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Pupillary responses driven by ipRGCs and classical photoreceptors are impaired in glaucoma

  • Neurophthalmology
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

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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Acknowledgments

We thank Dr. Anne Kurtenbach for her help with the manuscript.

Author information

Authors and Affiliations

  1. Pupil Research Group at the Centre for Ophthalmology, University of Tuebingen, Schleichstraße 12, 72076, Tuebingen, Germany

    Carina Kelbsch, Fumiatsu Maeda, Torsten Strasser, Barbara Wilhelm, Helmut Wilhelm & Tobias Peters

  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 Tuebingen, Tuebingen, Germany

    Torsten Strasser

  4. Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany

    Gunnar Blumenstock

Authors
  1. Carina Kelbsch
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  2. Fumiatsu Maeda
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  3. Torsten Strasser
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  4. Gunnar Blumenstock
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  5. Barbara Wilhelm
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  6. Helmut Wilhelm
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  7. Tobias Peters
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Corresponding author

Correspondence to Carina Kelbsch.

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Funding

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.

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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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

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