June 2020
Volume 61, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2020
Handheld chromatic pupillometry detects preclinical retinal dysfunction in patients with diabetes mellitus
Author Affiliations & Notes
  • Tien-En Tan
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Maxwell T Finkelstein
    Singapore Eye Research Institute, Singapore
  • Gavin SW Tan
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Anna Tan
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Choi Mun Chan
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Ranjana Mathur
    Singapore National Eye Centre, Singapore, Singapore
  • Edmund YM Wong
    Singapore National Eye Centre, Singapore, Singapore
  • Gemmy Cheung
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Tien Yin Wong
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Dan Milea
    Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore
  • Raymond Najjar
    Singapore Eye Research Institute, Singapore
  • Footnotes
    Commercial Relationships   Tien-En Tan, None; Maxwell Finkelstein, None; Gavin Tan, None; Anna Tan, None; Choi Mun Chan, None; Ranjana Mathur, None; Edmund Wong, None; Gemmy Cheung, None; Tien Wong, None; Dan Milea, WO2018203828A1 (P); Raymond Najjar, WO2018203828A1 (P)
  • Footnotes
    Support  Singapore National Medical Research Council NMRC/CIRG/1401/2014 and National Health Innovation Centre Singapore NHIC-I2D-1708181
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5039. doi:
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    • Get Citation

      Tien-En Tan, Maxwell T Finkelstein, Gavin SW Tan, Anna Tan, Choi Mun Chan, Ranjana Mathur, Edmund YM Wong, Gemmy Cheung, Tien Yin Wong, Dan Milea, Raymond Najjar; Handheld chromatic pupillometry detects preclinical retinal dysfunction in patients with diabetes mellitus. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5039.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the ability of handheld chromatic pupillometry to reveal retinal neural dysfunction in diabetic patients with and without diabetic retinopathy (DR).

Methods : In this cross-sectional study we included 82 patients with type 2 diabetes mellitus (DM) and 94 age-matched controls (60.4 ± 8.4 years, 43.6% males). The DM population included patients without (n = 25, 64.7 ± 6.3 years, 44.0% males) and with DR (n = 57, 60.3 ± 8.5 years, 64.9% males). At inclusion, all patients with DR were ocular treatment-naïve. Changes in pupil diameter in response to 10-second ramping-up (12.5 - 14.5 log photons/cm2/s) blue (469 nm) and red (640 nm) light stimuli were assessed monocularly, in clinics, using a custom-built handheld pupillometer. Baseline-adjusted constriction amplitudes and post-illumination pupillary responses (PIPR), were compared between controls, DM without DR, and DR. Net PIPR was defined as the difference between blue and red PIPR. The relationship between pupillary responses and glycemic control (glycated hemoglobin A1c [HbA1c] levels) was also explored in diabetics.

Results : Maximal constriction amplitudes to both blue and red lights were decreased in DR compared to DM without DR (P = 0.02; P = 0.02), and in DM without DR compared to controls (P = 0.001; P = 0.006). Net PIPR was decreased in both DR and DM without DR compared to controls (P = 0.03; P = 0.02), suggesting a wavelength-dependent (and hence afferent) pupillometric dysfunction in diabetics with or without DR. Patients with poor glycemic control (HbA1c ≥ 8.0%; n = 19) showed reduced maximal constriction amplitudes to both blue (P = 0.02) and red (P = 0.01) lights compared to patients with better control (HbA1c < 8.0%; n = 38). The distribution of patients with and without DR was not significantly different between the two groups.

Conclusions : Handheld chromatic pupillometry can detect a loss of retinal neural function in diabetic patients, even in the absence of DR. Pupillometric responses show greater reduction in patients with poor glycemic control. Longitudinal studies will establish the possible prognostic value of early retinal dysfunction in diabetes.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure 1. Maximal pupillary constriction amplitudes to blue (A) and red (B) lights, and net PIPR (C) in controls, DM without DR, and DR. Difference between groups is indicated as * for P < 0.05, ** for P < 0.01, and *** for P < 0.001.

Figure 1. Maximal pupillary constriction amplitudes to blue (A) and red (B) lights, and net PIPR (C) in controls, DM without DR, and DR. Difference between groups is indicated as * for P < 0.05, ** for P < 0.01, and *** for P < 0.001.

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