Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma.
Najjar Raymond P, Rukmini A V, Finkelstein Maxwell T, Nusinovici Simon, Mani Baskaran, Nongpiur Monisha Esther, Perera Shamira, Husain Rahat, Aung Tin, Milea Dan
AI Summary
Handheld chromatic pupillometry accurately and rapidly detects functional loss in glaucoma across all severities, offering a promising objective screening and diagnostic tool.
Abstract
Background/aims: Early detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.
Methods
In this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years) with confirmed glaucoma and 173 healthy controls (55.2 (26.7) years). Changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli were assessed monocularly using a custom-built handheld pupillometer. Pupillometric features were extracted from individual traces and compared between groups. Features with the highest classification potential, selected using a gradient boosting machine technique, were incorporated into a generalised linear model for glaucoma classification. Receiver operating characteristic curve analyses (ROC) were used to compare the performance of HCP, optical coherence tomography (OCT) and Humphrey Visual Field (HVF).
Results
Pupillary light responses were altered in glaucoma compared with controls. For glaucoma classification, HCP yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9% and specificity of 88.4%. The classification performance of HCP in early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB; AUC=0.91 (95% CI 0.87 to 0.95)) was similar to HVF (AUC=0.91) and reduced compared with OCT (AUC=0.97; p=0.01). For severe glaucoma (VFMD ≤ -12 dB), HCP had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to HVF and OCT.
Conclusion
HCP allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.
MeSH Terms
Shields Classification
Key Concepts5
Handheld chromatic pupillometry (HCP) yielded an area under the ROC curve (AUC) of 0.94 (95% CI 0.91 to 0.96), a sensitivity of 87.9%, and a specificity of 88.4% for glaucoma classification.
For early-moderate glaucoma (visual field mean deviation (VFMD) > -12 dB), the classification performance of handheld chromatic pupillometry (HCP) (AUC=0.91 (95% CI 0.87 to 0.95)) was similar to Humphrey Visual Field (HVF) (AUC=0.91) and reduced compared with optical coherence tomography (OCT) (AUC=0.97; p=0.01).
For severe glaucoma (visual field mean deviation (VFMD) ≤ -12 dB), handheld chromatic pupillometry (HCP) had an excellent classification performance (AUC=0.98, 95% CI 0.97 to 1) that was similar to Humphrey Visual Field (HVF) and optical coherence tomography (OCT).
Pupillary light responses were altered in glaucoma compared with controls, assessed monocularly using a custom-built handheld pupillometer in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli.
A custom-built handheld pupillometer was used to assess changes in pupil size in response to 9 s of exponentially increasing blue (469 nm) and red (640 nm) light-stimuli monocularly in a clinic-based, prospective study.
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