June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Symmetry of the Pupillary Light Reflex and its Relationship to Retinal Nerve Fiber Layer Thickness and Visual Field Defect in Subjects With and Without Glaucoma
Author Affiliations & Notes
  • Dolly Chang
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
    Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
  • Karun Arora
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
  • Michael Boland
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
  • David Friedman
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
    Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
  • Footnotes
    Commercial Relationships Dolly Chang, None; Karun Arora, None; Michael Boland, None; David Friedman, Alcon (C), Bausch & Lomb (C), Merck (C), QLT, Inc (C), Allergan (C), Nidek (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2261. doi:
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      Dolly Chang, Karun Arora, Michael Boland, David Friedman; Symmetry of the Pupillary Light Reflex and its Relationship to Retinal Nerve Fiber Layer Thickness and Visual Field Defect in Subjects With and Without Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2261.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To assess the relationship between the pupillary light reflex (PLR) and 1) visual field (VF) defect and 2) retinal nerve fiber layer (RNFL) thickness.

 
Methods
 

In this prospective case-control study, we enrolled 157 patients with glaucoma (mean age 67±11, 50% female) and 71 controls (mean age 60±10, 69% female). Using a pupillometer, we recorded and analyzed pupillary responses to various stimulus patterns (full field, superonasal and inferonasal quadrant arcs). We compared the responses between the two eyes, compared responses to superonasal and inferonasal stimuli within each eye, and calculated the absolute PLR value of each individual eye. We assessed the relationship between PLR, VF and RNFL using Pearson correlation coefficients. For analyses performed at the level of individual eyes, we used mixed effects multi-level modeling to account for between-eye correlations within individuals.

 
Results
 

Persons with glaucoma had a more asymmetric pupil response between the two eyes (p<0.001), between superonasal and inferonasal field within the same eye (p=0.014), and also had a smaller amplitude, slower velocity and longer latency of pupil response as compared to controls (all p<0.001). For every 0.3 log unit difference in between-eye asymmetry of PLR there was an average 2.3 dB difference in VF mean deviation (R2=0.62, p<0.001, Figure 1) and a 3.7μm difference in RNFL thickness between the two eyes (R2=0.34, p<0.001, Figure 2). Greater VF damage and a thinner RNFL for each individual eye were associated with a smaller response amplitude, slower velocity, and longer time to peak constriction and dilation (all p<0.001 after adjusting for age and gender). However, within-eye asymmetry of PLR between superonasal and inferonasal stimulation was not associated with within-eye differences of corresponding locations in VF or RNFL.

 
Conclusions
 

When measured precisely the PLR is strongly correlated with visual field functional testing and measurements of RNFL thickness. Quantitative pupillography may have a role in the diagnosis and management of optic neuropathies.

 
 
Figure 1. The relationship of between-eye symmetry in pupillary light reflex and visual field defect.
 
Figure 1. The relationship of between-eye symmetry in pupillary light reflex and visual field defect.
 
 
Figure 2. The relationship of between-eye symmetry in pupillary light reflex and retinal nerve fiber layer thickness.
 
Figure 2. The relationship of between-eye symmetry in pupillary light reflex and retinal nerve fiber layer thickness.
 
Keywords: 668 pupillary reflex • 758 visual fields  
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