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.
- 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.
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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.
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