Clinical evaluation of a rapid, pupil-based assessment of retinal damage associated with glaucoma

Nicholas Wride¹, Majed Habib¹, Keith Morris², Steve Campbell³, Scott Fraser¹

¹Sunderland Eye Infirmary, City Hospitals Sunderland NHS Foundation Trust, Sunderland, Tyne and Wear, UK; ²Applied Neurodiagnostics Ltd, Cramlington, Northumberland, UK; ³School of Health, University of New England, New South Wales, Australia

Aims: To evaluate the effectiveness of a new test, the Pupilmetrix™ PLR60, which uses the pupillary light reflex (PLR) to detect asymmetric retinal damage in patients diagnosed with glaucoma.

Methods: 30 patients, clinically diagnosed as having glaucoma, were recruited to the study, 29 of whom completed testing using the PLR60. A control group of 30 patients who had glaucoma excluded by clinical examination were also recruited and tested using the same protocol on the PLR60.

Results: Of the 110 eyes with test outcomes, overall agreement between the PLR60 result and clinical diagnosis (glaucoma positive or negative) per eye was 84.7%. Sensitivity was 93.1% (95% CI 77.2%–99.2%) and specificity was 76.7% (95% CI 57.7%–90.1%). Average (SD) test times (min:sec) for both eyes were 3:21 (0:33) minutes for the glaucoma group and 2:40 (0:35) minutes for the non-glaucoma group.

Conclusions: The results of this preliminary study suggest that the PLR as used in the Pupilmetrix™ PLR60 test is able to discriminate between patients with glaucomatous retinal defects and those with clinically normal retinas with a diagnostic accuracy that is potentially useful for screening for glaucoma. Test times were markedly quicker than with standard visual field testing.

Keywords: glaucoma, pupillary light reflex, retina, Pupilmetrix