency. Graefes Arch Clin Exp Ophthalmol 2024; 262:2625-2632. [PMID: 38416236 DOI: 10.1007/s00417-024-06428-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
PURPOSE To evaluate the effects of vitamin D deficiency on pupillary responses in the pediatric population. METHODS The study was conducted using data from the right eyes of 52 children with vitamin D deficiency and 52 healthy children. Measurements were taken under static and dynamic conditions with automatic pupillometry. Static measurements were performed at scotopic, mesopic, and photopic light intensities. The mean pupil dilation speed was calculated by observing the changes in pupil dilation over time according to dynamic measurements. Differences between patient and control groups were analyzed for the static and dynamic measurements and the mean pupil dilation speed. RESULTS While the two groups were similar in terms of scotopic, mesopic, the first dynamic measurements, and the pupil dilation speed data (p > 0.05), a significant difference was found in the photopic conditions (p = 0.001). The mean pupil diameter of the patient group was 4.46 ± 0.928 mm and 3.95 ± 0.556 mm in the control group under photopic conditions. CONCLUSIONS Pediatric patients with vitamin D deficiency have significantly larger pupil diameters in photopic conditions than healthy children. These results suggest that there is an autonomic dysfunction in vitamin D deficiency in the pediatric population, especially pointing to the parasympathetic system.
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Affiliation(s)
- Gamze Yıldırım Biçer
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey.
| | - Zeynep Yılmaz Öztorun
- Department of Pediatrics, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey
| | - Kadir Eren Biçer
- Department of Orthopedics and Traumatology, Niğde Education and Research Hospital, Kumluca, Nigde, Turkey
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Nigde, Turkey
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Erdem S, Yilmaz S, Karahan M, Dursun ME, Ava S, Alakus MF, Keklikci U. Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome? Int Ophthalmol 2021; 41:2555-2563. [PMID: 33763793 DOI: 10.1007/s10792-021-01814-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS). METHODS We included in this study patients with OSAS, who were divided into three groups according to the apnea-hypopnea index (AHI) (group 1, mild [n = 20]; group 2, moderate [n = 20]; and group 3, severe [n = 20]), and healthy controls (group 4, n = 20). Pupillary responses were measured using a pupillometry system. RESULTS Static (mesopic PD, P = 0.0019; low photopic PD, P = 0.001) and dynamic pupil responses (resting diameter, P = 0.004; amplitude of pupil contraction, P < 0.001; duration of pupil contraction, P = 0.022; velocity of pupil contraction, P = 0.001; and velocity of pupil dilation, P = 0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P = 0.008), low photopic PD (P = 0.003), resting diameter (P = 0.001), amplitude of pupil contraction (P < 0.001), duration of pupil contraction (P = 0.011), velocity of pupil contraction (P < 0.001), and velocity of pupil dilation (P = 0.001). CONCLUSION We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.
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Affiliation(s)
- Seyfettin Erdem
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey.
| | - Sureyya Yilmaz
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mine Karahan
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Mehmet Emin Dursun
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Sedat Ava
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
| | - Mehmet Fuat Alakus
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Ugur Keklikci
- Department Ophthalmology, Dicle University Medical Faculty, 21280, Diyarbakir, Turkey
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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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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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Redondo B, Vera J, Molina R, Garcia JA, Catena A, Muñoz-Hoyos A, Jimenez R. Accommodation and pupil dynamics as potential objective predictors of behavioural performance in children with attention-deficit/hyperactivity disorder. Vision Res 2020; 175:32-40. [DOI: 10.1016/j.visres.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023]
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Erdem S, Karahan M, Ava S, Pekkolay Z, Demirtas AA, Keklikci U. The effectiveness of automatic pupillometry as a screening method to detect diabetic autonomic neuropathy. Int Ophthalmol 2020; 40:3127-3134. [DOI: 10.1007/s10792-020-01499-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 11/24/2022]
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Shah SS, Ranaivo HR, Mets-Halgrimson RB, Rychlik K, Kurup SP. Establishing a normative database for quantitative pupillometry in the pediatric population. BMC Ophthalmol 2020; 20:121. [PMID: 32216772 PMCID: PMC7098071 DOI: 10.1186/s12886-020-01389-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting. METHODS Pupillometry was obtained prospectively for consecutive, normal patients < 18 years old being evaluated by Lurie Children's Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark. RESULTS 196 eyes of 101 participants (42.6% male, ages 1-17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1-8.1 mm 95% CI); MIN was 4.7 mm (3.1-6.1 mm 95% CI); CON was 30% (17-42 95% CI); LAT was 230 milliseconds (160-300 ms 95% CI); ACV was 3.70 mm/sec (2.21-5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38-1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2 and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤ 1.0 mm, respectively. CONCLUSIONS Quantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON.
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Affiliation(s)
- Sanket S Shah
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Rebecca B Mets-Halgrimson
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Karen Rychlik
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Sudhi P Kurup
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Accommodative response in children with attention deficit hyperactivity disorder (ADHD): the influence of accommodation stimulus and medication. Graefes Arch Clin Exp Ophthalmol 2020; 258:1299-1307. [DOI: 10.1007/s00417-020-04645-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/05/2020] [Accepted: 03/04/2020] [Indexed: 12/14/2022] Open
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Kallinikou D, Soldatou A, Tsentidis C, Louraki M, Kanaka-Gantenbein C, Kanavakis E, Karavanaki K. Diabetic neuropathy in children and adolescents with type 1 diabetes mellitus: Diagnosis, pathogenesis, and associated genetic markers. Diabetes Metab Res Rev 2019; 35:e3178. [PMID: 31083769 DOI: 10.1002/dmrr.3178] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 01/09/2023]
Abstract
Diabetic neuropathy (DN) is a common long-term complication of type 1 (T1D) and type 2 (T2D) diabetes mellitus, with significant morbidity and mortality. DN is defined as impaired function of the autonomic and/or peripheral nervous system, often subclinical, particularly in children and adolescents with T1D. Nerve conduction studies (NCS) and skin biopsies are considered gold-standard methods in the assessment of DN. Multiple environmental and genetic factors are involved in the pathogenesis of DN. Specifically, the role of metabolic control and glycemic variability is of paramount importance. A number of recently identified genes, including the AKR1B1, VEGF, MTHFR, APOE, and ACE genes, contribute significantly in the pathogenesis of DN. These genes may serve as biomarkers to predict future DN development or treatment response. In addition, they may serve as the basis for the development of new medications or gene therapy. In this review, the diagnostic evaluation, pathogenesis, and associated genetic markers of DN in children and adolescents with T1D are presented and discussed.
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Affiliation(s)
- Dimitra Kallinikou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Charalambos Tsentidis
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Louraki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Emmanouil Kanavakis
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
- Department of Medical Genetics, Choremeio Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Karavanaki
- Diabetes and Metabolism Clinic, 2nd Department of Pediatrics, National and Kapodistrian University of Athens-Faculty of Medicine, "P.&A. Kyriakou" Children's Hospital, Athens, Greece
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Kara K, Karaman D, Erdem U, Congologlu MA, Durukan I, Ilhan A. Investigation of Autonomic Nervous System Functions by Pupillometry in Children with Attention Deficit Hyperactivity Disorder. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20121130085850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Koray Kara
- Gulhane Military Academy, School of Medicine Department of Child and Adolescent Psychiatry, Ankara - Turkey
| | - Dursun Karaman
- Gulhane Military Academy, School of Medicine Department of Child and Adolescent Psychiatry, Ankara - Turkey
| | - Uzeyir Erdem
- Gulhane Military Academy, School of Medicine Department of Ophthalmology, Ankara - Turkey
| | - Mehmet Ayhan Congologlu
- Gulhane Military Academy, School of Medicine Department of Child and Adolescent Psychiatry, Ankara - Turkey
| | - Ibrahim Durukan
- Gulhane Military Academy, School of Medicine Department of Child and Adolescent Psychiatry, Ankara - Turkey
| | - Abdullah Ilhan
- Gulhane Military Academy, School of Medicine Department of Ophthalmology, Ankara - Turkey
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Yuan D, Spaeth EB, Vernino S, Muppidi S. Disproportionate pupillary involvement in diabetic autonomic neuropathy. Clin Auton Res 2014; 24:305-9. [DOI: 10.1007/s10286-014-0258-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
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Tang M, Donaghue KC, Cho YH, Craig ME. Autonomic neuropathy in young people with type 1 diabetes: a systematic review. Pediatr Diabetes 2013; 14:239-48. [PMID: 23627912 DOI: 10.1111/pedi.12039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/01/2013] [Accepted: 03/20/2013] [Indexed: 12/21/2022] Open
Abstract
Autonomic neuropathy is an under-recognized complication of diabetes, although it affects multiple organ systems and has widespread clinical manifestations including orthostatic hypotension, exercise intolerance, gastroparesis, diarrhea, constipation, and urinary incontinence. The most severe consequences include hypoglycemia unawareness and cardiovascular dysfunction. Autonomic neuropathy is also implicated in sudden unexplained deaths in otherwise healthy young people--the ‘dead in bed syndrome’. In adults, cardiovascular autonomic neuropathy is an independent predictor of mortality, predominantly due to cardiovascular disease, nephropathy, and hypoglycemia. While overt autonomic neuropathy is rare in childhood and adolescence, subclinical signs of autonomic dysfunction are common, and can be found soon after diabetes diagnosis. Risk factors for autonomic neuropathy in young people include diabetes duration, poor glycemic control, and presence of aldose reductase gene (AKR1B1) polymorphisms, specifically the Z-2/Z-2 genotype. Autonomic dysfunction is accelerated by puberty.
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Affiliation(s)
- Melissa Tang
- School of Women's and Children's Health, University of New South Wales, Kensington, NSW, 2052, Australia
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Mukherjee S, Vernino S. Dysfunction of the pupillary light reflex in experimental autoimmune autonomic ganglionopathy. Auton Neurosci 2007; 137:19-26. [PMID: 17613283 PMCID: PMC2190728 DOI: 10.1016/j.autneu.2007.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/09/2007] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
Autoimmune autonomic ganglionopathy (AAG) is an antibody-mediated form of severe autonomic failure. AAG is associated with serum antibodies against ganglionic acetylcholine receptors (AChR) and appears to result from impaired synaptic transmission in autonomic ganglia. The rabbit model of experimental AAG (EAAG), induced by immunization, reproduces the cardinal features of the human disease. Pupillary dysfunction is a prominent and defining feature in both AAG and EAAG. We adapted infrared computer-assisted video pupillometry to record direct pupil light responses in control and EAAG rabbits. Offline analysis algorithms were used to determine latency, velocity and amplitude of the constriction and redilation phases of the light reflex. Following immunization, pupillary abnormalities were the earliest sign of evolving autonomic failure. EAAG rabbits showed significant reduction in velocity and amplitude of pupil constriction while redilation parameters were only mildly affected. Fatigue in pupillary constriction, evidenced by premature redilation of the pupil prior to termination of the light stimulus, was observed only in seropositive rabbits. The severity of pupillary abnormalities was significantly correlated with ganglionic AChR antibody level. In chronic EAAG, treatment with pyridostigmine produced a partial recovery of pupil function. We conclude that pupillometry is a robust and sensitive diagnostic tool to assess autonomic dysfunction, distinguish AAG from other disorders, and assess responses to therapy. In EAAG, pupillary dysfunction is partially reversible, parasympathetic pupil function is more severely compromised than sympathetic function, and fatigue of pupillary constriction may be seen. These characteristic abnormalities of the pupillary light reflex may prove to have diagnostic value.
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Affiliation(s)
- Shalini Mukherjee
- Department of Neurology UT Southwestern Medical Center 5323 Harry Hines Blvd, Dallas, Texas 75390-9036, USA
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Maguire AM, Craig ME, Craighead A, Chan AKF, Cusumano JM, Hing SJ, Silink M, Howard NJ, Donaghue KC. Autonomic nerve testing predicts the development of complications: a 12-year follow-up study. Diabetes Care 2007; 30:77-82. [PMID: 17192337 DOI: 10.2337/dc06-0793] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cardiac autonomic nerve tests have predicted increased mortality in adults with diabetes, predominantly due to nephropathy, cardiac disease, and hypoglycemia. The significance of subclinical autonomic nerve test abnormalities has not been systematically studied in adolescents. We aimed to reassess an adolescent cohort, whose autonomic nervous system had been tested 12 years earlier by both pupillometry and cardiovascular tests. RESEARCH DESIGN AND METHODS From 1990 to 1993, adolescents with type 1 diabetes (n = 335) were assessed for autonomic neuropathy (median age 14.7 years [interquartile range 13.0-16.8], duration of diabetes 6.3 years [4.0-9.6], and A1C 8.3% [7.5-9.4]). Between 2003 and 2005, contact was made with 59% of the original group. Individual assessment 12 years later included completion of a validated hypoglycemia unawareness questionnaire (n = 123) and urinary albumin-to-creatinine ratio (n = 99) and retinal (n = 102) screening, as well as analysis of reports from external doctors (n = 35). RESULTS At baseline, there was no difference in age, duration of diabetes, or complications between those who participated in the follow-up phase (n = 137) and those who did not participate (n = 196). However, baseline A1C was lower in the follow-up participants (8.2 vs. 8.5% for participants vs. nonparticipants, respectively, P = 0.031). At 12 years of follow-up, 93% were aware and 7% were unaware that they had hypoglycemia; 32 (31%) had no retinopathy, but 10% required laser therapy, and 80 (81%) had no microalbuminuria. Small pupil size at baseline was independently associated with the development of microalbuminuria (odds ratio 4.36 [95% CI 1.32-14.42], P = 0.016) and retinopathy (4.83 [1.3-17.98], P = 0.019) but not with the development of hypoglycemia unawareness. There was no association with baseline cardiovascular tests and the development of complications 12 years later. CONCLUSIONS In this study, we found an association between baseline pupillometry tests and the presence of microalbuminuria and retinopathy at 12 years of follow-up. This suggests that pupillometry abnormalities may be early indicators of patients who are at high risk of future microvascular disease.
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Affiliation(s)
- Ann M Maguire
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia.
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Thamotharampillai K, Chan AKF, Bennetts B, Craig ME, Cusumano J, Silink M, Oates PJ, Donaghue KC. Decline in neurophysiological function after 7 years in an adolescent diabetic cohort and the role of aldose reductase gene polymorphisms. Diabetes Care 2006; 29:2053-7. [PMID: 16936152 DOI: 10.2337/dc06-0678] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This 7-year longitudinal study examines the potential impact of aldose reductase gene (AKR1B1) polymorphisms on the decline of nerve function in an adolescent diabetic cohort. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (n = 262) were assessed with three cardiovascular autonomic tests (heart rate variation during deep breathing, Valsalva maneuver, and during standing from a lying position) and pupillometry (resting pupil diameter, constriction velocity, and reflex amplitude), thermal, and vibration thresholds on the foot. Genotyping was performed for promoters (C-106T and C-12G), (CA)(n) dinucleotide repeats, and intragenic BamH1 polymorphism. RESULTS Median time between first and last assessment was 7.0 years (interquartile range 5.1-11.1), with a median of five assessments (four to seven) per individual. At first assessment, median age was 12.7 years (11.7-13.9), median duration was 5.3 years (3.4-8.0), and median HbA(1c) was 8.5% (7.8-9.3). All tests declined over time except for two cardiovascular autonomic tests and vibration discrimination. Faster decline in maximum constriction velocity was found to associate with the Z-2 allele (P = 0.045), Z-2/Z-2 (P = 0.026). Slower decline in hot thermal threshold discrimination associated with Z+2 (P = 0.044), Z+2/Z+2 (P < 0.0005), Z+2/T (P = 0.038), and bb (P = 0.0001). CONCLUSIONS Most autonomic and quantitative sensory nerve testings declined over time. AKR1B1 polymorphisms were strongly associated with the rate of decline of these complications.
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Affiliation(s)
- Keerthi Thamotharampillai
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
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Ambler GR, Fairchild J, Craig ME, Cameron FJ. Contemporary Australian outcomes in childhood and adolescent type 1 diabetes: 10 years post the Diabetes Control and Complications Trial. J Paediatr Child Health 2006; 42:403-10. [PMID: 16898876 DOI: 10.1111/j.1440-1754.2006.00889.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The reporting of the results of the Diabetes Control and Complications Trial in 1993 has led to a major reappraisal of management practices and outcomes in type 1 diabetes in children and adolescents. A considerable body of outcome data has been generated from Australia in this post-Diabetes Control and Complications Trial era relating to incidence, metabolic control, growth, hypoglycaemia, microvascular and macrovascular complications, cognition, behaviour and quality of life. These data are important in planning future management strategies and resource allocation and as a basis for future research.
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Affiliation(s)
- Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, and School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia.
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Donaghue KC, Margan SH, Chan AKF, Holloway B, Silink M, Rangel T, Bennetts B. The association of aldose reductase gene (AKR1B1) polymorphisms with diabetic neuropathy in adolescents. Diabet Med 2005; 22:1315-20. [PMID: 16176189 DOI: 10.1111/j.1464-5491.2005.01631.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Variants in the aldose reductase gene (AKR1B1) have been implicated in the development of diabetic retinopathy and nephropathy, with the most convincing data identifying a (CA)(n) repeat microsatellite allele (Z-2), which has a functional role in gene expression. In this study the association between polymorphisms in the AKR1B1 gene and diabetic neuropathy was investigated. METHODS The pupillary response to light was used as the major outcome in this study along with abnormal hot thermal threshold. Three hundred and sixty-three adolescents underwent genotyping of the AKR1B1 gene. The microsatellite (CA)(n) repeat was sequenced and two single nucleotide polymorphisms, -106C-->T and -12C-->G, were investigated by restriction fragment length polymorphism. RESULTS Seventy-six percent of participants had pupillary abnormalities (45% with two, 15% with three abnormalities). Presence of the Z-2/Z-2 genotype increased the risk nearly three-fold for pupillary abnormalities [odds ratio (OR) 3.02, 95% confidence interval (CI) 1.14, 7.98). The susceptibility genotypes (Z-2/Z-2 with -106C/-106C, Z-2/Z with -106C/-106C or Z/Z with -106C/-106C) were associated with resting pupil diameter abnormalities when compared with the protective genotypes (Z+2/Z+2 or -106T/-106T) (OR 2.83, 95% CI 1.25, 6.41). The combination of Z+2/-106T reduced the risk of abnormal heat discrimination (OR 0.48, 95% CI 0.23, 0.99). CONCLUSIONS In this study we have shown that Z-2/Z-2 genotype is significantly associated with the development of pupillary abnormality, an early indicator of diabetic autonomic neuropathy, in adolescent Australian patients with Type 1 diabetes.
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Affiliation(s)
- K C Donaghue
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, New South Wales, Australia.
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Filipe JAC, Falcão-Reis F, Castro-Correia J, Barros H. Assessment of autonomic function in high level athletes by pupillometry. Auton Neurosci 2003; 104:66-72. [PMID: 12559205 DOI: 10.1016/s1566-0702(02)00268-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Spectral analysis of heart rate variability has become a noninvasive standard method for assessment of autonomic nervous system activity in athletes. The effect of exercise training on autonomic regulation of pupillary light reflex is not known. The purpose of this study was to evaluate pupil autonomic function in athletes. We studied 46 highly trained athletes practicing gymnastics, swimming, long-distance running, soccer, and 51 healthy control subjects, using a portable infrared pupillometry. Five left pupil light response curves were recorded for each subject; the 485 pupillogram records were processed by a computer system. The following pupillometric parameters calculated were significantly higher (P<0.05) in runners than in controls: reflex amplitude (2.1 mm; 95% CI, 1.9-2.3 vs. 1.8 mm; 95% CI, 1.7-1.9), mean percent reflex amplitude of initial diameter (34%; 95% CI, 32-37 vs. 30%, 95% CI, 28-31) and mean time at which pupil redilated 75% of reflex amplitude (2.15 s; 95% CI, 1.99-2.31 vs. 1.86 s; 95% CI, 1.78-1.93). Sex, age, height, weight, body mass index and years of sports practice had no significant influence in the evaluated parameters. The results were consistent with an increased parasympathetic activity and a reduced sympathetic activity of pupillary light reflex in endurance-trained runners, supporting the hypothesis of a generalized "dysautonomy" associated with this type of training.
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Affiliation(s)
- João A Capão Filipe
- Pupillometry Unit, Department of Ophthalmology, University of Porto School of Medicine, S. João Hospital, Porto 4200-319, Portugal.
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Nakayama M, Nakamura J, Hamada Y, Chaya S, Mizubayashi R, Yasuda Y, Kamiya H, Koh N, Hotta N. Aldose reductase inhibition ameliorates pupillary light reflex and F-wave latency in patients with mild diabetic neuropathy. Diabetes Care 2001; 24:1093-8. [PMID: 11375376 DOI: 10.2337/diacare.24.6.1093] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present study was conducted to investigate the effect of an aldose reductase inhibitor, epalrestat, on autonomic and somatic neuropathy at an early stage in type 2 diabetic patients by assessing the pupillary light reflex and minimum latency of the F-wave. RESEARCH DESIGN AND METHODS A total of 30 diabetic patients with subclinical or mild diabetic neuropathy were randomly allocated to a control group (n = 15) and epalrestat (150 mg/day) group (n = 15). After 24 weeks, the pupillary light reflex test, cardiovascular autonomic function tests, and nerve conduction study were performed. RESULTS The beneficial effect of epalrestat on the pupillary light reflex was observed in the minimum diameter after light stimuli (P = 0.044), constriction ratio (P = 0.014), and maximum velocity of constriction (P = 0.008). Among cardiovascular autonomic nerve functions, the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing was significantly improved by epalrestat (P = 0.037). Minimum latencies of F-wave of median and tibial motor nerves were significantly shortened by epalrestat (P = 0.002 and P = 0.001, respectively); however, no significant effects were observed in motor or sensory nerve conduction velocity. CONCLUSIONS These observations suggest that epalrestat may have therapeutic value at the early stage of diabetic neuropathy and that the pupillary light reflex and minimum latency of F-wave may be useful indicators of diabetic neuropathy.
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Affiliation(s)
- M Nakayama
- Third Department of Internal Medicine, Nagoya University School of Medicine, 65 Tsurama-cho, Showa-ku, Nagoya 466-8550, Japan
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