Detecting autonomic dysfunction in patients with glaucoma using dynamic pupillometry.

Published on Mar 1, 2019in Medicine1.889
· DOI :10.1097/MD.0000000000014658
Hae-Young Lopilly Park30
Estimated H-index: 30
,
Suk Hoon Jung2
Estimated H-index: 2
+ 1 AuthorsChan Kee Park28
Estimated H-index: 28
Sources
Abstract
: Autonomic dysfunction is a feature of glaucoma patients, which are reported to be related to glaucoma progression. We investigated pupil responses to a light flash using dynamic pupillometry in glaucoma patients to assess autonomic nervous system status. In total, 97 glaucoma patients, including 21 eyes of 21 glaucoma patients with cardiac autonomic dysfunction, were enrolled. Pupil reactions were assessed using 1 flash of white light after 2 minutes of dark adaptation and recorded using dynamic pupillometry. Changes in the radius of the pupil were evaluated as a function of several time-dependent and pupil/iris (P/I) diameter ratio parameters. Autonomic function was assessed using a cardiac heart-rate-variability test which performs 5 autonomic function tests and classifies patients with cardiac autonomic neuropathy (CAN). Comparison of pupil parameters between eyes with and without disc hemorrhage indicated larger P/I ratios in darkness, greater changes in the P/I ratio during examination, shorter latency to plateau, and shorter duration of constriction in eyes with disc hemorrhages. A comparison of pupil parameters between eyes with and without CAN showed larger P/I ratios in darkness, larger P/I ratios at maximum constriction, and prolonged latency to maximum constriction. The presence of CAN was significantly related to the P/I ratio in darkness and the latency of maximum constriction. Using dynamic pupillometry, we found that glaucoma patients with CAN dysfunction have larger baseline pupils in darkness and different constriction responses to light. Assessing the pupils might be a good method of identifying patients with autonomic dysfunction.
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#2Jin Young Lee (Asan Medical Center)H-Index: 9
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#2Jin Wook Jeoung (SNU: Seoul National University)H-Index: 29
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Purpose To investigate the rate of progressive visual field (VF) loss and associated factors for structural or functional progression in preperimetric open-angle glaucoma (OAG). Design Longitudinal, observational study. Methods We included 127 eyes of 127 preperimetric OAG patients who were treated with topical medication and followed for more than 5 years. All patients underwent stereo optic disc photography, red-free retinal nerve fiber layer (RNFL) photography, frequency doubling technology p...
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#1Jin A Choi (Catholic University of Korea)H-Index: 15
#2Hae-Young Lopilly Park (Catholic University of Korea)H-Index: 30
Last. Chan Kee Park (Catholic University of Korea)H-Index: 28
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PURPOSE. To explore differences in optic disc tilt and torsion between normal control and glaucoma subjects, and to determine whether the direction of optic disc tilt is consistent with the initial location of glaucomatous visual field (VF) defect. METHODS. Glaucoma patients with isolated superior or inferior hemifield loss (n ¼ 136) and normal controls (n ¼ 99) were analyzed. Disc ovality index and torsion degree were measured on retinal photographs. Imaging of optic disc was obtained using Hei...
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#1Hae-Young Lopilly Park (Catholic University of Korea)H-Index: 30
#2Sung-Hwan Park (Catholic University of Korea)H-Index: 5
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RESULTS. The baseline VF showed similar stages of glaucoma damage between the lowest and highest heart-rate variability groups. The mean global rate of VF changes was similar between the two groups. Only the rate of VF changes in the central and superior central regions were significantly different between the lowest heart-rate variability group (� 1.16 dB/year in the central region and � 1.48 dB/year in the superior central region) and highest heart-rate variability group (� 0.52 dB/year in the...
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Purpose:To assess the relative afferent pupillary defect (RAPD) by swinging flashlight as a potentially useful screening test for glaucomatous optic neuropathy.Methods:One hundred seven subjects prospectively recruited from a mixed population of glaucomatous and nonglaucomatous patients were examine
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The aim of this study was to evaluate pupillary response to light stimulation in patients with different stages of glaucoma using computerized pupillometry. We conducted a retrospective study on a group of 44 glaucoma patients who had undergone complete ophthalmological examination, visual field test (Humphrey SITA Standard 24-2) and monocular dynamic pupillometry (MonCV3 Metrovision). Eyes were classified into stages of glaucoma according to visual field damage using the Glaucoma Staging System...
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Last. David S. Friedman (Johns Hopkins University)H-Index: 94
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Objective To assess the accuracy of using pupillary light reflex (PLR) in detecting glaucoma. Clinical Relevance Glaucoma is a specific disease of the optic nerve and is often more severe in 1 eye. When large enough, this asymmetry in disease severity can cause a relative afferent pupillary defect (RAPD). Better detection of RAPDs may be one way to identify persons with glaucoma. Methods We searched Medline and Embase through June 2012 and searched bibliographies for relevant studies for additio...
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#1Na Young Lee (Catholic University of Korea)H-Index: 6
#2Hae-Young Lopilly Park (Catholic University of Korea)H-Index: 30
Last. Chan Kee Park (Catholic University of Korea)H-Index: 28
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AbstractPurpose: To investigate the association between heart rate variability (HRV) and the plasma level of endothelin-1 (ET-1) in normal-tension glaucoma (NTG).Materials and methods: Twenty-four patients with NTG were enrolled. Subjects with systemic diseases were excluded. All patients underwent a complete ophthalmic examination and were referred to the rheumatology department, where HRV assessment was performed. Patients were divided into two groups according to the standard deviation of nor...
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Aims To define parameters of autonomic nervous system activity in patients with normal tension glaucoma (NTG). Methods Ambulatory 24-h ECG (Lifecard CF) and 24-h blood pressure (BP) monitoring (SpaceLab 90207-30) were carried out in 54 patients with NTG (44 women, mean age 59.7) and 43 matched control subjects (34 women, mean age 57.0). Heart rate variability time and frequency domain parameters (low frequency (LF), high frequency (HF) and LF/HF ratio), BP variability (BPV), diurnal and nocturna...
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Akt is a serine-threonine kinase that is amplified in a variety of human cancers, and as with other anticancer agents, some Akt inhibitors have produced functional cardiovascular effects such as marked hypotension that may limit their clinical benefit. Although identified in preclinical studies, the mechanism(s) responsible for these effects are often not fully characterized; potential targets include Akt signaling disruption in cardiac tissue, vascular smooth muscle, and/or autonomic system sig...
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This study aimed to investigate changes in Schlemm’s canal, intraocular pressure and ocular blood circulation following the activation of the sympathetic nervous system. Twenty healthy volunteers were enrolled in this study. The cold pressor test (CPT) was adopted. Cross-sectional area of Schlemm’s canal (SCAR), superficial and deep retinal vessel densities (s-RVD;d-RVD), pupil diameter (PD), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and heart rate variability (HRV) were ...
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Purpose of Review The purpose of this review is to examine the impact of pupillometer assessment on care and research of patients with neurological injury.
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