[A follow-up study of pupillary dynamics in patients with ocular hypertension and primary open angle glaucoma]

The authors previously reported light reflex abnormalities and adrenergic supersensitivity to topical epinephrine (DPE; dipivalyl epinephrine) of the pupils in patients with ocular hypertension (OH) and those with primary open angle glaucoma (POAG). In this investigation, we attempted to reconfirm pupillary light reflex abnormalities we reported previously, and to investigate the relationship between the normotensive effect of 0.1% DPE and the pupillary light reflex abnormalities in OHs and POAGs. A total of 11 OHs and 11 POAGs under good oculotensive control with neither mydriatics nor miotics were examined. They were measured by an open-loop photically stimulated infrared videopupilogram, and were neurologically diagnosed by comparing the simulated patterns of the light reflex made by topical autonomic agents. When we considered the progress of the stage of POAG, both OHs and POAGs showed satisfactory reproducibility of pupillary light reflex abnormalities. Other cases in which light reflexes altered, showed worsening of the visual field deficit, which was prominent when OHs developed into POAG. OHs with significant reduction of intraocular pressure (IOP) after topical administration of 0.1% DPE showed various kinds of abnormal pupillary light reflexes. On the contrary, cases with little reduction of IOP after 0.1% DPE instillation showed normal pupillary light reflexes in OHs and afferent pupillary defect on POAGs.