Denniss Jonathan, Cheloni Riccardo, Martin Joel T, Spitschan Manuel
School of Optometry & Vision Science, University of Bradford, Bradford, United Kingdom.
Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
PLoS One. 2025 May 23;20(5):e0324373. doi: 10.1371/journal.pone.0324373. eCollection 2025.
To test whether differences in pupil responses to melanopsin-isolating spectral stimuli in glaucoma may be useful as a diagnostic biomarker.
Spectral stimuli were presented to 20 glaucoma and 15 age-similar healthy control participants. Stimuli were pairs of silent-substitution spectra designed to provide (1) equal stimulation to cone photoreceptors but maximum (~325%) contrast to melanopsin or (2) equal stimulation to melanopsin but ~325% contrast to cones. Narrowband long-wavelength/red (657 nm) and short-wavelength/blue (471 nm) pulses were also presented from a dark background to 16 glaucoma and 12 control participants. Pulses lasted 3 seconds and pupil size was measured for 15 seconds. Pupil response metrics were compared by t-test and relationships with visual field and OCT summary indices were assessed by Spearman's rank correlation. Diagnostic accuracy was measured by area under the receiver operating characteristic curve (AUC).
Pupil constriction was more persistent after pulse offset for the melanopsin-directed stimulus (2% mean paired difference 6s post-pulse offset, p < 0.001). All pupil parameters were similar between groups (p = 0.04-0.90) for all stimuli. Correlations between pupil response parameters and visual field summary indices and circumpapillary retinal nerve fibre layer thickness were weak (rho 0.02-0.57, all p > 0.05). Diagnostic accuracy for all pupil parameters was poor, with AUC 95% confidence intervals overlapping 0.5 for all but time to maximal constriction for the cone-directed stimulus.
Pupil responses to melanopsin-isolating spectra were similar between glaucoma and control participants. Pupillary responses to melanopsin-isolating silent substitution spectra are unlikely to be useful as a diagnostic biomarker for glaucoma.
测试青光眼患者对分离黑视蛋白的光谱刺激的瞳孔反应差异是否可用作诊断生物标志物。
向20名青光眼患者和15名年龄相仿的健康对照者呈现光谱刺激。刺激是成对的无声替代光谱，旨在提供（1）对视锥光感受器的等量刺激，但对黑视蛋白的对比度最大（约325%），或（2）对黑视蛋白的等量刺激，但对视锥细胞的对比度约为325%。还从暗背景向16名青光眼患者和12名对照者呈现窄带长波长/红色（657nm）和短波长/蓝色（471nm）脉冲。脉冲持续3秒，测量瞳孔大小15秒。通过t检验比较瞳孔反应指标，并通过Spearman等级相关性评估与视野和OCT汇总指标的关系。通过受试者操作特征曲线下面积（AUC）测量诊断准确性。
对于针对黑视蛋白的刺激，脉冲偏移后瞳孔收缩更持久（脉冲偏移后6秒平均配对差异为2%，p<0.001）。所有刺激下两组之间的所有瞳孔参数相似（p=0.04-0.90）。瞳孔反应参数与视野汇总指标和视乳头周围视网膜神经纤维层厚度之间的相关性较弱（rho为0.02-0.57，所有p>0.05）。所有瞳孔参数的诊断准确性都很差，除了针对视锥细胞的刺激达到最大收缩时间外，所有AUC的95%置信区间都与0.5重叠。
青光眼患者和对照者对分离黑视蛋白光谱的瞳孔反应相似。对分离黑视蛋白的无声替代光谱的瞳孔反应不太可能用作青光眼的诊断生物标志物。
