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Corinne F. Carle, Andrew C. James, Maria Kolic, Rohan W. Essex, Ted L. Maddess; Targeting Melanopsin with mfPOP: Blue Multifocal Pupillographic Objective Perimetry in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5491.
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© ARVO (1962-2015); The Authors (2016-present)
This study investigated the utility of multifocal Pupillographic Objective Perimetry (mfPOP) stimuli that target the intrinsic photosensitivity of melanopsin retinal ganglion cells. These cells comprise the afferent arm of the subcortical pupillary pathway and exhibit differing dynamics dependent on the initiator of their response. The diagnostic potential for glaucoma is compared between protocols that favored either excitatory cone input to these cells or their intrinsic melanopsin response.
19 glaucoma and 24 normal subjects were tested using mfPOP stimulus protocols with either 33 ms yellow or 750 ms blue stimuli, Subjects’ color sensitivity was assessed using the Farnsworth 100-Hue Test (F100). Pupillary responses were recorded and multivariate linear regression used to quantify results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis.
Pupillary responses to the slow blue stimuli were highly suggestive of melanopsin involvement. F100 error scores increased significantly with age and were higher in glaucoma. The predominant errors in both groups were Type III blue/yellow anomalies. The mean reduction in patients’ pupillary response amplitudes to blue stimuli (-0.57dB (t(7490) = -7.2, p=8.4x10-13) was substantially less than that of yellow (-1.25dB (t(6749) = -10.9, p=1.6x10-27). ROC analysis revealed similar diagnostic accuracy: area under the curve, Blue: 100% for eyes classified as severe, 79.4% for moderate, Yellow: 100% for severe, 78.8% for moderate. The yellow protocol demonstrated much greater sensitivity to localized visual field damage, diagnostic power for the blue protocol however, was largely reliant on measures equivalent to the mean defect.
The blue protocol did not proffer any diagnostic advantage over the yellow protocol and appeared prone to confounding factors related to aging and the disease process.
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