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Assessing Pupil Light Reflex Metrics in Glaucoma: Insights from a Systematic Review and Meta-Analysis
Mohammadreza Moniritilaki1, Peter Wagner1, Sieu K Khuu1
1School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
Ophthalmology Science
|June 24, 2026
Summary
The amplitude of constriction is the most affected pupil light reflex (PLR) metric in glaucoma. Optimal detection of deficits involves a stimulus >1 second after <5 minutes of dark adaptation, particularly for mild glaucoma.
Area of Science:
- Ophthalmology
- Neuroscience
- Medical Diagnostics
Background:
- The pupil light reflex (PLR) is altered in glaucoma.
- Understanding these alterations can aid in disease detection and monitoring progression.
Purpose of the Study:
- Identify the most affected PLR metrics in glaucoma.
- Determine optimal stimulus conditions for detecting glaucomatous deficits.
Main Methods:
- Systematic review and meta-analysis of studies on PLR in glaucoma patients and controls.
- Extracted data on PLR metrics (amplitude, velocity, latency, PIPR) and stimulus conditions.
- Performed meta-analysis (Hedges' g) and subgroup/moderator analyses.
Main Results:
- Amplitude of constriction was the most affected PLR metric in mild and severe glaucoma.
- Optimal conditions for mild glaucoma: stimulus >1 second, <5 minutes dark adaptation.
- Age, RNFL thickness, and MD correlated with PLR metric variations.
Conclusions:
- Amplitude of constriction is a key indicator of glaucoma severity.
- Specific stimulus parameters enhance sensitivity for detecting PLR deficits in mild glaucoma.
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