title: Multifocal pupillography identifies retinal dysfunction in early age-related macular degeneration.
abstract: BACKGROUND
  Early age-related macular degeneration (AMD) is common among the elderly. While only a small number progress to sight-threatening stages of AMD, identifying prognostic functional markers remains paramount. Here, we objectively evaluate retinal function in patients with large drusen by multifocal pupillographic objective perimetry (mfPOP). Different temporal presentation rates and luminances were compared to optimize parameters for high signal to noise ratios (SNR) and diagnosticity for early AMD.
  
  
  METHODS
  Pupil responses were recorded from 19 early AMD patients (30 eyes) and 29 age-matched control subjects. We compared a luminance-balanced stimulus ensemble and two unbalanced stimulus variants, each consisting of 44 independent stimulus regions per eye extending from fixation to 15˚ eccentricity. Video cameras recorded pupil responses for each eye under infrared illumination. The amplitudes and delays of the peak responses were analysed by multivariate linear models. The diagnostic accuracy of the stimulus variants was compared using areas under the curve (AUC) of receiver operator characteristic (ROC) plots.
  
  
  RESULTS
  Early AMD eyes differed significantly from normal in their mean constriction amplitudes (-2.22 ± 0.15 dB, t = -14.8) and delays (17.92 ± 1.2 ms, t = 14.9). The brightest stimulus ensembles produced the highest median SNRs of 3.45 z-score units; however, the balanced method was found to be the most diagnostic. AUC values of 0.95 ± 0.03 (mean ± SE) for early AMD were obtained when the asymmetry of response amplitudes between eyes was considered.
  
  
  CONCLUSIONS
  The mfPOP responses of early AMD eyes showed significant abnormality in response amplitudes and peak time. The ROC AUCs of 95 % suggest that mfPOP is a sensitive tool for detecting early abnormalities in AMD and longitudinal studies measuring progression of retinal dysfunction are warranted.
authors: ARC Centre of Excellence in Vision Science, John Curtin School of Medical Research, Australian National University, Building 131, Garran Road, Acton, Canberra, ACT, 0200, Australia. faran.sabeti@anu.edu.au
authors: Faran
authors: F
authors: Sabeti
authors: Andrew C
authors: AC
authors: James
authors: Rohan W
authors: RW
authors: Essex
authors: Ted
authors: T
authors: Maddess
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D011680:Pupil / Q000502:physiology / Q000528:radiation effects*; D012372:ROC Curve; D012029:Refraction, Ocular / Q000502:physiology; D012160:Retina / Q000503:physiopathology*; D015593:Retinal Drusen / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D059629:Signal-To-Noise Ratio; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000503:physiopathology
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