Clinical and infrared pupillometry in central retinal vein occlusion.

Abstract

Measurements of pupiliary reactivity and size were recorded using neutral density filters and infrared pupiliometry (IRP) in a prospective masked study of acute central retinal vein occlusion (CRVO) to quantify the two methods of measurement and to compare their value in the prediction of rubeosis. Thirty two patients were examined within 45 days of disease onset. The mean relative afferent pupillary defect (RAPD) with filters was significantly greater in patients who developed rubeosis than in those who did not (0.9 vs 03 log units; p=0-012). Using IRP, the pupiliary diameters in the dark (maximum) and in the. light (minimum) were significantly greater, the rate of pupillary constriction was significantly lower, and the latency ofconstriction was significantly greater in affected eyes than in unaffected eyes. The differences between affected and unaffected eyes in the IRP parameters of latency, rate, maximum, and minimum pupillary diameters were significantly greater in patients who developed rubeosis than in those who did not. Discriminant analysis of the IRP parameters correctly and statistically significantly identified rubeotic patients with 83% sensitivity and 95% specificity. An RAPD of .-06 log units was 83% sensitive and 70% specific in this regard. It is concluded that pupillary reactions are abnormal in many patients with acute CRVO, as measured by both pupiliometric methods. The degree of these abnormalities has a relationship to the development of rubeosis, and might prove useful in planning the follow up of these patients or in deciding whether to apply panretinal photocoagulation. The neutral density filter test is readily available but subjective. IRP is more specific, objective, and suited to further development, but requires sophisticated equipment. (BrJ Ophthalmol 1993; 77: 75-80) Bristol Eye Hospital P A Bloom D Papakostopoulos S Papakostopoulos RH B Grey

Automated standardized pupillometry with optical method for purposes of clinical practice and research

“…In 32 central vein occlusion patients aged 48–85, Bloom et al . (1993) reported a latency time for constriction equal to 271 ± 21 ms and an amplitude of maximum miosis equal to 0·58 for the unaffected eye.…”

Intrinsically photosensitive melanopsin retinal ganglion cell contributions to the pupillary light reflex and circadian rhythm

“…The minimum latency is dependent on the temporal dynamics of cones (30 to 40 ms), rods (approximately 150 ms), iris muscle, innervation pathway and processing 7,81,82 . Under a low photopic light level (24.6 cd.m ‐2 ) a pupil constriction of 1.6 to 1.9 mm takes approximately 0.73 seconds 82–84 . Intrinsically photosensitive ganglion cells have a latency of 1.78 to 10 seconds 1,6,7 and therefore, do not have the temporal dynamics to contribute to the initial constriction.…”

“…7,81,82 Under a low photopic light level (24.6 cd.m -2 ) a pupil constriction of 1.6 to 1.9 mm takes approximately 0.73 seconds. [82][83][84] Intrinsically photosensitive ganglion cells have a latency of 1.78 to 10 seconds 1,6,7 and therefore, do not have the temporal dynamics to contribute to the initial constriction. The maximum pupil constriction varies with stimulus intensity, duration, spectral composition, retinal size and location.…”

A simple infrared-augmented digital photography technique for detection of pupillary abnormalities

“…It allows the capture and quantification of subtle pupillary abnormalities indicative of a number of life-threatening disease processes and neurologic diseases [3][4][5][6][7]. Infrared photographs and videos provide visual documentation of these abnormalities and contribute to medical education of students and house staff.…”