Abstract
The goal of this study was to determine the extent of rod-, cone-, and melanopsin-mediated pupillary light reflex (PLR) abnormalities in diabetic patients who have non-proliferative diabetic retinopathy (NPDR). Fifty diabetic subjects who have different stages of NPDR and 25 age-equivalent, non-diabetic controls participated. PLRs were measured in response to full-field, brief-flash stimuli under conditions that target the rod, cone, and intrinsically-photosensitive (melanopsin) retinal ganglion cell pathways. Pupil responses were compared among the subjects groups using age-corrected linear mixed models. Compared to control, the mean baseline pupil diameters were significantly smaller for all patient groups in the dark (all p < 0.001) and for the moderate-severe NPDR group in the light (p = 0.003). Pairwise comparisons indicated: (1) the mean melanopsin-mediated PLR was significantly reduced in the mild and moderate-severe groups (both p < 0.001); (2) the mean cone-mediated PLR was reduced significantly in the moderate-severe group (p = 0.008); (3) no significant differences in the mean rod-mediated responses. The data indicate abnormalities in NPDR patients under conditions that separately assess pupil function driven by different photoreceptor classes. The results provide evidence for compromised neural function in these patients and provide a promising approach for quantifying their neural abnormalities.
Highlights
IntroductionPrevious studies have focused primarily on the melanopsin-mediated response (often referred to as the post-illumination pupil response; “PIPR”) and pupillary responses have not been reported under rod- and cone-mediated conditions in diabetic patients
13 M 12 F transient constrictions[15,26,27,28]
The purpose of this study was to determine the effects of diabetic retinopathy on the pupil response measured under conditions designed to target selectively the rod, cone, and melanopsin pathways
Summary
Previous studies have focused primarily on the melanopsin-mediated response (often referred to as the post-illumination pupil response; “PIPR”) and pupillary responses have not been reported under rod- and cone-mediated conditions in diabetic patients. These measurements would be of value given the reports of potential inner-retina[29,30,31] and outer-retina[32,33] neural abnormalities in these individuals. An established protocol[15,24,34] was used to evaluate rod-, cone-, and melanopsin-mediated pupil responses in diabetic patients who have different stages of non-proliferative DR (NPDR). The pupil measurements were compared to patient characteristics such as HbA1C percentage, diabetes duration, age, and sex
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