Skip to main content

Pupillary light response after cataract surgery in healthy patients

Abstract

Purpose

To examine the changes in the pupillary light response after phacoemulsification and to compare the difference in the response among patients in different age categories.

Study design

Prospective observational study.

Methods

Four-hundred twenty-two eyes of 422 patients in 3 age categories (60-69 years, 70-79 years, and 80-89 years) scheduled for phacoemulsification were consecutively enrolled. The eyes underwent examinations with an infrared pupillometer to obtain the parameters of the pupillary light response preoperatively and at 1 day and 1 and 3 months postoperatively. Differences in the parameters of the pupillary response were compared among 4 time intervals and the 3 age categories.

Results

The mean maximum and minimum pupillary diameters significantly decreased at 1 day postoperatively and returned to the preoperative level by 1 month postoperatively (P<.0001). The mean percentage of pupillary constriction was significantly reduced at 1 and 3 months postoperatively compared with preoperatively and at 1 day postoperatively (P<.0001). The average pupillary constriction and dilation velocities were significantly lower at 1 and 3 months postoperatively than they were preoperatively and at 1 day postoperatively (P<.0001). The latency to constriction did not differ significantly among the time intervals. The percentage of pupillary constriction was significantly smaller, and the average constriction and dilation velocities were lower in association with higher age categories at all time intervals (P≤.0185).

Conclusion

The pupillary light response was impaired several months after cataract surgery and worsened with increasing patient age, indicating that cataract surgery may compromise the pupillary constriction and dilation functions in association with age.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Shindler KS, Revere K, Dutt M, Ying GS, Chung DC. In vivo detection of experimental optic neuritis by pupillometry. Exp Eye Res. 2012;100:1–6.

    CAS  Article  Google Scholar 

  2. 2.

    Chang DS, Arora KS, Boland MV, Supakontanasan W, Friedman DS. Development and validation of an associative model for the detection of glaucoma using pupillography. Am J Ophthalmol. 2013;156:1285–96.

    Article  Google Scholar 

  3. 3.

    Maynard ML, Zele AJ, Feigl B. Melanopsin-mediated post-illumination pupil response in early age-related macular degeneration. Invest Ophthalmol Vis Sci. 2015;56:6906–13.

    CAS  Article  Google Scholar 

  4. 4.

    Kardon R, Anderson SC, Damarjian TG, Grace EM, Stone E, Kawasaki A. Chromatic pupillometry in patients with retinitis pigmentosa. Ophthalmology. 2011;118:376–81.

    Article  Google Scholar 

  5. 5.

    Feigl B, Zele AJ, Fader SM, Howes AN, Hughes CE, Jones KA, et al. The post-illumination pupil response of melanopsin-expressing intrinsically photosensitive retinal ganglion cells in diabetes. Acta Ophthalmol. 2012;90:e230–4.

    Article  Google Scholar 

  6. 6.

    Van Stavern GP, Bei L, Shui YB, Huecker J, Gordon M. Pupillary light reaction in preclinical Alzheimer’s disease subjects compared with normal ageing controls. Br J Ophthalmol. 2019;103:971–5.

    Article  Google Scholar 

  7. 7.

    Oh AJ, Amore G, Sultan W, Asanad S, Park JC, Romagnoli M, et al. Pupillometry evaluation of melanopsin retinal ganglion cell function and sleep-wake activity in pre-symptomatic Alzheimer’s disease. PLoS ONE. 2019;14:e0226197.

    CAS  Article  Google Scholar 

  8. 8.

    Batawi H, Micieli JA. Adie’s tonic pupil presenting with unilateral photophobia successfully treated with dilute pilocarpine. BMJ Case Rep. 2020;13:e233136.

    Article  Google Scholar 

  9. 9.

    Gross JR, McClelland CM, Lee MS. An approach to anisocoria. Curr Opin Ophthalmol. 2016;27:486–92.

    Article  Google Scholar 

  10. 10.

    Zhao F, Han T, Chen X, Chen Z, Zheng K, Wang X, et al. Minimum pupil in pupillary response to light and myopia affect disk halo size: a cross-sectional study. BMJ Open. 2018;8:e019914.

    Article  Google Scholar 

  11. 11.

    Al-Hashimi S, Donaldson K, Davidson R, Dhaliwal D, Jackson M, Kieval JZ, et al. Medical and surgical management of the small pupil during cataract surgery. J Cataract Refract Surg. 2018;44:1032–41.

    Article  Google Scholar 

  12. 12.

    Kershner RM. Management of the small pupil for clear corneal cataract surgery. J Cataract Refract Surg. 2002;28:1826–31.

    Article  Google Scholar 

  13. 13.

    Duffin RM, Pettit TH, Straatsma BR. Maintenance of mydriasis with epinephrine during cataract surgery. Ophthalmic Surg. 1983;14:41–5.

    CAS  PubMed  Google Scholar 

  14. 14.

    Hayashi K, Hayashi H. Pupil size before and after phacoemulsification in nondiabetic and diabetic patients. J Cataract Refract Surg. 2004;30:2543–50.

    Article  Google Scholar 

  15. 15.

    Peters DR, Tychsen L. Recovery of pupillomotor function after cataract surgery. Aviat Space Environ Med. 1989;60:586–8.

    CAS  PubMed  Google Scholar 

  16. 16.

    Komatsu M, Oono S, Shimizu K. The effects of phaco-emulsification-aspiration and intra-ocular lens implantation on the pupil: pupillographic and pharmacologic study. Ophthalmologica. 1997;211:332–7.

    CAS  Article  Google Scholar 

  17. 17.

    Bitsios P, Prettyman R, Szabadi E. Changes in autonomic function with age: a study of pupillary kinetics in healthy young and old people. Age Ageing. 1996;25:432–8.

    CAS  Article  Google Scholar 

  18. 18.

    Kasthurirangan S, Glasser A. Age related changes in the characteristics of the near pupil response. Vision Res. 2006;46:1393–403.

    Article  Google Scholar 

  19. 19.

    Herbst K, Sander B, Lund-Andersen H, Broendsted AE, Kessel L, Hansen MS, et al. Intrinsically photosensitive retinal ganglion cell function in relation to age: a pupillometric study in humans with special reference to the age-related optic properties of the lens. BMC Ophthalmol. 2012;12:4.

    Article  Google Scholar 

  20. 20.

    Adhikari P, Pearson CA, Anderson AM, Zele AJ, Feigl B. Effect of age and refractive error on the melanopsin mediated post-illumination pupil response (PIPR). Sci Rep. 2015;5:17610.

    CAS  Article  Google Scholar 

  21. 21.

    Bremner FD. Pupillometric evaluation of the dynamics of the pupillary response to a brief light stimulus in healthy subjects. Invest Ophthalmol Vis Sci. 2012;53:7343–7.

    Article  Google Scholar 

  22. 22.

    Asakawa K, Nanno M, Ishikawa H, Shoji N. Evaluation of pupil fields using a newly developed head-mounted perimeter in healthy subjects. J Glaucoma. 2018;27:807–15.

    Article  Google Scholar 

  23. 23.

    Hayashi K, Yoshida M, Hirata A, Yoshimura K. Changes in shape and astigmatism of total, anterior, and posterior cornea after long versus short clear corneal incision cataract surgery. J Cataract Refract Surg. 2018;44:39–49.

    Article  Google Scholar 

  24. 24.

    Asakawa K, Ishikawa H. Reproducibility and normative values of the parameters of a new hand-held digital pupillometer. J Clin Exp Ophthalmol. 2017;8:1000654.

    Article  Google Scholar 

  25. 25.

    Zhao W, Stutzman S, DaiWai O, Saju C, Wilson M, Aiyagari V. Inter-device reliability of the NPi-100 pupillometer. J Clin Neurosci. 2016;33:79–82.

    Article  Google Scholar 

  26. 26.

    Perkins ES. Influence of the fifth cranial nerve on the intra-ocular pressure of the rabbit eye. Br J Ophthalmol. 1957;41:257–300.

    CAS  Article  Google Scholar 

  27. 27.

    Kottow MH, Seligman LJ. Consensual reactions to anterior chamber paracentesis in the rabbit. Am J Ophthalmol. 1978;85:392–9.

    CAS  Article  Google Scholar 

  28. 28.

    Araie M, Sawa M, Takase M. Effect of topical indomethacin on the blood-aqueous barrier after intracapsular extraction of senile cataract: a fluorophotometric study. Jpn J Ophthalmol. 1981;25:237–47.

    Google Scholar 

  29. 29.

    Asakawa K, Ito A, Kobayashi H, Iwai A, Ito C, Ishikawa H. Adaptation time, electroretinography, and pupillography in healthy subjects. Doc Ophthalmol. 2019;139:33–44.

    Article  Google Scholar 

  30. 30.

    de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Sys Rev. 2016;12:CD003169.

    Google Scholar 

  31. 31.

    Kamiya K, Hayashi K, Shimizu K, Negishi K, Sato M, Bissen-Miyajima H, et al. Multifocal intraocular lens explantation: a case series of 50 eyes. Am J Ophthalmol. 2014;158:215–20.

    Article  Google Scholar 

  32. 32.

    Puell MC, Pérez-Carrasco MJ, Hurtado-Ceña FJ, Álvarez-Rementería L. Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses. J Cataract Refract Surg. 2015;41:2417–23.

    CAS  Article  Google Scholar 

  33. 33.

    LoBue SA, Mano F, Schaefer E, LoBue TD. Unilateral multifocal intraocular lens implantation in a patient with Adie’s pupil. Case Rep Ophthalmol. 2018;9:369–74.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Koji Yonemoto, PhD (Ryukyu University, Naha, Japan), for statistical assistance.

Funding

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ken Hayashi.

Ethics declarations

Conflict of interest

K. Hayashi, None; M. Yoshida, None; S. Ishiyama, None; A. Hirata, None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Ken Hayashi.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hayashi, K., Yoshida, M., Ishiyama, S. et al. Pupillary light response after cataract surgery in healthy patients. Jpn J Ophthalmol 65, 616–623 (2021). https://doi.org/10.1007/s10384-021-00837-5

Download citation

Keywords

  • Pupillary light response
  • Pupillary diameter
  • Cataract surgery
  • Age