State-dependent pupil dilation rapidly shifts visual feature selectivity

To increase computational flexibility, the processing of sensory inputs changes with behavioural context. In the visual system, active behavioural states characterized by motor activity and pupil dilation1,2 enhance sensory responses, but typically leave the preferred stimuli of neurons unchanged2-9. Here we find that behavioural state also modulates stimulus selectivity in the mouse visual cortex in the context of coloured natural scenes. Using population imaging in behaving mice, pharmacology and deep neural network modelling, we identified a rapid shift in colour selectivity towards ultraviolet stimuli during an active behavioural state. This was exclusively caused by state-dependent pupil dilation, which resulted in a dynamic switch from rod to cone photoreceptors, thereby extending their role beyond night and day vision. The change in tuning facilitated the decoding of ethological stimuli, such as aerial predators against the twilight sky10. For decades, studies in neuroscience and cognitive science have used pupil dilation as an indirect measure of brain state. Our data suggest that, in addition, state-dependent pupil dilation itself tunes visual representations to behavioural demands by differentially recruiting rods and cones on fast timescales.

Arousal-based pupil modulation is dictated by luminance

Pupillometry has become a standard measure for assessing arousal state. However, environmental factors such as luminance, a primary dictator of pupillary responses, often vary across studies. To what degree does luminance interact with arousal-driven pupillary changes? Here, we parametrically assessed luminance-driven pupillary responses across a wide-range of luminances, while concurrently manipulating cognitive arousal using auditory math problems of varying difficulty. At the group-level, our results revealed that the modulatory effect of cognitive arousal on pupil size interacts multiplicatively with luminance, with the largest effects occurring at low and mid-luminances. However, at the level of individuals, there were qualitatively distinct individual differences in the modulatory effect of cognitive arousal on luminance-driven pupillary responses. Our findings suggest that pupillometry as a measure for assessing arousal requires more careful consideration: there are ranges of luminance levels that are more ideal in observing pupillary differences between arousal conditions than others.

Phasic Activation of Dorsal Raphe Serotonergic Neurons Increases Pupil Size

Transient variations in pupil size (PS) under constant luminance are coupled to rapid changes in arousal state,1-3 which have been interpreted as vigilance,4 salience,5 or a surprise signal.6-8 Neural control of such fluctuations presumably involves multiple brain regions5,9-11 and neuromodulatory systems,3,12,13 but it is often associated with phasic activity of the noradrenergic system.9,12,14,15 Serotonin (5-HT), a neuromodulator also implicated in aspects of arousal16 such as sleep-wake transitions,17 motivational state regulation,18 and signaling of unexpected events,19 seems to affect PS,20-24 but these effects have not been investigated in detail. Here we show that phasic 5-HT neuron stimulation causes transient PS changes. We used optogenetic activation of 5-HT neurons in the dorsal raphe nucleus (DRN) of head-fixed mice performing a foraging task. 5-HT-driven modulations of PS were maintained throughout the photostimulation period and sustained for a few seconds after the end of stimulation. We found no evidence that the increase in PS with activation of 5-HT neurons resulted from interactions of photostimulation with behavioral variables, such as locomotion or licking. Furthermore, we observed that the effect of 5-HT on PS depended on the level of environmental uncertainty, consistent with the idea that 5-HT could report a surprise signal.19 These results advance our understanding of the neuromodulatory control of PS, revealing a tight relationship between phasic activation of 5-HT neurons and changes in PS.

Optical quality comparison between laser ablated myopic eyes with centration on coaxially sighted corneal light reflex and on entrance pupil center

This paper aims to compare the image quality between centration on the coaxially sighted corneal light reflex (CSCLR) and on the entrance pupil center (EPC). Myopic laser ablation was simulated on eye models, and the optical performances were compared. Centration on the EPC leads to higher wavefront aberrations and lower modulation transfer function. The two centration methods give nearly identical retinal images for angle kappa less than 5°. Because of less tissue removal, centration on the EPC is probably preferable for angle kappa less than 5°, but CSCLR centration may be preferable for angle kappa larger than 5°. The degree of tilt of the post-surgery anterior corneal surface explains the differences between the two methods.

Tear-film dynamics by combining double-pass images, pupil retro-illumination, and contrast sensitivity

Tear-film dynamics were analyzed by a synchronizing recording of double-pass (DP) and pupil retro-illumination (RI) images with contrast sensitivity (CS) measurements. Simultaneous DP and RI images were acquired in three subjects wearing contact lenses while keeping the eye open. Changes in contrast sensitivity for an 18 c/deg green grating were also estimated. From the DP retinal images, the effect of the tear film is described through the objective scattering index (OSI). This presented a negative correlation with the increase in CS during tear-film deterioration (as observed by RI imaging). These results show a relationship between visual outcome degradation due to tear-film breakup and the increase in intraocular scattering. This work shows a combined methodology for the evaluation of tear-film dynamics.

iPhone-based Pupillometry: A Novel Approach for Assessing the Pupillary Light Reflex

SIGNIFICANCE

The response of the pupil to a flash of light, the pupillary light reflex (PLR), is an important measure in optometry and in other fields of medicine that is typically evaluated by qualitative observation. Here we describe a simple, portable, iPhone-based pupillometer that quantifies the PLR in real time.

PURPOSES

The purposes of this study were to describe a novel application that records the PLR and to compare its technical capabilities with a laboratory-based infrared (IR) camera system.

METHODS

Pupil sizes were measured from 15 visually normal subjects (age, 19 to 65 years) using an IR camera system and the Sensitometer test. This test elicits pupillary constriction using the iPhone flash, records pupil size using the camera, and provides measurements in real time. Simultaneous recordings were obtained with the Sensitometer test and IR camera, and two measures were calculated: (1) dark-adapted steady-state pupil size and (2) minimum pupil size after the flash. The PLR was defined as the difference between these two measures. Pupil size was also recorded during the redilation phase after the flash. Bland-Altman analysis was used to assess the limits of agreement between the two methods.

RESULTS

Statistically significant correlations between the IR and Sensitometer test measures were found for the PLR (r = 0.91, P < .001) and redilation size (r = 0.65, P = .03). Bland-Altman analysis indicated a mean PLR difference of 6% between these two methods. The PLR limit of agreement was 14%, indicating that 95% of subjects are expected to have IR and Sensitometer test measurements that differ by 14% or less. Bland-Altman analysis indicated a mean redilation size difference of 1% between the two methods; the limit of agreement was 5%.

CONCLUSIONS

There is excellent agreement between pupil responses recorded using the Sensitometer test and IR camera. The Sensitometer test provides a highly promising approach for simple, portable, inexpensive pupillary measurements.

Pupil Size in Outdoor Environments

When addressing the risk of laser-induced retinal injury in daylight, an individual's pupil size (diameter) is of great importance since the retinal illumination varies as the square of the pupil size. Pupil size was measured under daylight conditions for 87 subjects to fill the data gap in over a century of laboratory pupillometry studies. Photography with a fixed chin/head rest and digital camera platform was employed to measure pupil diameter of subjects viewing a full-field neutral screen. The digital images of the pupils of 87 subjects were measured using computer software. Screen luminance values ranged between 790 cd m to 4,300 cd m. The average pupil size for this study was 2.39 mm for an average luminance of 1,473 cd m. Pupil size measurements ranged from 1.44 mm to 3.03 mm. The data were stratified over luminance intervals, sex, eye color, and age.

A novel method of inducing endogenous pupil oscillations to detect patients with unilateral optic neuritis

Purpose

To use and test a new method of inducing endogenously generated pupillary oscillations (POs) in patients with unilateral optic neuritis (ON), to describe a signal analysis approach quantifying pupil activity and to evaluate the extent to which POs permit to discriminate patients from control participants.

Method

Pupil size was recorded with an eye-tracker and converted in real time to modulate the luminance of a stimulus (a 20° disk) presented in front of participants. With this biofeedback setting, an increasing pupil size transforms into a high luminance, entraining a pupil constriction that in turn decreases the stimulus luminance, and so on, resulting in endogenously generated POs. POs were recorded for 30 seconds in the affected eye, in the fellow eye and in binocular conditions with 22 patients having a history of unilateral ON within a period of 5 years, and with 22 control participants. Different signal analysis methods were used to quantify the power and frequency of POs.

Results

On average, pupil size oscillated at around 1 Hz. The amplitude of POs appears not to be a reliable marker of ON. In contrast, the frequency of POs was significantly lower, and was more variable over time, in the patients’ affected eye, as compared to their fellow eye and to the binocular condition. No such differences were found in control participants. Receiver operating characteristic analyses based on the frequency and the variability of POs to classify patients and control participants gave an area under the curve of 0.82, a sensitivity of 82% (95%CI: 60%-95%) and a specificity of 77% (95%CI: 55%-92%).

Conclusions

The new method used to induce POs allowed characterizing the visual afferent pathway defect in ON patients with encouraging accuracy. The method was fast, easy to use, only requiring that participants look ahead, and allows testing many stimulus parameters (e.g. color, stimulus location, size, etc).

The significance of changes in pupil size during straylight measurement and with varying environmental illuminance

PURPOSE

In this work, we investigated the pupillary conditions during straylight measurement, and the potential effect this might have on the measured straylight.

METHODS

Five young (26-29-years-old) and 15 older (50-68-years-old) individuals participated in this study. First, the pupil diameter of both eyes was measured at three room illuminances. Next, straylight was assessed at two room illuminances. Simultaneously, the change in pupil size of the fellow eye was registered by a camera.

RESULTS

Pupil size decreased with room illuminance and with age (both p<0.05). The dependency of pupil size on age decreased as room illuminance increased (0.018mm/year at 4 lux, 0.014mm/year at 40 lux, and 0.008mm/year at 400 lux illuminances). However, during straylight measurement, pupil sizes hardly differed between 4 and 40 lux illuminances. Respective pupil sizes corresponded with 399 and 451 lux adaptation on average. No statistically significant difference was found between the straylight under the two illuminances with average R2=0.85, p<0.05.

CONCLUSION

We conclude that the illuminance of the examination room during straylight assessment does not affect the outcome in normal eyes. In fact, under mesopic and scotopic conditions, the luminance of the test field is so much higher than that of the room so that it determines the pupil size. Regardless of the lighting level, straylight measured in a laboratory, is valid for photopic pupils at an adaptation level corresponding with about 400 lux room illuminance.

The Sensitivity of Clinical Outcomes to Centration on the Light-Constricted Pupil for a Shape-Changing Corneal Inlay

PURPOSE

To assess the clinically acceptable range of inlay decentration with respect to the light-constricted pupil center and the coaxially sighted corneal light reflex (CSCLR) for an inlay (Raindrop Near Vision Inlay; ReVision Optics, Inc., Lake Forest, CA) that reshapes the anterior corneal surface.

METHODS

In this retrospective, observational cohort study of 115 patients with emmetropic or low hyperopic presbyopia who were implanted with a shape-changing corneal inlay, visual acuity, task performance (in good and dim light), reports of halos and glare, and satisfaction data were collected from the preoperative and 3-month postoperative examinations. Inlay centration with respect to the pupil center and CSCLR was determined from the center of the inlay effect derived from iTrace (Tracey Technologies, Houston, TX) wavefront measurements. Multivariate regression models assessed the influence of inlay position on visual outcomes.

RESULTS

On average, monocular uncorrected near visual acuity (UNVA) improved 4.9 ± 1.7 lines in the treated eye, with no loss in binocular distance vision. Eighty-three percent of implants were centered radially within 0.5 mm of the pupil center. Multivariate analysis of decentration with respect to both the pupil center and CSCLR revealed no significant interaction with the above clinical outcomes, with the exception of UNVA in the treated eye (all P > .05, α = 0.05). For decentration of less than 0.75 mm, the change in UNVA was less than 1 line.

CONCLUSIONS

Distance and near visual acuity, task performance, severity of halos and glare, and satisfaction were independent of radial decentration of the Raindrop Near Vision Inlay of less than 0.75 mm from the light-constricted pupil. [J Refract Surg. 2018;34(3):164-170.].

A system to measure the pupil response to steady lights in freely behaving mice

BACKGROUND

Transgenic mice are widely used for the study of basic visual function and retinal disease, including in psychophysical tests. Mice have a robust pupillary light reflex that controls the amount of light that enters the eye, and the attenuating effects of the pupil must be considered during such tests. Measurement of the size of pupils at various luminance levels requires that mice remain stable over prolonged periods of time; however, sedation of mice with anesthesia and/or manual restraint can influence the size of their pupils.

NEW METHOD

We present a system to measure the pupillary light response to steady lights of freely behaving mice using a custom-built, portable device that automatically acquires close-up images of their eyes. The device takes advantage of the intrinsic nature of mice to inspect objects of interest and can be used to measure pupillary responses in optomotor or operant behavior testing chambers.

RESULTS

The size of the pupils in freely behaving mice decreased gradually with luminance from a maximal area in the dark of 3.8mm² down to a minimum 0.14mm² at 80 scotopic cd/m². The data was well fit with a Hill equation with Lo equal to 0.21cd/m² and coefficient h=0.48.

COMPARISON WITH EXISTING METHODS

These values agree with prior measurements of the pupillary response of unrestrained mice that use more laborious and time consuming approaches.

CONCLUSIONS

Our new method facilitates practical, straightforward and accurate measurements of pupillary responses made under the same experimental conditions as those used during psychophysical testing.

Rhodopsin and Melanopsin Contributions to the Early Redilation Phase of the Post-Illumination Pupil Response (PIPR)

Melanopsin expressing intrinsically photosensitive Retinal Ganglion Cells (ipRGCs) entirely control the post-illumination pupil response (PIPR) from 6 s post-stimulus to the plateau during redilation after light offset. However, the photoreceptor contributions to the early redilation phase of the PIPR (< 6 s post-stimulus) have not been reported. Here, we evaluated the photoreceptor contributions to the early phase PIPR (0.6 s to 5.0 s) by measuring the spectral sensitivity of the criterion PIPR amplitude in response to 1 s light pulses at five narrowband stimulus wavelengths (409, 464, 508, 531 and 592 nm). The retinal irradiance producing a criterion PIPR was normalised to the peak and fitted by either a single photopigment nomogram or the combined melanopsin and rhodopsin spectral nomograms with the +L+M cone photopic luminous efficiency (Vλ) function. We show that the PIPR spectral sensitivity at times ≥ 1.7 s after light offset is best described by the melanopsin nomogram. At times < 1.7 s, the peak PIPR sensitivity shifts to longer wavelengths (range: 482 to 498 nm) and is best described by the combined photoreceptor nomogram, with major contributions from melanopsin and rhodopsin. This first report of melanopsin and rhodopsin contributions to the early phase PIPR is in line with the electrophysiological findings of ipRGC and rod signalling after the cessation of light stimuli and provides a cut-off time for isolating photoreceptor specific function in healthy and diseased eyes.

Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry

AIM

To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy.

METHODS

We conducted a cross-sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration-to-inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated.

RESULTS

Data from 384 people, 213 with diabetes, were analysed. The mean (±sd) age of the people with diabetes was 58.6 (±8.2) years and in the control subjects it was 56.1 (±8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8-45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)].

CONCLUSIONS

Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool.

Isoforms of Melanopsin Mediate Different Behavioral Responses to Light

Melanopsin (OPN4) is a retinal photopigment that mediates a wide range of non-image-forming (NIF) responses to light [1, 2] including circadian entrainment [3], sleep induction [4], the pupillary light response (PLR) [5], and negative masking of locomotor behavior (the acute suppression of activity in response to light) [6]. How these diverse NIF responses can all be mediated by a single photopigment has remained a mystery. We reasoned that the alternative splicing of melanopsin could provide the basis for functionally distinct photopigments arising from a single gene. The murine melanopsin gene is indeed alternatively spliced, producing two distinct isoforms, a short (OPN4S) and a long (OPN4L) isoform, which differ only in their C terminus tails [7]. Significantly, both isoforms form fully functional photopigments [7]. Here, we show that different isoforms of OPN4 mediate different behavioral responses to light. By using RNAi-mediated silencing of each isoform in vivo, we demonstrated that the short isoform (OPN4S) mediates light-induced pupillary constriction, the long isoform (OPN4L) regulates negative masking, and both isoforms contribute to phase-shifting circadian rhythms of locomotor behavior and light-mediated sleep induction. These findings demonstrate that splice variants of a single receptor gene can regulate strikingly different behaviors.

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The retinal photopigment melanopsin is alternatively spliced

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The isoforms mediate different physiological and behavioral responses to light

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The short variant regulates pupil size, the long, negative masking of activity

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Both variants regulate sleep and phase shifting of circadian rhythms

Standard deviation of luminance distribution affects lightness and pupillary response

We examined whether the standard deviation (SD) of luminance distribution serves as information of illumination. We measured the lightness of a patch presented in the center of a scrambled-dot pattern while manipulating the SD of the luminance distribution. Results showed that lightness decreased as the SD of the surround stimulus increased. We also measured pupil diameter while viewing a similar stimulus. The pupil diameter decreased as the SD of luminance distribution of the stimuli increased. We confirmed that these results were not obtained because of the increase of the highest luminance in the stimulus. Furthermore, results of field measurements revealed a correlation between the SD of luminance distribution and illuminance in natural scenes. These results indicated that the visual system refers to the SD of the luminance distribution in the visual stimulus to estimate the scene illumination.

Using siRNA to define functional interactions between melanopsin and multiple G Protein partners

Melanopsin expressing photosensitive retinal ganglion cells (pRGCs) represent a third class of ocular photoreceptors and mediate a range of non-image forming responses to light. Melanopsin is a G protein coupled receptor (GPCR) and existing data suggest that it employs a membrane bound signalling cascade involving Gnaq/11 type G proteins. However, to date the precise identity of the Gα subunits involved in melanopsin phototransduction remains poorly defined. Here we show that Gnaq, Gna11 and Gna14 are highly co-expressed in pRGCs of the mouse retina. Furthermore, using RNAi based gene silencing we show that melanopsin can signal via Gnaq, Gna11 or Gna14 in vitro, and demonstrate that multiple members of the Gnaq/11 subfamily, including Gna14 and at least Gnaq or Gna11, can participate in melanopsin phototransduction in vivo and contribute to the pupillary light responses of mice lacking rod and cone photoreceptors. This diversity of G protein interactions suggests additional complexity in the melanopsin phototransduction cascade and may provide a basis for generating the diversity of light responses observed from pRGC subtypes.

Hydrogen-rich saline promotes survival of retinal ganglion cells in a rat model of optic nerve crush

OBJECTIVE

To investigate the effect of molecular hydrogen (H2) in a rat model subjected to optic nerve crush (ONC).

METHODS

We tested the hypothesis that after optic nerve crush (ONC), retinal ganglion cell (RGC) could be protected by H₂. Rats in different groups received saline or hydrogen-rich saline every day for 14 days after ONC. Retinas from animals in each group underwent measurements of hematoxylin and eosin (H&E) staining, cholera toxin beta (CTB) tracing, gamma synuclein staining, and terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL) staining 2 weeks post operation. Flash visual evoked potentials (FVEP) and pupillary light reflex (PLR) were then tested to evaluate the function of optic nerve. The malondialdehyde (MDA) level in retina was evaluated.

RESULTS

H&E, gamma synuclein staining and CTB tracing showed that the survival rate of RGCs in hydrogen saline-treated group was significantly higher than that in saline-treated group. Apoptosis of RGCs assessed by TUNEL staining were less observed in hydrogen saline-treated group. The MDA level in retina of H₂ group was much lower than that in placebo group. Furthermore, animals treated with hydrogen saline showed better function of optic nerve in assessments of FVEP and PLR.

CONCLUSION

These results demonstrated that H₂ protects RGCs and helps preserve the visual function after ONC and had a neuroprotective effect in a rat model subjected to ONC.

The impact of domestication on the chicken optical apparatus

Domestication processes tend to release animals from natural selection and favour traits desired by humans, such as food-production and co-operative behaviour. A side effect of such selective breeding is the alteration of unintended traits. In this paper, we investigate how active selection for egg production in chickens has affected the visual system, in particular the optical sensitivity that relates to the ability of chickens to see in dim light. We measured eye dimensions as well as the pupil diameter at different light intensities (the steady state pupil dynamics), in adult male and female White Leghorns and the closest relatives to their ancestor, the Red Junglefowls. With this information, we calculated the focal length and optical sensitivity (f-number) of the eyes. Males have larger eyes than females in both breeds and White Leghorn eyes are larger than those of Red Junglefowls in both sexes. The steady state pupil dynamics is less variable, however, the combination of pupil dynamics and eye size gives a higher optical sensitivity in Red Junglefowl eyes than in White Leghorns at light intensities below approximately 10 cd/m². While eye size and focal length match the larger body size in White Leghorns compared to Red Junglefowls, the steady state pupil dynamics do not. The reason for this is likely to be that eye morphology and the neuro-muscular control of the pupil have been affected differently by the strong selection for egg production and the simultaneous release of the selection pressure for high performing vision. This study is the first description of how optical sensitivity has changed in a domesticated species and our results demonstrate important considerations regarding domestication processes and sensory ability.

Non-image-forming light driven functions are preserved in a mouse model of autosomal dominant optic atrophy

Autosomal dominant optic atrophy (ADOA) is a slowly progressive optic neuropathy that has been associated with mutations of the OPA1 gene. In patients, the disease primarily affects the retinal ganglion cells (RGCs) and causes optic nerve atrophy and visual loss. A subset of RGCs are intrinsically photosensitive, express the photopigment melanopsin and drive non-image-forming (NIF) visual functions including light driven circadian and sleep behaviours and the pupil light reflex. Given the RGC pathology in ADOA, disruption of NIF functions might be predicted. Interestingly in ADOA patients the pupil light reflex was preserved, although NIF behavioural outputs were not examined. The B6; C3-Opa1(Q285STOP) mouse model of ADOA displays optic nerve abnormalities, RGC dendropathy and functional visual disruption. We performed a comprehensive assessment of light driven NIF functions in this mouse model using wheel running activity monitoring, videotracking and pupillometry. Opa1 mutant mice entrained their activity rhythm to the external light/dark cycle, suppressed their activity in response to acute light exposure at night, generated circadian phase shift responses to 480 nm and 525 nm pulses, demonstrated immobility-defined sleep induction following exposure to a brief light pulse at night and exhibited an intensity dependent pupil light reflex. There were no significant differences in any parameter tested relative to wildtype littermate controls. Furthermore, there was no significant difference in the number of melanopsin-expressing RGCs, cell morphology or melanopsin transcript levels between genotypes. Taken together, these findings suggest the preservation of NIF functions in Opa1 mutants. The results provide support to growing evidence that the melanopsin-expressing RGCs are protected in mitochondrial optic neuropathies.

Short wavelength light filtering by the natural human lens and IOLs -- implications for entrainment of circadian rhythm

PURPOSE

Photoentrainment of circadian rhythm begins with the stimulation of melanopsin containing retinal ganglion cells that respond directly to blue light. With age, the human lens becomes a strong colour filter attenuating transmission of short wavelengths. The purpose of the study was to examine the effect the ageing human lens may have for the photoentrainment of circadian rhythm and to compare with intraocular implant lenses (IOLs) designed to block UV radiation, violet or blue light.

METHODS

The potential for photoentrainment of circadian rhythm was computed for 29 human donor lenses (18-76 years) and five IOLs (one UV, two violet and two blue light blocking) based on the transmission properties of the lenses and the spectral characteristics of melanopsin activation and two of it's physiological outcomes; melanopsin-driven pupillary light reponse and light-induced melatonin suppression.

RESULTS

The potential for melanopsin stimulation and melatonin suppression was reduced by 0.6-0.7 percentage point per year of life because of yellowing of the natural lens. The computed effects were small for the IOLs and did not exceed that of a 22.2-year-old natural lens for the blue-blocking IOLs.

CONCLUSION

The results show that photoentrainment of circadian rhythm may be significantly impaired in older subjects because of the colour filtering characteristics of the human lens, whereas the effects were small for all three types of IOLs studied. Consequently, the ageing process of the natural lens is expected to influence the photoentrainment of circadian rhythm, whereas IOLs are not expected to be detrimental to circadian rhythm.

The post-illumination pupil response of melanopsin-expressing intrinsically photosensitive retinal ganglion cells in diabetes

PURPOSE

This study investigates the clinical utility of the melanopsin-expressing intrinsically photosensitive retinal ganglion cell (ipRGC) controlled post-illumination pupil response (PIPR) as a novel technique for documenting inner retinal function in patients with Type II diabetes without diabetic retinopathy.

METHODS

The PIPR was measured in seven patients with Type II diabetes, normal retinal nerve fibre thickness and no diabetic retinopathy compared to healthy age-similar controls. A 488- and 610-nm, 7.15-diameter stimulus was presented in Maxwellian view to the right eye and the left consensual pupil light reflex was recorded.

RESULTS

The group data for the blue PIPR (488 nm) identified a trend of reduced ipRGC function in patients with diabetes with no retinopathy. The transient pupil constriction was lower on average in the diabetic group. The relationship between duration of diabetes and the blue PIPR amplitude was linear, suggesting that ipRGC function decreases with increasing diabetes duration.

CONCLUSION

This is the first report to show that the ipRGC-controlled PIPR may have clinical applications as a non-invasive technique for determining the progression of inner neuroretinal changes in patients with diabetes before they are ophthalmoscopically or anatomically evident. The lower transient pupil constriction amplitude indicates that outer retinal photoreceptor inputs to the pupil light reflex may also be affected in diabetes.

In vivo detection of experimental optic neuritis by pupillometry

Optic neuritis is an inflammatory demyelination of optic nerve often occurring in multiple sclerosis (MS) patients. Mice with experimental autoimmune encephalomyelitis (EAE), an MS model, develop optic neuritis, but it is detected histologically after sacrifice, limiting the ability to monitor progression or treatment in vivo. We examined whether pupillary light responses measured by pupillometry can identify eyes with optic neuritis in EAE mice. C57BL/6 mice were exposed to unilateral light flashes of increasing intensity at 10 s intervals (4.7, 37, and 300 μW/cm(2)). Pupillary responses were recorded with a commercially available pupillometer. EAE was then induced by immunization with myelin oligodendrocyte glycoprotein. Pupillometry was repeated up to 17 days post-immunization, and responses were correlated with optic nerve inflammation. By day 17 post-immunization, 90% of EAE eyes had optic nerve inflammation. EAE eyes had significantly reduced pupillary constriction compared to control eyes. Mice exhibited more than a 25% decrease in pupillary constriction in at least one eye by days 13-15 post-immunization. In some eyes, pupil responses decreased prior to onset of detectable inflammation. Results show that pupillometry detects decreased optic nerve function in experimental optic neuritis, even in the absence of histological detection. Measuring pupillary constriction allows in vivo identification and functional assessment of eyes with optic neuritis that will be useful in evaluating potential therapies over time. Furthermore, results demonstrate that decreased visual function occurs early in optic neuritis, before optic nerve inflammation reaches its peak level.

Age-dependent pupillary light reflex parameters in children

Pupillary light reflex (PLR) refers to the phenomenon where pupil size changes in response to stimulation with a flash of light. It is a simple functional test that can reveal dysfunctions associated with the PLR pathway. Although abnormal PLR responses have been reported in many neurological disorders, few studies investigated neurodevelopmental effects on PLR parameters. We studied the effect of age on PLR in a group of 6 to 17 year old children with typical development. A significant and consistent age effect was found on PLR latency in children younger than 10 years old. Age effects were also observed in resting pupil diameter and constriction amplitude. However such age related trends were not observed in children with neurodevelopment disorders. These results suggest that PLR has the potential to be used as a simple noninvasive tool for monitoring neurodevelopment in children.

The circadian response of intrinsically photosensitive retinal ganglion cells

Intrinsically photosensitive retinal ganglion cells (ipRGC) signal environmental light level to the central circadian clock and contribute to the pupil light reflex. It is unknown if ipRGC activity is subject to extrinsic (central) or intrinsic (retinal) network-mediated circadian modulation during light entrainment and phase shifting. Eleven younger persons (18–30 years) with no ophthalmological, medical or sleep disorders participated. The activity of the inner (ipRGC) and outer retina (cone photoreceptors) was assessed hourly using the pupil light reflex during a 24 h period of constant environmental illumination (10 lux). Exogenous circadian cues of activity, sleep, posture, caffeine, ambient temperature, caloric intake and ambient illumination were controlled. Dim-light melatonin onset (DLMO) was determined from salivary melatonin assay at hourly intervals, and participant melatonin onset values were set to 14 h to adjust clock time to circadian time. Here we demonstrate in humans that the ipRGC controlled post-illumination pupil response has a circadian rhythm independent of external light cues. This circadian variation precedes melatonin onset and the minimum ipRGC driven pupil response occurs post melatonin onset. Outer retinal photoreceptor contributions to the inner retinal ipRGC driven post-illumination pupil response also show circadian variation whereas direct outer retinal cone inputs to the pupil light reflex do not, indicating that intrinsically photosensitive (melanopsin) retinal ganglion cells mediate this circadian variation.

PACAP-deficient mice exhibit light parameter-dependent abnormalities on nonvisual photoreception and early activity onset

Background

The photopigment melanopsin has been suggested to act as a dominant photoreceptor in nonvisual photoreception including resetting of the circadian clock (entrainment), direct tuning or masking of vital status (activity, sleep/wake cycles, etc.), and the pupillary light reflex (PLR). Pituitary adenylate cyclase-activating polypeptide (PACAP) is exclusively coexpressed with melanopsin in a small subset of retinal ganglion cells and is predicted to be involved extensively in these responses; however, there were inconsistencies in the previous reports, and its functional role has not been well understood.

Methodology/Principal Findings

Here we show that PACAP-deficient mice exhibited severe dysfunctions of entrainment in a time-dependent manner. The abnormalities in the mutant mice were intensity-dependent in phase delay and duration-dependent in phase advance. The knockout mice also displayed blunted masking, which was dependent on lighting conditions, but not completely lost. The dysfunctions of masking in the mutant mice were recovered by infusion of PACAP-38. By contrast, these mutant mice show a normal PLR. We examined the retinal morphology and innervations in the mutant mice, and no apparent changes were observed in melanopsin-immunoreactive cells. These data suggest that the dysfunctions of entrainment and masking were caused by the loss of PACAP, not by the loss of light input itself. Moreover, PACAP-deficient mice express an unusually early onset of activities, from approximately four hours before the dark period, without influencing the phase of the endogenous circadian clock.

Conclusions/Significance

Although some groups including us reported the abnormalities in photic entrainments in PACAP- and PAC₁-knockout mice, there were inconsistencies in their results [1], [2], [3], [4]. The time-dependent dysfunctions of photic entrainment in the PACAP-knockout mice described in this paper can integrate the incompatible data in previous reports. The recovery of impaired masking by infusion of PACAP-38 in the mutant mice is the first direct evidence of the relationship between PACAP and masking. These results indicate that PACAP regulates particular nonvisual light responses by conveying parametric light information—that is, intensity and duration. The “early-bird” phenotype in the mutant mice originally reported in this paper supposed that PACAP also has a critical role in daily behavioral patterns, especially during the light-to-dark transition period.

Nonvisual ocular photoreception in the mammal

Rodents blind from outer retinal (rod and cone) degeneration still retain several light-dependent phenomena, including entrainment of the circadian clock and pupillary light responsiveness. This paradox is explained by the presence of intrinsically photosensitive retinal ganglion cells in the inner retina. These cells have unique properties, including a novel action spectrum, resistance to bleaching and adaptation under continuous light, and resistance to vitamin A depletion. Two candidate classes of photopigment have been proposed: melanopsin and cryptochromes. Physiologic analysis of circadian entrainment and pupillary light responsiveness in mice lacking these proteins leads to three conclusions: (1) outer and inner retinal photoreceptors provide partially redundant information to the inner retina, (2) melanopsin is required for inner retinal phototransduction in the absence of rod and cone signaling, and (3) cryptochromes contribute to the amplitude of inner retinal phototransduction but are not strictly required.

Bilateral tonic pupils: Holmes Adie syndrome or generalised neuropathy?

AIM

To compare the pupil signs in patients with bilateral pupillotonia caused by Holmes-Adie syndrome or generalised peripheral neuropathy.

METHODS

Infrared video pupillographic techniques were used to measure a number of pupil variables in patients with Holmes-Adie syndrome, generalised neuropathy (various aetiologies) and healthy age-matched control subjects.

RESULTS

Regardless of aetiology, the patients generally had pupil signs typical of pupillotonia (small dark diameters, large light diameters, tonic near responses, attenuated light responses with light-near dissociation, and sector palsy). However, significant differences were found in the prevalence and magnitude of several pupil variables in the two patient groups. In particular, sector palsy and anisocoria exceeding 1 mm (in the light) were seen much more commonly in Holmes-Adie patients than patients with generalised neuropathy. The presence of both these pupil signs can be used to distinguish between these diagnoses with a sensitivity of 58% and a specificity of 90%.

CONCLUSIONS

The tonic pupils of patients with Holmes-Adie syndrome are significantly different to those found in patients with generalised neuropathy; recognition of these differences may allow distinction between these diagnoses.

Dynamic analysis of dark-light changes of the anterior chamber angle with anterior segment OCT

PURPOSE

To describe the use of anterior segment optical coherence tomography (OCT) in studying the dynamic dark-light changes of the anterior chamber angle.

METHODS

Thirty-seven normal subjects with open angles on dark-room gonioscopy and 18 subjects with narrow angles were analyzed. The dynamic dark-light changes of the anterior-chamber angle were captured with real-time video recording. The angle opening distance (AOD500) and trabecular iris space area (TISA500) of the nasal angle and the pupil diameter in each of the representative serial images were measured. Linear regression analysis was performed to investigate the association between AOD500/TISA500 and pupil diameter. Demographic and biometry measurements associated with the AOD difference (AOD500((light)) - AOD500((dark))) and TISA difference (TISA500((light)) - TISA500((dark))) were analyzed with univariate and multivariate regression models.

RESULTS

The AOD500/TISA500 measured in the light in the open-angle and the narrow-angle groups were 694 +/- 330 microm/0.24 +/- 0.10 mm(2) and 265 +/- 78 microm/0.10 +/- 0.03 mm(2), respectively. These values were significantly greater than the AOD500/TISA500 measured in the dark (492 +/- 265 microm/0.16 +/- 0.08 mm(2) and 119 +/- 82 microm/0.05 +/- 0.04 mm(2), respectively, all with P < 0.001). The ranges of the AOD/TISA difference were 13 to 817 microm/0.011 to 0.154 mm(2), with an average of 180 microm/0.073 mm(2). Multivariate regression analysis identified a positive correlation between anterior chamber depth and the AOD/TISA difference. Fifty eyes showed significant correlations between AOD/TISA and pupil diameter, whereas one eye showed no association. Four eyes in the narrow angle group developed appositional angle closure in the dark.

CONCLUSIONS

The dynamic dark-light changes of the anterior chamber angle can be imaged and analyzed with anterior segment OCT. Although the angle width generally decreased linearly with increasing pupil diameter, the differences of the angle width measured in the dark and in the light varied substantially among individuals.

Recovery of vision and pupil responses in optic neuritis and multiple sclerosis

The recovery of visual performance and pupil responses were investigated in patients with demyelinating optic neuritis (ON) and multiple sclerosis (MS). The pupil constriction amplitude and the time delay (latency) of the pupil response were measured in 14 patients with a history of unilateral ON in response to either achromatic (luminance) or chromatic (isoluminant) stimulus modulation. Five of these subjects were diagnosed later with MS. In addition, we measured detection thresholds for achromatic stimuli using standard visual field perimetry and chromatic thresholds using a new colour assessment and diagnosis (CAD) test that isolates the use of colour signals. The results show that, despite significant improvements in visual function following the acute phase (as assessed using visual acuity and fields), significant pupil response deficits remain. The findings also demonstrate that accurate measurements of pupil responses and chromatic thresholds can reveal deficits that remain undetected with more conventional techniques. These preliminary findings suggest that the techniques described here can provide useful information about remitting and relapsing demyelinative phases, often observed during MS and ON.

Variations in the light-induced suppression of nocturnal melatonin with special reference to variations in the pupillary light reflex in humans

The purpose of the present study was to elucidate the existence of individual differences of pupil response to light stimulation, and to confirm the reproducibility of this phenomenon. Furthermore, the relationship between the individual differences in nocturnal melatonin suppression induced by lighting and the individual differences of pupillary light response (PLR) was examined. The pupil diameter and salivary melatonin content of 20 male students were measured at the same period of time (00:00-02:30 hr) on different days, accordingly. Illumination (530 nm) produced by a monochromatic light-emitting diode (LED) was employed as the light stimulation: pupil diameter was measured with 4 different levels of illuminance of 1, 3, 30 and 600 lux and melatonin levels were measured at 30 and 600 lux (respective controls were taken at 0 lux). Oral temperature, blood pressure and subjective index of sleepiness were taken in experiments where melatonin levels were measured. Changes of the pupil diameter in response to light were expressed as PLR and light-induced melatonin suppression was expressed as a control-adjusted melatonin suppression score (control-adjusted MSS), which was compared to the melatonin level measured at 0 lux. In the PLR, the coefficients of variation obtained at 30 lux or less were large (51.5, 45.0, 28.4 and 6.2% at 1, 3, 30 and 600 lux, respectively). Correlations of illuminance of any combination at 30 lux or less were statistically significant at less than 1% level (1 vs. 3 lux: r=0.68; 1 vs. 30 lux: r=0.64; 3 vs. 30 lux: r=0.73), which showed the reproducibility of individual differences. The control-adjusted MSS at 600 lux (-1.14+/-1.16) was significantly (p<0.05) lower than that registered at 30 lux (-0.22+/-2.12). PLR values measured at 30 and 600 lux were then correlated with control-adjusted MSS; neither indicated a significant linear relationship. However, the control-adjusted MSS showed around 0 under any of the illuminance conditions in subjects with high PLR. In control-adjusted MSS of low values (i.e., melatonin secretions were easily suppressed), subjects indicated typically low PLR. In subjects with low control-adjusted MSS (n=3), characteristic changes in the autonomic nervous system, such as body temperature and blood pressure, were noted in subjects exposed to low illuminance of 30 lux. The fact that the relationship between PLR and control-adjusted MSS portray a similar pattern even under different luminance conditions suggests that MSS may not be affected in those with high PLR at low illuminance, regardless of the illuminance condition.

Melanopsin-dependent persistence and photopotentiation of murine pupillary light responses

PURPOSE

To determine the relative contributions of inner and outer retinal photoreception to the pupillary light response.

METHODS

Wild-type, retinal degenerate (rd/rd), and melanopsin mutant (opn4(-/-)) mice were tested for pupillary light responsiveness by video pupillometry before, during, and after exposure to supersaturating light intensities. Similar lighting protocols were used to probe responses of intrinsically photosensitive retinal ganglion cells (ipRGCs) recorded with multielectrode arrays ex vivo.

RESULTS

Both outer retinal photoreceptors (rods and cones) and inner retinal photoreceptors (intrinsically photosensitive retinal ganglion cells [ipRGCs]) are sufficient to drive the pupillary light response in mice. After supersaturating light exposure, rather than bleaching or adapting, rd/rd mice showed paradoxical potentiation of responses to subsaturating light exposure. opn4(-/-) mice, in contrast, could not sustain pupillary constriction under continuous bright illumination, and showed desensitization after bright-light exposure. Both the intensity of light necessary to induce potentiation and the spectral sensitivity for sustained and potentiated responses differed from that necessary to trigger pupillary constriction, suggesting that photopotentiation is dependent on a pigment-state distinct from that triggering the pupillary light response itself. Multielectrode array recordings of ipRGCs from rd/rd retinas demonstrated persistent cell firing under continuous light exposure but did not show potentiation.

CONCLUSIONS

Unique photoreceptive properties of intrinsically photosensitive RGCs confer resistance to bleaching and/or adaptation under continuous bright illumination to the pupillary light response and suggest the presence of a photopigment with multiple absorption states.

Measurement of pupil reactivity using fast pupillometry

Analysis of human eye pupil reactivity is a very valuable diagnostic method used mainly for evaluation of the condition of the autonomic nervous system and the visual system. The paper presents an experimental pupillometer built in the Institute of Physics of the Wroclaw University of Technology. The apparatus makes it possible to record and analyze pupillary light reflex and spontaneous changes in the pupil diameter during a session in the dark. The detector system used in the pupillometer allows us to record the pupil diameter at a rate of 90 Hz with a linear accuracy of 0.008 mm. In this paper, the proposed detection method, the principle of operation and calibration of the apparatus and the possibilities of the measurement system are presented.

Origin of the Relative Afferent Pupillary Defect in Optic Tract Lesions

OBJECTIVE

To determine the percent decussation of pupil input fibers in humans and to explain the size and range of the log unit relative afferent pupillary defect (RAPD) in patients with optic tract lesions.

DESIGN

Experimental study.

PARTICIPANTS AND CONTROLS

Five patients with a unilateral optic tract lesion.

METHODS

The pupil response from light stimulation of the nasal hemifield, temporal hemifield, and full field of each eye of 5 patients with a unilateral optic tract lesion was recorded using computerized binocular infrared pupillography. Six stimulus light intensities, separated by 0.5-log unit steps, were used; 12 stimulus repetitions were given for each stimulus condition.

MAIN OUTCOME MEASURES

For each stimulus condition, the pupil response of each eye was characterized by plotting the mean pupil contraction amplitude as a function of stimulus light intensity. The percentage of decussating afferent pupillomotor input fibers was calculated from the ratio of the maximal pupil contractions elicited from each eye. The RAPD was determined pupillographically from full-field stimulation to each eye.

RESULTS

In all patients, the pupil response from the functioning temporal hemifield ipsilateral to the tract lesion was greater than that from the functioning contralateral nasal hemifield. This temporal-nasal asymmetry increased with increasing stimulus intensity and was similar in hemifield and full-field stimuli, eventually saturating at maximal light intensity. The log unit RAPD did not correlate with the estimated percentage of decussating pupil fibers, which ranged from 54% to 67%.

CONCLUSIONS

In patients with a unilateral optic tract lesion, the pupillary responses from full-field stimulation to each eye are the same as comparing the functioning temporal field with the functioning nasal field. The percentage of decussating fibers is reflected in the ratio of the maximal pupil contraction amplitudes resulting from stimulus input between the two eyes. The RAPD that occurs in this setting reflects the difference in light sensitivity between the intact temporal and nasal hemifields. Its magnitude does not correlate with the difference in the number of crossed and uncrossed axons, but its sidedness contralateral to the side of the optic tract lesion is consistent with the greater percentage of decussating pupillomotor input.

Pupil size and corneal laser surgery

PURPOSE OF REVIEW

The role of scotopic pupil size as a factor in predicting night vision complaints is controversial. This review summarizes reports in the literature, some that have found and some that have failed to find a correlation with scotopic pupil size and night vision complaints.

RECENT FINDINGS

Pupil-measuring devices are discussed along with informed consent issues and reports showing that wavefront aberrations increase with increasing pupil size. A new objective measuring device (Larson) showed a correlation with postoperative starbursts and pupil size and a decrease in starbursts with wavefront-guided treatments compared with conventional excimer laser treatments. Cortical adaptation allows many patients to adapt to their new night vision. Treatment options for those who remain symptomatic include drops to reduce pupil size and wavefront-guided retreatments.

SUMMARY

Reports in the literature are conflicting, and refractive surgeons would be wise to inform their patients that large scotopic pupil size is a potential risk factor for night vision complaints. By doing this they will follow the recommendations in recent patient information brochures of both VISX (Santa Clara, California) and Alcon (Orlando, Florida) and on the United States Food and Drug Administration web site.

[Dynamics of the pupillary light reflex in unilateral Horner's syndrome]

BACKGROUND

The aim of this study was to characterise the changes of the dynamic pupillary light reflex in patients with unilateral Horner's syndrome by appropriate pupillographic parameters.

METHODS

The dynamic changes of pupillary diameter in response to light flashes of 100 ms were recorded in darkness with two infrared video cameras in 15 patients.

RESULTS

Significant changes in the pupillary light reflex of the affected side were observed only during the phase of redilatation. The decelerated redilatation was defined by the following parameters: (1) time parameters (percentage of redilatation after 4 s and after 5 s, time to reach 67% and 75% of redilatation) and (2) amplitude-adjusted velocity parameters (relative velocity at 67% and at 75% of redilatation).

CONCLUSION

A slowed pupil redilatation in patients with Horner's syndrome can be detected also after short light flashes and is characterised by prolonged redilatation time parameters and reduced amplitude-adjusted redilatation velocity parameters.

Demonstration of Aqueous Streaming Through a Laser Iridotomy Window Against the Corneal Endothelium

OBJECTIVE

To determine the pathogenesis of the bullous keratopathy that is frequently observed in patients after argon laser iridotomy (ALI) by comparing the changes in aqueous flow after ALI with those that follow peripheral iridectomy in rabbit eyes.

METHODS

Silicone particles were injected into the anterior chamber of rabbit eyes as tracers to monitor aqueous flow. Particle tracking velocimetry with image analysis was used to determine the direction and speed of aqueous flow in 5 pigmented rabbits that underwent ALI and 5 that underwent peripheral iridectomy.

RESULTS

In the ALI group, silicone particles were found to stream through the iridotomy window against the corneal endothelium immediately after the pupil was constricted by a light stimulus. The mean +/- SD speed of the particles was 2.97 +/- 1.51 mm/s. In contrast, the mean +/- SD flow rate through the iridectomy window in the peripheral iridectomy group was significantly slower at 0.36 +/- 0.30 mm/s (P = .01).

CONCLUSION

Constriction of the pupil elicited marked aqueous streaming through the ALI window against the corneal endothelium. Clinical Relevance The mechanical stress to the corneal endothelium by the abnormal aqueous stream may be partially responsible for the corneal decompensation that follows ALI.

Measurement of the spatial shift of the pupil center

PURPOSE

To evaluate the effectiveness of the pupil center as an anatomic landmark for excimer laser treatments.

SETTING

Sekal-Microchirurgia-Rovigo Centre, Rovigo, Italy.

METHODS

Pupillometry with the Costruzione Strumenti Oftalmici S.R.L. (CSO) pupil-measuring module (incorporated in Eye Top videokeratoscope) was performed in 52 patients with a diagnosis of myopia and in 25 patients with a diagnosis of hyperopia. Measurements both in mesopic and photopic conditions consisted of pupil diameters, spatial shift of the pupil center, and the distance between the pupil center and keratoscopic axis.

RESULTS

The mean pupil diameter in photopic conditions of illumination in myopic eyes was 3.52 mm +/- 0.56 (SD), while in mesopic conditions it was 5.37 +/- 0.78 mm; in hyperopic eyes the mean photopic pupil diameter was 3.01 +/- 0.46 mm, while the mean mesopic diameter was 5.12 +/- 0.48 mm. The mean spatial shift of the pupil center in myopic eyes was 0.086 mm (maximum 0.269 mm), while in the hyperopic eyes it was 0.095 mm (maximum 0.283 mm). The mean distance between the pupil center and keratoscopic axis in myopic eyes was 0.226 +/- 0.13 mm (maximum 0.75 mm), while in hyperopic eyes it was 0.45 +/- 0.19 mm (maximum 0.8 mm).

CONCLUSIONS

The mean of the measured pupil sizes was greater in myopic eyes than in hyperopic eyes. The spatial shift of the pupil center, as the pupil dilates, was relatively small in all groups; therefore, the pupil center is a good anatomic landmark for both traditional refractive surgery and wavefront-guided treatments. The mean distance between the keratoscopic axis and pupil center was greater in the hyperopic group than in the myopic group. Therefore, centration of any laser treatment on the basis of the keratoscopic analysis should be done carefully, especially in hyperopic eyes and in cases in which the pupil center is meaningfully shifted from keratoscopic axis, even in photopic conditions of illumination.

Influence of pupillary diameter, ciliary muscle tone, and ambient light on nerve fiber layer measurements with scanning laser polarimetry

PURPOSE

To evaluate the influence of the pupillary diameter, ciliary muscle tone, and room light on nerve fiber layer measurements with the scanning laser polarimeter (GDx).

METHODS

One randomly selected eye of ten normal volunteers was examined with the GDx in a two-day protocol under eight testing conditions (pilocarpine 1%, phenylephrine 10%, tropicamide 1%, or no drops with room lights on or off). The twelve parameters, obtained by the GDx, were compared under the eight testing conditions, using two way ANOVA for repeated measurements and Tukey HSD post hoc test.

RESULTS

Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops.

CONCLUSIONS

Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone.

Comparison of pupil responses to luminance and colour in severe optic neuritis

OBJECTIVE

The pupil response to light flux increments is abnormal in severe optic neuritis, but little is known about the effects of this condition on the pupil colour response. The aim of this study was to examine how optic neuritis affects pupil responses to light flux and colour modulation and the extent to which such pupil responses mirror the loss and recovery of vision.

METHODS

A new pupil examination technique that makes use of sinusoidal modulation of either luminance contrast or chromatic saturation was employed. This technique enables the automatic extraction of both pupil response amplitude and latency and achieves a high signal to noise ratio with fewer averages.

RESULTS

The study reveals a greater loss of pupil response amplitude and significantly longer latencies to chromatic modulation (i.e. approximately 80 ms). Stimulation of the unaffected eye in the optic neuritis group results in smaller response amplitudes when compared to the normal group for both light flux and colour modulation.

CONCLUSIONS

Pupil response components can be affected differently in optic neuritis. These findings suggest that the pupil colour response, in particular, may provide a useful, objective estimator to judge the extent of damage and recovery in diseases of the optic nerve.

Measurement of Refractive State and Deprivation Myopia in Two Strains of Mice

PURPOSE

The mouse eye has a bright retinal image (f/number <1) but low optical quality (visual acuity about 0.5 cpd) that may render emmetropization unnecessary. However, this species is potentially a powerful model to study eye growth and myopia because its genome can be readily manipulated and has been completely sequenced. We have investigated how precisely eyes of mice can be refracted and tested whether deprivation myopia can be induced by frosted diffusers.

METHODS

An automated eccentric infrared photorefractor was adapted to refract eyes of two mouse strains--C57BL/6 (B6) and DBA/2 (D2)--during Tropicamide cycloplegia without anesthesia. Axial lengths were measured in highly magnified video images of freshly excised eyes. Plastic hemispherical diffusers were applied between postnatal days and 29 and left attached for 7 or 14 days.

RESULTS

(1) Trial lenses ranging from +10 to -10 D produced high correlations between the brightness slope in the pupil and applied lens power (r = 0.81 and r = 0.87), demonstrating reliable refraction. Five repeated measures in 12 eyes showed an average standard deviation of 3.0 D, equivalent to an axial length change <10 microm (derived from schematic eye modeling). (2) Deprivation produced a significant shift toward myopia, relative to untreated eyes, but only after 14 days and only in B6 mice (p = 0.02 with or p = 0.00038 without one outlier; N = 9). In contrast, DBA/2J were unaffected by occlusion, perhaps due to mutations that target eye, lens, or anterior segment. (3) Both eyes of untreated animals often had axial lengths that differed markedly. Surprisingly, we detected no significant correlation between refractive error and axial length after treatment.

CONCLUSIONS

The infrared refraction technique is sufficiently sensitive to resolve equivalent changes in axial length of only +/- 10 microm in alert mice. Prolonged occlusion produces a significant myopic shift in B6 mice, but not in D2 mice. Even among isogenic B6 mice, the response is variable for reasons that presumably trace back to subtle developmental, environmental, and technical factors.

Measuring eye aberrations with Hartmann-Shack wave-front sensors: should the irradiance distribution across the eye pupil be taken into account?

A usual approximation in Hartmann-Shack aberrometry is that the centroid displacements are proportional to the spatial averages of the wave-front slopes at the sampling subapertures. However, these spatial averages are actually weighted by the local irradiance distribution across each microlens. The irradiance across the eye pupil is not uniform in usual reflectometric aberrometers, which is due to several factors including retinal scattering and cone waveguiding directionality. It is shown that neglecting this fact in usual least-squares reconstruction procedures gives rise to a biased estimation of the aberration coefficients. The magnitude of this bias depends on the actual irradiance distribution across the eye pupil, the mode being estimated, the detailed modal composition of the aberrated wave front, and the geometry of the wave-front sampling array. Order-of-magnitude calculations suggest that this bias may well be in the range 5%-10% for relatively smooth irradiance distributions. The systematic nature of this error makes it advisable to check for its presence and, if required, to compensate for it by an adequate choice of the least-squares reconstruction matrix.

Diode laser transscleral cyclophotocoagulation in the treatment of chronic angle-closure glaucoma: a preliminary study

PURPOSE

To evaluate the efficacy and safety of diode laser transscleral cyclophotocoagulation in the treatment of chronic angle-closure glaucoma.

PATIENTS AND METHODS

A prospective, non-comparative interventional pilot study was conducted. Fourteen eyes of 14 Chinese patients with chronic angle-closure glaucoma whose intraocular pressures were greater than 21 mm Hg on medications were treated with diode laser transscleral cyclophotocoagulation using the G-probe at the United Christian Hospital between February 2000 and May 2001. The inferior 270 degrees quadrant (from 2 to 11 o'clock for right eye and from 1 to 10 o'clock for left eye) was treated and the patients were followed up regularly. The initial laser energy was set at 2,000 mWatt with a duration of 2 seconds. The post-treatment anti-glaucoma medications were adjusted according to the intraocular pressure. If medications failed to lower the intraocular pressure to below 21 mm Hg, cyclophotocoagulation to the same inferior 270 degrees quadrant was repeated.

RESULTS

All patients completed a 12-month follow-up period. The total success rate defined as IOP < 21 mm Hg with or without medication(s) was 85.7% at 1 year of follow-up review. The mean +/- SD intraocular pressure decreased from pre-treatment level of 36.9 +/- 11.7 mm Hg to 18.9 +/- 6.5 mm Hg at 1 year after treatment. The difference was statistically significant (P < 0.001) (Paired t test). The mean +/- SD number of IOP-lowering eyedrops was significantly reduced from 1.9 +/- 0.7 before cyclophotocoagulation to 0.4 +/- 0.8 at 1 year after treatment (P = 0.0002) (Paired t test). Two eyes required repeat treatment. Seven eyes (50%) had atonic pupil following the laser treatment.

CONCLUSION

Diode laser transscleral cyclophotocoagulation is effective in lowering the intraocular pressure in chronic angle-closure glaucoma and its effect lasts for at least 1 year.

Spectral sensitivity of the pupillary system

BACKGROUND

The spectral sensitivity of the pupillary mechanism is reported to be greater in the blue part of the visible spectrum compared to the sensitivity of the visual system as defined by V(lambda) for a two-degree field. This means that blue light gives rise to smaller pupils compared to those that occur with light of other colours of the same luminance. This has been interpreted as indicating that there may be a rod input to pupil response even at photopic levels of illumination. An alternative explanation is that the smaller pupil size for blue light is an artefact arising from the use of the CIE V(lambda) function which is based on the spectral sensitivity of the eye to a two-degree field. In most investigations of pupil response, the adapting luminous field is much larger than two degrees.

METHOD

The size of the static pupil was measured using an entoptic method when the eye was adapted to a large 'Ganzfeld' field of wavelengths of 624, 580, 521, 467 and 429 nm and luminances ranging from mesopic to photopic.

RESULTS

The pupil is smaller for light of shorter wavelengths compared to that for light of longer wavelengths of the same luminance. This effect disappears at photopic luminances when luminance is calculated using the V(10 degrees ) (lambda) function instead of the V(2 degrees ) (lambda) function but is still evident at mesopic levels. When pupil size is plotted against equivalent luminance for a 10-degree field V(10 degrees ) (lambda, L(eq)) pupil size is independent of wavelength.

CONCLUSION

The apparent enhanced sensitivity of the pupil to blue light at photopic levels is an artefact arising from the inappropriate use of the V(2 degrees ) (lambda) for the measurement of luminance when the adapting field in pupil response measurements is a large field. Pupil size is a simple linear function of the log of equivalent luminance calculated for large fields for adapting luminances from photopic to mesopic and is independent of the wavelength of the adapting field for the whole range of adapting luminances.

Wavelength dependence of reflectometric cone photoreceptor directionality

We present evidence for the wavelength dependence of the directionality of light reflected from cone receptor cells (optical Stiles-Crawford effect): Blue light is more directional than red. According to the waveguide-scattering model of Marcos et al. [J. Opt. Soc. Am. A 15, 2012 (1998)], directionality is the sum of a waveguide component and a scattering component. The latter is proportional to 1 over wavelength squared, and it is related to the row-to-row spacing of the cone lattice. Our results allow a firm confirmation of Marcos et al.'s theory. For a 1.9-deg foveal area, group mean (n = 18) cone spacing was 3.42 microm, in good agreement with anatomical data. Group mean waveguide directionality was 0.077 mm(-2).