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How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli

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Title: How lesions at different locations along the visual pathway influence pupillary reactions to chromatic stimuli
Authors: Carina Kelbsch, Krunoslav Stingl, Ronja Jung, Melanie Kempf, Paul Richter, Torsten Strasser, Tobias Peters, Barbara Wilhelm, Helmut Wilhelm, Felix Tonagel
Source: Graefes Arch Clin Exp Ophthalmol
Publisher Information: Springer Science and Business Media LLC, 2021.
Publication Year: 2021
Subject Terms: Neurophthalmology, 0301 basic medicine, 03 medical and health sciences, 0302 clinical medicine, Pupil Disorders, Humans, Visual Field Tests, Pupil, Visual Pathways, Pupillometry, CPC, Visual Field Tests [MeSH], Humans [MeSH], Chromatic pupil campimetry, Reflex, Pupillary/physiology [MeSH], Visual Pathways [MeSH], Chiasm, Pupil Disorders/diagnosis [MeSH], Photic Stimulation [MeSH], Pupil/physiology [MeSH], Visual Fields [MeSH], Visual pathway, Neuro-ophthalmology, Visual Fields, Reflex, Pupillary, Photic Stimulation
Description: Purpose To examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli. Methods Chromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses. Results A statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015). Conclusion Our results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.
Document Type: Article
Other literature type
Language: English
ISSN: 1435-702X
0721-832X
DOI: 10.1007/s00417-021-05513-5
Access URL: https://link.springer.com/content/pdf/10.1007/s00417-021-05513-5.pdf
https://pubmed.ncbi.nlm.nih.gov/34902059
https://repository.publisso.de/resource/frl:6450100
Rights: CC BY
URL: http://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (http://creativecommons.org/licenses/by/4.0/) .
Accession Number: edsair.doi.dedup.....5d1baa427423ba0fb6beab37e20dbdc7
Database: OpenAIRE
Description
Abstract:Purpose To examine systematically how prechiasmal, chiasmal, and postchiasmal lesions along the visual pathway affect the respective pupillary responses to specific local monochromatic stimuli. Methods Chromatic pupil campimetry (CPC) was performed in three patient groups (10 subjects with status after anterior ischemic optic neuropathy, 6 with chiasmal lesions, and 12 with optic tract or occipital lobe lesions (tumor, ischemia)) using red, low-intensity red, and blue local stimuli within the central 30° visual field. Affected areas - as determined by visual field defects revealed using conventional static perimetry - were compared with non-affected areas. Outcome parameters were the relative maximal constriction amplitude (relMCA) and the latency to constriction onset of the pupillary responses. Results A statistically significant relMCA reduction was observed in the affected areas of postchiasmal lesions with red (p = 0.004) and low-intensity red stimulation (p = 0.001). RelMCA reduction in the affected areas seemed more pronounced for low-intensity red stimulation (46.5% mean reduction compared to non-affected areas; 36% for red stimulation), however statistically not significant. In prechiasmal lesions, a statistically significant latency prolongation could be demonstrated in the affected areas with low-intensity red stimulation (p = 0.015). Conclusion Our results indicate that the choice of stimulus characteristics is relevant in detecting defects in the pupillary pathway of impairment along the visual pathway, favoring red stimuli of low intensity over blue stimuli. Such knowledge opens the door for further fundamental research in pupillary pathways and is important for future clinical application of pupillography in neuro-ophthalmologic patients.
ISSN:1435702X
0721832X
DOI:10.1007/s00417-021-05513-5