Retinal neural dysfunction in diabetes revealed with handheld chromatic pupillometry

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Tien En Tan
  • Maxwell T. Finkelstein
  • Gavin Siew Wei Tan
  • Anna Cheng Sim Tan
  • Choi Mun Chan
  • Ranjana Mathur
  • Edmund Yick Mun Wong
  • Chui Ming Gemmy Cheung
  • Tien Yin Wong
  • Milea, Dan
  • Raymond P. Najjar

Background: To evaluate the ability of handheld chromatic pupillometry to reveal and localise retinal neural dysfunction in diabetic patients with and without diabetic retinopathy (DR). Methods: This cross-sectional study included 82 diabetics (DM) and 93 controls (60.4 ± 8.4 years, 44.1% males). DM patients included those without (n = 25, 64.7 ± 6.3 years, 44.0% males) and with DR (n = 57, 60.3 ± 8.5 years, 64.9% males). Changes in horizontal pupil radius in response to blue (469 nm) and red (640 nm) light stimuli were assessed monocularly, in clinics, using a custom-built handheld pupillometer. Pupillometric parameters (phasic constriction amplitudes [predominantly from the outer retina], maximal constriction amplitudes [from the inner and outer retina] and post-illumination pupillary responses [PIPRs; predominantly from the inner retina]) were extracted from baseline-adjusted pupillary light response traces and compared between controls, DM without DR, and DR. Net PIPR was defined as the difference between blue and red PIPRs. Results: Phasic constriction amplitudes to blue and red lights were decreased in DR compared to controls (p < 0.001; p < 0.001). Maximal constriction amplitudes to blue and red lights were decreased in DR compared to DM without DR (p < 0.001; p = 0.02), and in DM without DR compared to controls (p < 0.001; p = 0.005). Net PIPR was decreased in both DR and DM without DR compared to controls (p = 0.02; p = 0.03), suggesting a wavelength-dependent (and hence retinal) pupillometric dysfunction in diabetic patients with or without DR. Conclusions: Handheld chromatic pupillometry can reveal retinal neural dysfunction in diabetes, even without DR. Patients with DM but no DR displayed primarily inner retinal dysfunction, while patients with DR showed both inner and outer retinal dysfunction.

OriginalsprogEngelsk
TidsskriftClinical and Experimental Ophthalmology
Vol/bind50
Udgave nummer7
Sider (fra-til)745-756
ISSN1442-6404
DOI
StatusUdgivet - 2022
Eksternt udgivetJa

Bibliografisk note

Funding Information:
Singhealth Duke‐NUS Academic Medicine Research Grant, Grant/Award Number: AM/TP018/2018; National Health Innovation Center Singapore, Grant/Award Number: NHIC‐I2D‐1708181; National Medical Research Council, Grant/Award Number: NMRC/CIRG/1401/2014 Funding information

Publisher Copyright:
© 2022 Royal Australian and New Zealand College of Ophthalmologists.

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