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Glaucoma
Handheld chromatic pupillometry can reliably detect functional glaucomatous damage in eyes with high myopia
  1. Maxwell Toan Finkelstein1,
  2. Monisha Esther Nongpiur2,3,4,
  3. Rahat Husain2,3,4,
  4. Shamira Perera2,3,4,
  5. Mani Baskaran2,3,
  6. Tina T Wong2,3,4,5,
  7. Tin Aung2,3,4,
  8. Dan Milea1,4,6,
  9. Raymond P Najjar1,4,7,8,9
  1. 1 Visual Neurosciences, Singapore Eye Research Institute, Singapore
  2. 2 Glaucoma, Singapore Eye Research Institute, Singapore
  3. 3 Glaucoma, Singapore National Eye Centre, Singapore
  4. 4 Ophthalmology & Visual Sciences, Duke-NUS Medical School, Singapore
  5. 5 Ocular Therapeutics & Drug Delivery, Singapore Eye Research Institute, Singapore
  6. 6 Neuro-ophthalmology, Singapore National Eye Centre, Singapore
  7. 7 Ophthalmology, National University of Singapore, Singapore
  8. 8 Biomedical Engineering, National University of Singapore, Singapore
  9. 9 Center for Innovation & Precision Eye Health, National University of Singapore, Singapore
  1. Correspondence to Dr Raymond P Najjar, Ophthalmology, National University of Singapore, Singapore, Singapore; rpnajjar{at}nus.edu.sg

Abstract

Background/aims To assess pupillary light responses (PLRs) in eyes with high myopia (HM) and evaluate the ability of handheld chromatic pupillometry (HCP) to identify glaucomatous functional loss in eyes with HM.

Methods This prospective, cross-sectional study included 28 emmetropes (EM), 24 high myopes without glaucoma (HM) and 17 high myopes with confirmed glaucoma (HMG), recruited at the Singapore National Eye Center. Monocular PLRs were evaluated using a custom-built handheld pupillometer that recorded changes in horizontal pupil radius in response to 9 s of exponentially increasing blue (469.1 nm) and red (640.1 nm) lights. Fifteen pupillometric features were compared between groups. A logistic regression model (LRM) was used to distinguish HMG eyes from non-glaucomatous eyes (EM and HM).

Results All pupillometric features were similar between EM and HM groups. Phasic constriction to blue (p<0.001) and red (p=0.006) lights, and maximum constriction to blue light (p<0.001) were reduced in HMG compared with EM and HM. Pupillometric features of melanopsin function (postillumination pupillary response, PIPR area under the curve (AUC) 0–12 s (p<0.001) and PIPR 6 s (p=0.01) to blue light) were reduced in HMG. Using only three pupillometric features, the LRM could classify glaucomatous from non-glaucomatous eyes with an AUC of 0.89 (95% CI 0.77 to 1.00), sensitivity 94.1% (95% CI 82.4% to 100.0%) and specificity 78.8% (95% CI 67.3% to 90.4%).

Conclusion PLRs to ramping-up light stimuli are unaltered in highly myopic eyes without other diagnosed ocular conditions. Conversely, HCP can distinguish glaucomatous functional loss in eyes with HM and can be a useful tool to detect/confirm the presence of glaucoma in patients with HM.

  • Glaucoma
  • Pupil
  • Diagnostic tests/Investigation
  • Optic Nerve

Data availability statement

RPN had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.1136/bjo-2023-323878

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    Data availability statement

    RPN had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis.

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    Footnotes

    • X @Ray_Najjar

    • Contributors Concept and design: MEN, DM and RPN. Data acquisition and research execution: MTF, MEN, RH, SP, MB, TTW, TA, DM and RPN. Analysis and interpretation: MTF, MEN, TA, DM and RPN. Manuscript preparation: MTF, MEN, RH, SP, MB, TTW, TA, DM and RPN.

      RPN accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work was supported by the National Medical Research Council, Singapore (NMRC/CIRG/1401/2014) and the National Health Innovation Centre Singapore (NHIC-l2D-170818l) to DM, and the Singhealth Duke-NUS Academic Medicine Research Grant (AM/TP018/2018) and the ASPIRE-NUS startup grant (NUHSRO/2022/038/Startup/08) to RPN.

    • Disclaimer The funding organisations had no role in the design and conduct of the research.

    • Competing interests RPN, DM and TA have a patent application based on the handheld pupillometer used in this study (PCT/SG2018/050204): Handheld ophthalmic and neurological screening device. The rest of the authors have no conflicts of interest to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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