Visual Neurosciences, Singapore Eye Research Institute, Singapore.
Glaucoma, Singapore Eye Research Institute, Singapore.
Br J Ophthalmol. 2024 May 21;108(6):818-825. doi: 10.1136/bjo-2023-323878.
BACKGROUND/AIMS: To assess pupillary light responses (PLRs) in eyes with high myopia (HM) and evaluate the ability of handheld chromatic pupillometry (HCP) to identify glaucomatous functional loss in eyes with HM.
This prospective, cross-sectional study included 28 emmetropes (EM), 24 high myopes without glaucoma (HM) and 17 high myopes with confirmed glaucoma (HMG), recruited at the Singapore National Eye Center. Monocular PLRs were evaluated using a custom-built handheld pupillometer that recorded changes in horizontal pupil radius in response to 9 s of exponentially increasing blue (469.1 nm) and red (640.1 nm) lights. Fifteen pupillometric features were compared between groups. A logistic regression model (LRM) was used to distinguish HMG eyes from non-glaucomatous eyes (EM and HM).
All pupillometric features were similar between EM and HM groups. Phasic constriction to blue (p<0.001) and red (p=0.006) lights, and maximum constriction to blue light (p<0.001) were reduced in HMG compared with EM and HM. Pupillometric features of melanopsin function (postillumination pupillary response, PIPR area under the curve (AUC) 0-12 s (p<0.001) and PIPR 6 s (p=0.01) to blue light) were reduced in HMG. Using only three pupillometric features, the LRM could classify glaucomatous from non-glaucomatous eyes with an AUC of 0.89 (95% CI 0.77 to 1.00), sensitivity 94.1% (95% CI 82.4% to 100.0%) and specificity 78.8% (95% CI 67.3% to 90.4%).
PLRs to ramping-up light stimuli are unaltered in highly myopic eyes without other diagnosed ocular conditions. Conversely, HCP can distinguish glaucomatous functional loss in eyes with HM and can be a useful tool to detect/confirm the presence of glaucoma in patients with HM.
背景/目的：评估高度近视（HM）眼中的瞳孔光反应（PLR），并评估手持式色度瞳孔计（HCP）识别 HM 眼中青光眼功能性丧失的能力。
本前瞻性、横断面研究纳入了在新加坡国家眼科中心招募的 28 名正视眼（EM）、24 名无青光眼的高度近视（HM）和 17 名确诊青光眼的高度近视（HMG）患者。使用定制的手持式瞳孔计评估单眼 PLR，该瞳孔计记录了水平瞳孔半径在 9 秒内响应指数增加的蓝色（469.1nm）和红色（640.1nm）光的变化。比较了三组之间的 15 个瞳孔计特征。使用逻辑回归模型（LRM）来区分 HMG 眼与非青光眼眼（EM 和 HM）。
EM 和 HM 组之间的所有瞳孔计特征均相似。与 EM 和 HM 相比，HMG 对蓝色（p<0.001）和红色（p=0.006）光的相位收缩以及对蓝色光的最大收缩减少。与 HM 相比，黑视蛋白功能的瞳孔计特征（后光照瞳孔反应，PIPR 0-12s 的曲线下面积（AUC）0-12s（p<0.001）和 PIPR 6s（p=0.01）对蓝色光）减少。使用仅三个瞳孔计特征，LRM 可以以 0.89（95%CI 0.77 至 1.00）的 AUC、94.1%（95%CI 82.4%至 100.0%）的敏感性和 78.8%（95%CI 67.3%至 90.4%）的特异性来区分青光眼与非青光眼眼。
在没有其他诊断性眼部疾病的高度近视眼中，对递增光刺激的 PLR 未改变。相反，HCP 可以区分 HM 眼中的青光眼功能性丧失，并且可以成为一种有用的工具来检测/确认 HM 患者青光眼的存在。
