Abnormal Dynamic Pupillometry Relates to Neurologic Disability and Retinal Axonal Loss in Patients With Multiple Sclerosis

Abstract

Purpose To assess alterations in quantitative dynamic pupil responses to light in relation to neurologic disability and retinal axonal loss in patients with multiple sclerosis (MS). Methods Twenty-five patients with relapsing-remitting MS and 25 healthy subjects were included in this cross-sectional study. Pupillary responses were measured with an infrared dynamic pupillometry unit, and peripapillary retinal nerve fiber layer (RNFL) thickness was measured with spectral-domain optical coherence tomography. Neurologic disability was assessed by the Expanded Disability Status Scale (EDSS). Patients with a history of optic neuritis (ON) within 6 months were excluded. Only the right eyes were assessed, except in 11 patients with a history of unilateral ON in whom both eyes were further analyzed to evaluate the effect of previous ON. Results The initial pupil diameter ( P = 0.003) and pupil contraction amplitude ( P = 0.027) were lower in patients with MS compared with healthy controls. Initial pupil diameter correlated with EDSS score (ρ = −0.458; P = 0.021), and RNFL correlated with contraction latency (ρ = −0.524; P = 0.007). There were no significant differences in any of the pupil parameters between eyes with and without a history of ON, and between the ON and fellow eyes of the 11 patients with previous unilateral ON. Conclusions Dynamic pupillometry reveals significant alterations in pupillary light reflex responses associated with neurologic disability and retinal axonal loss, independent of previous ON. Translational Relevance Dynamic pupillometry is a simple, noninvasive tool that may be useful in detecting autonomic dysfunction in patients with MS.

Rapid, non-contact multifocal visual assessment in multiple sclerosis

“…Classical VEPs have only been shown to demonstrate abnormalities in eyes with a history of ON [4]. Similar to our previous mfPOP studies [16] and other pupillographic studies of MS [28], this study found that the presence or absence of a history of ON did not significantly affect the ability of mfPOP to distinguish individuals with MS from controls. If anything, the test performed better in individuals without a history of ON.…”

Objective perimetry and progression of multiple sclerosis

“…Interestingly, as reported for sparse mfVEPs [ 4 ], sensitivity and specificity for diagnosing MS did not depend on a history of optic neuritis, suggesting that mfPOP might have been measuring something correlated with disease severity and progression rather than being a marker of previous inflammation. Others have reported a similar finding [ 16 ].We have recently reported similar results, and AUROCs up to 96.5% using a new 5th generation mfPOP method [ 17 ].…”

Photopic negative response recorded with RETeval system in eyes with optic nerve disorders

“…The mean pupil diameter during PhNR recordings was significantly larger in the optic nerve diseases except for the acute ON/ION group. Previous studies have reported that degree of impaired pupillary light response in patients with chronic phase of optic neuritis was significantly correlated with the severity of the neurologic disability and RNFLT 28 . We suggest that the larger pupil diameter during PhNR recording in chronic ON/ION and TON/DOA compared to the control group may be due to irreversible impairment of optic nerve function caused by the primary disease.…”