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Ted Maddess, Lauren Baker, Andrew James, Caitlin Coombes, Veronica Cheung, Melody Melody Chiou, Maria Kolic, Christopher Nolan, Faran Sabeti; Clinical Utility of Multifocal Pupillographic Objective Perimetry in Type 1 Diabetes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):218. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the sensitivity and specificity of five variants of multifocal pupillographic objective perimetry (mfPOP) for discriminating controls from patients with type 1 diabetes (T1D) presenting with nil to non-proliferative diabetic retinopathy (NPDR).
25 T1D patients (37.9 ± 2.44 years, 12 females, mean duration 22.5 ± 10.1 years) and 23 normal (36.0 ± 2.58 years, 12 females) subjects were recruited. Pupillary contraction amplitudes and times-to-peak responses to red/green, yellow and blue dichoptic stimuli with 44 test regions/eye extending, to either ±15° or ±30°. Disease severity was based on either ETDRS scores from fundus photos; or scores based or factors from correlations between 18 patient variables, which were mainly based on blood analyses, but included peripheral neuropathy, and advanced glycation end-products.
Factor scores based mainly on renal function, HBA1c and BMI were the best indicator of diabetic damage as measured by mfPOP. In eyes with no or mild NPDR, red/green mfPOP stimuli extending to ±30° achieved the highest ROC area under the curve (AUC) of 0.95 ± 0.05 (mean ± SE) for delay deviations and 0.91 ± 0.05 when amplitude deviations were considered. In moderate NPDR eyes diagnostic accuracy improved to 1.00 ± 0.05 for blue and yellow protocols.
The results suggest that red/green stimuli presented within the central 30° of fixation achieved good diagnostic power to determine diabetes status in eyes with minimal to no retinopathy. MfPOP may be a useful clinical tool in evaluating and monitoring eyes with early NPDR.
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