Altered non-visual photoreception and sleep in patients with age-related macular degeneration

Abstract

Purpose : To investigate changes in non-visual photoreception evaluated using handheld chromatic pupillometry (HCP), and their association with objective sleep quality in patients with age-related macular degeneration (AMD).

Methods : Patients with confirmed unilateral or bilateral AMD (n=87, average age ±SD: 69.2 ± 8.0 years, 57.5% males; 22 early and 65 late AMD [including wet AMD and polypoidal choroidal vasculopathy] in the worse eye) and healthy controls (n=50, 61.4 ± 8.3 years, 30.0% males) were included in this cross-sectional study. Participants’ non-visual photoreception was evaluated using HCP examining the pupillary response to 9-sec ramping-up blue and red light stimuli. Subsequently, participants underwent ~14 days of objective sleep monitoring using wrist actimetry. Pupillometric features, sleep onset latency [SOL], and sleep efficiency [SE] were compared using a t-test between groups and a one-way ANCOVA (cov: age, gender) between controls, unilateral (n=47), and bilateral (n=40) AMD.

Results : Multiple pupillometric features associated with cone (e.g., phasic constrictions to blue and red lights; P<0.001) and intrinsically photosensitive retinal ganglion cell function (e.g., maximum constriction and area under the redilation curve, in response to blue light; P<0.001) were reduced in eyes with AMD compared to controls (Fig 1A-D). These findings remained significant in a sub-group analysis in age-matched groups. AMD patients generally showed limited sleep alterations compared to controls. However, in subgroup analysis, only unilateral AMD (100% late AMD) exhibited similar sleep quality to controls, while bilateral AMD (55% bilateral early AMD), showed increased SOL (>10min, P=0.02), and reduced SE (~6%) compared to controls and unilateral AMD (P<0.01) (Fig 1E, F). Phasic constriction to red light (R=0.62, P<0.001) and maximum constriction to blue light (R=0.51, P<0.01) were significantly correlated with SE in bilateral AMD patients (Fig 1G, H).

Conclusions : AMD alters non-visual photoreception which may contribute to sleep disruptions in patients with bilateral AMD. Screening sleep quality in these patients could allow for a holistic treatment to enhance overall health and wellbeing.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Fig 1. Altered pupillary light responses (A), pupillometric features (B-D), and sleep (E, F) in AMD patients. Correlations between pupillometric features and SE in bilateral AMD (G, H). *P<0.05; **P<0.01; ***P<0.001.