Correlation Between Pupillary Examination And Glaucoma Injury

Objective:By detecting the pupillary light reflex of patients with primary glaucoma in different stages and normal people of the same age,the differences between the pupil light reflex characteristics of glaucoma and normal people were compared,and the correlation between pupil examination and glaucoma stage,common glaucoma structure and function examination was explored.Methods:During the period of February 2018 to March 2019 in Affiliated Eye Hospital of Nanchang University,34 eyes in 17 patients with primary glaucoma and 14 eyes in 7 healthy individuals were enrolled in this study.All the subjects received comprehensive eye examination,visual field examination and OCT examination.The NIDEK ARK-510 A computer optometry was used to measure the light-adapted pupil diameter and dark-adapted pupil diameter under the same light condition,and the pupil contraction amplitude was calculated.The degree of relative pupillary afferent disorder(RAPD)was examined by Swinging Flashlight Test and the score was quantified.According to the HPA glaucoma staging criteria,glaucoma patients were divided into three subgroups.Independent sample T test was used to compare the differences of pupil light reflex parameters between the glaucoma subgroup and the normal control group.Confidence interval distribution diagram and scatter diagram were drawn to depict the variation trend of each parameter with the change of stage.Finally,Logistic regression analysis was used to evaluate the correlation between pupil light reflex test parameters and glaucoma stage,field of vision and OCT examination.SPSS22.0 statistical software was used for statistical analysis of the data,P < 0.05 was considered statistically significant.Results:1.There were significant differences on the pupillary reflex amplitude and light-adapted pupil diameter between patients with middle、advanced glaucoma and the normal control group.With the aggravation of glaucoma stage,the light-adapted pupil diameter increased and the pupillary reflex amplitude decreased.2.The light-adapted pupil diameter and pupillary reflex amplitude are correlated with the glaucoma 24-2 visual field and optic disc OCT.The light-adapted pupil diameter is negatively correlated with the MD value and the average nerve fiber layer thickness around the optic disc,while the pupillary reflex amplitude is positively correlated with the MD value and the average nerve fiber layer thickness around the optic disc.3.The RAPD score was correlated with the RNFL layer thickness difference between the eyes.Higher RAPD level corresponds the greater difference in the average thickness of the nerve fiber layer.Conclusions:Glaucoma is usually accompanied by changes of pupillary light reflex.Due to many interfering factors and the lack of professional examination equipment,these changes are overlooked in clinical work.In our study,we found the basis for the impaired light reflex of the pupil in glaucoma patients: The light-adapted pupil diameter increased and the pupillary reflex amplitude decreased,and these changes were correlated with the glaucoma stage,visual field and nerve fiber layer damage.The correlation between pupil light reflex and glaucoma injury makes pupil examination a new method to evaluate glaucoma injury.