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Year : 2019  |  Volume : 67  |  Issue : 8  |  Page : 1319

Commentary: Abnormal pupillary light reflexes - A sign of diabetic autonomic neuropathy

Neuro-Ophthalmology and Strabismus Services, Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication22-Jul-2019

Correspondence Address:
Dr. Rohit Saxena
Professor of Ophthalmology, Neuro-Ophthalmology and Strabismus Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_770_19

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How to cite this article:
Saxena R, Dhiman R. Commentary: Abnormal pupillary light reflexes - A sign of diabetic autonomic neuropathy. Indian J Ophthalmol 2019;67:1319

How to cite this URL:
Saxena R, Dhiman R. Commentary: Abnormal pupillary light reflexes - A sign of diabetic autonomic neuropathy. Indian J Ophthalmol [serial online] 2019 [cited 2020 May 27];67:1319. Available from: http://www.ijo.in/text.asp?2019/67/8/1319/263150

Diabetes is a major public health problem in India with a rising prevalence of 7.3%.[1] Diabetic autonomic neuropathy (DAN), although a common and serious complication of diabetes, is poorly recognized.[2] Various manifestations of the disease like tachycardia, orthostatic hypotension, erectile dysfunction (ED), etc. attribute to disease-related morbidity, and mortality. In the absence of any effective screening test, DAN often goes undiagnosed.

Affection of pupillary light reflex, which is governed by the autonomic nervous system, has also been well reported in DAN.[3] Ferrari et al.[4] demonstrated the use of dynamic pupillometry, which consists of the measurement of the variation of pupil diameter in response to a light stimulus of fixed intensity and duration, in the detection and assessment of peripheral neuropathies. Dütsch et al.[5] concluded that pupillary dysfunction occurs regardless of cardiac autonomic and peripheral somatic neuropathies in diabetics. Pittasch et al.[6] found that the pupil size is smaller in diabetics, even in the absence of clinical evidence of neuropathy. A recent study showed that pupillary dynamics i.e., small basal pupillary diameter, reduced amplitude of pupillary constriction, velocity of pupillary constriction and velocity of pupillary dilation in response to light in diabetics. These changes were documented even in early stage of diabetic retinopathy that progressed with increasing retinopathy severity.[7]

In the current study,[8] authors reported abnormal pupillary functions (both static and dynamic) in diabetics with erectile dysfunction (ED). They reported a greater mean pupillary diameter in controls than in cases. On comparing the dilation speed in different ED groups, lowest speed was noted in patients with greater ED severity.

Although it is too early to establish a definite relationship, there definitely seems to be a causative association between the abnormality of pupillary dynamics and other manifestations of DAN. Dynamic pupillometry is a valuable tool to assess the pupillary dysfunction in early stages of the disease. With further research on pupillary assessment in patients with DM, it might be possible to develop a simple non-invasive screening test for DAN and to quantify their neural dysfunction.

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  References Top

Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol 2017;5:585-96.  Back to cited text no. 1
Datta S, Biswas NR, Saxena R, Deepak KK, Menon V, Garg SP, et al. Ocular and cardiovascular autonomic function in diabetic patients with varying severity of retinopathy. Indian J Physiol Pharmacol 2005;49:171-8.  Back to cited text no. 2
Reduced pupillary light reflexes in diabetic autonomic neuropathy. Diabetologia 1983;24:330-2.  Back to cited text no. 3
Ferrari GL, Marques JL, Gandhi RA, Heller S, Schneider FK, Tesfaye S, et al. Using dynamic pupillometry as a simple screening tool to detect autonomic neuropathy in patients with diabetes: A pilot study. Biomed Eng Online 2010;9:26-41.  Back to cited text no. 4
Dütsch M, Marthol H, Michelson G, Neundörfer N, Hilz MJ. Pupillography refines the diagnosis of diabetic autonomic neuropathy. J Neurol Sci 2014;222:75-81.  Back to cited text no. 5
Pittasch D, Lobmann R, Behrens-Baumann W, Lehnert H. Pupil signs of sympathetic autonomic neuropathy in patients with type 1 diabetes. Diabetes Care 2002;25:1545-50.  Back to cited text no. 6
Jain M, Devan S, Jaisankar D, Swaminathan G, Pardhan S, Raman R. Pupillary abnormalities with varying severity of diabetic retinopathy. Sci Rep 2018;8:5636.  Back to cited text no. 7
Cankurtaran V, Ozates S, Ozler S. Association of pupil responses with severity of erectile dysfunction in diabetes mellitus. Indian J Ophthalmol 2019;67:1314-9.  Back to cited text no. 8
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