Handheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma

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.

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, Handheld chromatic pupillometry yielded an area under the ROC curve (AUC) of 0.94, a sensitivity of 87.9% and specificity of 88.4%.

The classification performance of HCP in early-moderate glaucoma was similar to HVF (AUC=0.91) and reduced compared with optical coherence tomography (OCT).

For severe glaucoma (VFMD ≤ -12 dB), Handheld chromatic pupillometry had an excellent classification performance that was similar to HVF and optical coherence tomography (OCT).

Handheld chromatic pupillometry allows for an accurate, objective and rapid detection of functional loss in glaucomatous eyes of different severities.

Reference:

Najjar RP, Rukmini AV, Finkelstein MT, et alHandheld chromatic pupillometry can accurately and rapidly reveal functional loss in glaucoma, British Journal of Ophthalmology 2023;107:663-670.

Keywords:

Handheld, chromatic pupillometry, accurately, rapidly, reveal, functional, loss, glaucoma, British Journal of Ophthalmology, Najjar RP, Rukmini AV, Finkelstein MT