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Augusto Paranhos, Carolina Pelegrini Barbosa Gracitelli, Gloria L. Duque-Chica, Marina Roizenblatt, Ana Laura de Araujo Moura, Balazs Nagy, Geraldine de Melo, Paula Borba, Sergio H. Teixeira, Dora Fix Ventura; Intrinsically photosensitive retinal ganglion cell activity is associated with decreased sleep quality in glaucoma patients . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3176.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the function of intrinsically photosensitive retinal ganglion cells (ipRGCs) using the pupillary light reflex and compared with polysomnography in glaucoma patients.
A cross-sectional study was conducted on both eyes of 45 participants (32 glaucoma patients and 13 healthy subjects). For the pupillary reflex evaluation, patients were tested in the dark using a Ganzfeld system for stimulation; pupil diameter was measured with an eye tracker system. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m2. To stimulate different retinal photoreceptors (cones and rods), we used a 1-second 630-nm flash with a luminance of 250 cd/m2. All subjects underwent polysomnography. For ophthalmological assessments, all subjects underwent standard automated perimetry and optical coherence tomography (Cirrus HD-OCT).<br /> Correlations among ipRGC activity measured by the pupillary light reflex, polysomnography and retinal nerve fiber layer (RNFL) thickness were performed.
The mean patient ages in the healthy and glaucoma groups were 56.8 ± 7.8 and 61.5 ± 11.6 years, respectively (p= 0.174). Glaucoma patients had a significantly lower average total sleep time, sleep efficiency and minimum oxyhemoglobin saturation compared to the healthy subjects (p = 0.008, p = 0.002 and p = 0.028, respectively). Additionally, glaucoma patients had significantly higher arousal durations after falling asleep and periodic limb movements (p = 0.002 and p = 0.045, respectively). There was a correlation between the REM latency and the peak of the pupillary response to the blue flash (p = 0.004). The total arousals were associated with the sustained blue flash response (p = 0.029). The RNFL thickness was associated with the peak and sustained response to the blue flash (p < 0.001 for both comparisons); however, the RNFL thickness was only associated with the mean oxygen desaturation index for polysomnography parameters (p = 0.023).
This study demonstrates the decreased ipRGC function caused by glaucoma disease affects not only the pupillary response but also the sleep quality.
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