Visual Neurosciences Research Group, Singapore Eye Research Institute, Singapore.
Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.
Br J Ophthalmol. 2023 May;107(5):663-670. doi: 10.1136/bjophthalmol-2021-319938. Epub 2021 Dec 1.
BACKGROUND/AIMS: Early detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.
In this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF).
Pupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT.
HCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.
背景/目的：早期发现和治疗青光眼可以延缓视力丧失。本研究旨在评估手持式彩色瞳孔计（HCP）在客观、快速检测青光眼功能损失方面的性能。
本研究为基于临床的前瞻性研究，共纳入 149 名确诊青光眼患者（中位（IQR）年龄：68.5（13.6）岁）和 173 名健康对照者（55.2（26.7）岁）。使用定制的手持式瞳孔计对单侧眼进行 9 秒的指数递增蓝（469nm）和红（640nm）光刺激，评估瞳孔大小的变化。从个体轨迹中提取瞳孔计特征，并在组间进行比较。使用梯度提升机技术选择具有最高分类潜力的特征，并将其纳入用于青光眼分类的广义线性模型。采用受试者工作特征曲线分析（ROC）比较 HCP、光学相干断层扫描（OCT）和 Humphrey 视野（HVF）的性能。
与对照组相比，青光眼患者的瞳孔光反应发生改变。对于青光眼分类，HCP 的 ROC 曲线下面积（AUC）为 0.94（95%CI 0.91 至 0.96），灵敏度为 87.9%，特异性为 88.4%。HCP 在早期中度青光眼（视野平均偏差（VFMD）>-12dB；AUC=0.91（95%CI 0.87 至 0.95））的分类性能与 HVF（AUC=0.91）相似，而与 OCT（AUC=0.97；p=0.01）相比有所降低。对于严重青光眼（VFMD≤-12dB），HCP 具有出色的分类性能（AUC=0.98，95%CI 0.97 至 1），与 HVF 和 OCT 相似。
HCP 可准确、客观、快速地检测出不同严重程度的青光眼眼的功能损失。
