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Disproportionate pupillary involvement in diabetic autonomic neuropathy

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Abstract

Objective

To study the degree of pupillary impairment in diabetic and non-diabetic autonomic neuropathy.

Methods

We retrospectively sampled from all patients who underwent comprehensive autonomic testing and infrared pupillometry at UT Southwestern Medical Center. Composite autonomic severity score (CASS) and pupillary indices from the average of at least three pupillary response curves were recorded. We randomly matched patients with diabetic autonomic neuropathy (DAN) and patients with autonomic impairment unrelated to diabetes (non-DAN) based on gender, age (±5 years), and CASS (±1 point). We used the paired t test to analyze differences between the groups.

Results

We identified 40 patients with DAN and 40 matched controls with non-DAN. M:F ratio was 1:1. Mean CASS was 4.2 and mean age was 62.4 years. Six had type I and the rest had type II diabetes mellitus. Both absolute constriction amplitude (ACA) and maximum constriction velocity (MCV) were significantly lower in DAN compared to non-DAN; mean ACA was 0.9 mm vs. 1.17 mm (p = 0.0077) and mean MCV was 2.8 vs. 3.6 mm/s (p = 0.0039). Severely diminished MCV for age was noted in 48 % of diabetic and in only 28 % of non-DAN patients. The ACA-corrected time to 75 % re-dilation was significantly delayed in DAN vs. non-DAN [mean 3.2 vs. 1.7 s/mm (p = 0.025)]. A statistically significant decline was noted for both the MCV and ACA with higher cardiovagal subscores among DAN patients.

Conclusions

Parasympathetic and sympathetic pupillary dysfunction appears to be a common feature of autonomic impairment in diabetes compared to non-diabetic causes of autonomic impairment.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study was approved by the local institutional review board.

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Authors and Affiliations

  1. Department of Neurology and Neurotherapeutics, U.T. Southwestern Medical Center, Dallas, Texas

    Doyle Yuan, Elaine B. Spaeth & Steven Vernino

  2. Department of Neurology and Neurological Sciences, Stanford Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5235, USA

    Srikanth Muppidi

Authors
  1. Doyle Yuan
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  2. Elaine B. Spaeth
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  3. Steven Vernino
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  4. Srikanth Muppidi
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Corresponding author

Correspondence to Srikanth Muppidi.

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Yuan, D., Spaeth, E.B., Vernino, S. et al. Disproportionate pupillary involvement in diabetic autonomic neuropathy. Clin Auton Res 24, 305–309 (2014). https://doi.org/10.1007/s10286-014-0258-6

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  • DOI: https://doi.org/10.1007/s10286-014-0258-6

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