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Chromatic pupillography in hemianopia patients with homonymous visual field defects

  • Neurophthalmology
  • Published:
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Abstract

Purpose

The pupil light reflex is considered to be a simple subcortical reflex. However, many studies have proven that patients with isolated occipital lesions with homonymous hemianopia show pupillary hemihypokinesia. Our hypothesis is that the afferent pupillary system consists of two pathways: one via intrinsically photosensitive retinal ganglion cells (ipRGCs), the other running through the normal RGCs via the visual cortex. The purpose of this study was to test the hypothesis of these two separate pupillomotor pathways.

Methods

12 patients (59.1 ± 18.8 years) with homonymous hemianopia due to post-geniculate lesions of the visual pathway and 20 normal controls (58.6 ± 12.9 years) were examined using chromatic pupillography: stimulus intensity was 28 lx corneal illumination, stimulus duration was 4.0 s, and the stimulus wavelengths were 420 ± 20 nm (blue) and 605 ± 20 nm (red), respectively. The examined parameters were baseline pupil diameter, latency, and relative amplitudes (absolute amplitudes compared to baseline), measured at maximal constriction, at 3 s after stimulus onset, at stimulus offset, and at 3 s and 7 s after stimulus offset.

Results

The relative amplitudes for the red stimulus were significantly smaller for hemianopia patients compared to the normal controls [maximal constriction: 35.6 ± 5.9% (hemianopia) to 42.3 ± 5.7% (normal); p = 0.004; 3 s after stimulus onset: p = 0.004; stimulus offset: p = 0.001]. No significant differences in any parameter were found between the two groups using the blue stimulus.

Conclusions

The results support the hypothesis that the ipRGC pathway is mainly subcortical, whereas a second, non-ipRGC pathway via the occipital cortex exists.

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Acknowledgements

We thank Ms. Margaret Clouse for her help with the manuscript.

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Authors and Affiliations

  1. Pupil Research Group, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany

    Fumiatsu Maeda, Carina Kelbsch, Torsten Straßer, Karolína Skorkovská, Tobias Peters, Barbara Wilhelm & Helmut Wilhelm

  2. Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan

    Fumiatsu Maeda

  3. Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany

    Torsten Straßer

  4. Department of Optometry and Orthoptics, Masaryk University, Brno, Czech Republic

    Karolína Skorkovská

Authors
  1. Fumiatsu Maeda
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  2. Carina Kelbsch
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  3. Torsten Straßer
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  4. Karolína Skorkovská
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  5. Tobias Peters
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  6. Barbara Wilhelm
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  7. Helmut Wilhelm
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Correspondence to Helmut Wilhelm.

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Funding

The Egon Schumacher-Stiftung, Germany, a private foundation without commercial interest, provided financial support in the form of labor and material costs funding. The sponsor had no role in the design or conduct of this research.

Conflict of interest

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.

Ethical approval

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.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Maeda, F., Kelbsch, C., Straßer, T. et al. Chromatic pupillography in hemianopia patients with homonymous visual field defects. Graefes Arch Clin Exp Ophthalmol 255, 1837–1842 (2017). https://doi.org/10.1007/s00417-017-3721-y

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  • DOI: https://doi.org/10.1007/s00417-017-3721-y

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