September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Chromatic multifocal pupillometer for objective diagnosis of neurodegeneration in the eye and the brain.
Author Affiliations & Notes
  • Ygal Rotenstreich
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Daniel Ben Ner
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Ron Chibel
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
  • Yakir Berchenko
    Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
  • Bernice Oberman
    Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
  • Ofra Kalter-Leibovici
    Unit of Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Laurence Freedman
    Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
  • Michal Beeri
    Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
    Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Ramit Ravona-Springer
    Psychiatry Department A, , Sheba Medical Center, Tel Hashomer, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Sagi Harnof
    Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Ifat Sher-Rosenthal
    Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
    Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
  • Footnotes
    Commercial Relationships   Ygal Rotenstreich, Accutome Inc (F), Accutome Inc (P); Daniel Ben Ner, None; Ron Chibel, None; Yakir Berchenko, None; Bernice Oberman, None; Ofra Kalter-Leibovici , None; Laurence Freedman, None; Michal Beeri, None; Ramit Ravona-Springer , None; Sagi Harnof, None; Ifat Sher-Rosenthal, None
  • Footnotes
    Support  Accutome research grant, Israeli Defense Force research grant
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 636. doi:
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      Ygal Rotenstreich, Daniel Ben Ner, Ron Chibel, Yakir Berchenko, Bernice Oberman, Ofra Kalter-Leibovici, Laurence Freedman, Michal Beeri, Ramit Ravona-Springer, Sagi Harnof, Ifat Sher-Rosenthal; Chromatic multifocal pupillometer for objective diagnosis of neurodegeneration in the eye and the brain.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):636.

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

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Abstract

Purpose : To evaluate the use of chromatic multifocal pupillometry (CMP) for objective diagnosis of neurodegeneration in the retina and brain.

Methods : A CMP device (Accutome, Inc.) was used to record pupillary responses to red and blue light presented at 76 different locations of a 30-degree visual field (VF). Maximal percentage of pupil constriction (PPC), maximal constriction velocity (MCV) and the latency of MCV (LMCV) were determined. In the eye study, 13 patients with retinal dystrophy, 5 patients with macular dystrophy and 27 aged-matched controls were included. Patient's CMP results were compared to subjective VF testing [Humphrey 24-2 VF (HFA-VF) or Dark Adapted Goldmann VF (DA-GVF)]. In the brain study, 12 cognitively normal, subjects (ages 60-74) were included and CMP results were associated with cognitive (Montreal Cognitive Assessment, MoCA) testing.

Results : In retinal dystrophy patients, test points in which the PPC was lower than 4 standard errors (SEs) away from the mean of controls correlated with VF areas that were abnormal by DA-GVF. The variability in LMCV between different test points in response to red light was significantly higher in patients (range: 0.16-0.47) than in controls (range: 0.02-0.16; p<0.0001) and indicated its usefulness as a diagnostic tool with high sensitivity and specificity (Mann–Whitney–Wilcoxon analysis, area under the curve = 0.97.) Patients with macular degeneration demonstrated reduced PPC and MCV, more than 2 SEs away from the mean of controls, in response to red light in the majority of central (16 degree) HFA-VF locations. In the brain study, low MoCA (<26) was associated with reduced PPC in response to red light in the nasal region compared to normal MoCA (≥26) (3.3% [SE=0.3] vs 10.1% [SE=0.8]; p=0.018). Subjects with MoCA<26 compared to MoCA ≥26 showed reduced PPC in response to blue light in all regions except the inferior (nasal 5.8% vs 15.1% p=0.032; temporal 4.6% vs 13.9% p=0.028; superior 4.8% vs 13.8% p=0.033).

Conclusions : This study demonstrated the feasibility of using the CMP for identification of defects in visual pathways in different locations of the retina associated with VF defects and cognitive impairment. Different parameters of pupil response to chromatic multifocal stimuli may clarify the pathophysiology of different neurodegeneration diseases.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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