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Scott Ketner, Jr., Zimei Zhou, Cheryl Yondorf, Jonathan Levine, Rudrani Banik; Dynamic Pupillometry in Diabetic Patients with and without Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2871.
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To determine whether dynamic pupillometry with the NeurOptics VIP-200 pupillometer can be used as a quick and easy screening tool for diabetic retinopathy (DR), thereby helping to meet the need for increased screening compliance.
We conducted a retrospective chart review. We included adult diabetic patients who had undergone pupillometry and dilated fundoscopic examination within one month of each other. Parameters measured with dynamic pupillometry included latency to constriction, constriction velocity (maximal and average), dilation velocity (average), and "T75" (time required to constrict and then re-dilate to 75% of initial pupil diameter). We excluded eyes with optic neuropathy, non-diabetic retinal disease, or previous penetrating corneoscleral surgery. We divided the patients into three groups: no DR, nonproliferative DR (NPDR), and proliferative DR (PDR), and compared pupil responses across the groups using analysis of variance analysis (ANOVA) and student’s t-test.
We reviewed 88 charts. Fifty-two patients (90 eyes) had no DR, 20 patients (34 eyes) had NPDR, and 16 patients (24 eyes) had PDR. We found significant differences between the group with no DR and that with PDR in regards to latency (p=0.0001), constriction velocity (p=0.0016 for average velocity, p=0.0017 for maximal velocity), and dilation velocity (p=0.0001 for average velocity).
When compared to eyes with no DR, eyes with PDR have autonomic pupil dysfunction. Given that most (all but four) PDR eyes in our study had undergone panretinal photocoagulation (PRP) prior to pupillometry, the extent to which this pupil dysfunction is due to DR itself as opposed to PRP is unclear. Dynamic pupillometry is not useful for differentiating between eyes with no DR and those with NPDR.
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