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Clinton Norton Sims; A functional biomarker for early detection of age-related macular degeneration (ARMD) and other retinal diseases. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2410. doi: https://doi.org/.
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Previous studies have demonstrated that dull calibrated retinoscopic pupillary streaks are associated with varying degrees of age-related macular degeneration (ARMD) in older adults while bright reflexes were typically associated with healthy retinae. This study seeks to determine if dull pupillary streaks occur in younger eyes.
This was a retrospective study of 16 patients (ages 9-29) and 14 adults (ages 30-60) with clear optical media. After a non-cycloplegic subjective refraction, a modified retinoscope (Fig. 1) using parallel retinoscopic light, was used to produce the 1st pupillary streak. For the 2nd pupillary streak, the brightness was reduced 1.8x using converging retinoscopic light. The luminosity of the two pupillary streaks were graded using a 5 point scale (Fig. 2). The percentages of the subjects with dull scores were calculated.
In the 9-29 age group 35.3% had a dull pupillary streak in at least one eye. Of these, 83.4% had a family history of ARMD and 66.6% reported a BMI >25. Two of the patients with dull reflexes had atypical fundi and were referred. A retinal specialist subsequently diagnosed Retinitis Pigmentosa without pigment (age 19) and early ARMD (aged 29). In the 30-60 age group 57.1% had a dull pupillary reflex and of these 62.5% reported a family history ARMD and 62.5% a BMR>25.
This study demonstrates that dull pupillary streaks can be seen in younger patients and often is associated with a family history of ARMD. Only two patients had pathological disease but without this technique would probably not have been diagnosed. Dull streaks appear to be functional biomarkers of retinal disease.The luminosity of the streak depends upon the health of the photoreceptors and pigment particles of the retinal pigment epithelium and choroid. Degradation of the pigment particles by the lysosomes and low density lipofuscin attached to melanosomes and engulfing the pigment particles1 act to decrease the streak luminosity and cause retinal disease.Early detection is important as ARMD reaches epidemic proportions. Just as biomarkers and life style changes have been important in reducing cardiovascular disease, calibrated retinoscopy offers the opportunity to identify early those at risk for retinal disease and the choice to make informed lifestyle changes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Fig. 1 Calibrated retinoscope
Fig. 2 Calibrated pupillary streak scale
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