Quadrant Field Pupillometry Detects Melanopsin Dysfunction in Glaucoma Suspects and Early Glaucoma

• DOI: 10.1038/srep33373
• Publication Date: 2016-09-13T12:57:30Z
• Authors: Prakash Adhikari; Andrew J. Zele; Ravi Thomas; Beatrix Feigl
• Keywords: Adult; Male; Retinal Ganglion Cells; 610; intrinsically photosensitive Retinal Ganglion cells; Reflex, Pupillary; Article; Retina; pupil light reflex; 03 medical and health sciences; Nerve Fibers; 0302 clinical medicine; 616; Humans; Aged; Aged, 80 and over; Multidisciplinary; Rod Opsins; Glaucoma; Middle Aged; glaucoma; Early Diagnosis; 1000 General; Visual Field Tests; Female; Ocular Hypertension; Visual Fields; melanopsin

AbstractIt is difficult to detect visual function deficits in patients at risk for glaucoma (glaucoma suspects) and at early disease stages with conventional ophthalmic tests such as perimetry. To this end, we introduce a novel quadrant field measure of the melanopsin retinal ganglion cell mediated pupil light response corresponding with typical glaucomatous arcuate visual field defects. The melanopsin-mediated post-illumination pupil response (PIPR) was measured in 46 patients with different stages of glaucoma including glaucoma suspects and compared to a healthy group of 21 participants with no disease. We demonstrate that the superonasal quadrant PIPR differentiated glaucoma suspects and early glaucoma patients from controls with fair (AUC = 0.74) and excellent (AUC = 0.94) diagnostic accuracy, respectively. The superonasal PIPR provides a linear functional correlate of structural retinal nerve fibre thinning in glaucoma suspects and early glaucoma patients. This first report that quadrant PIPR stimulation detects melanopsin dysfunction in patients with early glaucoma and at pre-perimetric stages may have future implications in treatment decisions of glaucoma suspects.