Intrinsically Photosensitive Retinal Ganglion Cell Activity Is Associated with Decreased Sleep Quality in Patients with Glaucoma

Author(s):Show less -

Gracitelli, Carolina P. B. ^[1] ; Duque-Chica, Gloria Liliana ^[2] ; Roizenblatt, Marina ^[1] ; de Araujo Moura, Ana Laura ^{[1, 2]} ; Nagy, Balazs V. ^[2] ; de Melo, Geraldine Ragot ^[1] ; Borba, Paula Delegrego ^[1] ; Teixeira, Sergio H. ^[1] ; Tufik, Sergio ^[3] ; Ventura, Dora Fix ^[2] ; Paranhos, Jr., Augusto ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Inst Psychol, Dept Expt Psychol, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Dept Psychobiol, Sleep Med Div, Sao Paulo - Brazil

• Document type: Journal article
• Source: OPHTHALMOLOGY; v. 122, n. 6, p. 1139-1148, JUN 2015.
• Web of Science Citations: 30

Abstract

Purpose: To use the pupillary light reflex and polysomnography to evaluate the function of intrinsically photosensitive retinal ganglion cells (ipRGCs) and to correlate this function with structural damage in glaucoma. Design: Cross-sectional study. Participants: A study was conducted on both eyes of 45 participants (32 patients with glaucoma and 13 healthy subjects). Methods: For the pupillary reflex evaluation, patients were tested in the dark using a Ganzfeld system (RETIport; Roland Consult, Brandenburg, Germany); pupil diameter was measured with an eye tracker system. To preferentially stimulate ipRGCs, we used a 1-second 470-nm flash with a luminance of 250 cd/m(2). To stimulate different retinal photoreceptors, we used a 1-second 640-nm flash with a luminance of 250 cd/m(2). All of the subjects underwent polysomnography. Subjects underwent standard automated perimetry and optical coherence tomography (Cirrus HD-OCT; Carl Zeiss Meditec Inc, Dublin, CA). Main Outcome Measures: Correlations between ipRGC activity, as measured by the pupillary light reflex, and polysomnography parameters, and correlations between retinal nerve fiber layer (RNFL) thickness and the pupillary light reflex and polysomnography parameters. Results: The mean patient ages in the healthy and glaucoma groups were 56.8 +/- 7.8 years and 61.5 +/- 11.6 years, respectively (P = 0.174). Patients with glaucoma had significantly lower average total sleep time, sleep efficiency, and minimum oxyhemoglobin saturation compared with the healthy subjects (P = 0.008, P = 0.002, and P = 0.028, respectively). Patients with glaucoma had significantly higher arousal durations after falling asleep and more periodic limb movements (P = 0.002 and P = 0.045, respectively). There was an inverse correlation between the rapid eye movement latency and the peak of the pupillary response to the blue flash (P = 0.004). The total arousals were inversely correlated with the sustained blue flash response (P = 0.029). The RNFL thickness was associated with the peak and sustained responses to the blue flash (P < 0.001 for both comparisons); however, RNFL thickness was only associated with the mean oxygen desaturation index among the polysomnography parameters (P = 0.023). Conclusions: This study demonstrated that decreased ipRGC function caused by glaucoma affected pupillary response and sleep quality. (C) 2015 by the American Academy of Ophthalmology. (AU)

• FAPESP's process: 08/58731-2 - Vision as a sensitive indicator of conditions threatening retinal and central nervous system function
• Grantee: Dora Selma Fix Ventura
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 13/03553-0 - Study of the role of melanopsin through the pupillary light response in optic neuropathy and disturbed sleep
• Grantee: Gloria Liliana Duque Chica
• Support Opportunities: Scholarships in Brazil - Doctorate