Pupillary Abnormalities with Varying Severity of Diabetic Retinopathy

Mukesh Jain,Gayathri Swaminathan,Rajiv Raman,Sandeep Devan,Durgasri Jaisankar,Shahina Pardhan

doi:10.1038/s41598-018-24015-9

Abstract

Our aim is to study the dynamics of pupillary abnormalities in varying severity of diabetic retinopathy. A non-interventional case-control study with 405 eyes of 244 subjects with diabetes, and 41 eyes of 26 subjects with no history of diabetes was done. Diabetes group was classified according to retinopathy severity: no retinopathy, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR). After dark adaptation, pupil size and flashlight response were captured with an infrared camera. Baseline Pupil Diameter (BPD), Amplitude of Pupillary Constriction (APC), Velocity of Pupillary Constriction (VPC) and Velocity of Pupillary Dilatation (VPD). Compared to controls, mean BPD decreased with increasing severity of diabetic retinopathy. Mean APC in control group was 1.73 ± 0.37 mm and reduced in mild NPDR (1.57 ± 0.39, p = 1.000), moderate NPDR (1.51 ± 0.44, p = 0.152) and found to be significant reduced in severe NPDR (1.43 ± 0.48, p = 0.001) and PDR (1.29 ± 0.43, p = 0.008). Compared to controls, mean VPC decreased progressively with increasing severity of retinopathy, with a maximal difference in the PDR group. Mean VPD as compared to the control group was significantly reduced in the no DR (p = 0.03), mild NPDR (p = 0.038), moderate NPDR (p = 0.05), PDR group (p = 0.02). We found pupillary dynamics are abnormal in early stages of diabetic retinopathy and progress with increasing retinopathy severity.

Highlights

Conventional diagnostic modality for assessing DAN include a battery of tests needing sophisticated and specific equipment, trained technicians and are time-consuming[2]
We found that alteration of pupillary dynamics even in early stages of diabetic retinopathy which progresses with increase in severity
Compared to the control group, the mean Baseline Pupil Diameter (BPD) decreased with increasing severity of diabetic retinopathy, with a demonstrable trend towards significance (p = 0.06 in proliferative diabetic retinopathy (PDR) group; Fig. 2)

Summary

Introduction

Conventional diagnostic modality for assessing DAN include a battery of tests needing sophisticated and specific equipment, trained technicians and are time-consuming[2]. These tests require active patient participation and compliance which limits its use in common clinical practice. There are many studies that showed abnormal pupillary dynamics in diabetes, suggestive of autonomic dysfunction, its relation to the varying severity of diabetic retinopathy (DR) has not been explored extensively[4,6,7,8,9,10]. Clark studied ocular autonomic dysfunction in 28 diabetic subjects with proliferative diabetic retinopathy[11]. The entire spectrum of DR: no DR, mild NPDR, moderate NPDR, severe NPDR and PDR, and compare it age matched normals

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Conclusion