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Raymond Najjar, Annadata V Rukmini, Pratik Chougule, Petteri Teikari, Shamira Perera, Baskaran Mani, Monisha Esther Nongpiur, Tin Aung, Dan Milea; Handheld Chromatic Pupillometry for Earlier Detection of Functional Loss in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3926.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the performance of a novel handheld chromatic pupillometer for the detection of glaucoma.
In this cross-sectional study, we included 109 patients with glaucoma (62.4 ± 8.7 years, 68% male, 84% ethnic-Chinese) and 91 healthy age-matched controls (60.3 ± 7.0 years, 40% male, 92% ethnic-Chinese). Glaucoma patients were assigned to 3 severity groups (48 early, 31 moderate and 30 severe) based on the Hodapp-Parrish-Anderson criteria for glaucomatous visual field defect. Changes in pupil diameter in response to 10-second ramping-up (12.5-14.5 log photons/cm2/s) blue (469nm) and red (640nm) light stimuli were assessed monocularly, in clinics, using a handheld pupillometer developed at the Singapore Eye Research Institute. Baseline-adjusted constriction amplitudes and post-illumination pupillary responses (PIPR), were compared between glaucoma groups and controls. Receiver operating characteristics curve analyses (ROC) were used to compare the classification performance of pupillometric outcomes to those of structural (average peripapillary retinal nerve fiber layer thickness [RNFL-t]) and functional (visual field mean deviation [MD]) ophthalmic features assessed using optical coherence tomography (OCT) and Humphrey Visual Field (HVF). Clinical diagnosis by a glaucoma expert was used as reference standard.
Average constriction amplitudes to blue and red lights, as well as PIPR to blue light, were reduced in all glaucoma groups compared to controls (P<0.001). The best pupillometric classifier for glaucoma was maximum constriction amplitude to blue light (MCAb), with an area under the ROC (AUC) of 0.91 (95% CI: 0.86 - 0.94). MCAb yielded similar performance as RNFL-t and MD scores for the detection of moderate and severe glaucoma, but outperformed MD scores in the classification of early glaucoma (MCAb: AUC = 0.90 (0.84 - 0.96); MD: AUC = 0.76 (0.67 - 0.84)) (P = 0.002) (Fig 1).
Chromatic pupillometry, performed using a handheld pupillometer and a dedicated short ramping-up light paradigm, can detect early functional loss in eyes with glaucoma, allowing similar classification performance as OCT and outperforming HVF. Further population-based studies are needed to establish the value of chromatic pupillometry as a fast and objective method for glaucoma detection.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Fig 1. Receiver operating characteristics curve for the classification of early glaucoma using MCAb, MD and RNFL-t.
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