Evaluating State-of-the-Art Computerized Pupillary Assessments for Glaucoma Detection: A Systematic Review and Meta-Analysis

Abstract

Computerized pupillary light reflex assessment devices (CPLRADs) may serve as an effective screening tool for glaucomatous optic neuropathy, since they can dynamically detect abnormal pupillary responses from a novel sequence of light stimuli and functionally-shaped stimuli. The aim of this study was to systematically evaluate the current state of advanced CPLRADs and accuracy of application in detecting glaucoma. An electronic literature search of PubMed, MEDLINE, and Embase from database inception to December 2019 was performed. Studies that reported data on the use of computer-aided pupillometry with monocular and/or binocular monitoring in glaucoma patients were included. Two review authors independently conducted the study selection and extracted study data. A total of twenty-five studies were included in this review; eight studies with a total of 829 subjects were included in this meta-analysis. Data were pooled using a random-effect model, since the significant heterogeneity ( P < 0.1, I 2 > 50%). Our meta-analysis of eight studies showed reasonably high summary sensitivity and specificity estimates of 0.81 (95% CI 0.73–0.89) and 0.83 (95% CI: 0.75–0.91), respectively. Simpler monochromatic devices, such as Pupilmetrix TM PLR60, generally performed as well as or slightly better than more complex chromatic devices. This review suggests that CPLRADs may facilitate direct clinical decision making for glaucoma diagnosis and evaluation, and may provide a deeper understanding of the pathomechanism of glaucoma.

Computerized biofeedback to characterize Pupil Cycle Time (PCT) in neuropathies and retinopathies

“…Other experimental studies aim at assessing visual loss by analyzing the pupillary response to light stimuli 7 . The underlying rationale is that light stimulation within a damage retinal region will elicit reduced pupillary responses because cells involved in this process are malfunctioning or lacking.…”

Pupillary Response to Chromatic Light Stimuli as a Biomarker at the Early Stage of Glaucoma

“…Based on current research, the idea of studying chromatic pupillary response as a feasible option to recognize in time changes generated by glaucoma through a simple, fast-application method, affordable and easily transportable, allows an expanded diagnostic evaluation of different risk groups [122]. In addition, it is a non-invasive method and does not depend on the high cooperation of the patient or their health condition, achieving more reliable results and overcoming both the barriers generated by the physical and psychological state.…”

Chromatische Pupillometrie – ein neuer Weg zur funktionellen Glaukomdiagnostik?

“…While an attempt has been made to reach a consensus on key points [25], there is still a large degree of variability, and there are no standards that are comparable to the ISCEV standards in electrophysiology. A table of devices used in recent studies on pupillometry in glaucoma is provided in the supplement to the systematic review by Suo et al [26].…”