Abstract
Purpose
The aim was to investigate the involvement of intrinsically photosensitive retinal ganglion cells (ipRGCs) in patients with manifest glaucoma and ocular hypertension (OH) using specific parameters of the pupil light reflex to chromatic stimuli.
Methods
Twenty-five patients with manifest glaucoma, 16 patients with OH and 16 healthy control subjects were stimulated with 28 lx red (605 nm) or blue (420 nm) light with a duration of either 1 s or 4 s. The consensual pupil light reaction was recorded by means of infrared pupillometry. The maximal relative amplitude (MRA), the post-illumination pupil response PIPRblue-red, and the slope of the response during exposure to the 4 s red stimulus (SORRS) were calculated and compared using ANOVA and Tukey-Kramer post-hoc tests. Correlations between pupil parameters and visual field defects were analyzed using Pearson correlation coefficient r.
Results
PIPRblue-red was reduced in glaucoma patients compared to normals (p < 0.001) and OH (p < 0.01). There was no significant difference between OH and normals. Glaucoma patients showed additionally reduced MRA for red and blue light (p < 0.05) and a pupillary escape during exposure to red light (increased SORRS, p < 0.0005). This pupillary escape could also be seen in single subjects with OH. Significant correlations between pupil parameters and visual field defects were detected.
Conclusions
The reduced PIPRblue-red indicates a characteristic impairment of the melanopsin-driven pathway of ipRGCs in glaucoma patients, whereas the reduced MRA and increased SORRS suggest a disturbed synaptic function and altered interaction between outer photoreceptors, RGCs, and ipRGCs.
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We thank Dr. Anne Kurtenbach for her help with the manuscript.
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The Egon Schumacher-Stiftung, Germany, a private foundation without commercial interest, provided financial support in the form of labour and material costs funding. The sponsor had no role in the design or conduct of this research.
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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
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All procedures performed in this study were in accordance with the ethical standards of the local institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Kelbsch, C., Maeda, F., Strasser, T. et al. Pupillary responses driven by ipRGCs and classical photoreceptors are impaired in glaucoma. Graefes Arch Clin Exp Ophthalmol 254, 1361–1370 (2016). https://doi.org/10.1007/s00417-016-3351-9
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DOI: https://doi.org/10.1007/s00417-016-3351-9