The pupillary light reflex in diabetes mellitus: evaluation of a newly developed infrared light reflection method

Pupillary light reflexes were measured in 18 diabetic patients without clinical signs of neuropathy and in 18 control subjects, using a newly developed infrared light reflection technique called IRIS. This method has some important advantages. Apart from being non traumatic, it enables the recording of dynamic pupillary light reflexes simultaneously in both eyes. Furthermore, it has a large amplitude and time resolution (1 ms), permitting accurate determination of latency values. It was found that 78% of the diabetic patients show a significantly prolonged latency of the constriction reaction, while 39% of the diabetic patients show an abnormally prolonged dilatation latency. All patients with an abnormally prolonged dilatation latency also show a prolonged constriction latency. This finding suggests that in diabetes mellitus the parasympathetic system is affected before abnormalities of the sympathetic nervous system can be demonstrated. Assessment of the pupillary light reflex, using the sensitive IRIS method, is an easily applicable and reliable method for detection of subclinical autonomic nervous system dysfunction associated with diabetes mellitus. The method may also provide an objective tool for the assessment of therapy results in diabetic neuropathy.