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Title: The Pupil Light Reflex in Leber's Hereditary Optic Neuropathy: Evidence for Preservation of Melanopsin-Expressing Retinal Ganglion Cells
Authors: Moura, Ana Laura A.
Nagy, Balazs V.
La Morgia, Chiara
Barboni, Piero
Oliveira, Andre Gustavo Fernandes
Salomão, Solange Rios [UNIFESP]
Berezovsky, Adriana [UNIFESP]
Moraes-Filho, Milton Nunes de [UNIFESP]
Chicani, Carlos Filipe
Belfort, Rubens Junior [UNIFESP]
Carelli, Valerio
Sadun, Alfredo A.
Hood, Donald C.
Ventura, Dora Fix
Universidade de São Paulo (USP)
Budapest Univ Technol & Econ
IRCCS Ist Sci Neurol Bologna
Univ Bologna
Studio Oculist Azeglio
Universidade Federal de São Paulo (UNIFESP)
Univ So Calif
Columbia Univ
Keywords: pupillometry
ganglion cells
Issue Date: 1-Jul-2013
Publisher: Assoc Research Vision Ophthalmology Inc
Citation: Investigative Ophthalmology & Visual Science. Rockville: Assoc Research Vision Ophthalmology Inc, v. 54, n. 7, p. 4471-4477, 2013.
Abstract: PURPOSE. To investigate the pupillary light reflex (PLR) of patients with severe loss of vision due to Leber's Hereditary Optic Neuropathy (LHON) in the context of a proposed preservation of melanopsin-expressing retinal ganglion cells (mRGCs).METHODS. Ten LHON patients (7 males; 51.6 +/- 14.1 years), with visual acuities ranging from 20/400 to hand motion perception and severe visual field losses, were tested and compared with 16 healthy subjects (7 males; 42.15 +/- 15.4 years) tested as controls. PLR was measured with an eye tracker and the stimuli were controlled with a Ganzfeld system. Pupil responses were measured monocularly, to 1 second of blue (470 nm) and red (640 nm) flashes with 1, 10, 100, and 250 cd/m(2) luminances. the normalized amplitude of peak of the transient PLR and the amplitude of the sustained PLR at 6 seconds after the flash offset were measured. in addition, optical coherence topography (OCT) scans of the peripapillary retinal nerve fiber layer were obtained.RESULTS. the patient's peak PLR responses were on average 15% smaller than controls (P < 0.05), but 5 out of 10 patients had amplitudes within the range of controls. the patients' sustained PLRs were comparable with controls at lower flash intensities, but on average, 27% smaller to the 250 cd/m(2) blue light, although there was considerable overlap with the PLR amplitudes of control. All patients had severe visual field losses and the retinal nerve fiber layer thickness was reduced to a minimum around the optic disc in 8 of the 10 patients.CONCLUSIONS. the PLR is maintained overall in LHON patients despite the severity of optic atrophy. These results are consistent with previous evidence of selective preservation of mRGCs.
ISSN: 0146-0404
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