Using dynamic pupillometry as a simple screening tool to detect autonomic neuropathy in patients with diabetes: a pilot study.
BACKGROUND
Autonomic neuropathy is a common and serious complication of diabetes. Early detection is essential to enable appropriate interventional therapy and management. Dynamic pupillometry has been proposed as a simpler and more sensitive tool to detect subclinical autonomic dysfunction. The aim of this study was to investigate pupil responsiveness in diabetic subjects with and without cardiovascular autonomic neuropathy (CAN) using dynamic pupillometry in two sets of experiments.


METHODS
During the first experiment, one flash was administered and the pupil response was recorded for 3 s. In the second experiment, 25 flashes at 1-s interval were administered and the pupil response was recorded for 30 s. Several time and pupil-iris radius-related parameters were computed from the acquired data. A total of 24 diabetic subjects (16 without and 8 with CAN) and 16 healthy volunteers took part in the study.


RESULTS
Our results show that diabetic subjects with and without CAN have sympathetic and parasympathetic dysfunction, evidenced by diminished amplitude reflexes and significant smaller pupil radius. It suggests that pupillary autonomic dysfunction occurs before a more generalized involvement of the autonomic nervous system, and this could be used to detect early autonomic dysfunction.


CONCLUSIONS
Dynamic pupillometry provides a simple, inexpensive, and noninvasive tool to screen high-risk diabetic patients for diabetic autonomic neuropathy.
Ferrari
Giselle L
GL
School of Electrical Engineering and Applied Computer Sciences-CPGEI, Federal University of Technology-Paraná, Curitiba, PR - Brazil.
Marques
Jefferson L B
JL
Gandhi
Rajiv A
RA
Heller
Simon R
SR
Schneider
Fábio K
FK
Tesfaye
Solomon
S
Gamba
Humberto R
HR
D002318:Cardiovascular Diseases / Q000150:complications; D016022:Case-Control Studies; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011680:Pupil / Q000502:physiology*