A pharmacologic pupillary test in the diagnosis of diabetic autonomic neuropathy.
OBJECTIVE
To screen for diabetic autonomic neuropathy of the pupil using 0.5% apraclonidine and 0.1% pilocarpine and to evaluate the early diagnostic value of this pharmacologic pupillary test by assessing the relationship between pupillary and cardiovascular autonomic neuropathies.


METHODS
A total of 22 diabetic patients were recruited. Baseline pupillary diameter (PD) and the difference in PD between the test eye and the control eye before and after instillation of apraclonidine and pilocarpine were measured. All patients also underwent cardiovascular autonomic function (CAF) testing.


RESULTS
Baseline PD in room light correlated with duration of diabetes mellitus (DM, p=0.049) and the presence of DM retinopathy (DMR, p=0.022). Eleven patients (50%) had positive apraclonidine tests, and two patients had positive pilocarpine tests. The patients who had positive pilocarpine tests also had positive apraclonidine tests. Patients who had a positive pupillary test had a significantly higher rate of positive CAF tests (p=0.032).


CONCLUSIONS
Pupillary autonomic neuropathy was related to the duration of diabetes and the degree of DMR. There was also a significant correlation between pupillary autonomic neuropathy and cardiovascular autonomic neuropathy (CAN). Also, sympathetic nerve dysfunction occurred prior to parasympathetic dysfunction in this study. A simple pharmacologic pupillary test can help manage complications in diabetic patients because patients with pupillary autonomic dysfunction have an increased risk of CAN.
Kwon
Hee Jung
HJ
Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital, #1232 Baekseok-dong, Ilsandong-gu, Goyang, Korea.
Kim
Hye Young
HY
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015877:Miosis / Q000139:chemically induced* / Q000503:physiopathology; D008916:Miotics / Q000008:administration & dosage; D009883:Ophthalmic Solutions; D010862:Pilocarpine / Q000008:administration & dosage; D011680:Pupil / Q000187:drug effects / Q000502:physiology*; D015203:Reproducibility of Results
D000316:Adrenergic alpha-Agonists; D008916:Miotics; D009883:Ophthalmic Solutions; D010862:Pilocarpine; C016986:apraclonidine; D003000:Clonidine