title: The Pupillary Light Reflex in Idiopathic Intracranial Hypertension.
abstract: OBJECTIVE
  To evaluate the effects of idiopathic intracranial hypertension (IIH) on rod-, cone-, and melanopsin-mediated pupillary light reflexes (PLRs).
  
  
  METHODS
  Pupillary light reflexes elicited by full-field, brief-flash stimuli were recorded in 13 IIH patients and 13 normal controls. Subjects were dark-adapted for 10 minutes and the PLR was recorded in response to short-wavelength flashes (0.001 cd/m2: rod condition; 450 cd/m2: melanopsin condition). Subjects were then exposed to a rod-suppressing field and 10 cd/m2 long-wavelength flashes were presented (cone condition). Pupillary light reflexes were quantified as the maximum transient constriction (rod and cone conditions) and the post-illumination pupil constriction (melanopsin condition), relative to the baseline pupil size. Diagnostic power was evaluated using receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  The IIH patients had significantly smaller PLRs under the melanopsin (P < 0.001) and rod (P = 0.04) paradigms; a trend for reduced cone-mediated PLRs was also found (P = 0.08). Receiver operating characteristic analysis indicated areas under the curves (AUC) of 0.83 (melanopsin-meditated; P = 0.001), 0.71 (rod-mediated; P = 0.07), and 0.77 (cone-mediated; P = 0.02). The AUC (0.90, P < 0.001), sensitivity (85%), and specificity (85%) were high for ROC analysis performed on the mean of the rod, cone, and melanopsin PLRs.
  
  
  CONCLUSIONS
  Pupillary light reflex reductions in IIH patients indicate compromised RGC function. PLR measurement, particularly under rod- and melanopsin-mediated conditions, may be a useful adjunct to standard clinical measures of visual function in IIH.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States 2Department of Neurology & Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, United States.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Moss
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States 3Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, United States 4Department of Bioengineering, University o.
authors.forename: J Jason
authors.initials: JJ
authors.lastname: McAnany
mesh_terms: D000328:Adult; D003623:Dark Adaptation; D005260:Female; D006801:Humans; D008297:Male; D010211:Papilledema / Q000209:etiology / Q000503:physiopathology*; D010775:Photic Stimulation; D011559:Pseudotumor Cerebri / Q000150:complications / Q000503:physiopathology*; D011680:Pupil / Q000502:physiology*; D012372:ROC Curve; D012025:Reflex, Pupillary / Q000502:physiology*; D017949:Retinal Cone Photoreceptor Cells / Q000502:physiology; D017948:Retinal Rod Photoreceptor Cells / Q000502:physiology