title: Multifocal pupillography in early age-related macular degeneration.
abstract: OBJECTIVE
  To investigate the potential of multifocal pupillographic objective perimetry to assess changes in retinal function with clinical severity of age-related macular degeneration (AMD).
  
  
  METHODS
  Pupil responses were recorded from 40 subjects with AMD and 23 normal control subjects (mean ± SD age, 71.3 ± 5.1 years). Age-related macular degeneration subjects were classified according to the Age-Related Eye Disease Study (AREDS) classification system and allocated into one of four AMD severity groups. Three multifocal pupillographic objective perimetry stimulus variants that were identical in luminance but varied in spatiotemporal sequence were used. In one of the three protocols, stimuli were presented with a pedestal flicker for 266 milliseconds at 15 Hz.
  
  
  RESULTS
  On average, response amplitudes demonstrated a significant change in sensitivity with progression from early-stage (0.32 ± 0.08 dB, t = 3.88) to late-stage (-1.60 ± 0.12 dB, t = -12.7) age-related macular degeneration. Response delays followed a similar trend with the longest delays in AREDS4 (57.2 ± 1.9 milliseconds, t = 29.5). Ring analysis identified the largest mean effect on responses within the central 6 degrees of fixation. The NewStimuli protocol achieved the best diagnostic accuracy across all severity groups with area under the curve values of 0.85 ± 0.066 (AREDS1), 0.908 ± 0.085 (AREDS2), 0.929 ± 0.040 (AREDS3), and 1.0 ± 0.0 (AREDS4).
  
  
  CONCLUSIONS
  The mean effect of AMD on contraction amplitudes and response delays reflected the severity of disease, and the NewStimuli protocol achieved good diagnostic accuracy across all AMD severity groups. Multifocal pupillographic objective perimetry may potentially be a useful method in monitoring progression of AMD and assessing change in retinal function with novel interventions in early AMD. Longitudinal studies are required to identify biomarkers that predict eyes at risk of progression.
authors.affiliation: *PhD †MBBS ‡BSc ARC Centre of Excellence in Vision Science and Centre for Visual Sciences, The John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia (all authors); and Ophthalmology Department, The Australian National University, Canberra Hospital, Australian Capital Territory, Australia (RWE).
authors.forename: Faran
authors.initials: F
authors.lastname: Sabeti
authors.forename: Ted
authors.initials: T
authors.lastname: Maddess
authors.forename: Rohan W
authors.initials: RW
authors.lastname: Essex
authors.forename: Aiasha
authors.initials: A
authors.lastname: Saikal
authors.forename: Andrew C
authors.initials: AC
authors.lastname: James
authors.forename: Corinne F
authors.initials: CF
authors.lastname: Carle
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D011680:Pupil / Q000502:physiology*; D012025:Reflex, Pupillary / Q000502:physiology*; D012160:Retina / Q000503:physiopathology*; D012680:Sensitivity and Specificity; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology