Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Invest Ophthalmol Vis Sci. 2013 Aug 19;54(8):5596-601. doi: 10.1167/iovs.13-12142.
To assess the relationship between the pupillary light reflex (PLR) and visual field (VF) mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness.
A total of 148 patients with glaucoma (mean age 67 ± 11, 49% female) and 71 controls (mean age 60 ± 10, 69% female) were included in this study. Using a pupillometer, we recorded and analyzed pupillary responses at varied stimulus patterns (full field, superonasal and inferonasal quadrant arcs). We compared the responses between the two eyes, compared responses to stimuli in the superonasal and inferonasal fields within each eye, and calculated the absolute PLR value of each individual eye. We assessed the relationship among PLR, MD, and RNFL thickness using the Pearson correlation coefficient. For analyses performed at the level of individual eyes, we used multilevel modeling to account for between-eye correlations within individuals.
For every 0.3 log unit difference in between-eye asymmetry of PLR, there was an average 2.6-dB difference in visual field MD (correlation coefficient R = 0.83, P < 0.001) and a 3.2-μm difference in RNFL thickness between the two eyes (R = 0.67, P < 0.001). Greater VF damage and thinner RNFL for each individual eye were associated with smaller response amplitude, slower velocity, and longer time to peak constriction and dilation after adjusting for age and sex (all P < 0.001). However, within-eye asymmetry of PLR between superonasal and inferonasal stimulation was not associated with corresponding within-eye differences in VF or RNFL.
As measured by this particular device, the PLR is strongly correlated with VF functional testing and measurements of RNFL thickness.
评估瞳孔对光反射（PLR）与视野（VF）平均偏差（MD）和视网膜神经纤维层（RNFL）厚度之间的关系。
本研究共纳入 148 例青光眼患者（平均年龄 67 ± 11 岁，49%为女性）和 71 例对照者（平均年龄 60 ± 10 岁，69%为女性）。使用瞳孔计，我们记录并分析了不同刺激模式（全视野、超鼻侧和鼻下象限弧形）下的瞳孔反应。我们比较了双眼之间的反应，比较了每只眼的超鼻侧和鼻下视野刺激之间的反应，并计算了每只眼的绝对 PLR 值。我们使用 Pearson 相关系数评估 PLR、MD 和 RNFL 厚度之间的关系。对于个体眼水平的分析，我们使用多水平模型来解释个体内双眼之间的相关性。
每只眼之间 PLR 对称性相差 0.3 个对数单位，VF MD 平均相差 2.6dB（相关系数 R=0.83，P<0.001），两只眼之间的 RNFL 厚度相差 3.2μm（R=0.67，P<0.001）。每只眼的 VF 损伤越大，RNFL 越薄，调整年龄和性别后，瞳孔收缩和扩张的反应幅度越小，速度越慢，达到峰值的时间越长（均 P<0.001）。然而，超鼻侧和鼻下刺激之间的 PLR 眼内不对称与相应的眼内 VF 或 RNFL 差异无关。
通过这种特殊设备测量，PLR 与 VF 功能测试和 RNFL 厚度测量密切相关。
