Pupillary dynamics in patients with primary open angle glaucoma

In patients with primary open angle glaucoma (POAG), the evaluation of neurological status is clinically important. A detailed analysis of the pupillary dynamics under the control of the autonomic nervous system was performed in patients with POAG. Pupil size and pupillary light reflex were measured by an infrared videopupillogram in 13 patients with POAG (from 25 to 67 years old) with good oculotensive controls without applications mydriatics nor miotics revealed. Pupillary light reflexes were analyzed by comparing the simulated patterns obtained after the studies with topical autonomic agents. Effects of topical adrenergics (dipivalyl epinephrine: DPE 0.025%) on the pupil were also investigated. Three types of autonomic abnormalities (cholinergic, adrenergic and physiological mydriatic reflex patterns) of the light reflex were detected in 11 eyes of 6 patients, and a normal pattern was found in only 2 eyes of one patient. Afferent pupillary defect (APD) pattern was detected in 13 eyes. Although APD was generally described as a reduced visual input, the degree of APD was not related to the stage of the visual field defect in POAG.