Pupil response to accommodation and convergence in healthy children and adolescents of various age groups and autonomic nervous system tone
Shakir Dukhayer, Ophthalmologist; N.M. Bushuieva, Dr Sc (Med); S.B. Slobodianyk, Cand Sc (Med)
SI "Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine"; Odesa (Ukraine)
TO CITE THIS ARTICLE: Shakir Dukhayer, Bushuieva NM, Slobodianyk SB. Pupil response to accommodation and convergence in healthy children and adolescents of various age groups and autonomic nervous system tone. J.ophthalmol.(Ukraine).2020;2:36-44. http://doi.org/10.31288/oftalmolzh202023644
Background: As there is close association between pupil response and accommodation during gaze fixation on an object at any distance, it is important to assess accommodative pupil response both in healthy children and in those with accommodative disorders. It is also important to assess relationships of characteristics of pupil response to accommodation and convergence with age and autonomic nervous system (ANS) tone. It is hypothesized that pupillography parameters can be regarded as objective criteria for assessing pupil response to accommodation and convergence, and serve as an important consideration in choosing the treatment method in patients with accommodative disorders.
Purpose: To assess pupil response to accommodation and convergence in healthy children and adolescents of various age groups and autonomic nervous system (ANS) tones.
Material and Methods: Pupil response to accommodation and convergence was studied in 269 systemically and ophthalmologically healthy children and adolescents (538 eyes) aged 6 to 18 years. Subjects were divided into three groups based on their age: group 1 (6-9 years; 77 subjects), group 2 (10-14 years; 96 subjects), and group 3 (15-18 years; 96 subjects). ANS tone was assessed using the Kerdo index. Pupillography studies were performed using an OK-2 pupillographer (Odesa, Ukraine). Pupil area, amplitude of change in pupil area, and duration of phases of change in pupil area were determined.
Results: We determined normative values for pupillographic characteristics for 6-9, 10-14 and 15-18 years age groups with various ANS tones (increased parasympathetic, normal or increased sympathetic tone). In addition, we determined whether these characteristics depend on the child’s age and/or balance of autonomic innervation. There was pupillographic evidence that those with increased sympathetic tone had significantly greater pupil area and amplitude of changes in pupil area, and significantly shorter timing of changes in pupil size than those with normal ANS tone or increased parasympathetic tone. The fact that younger children (i.e., those aged 6-9 years) had slower pupil response to accommodation and lower amplitude of change in pupil area compared to older children and adolescents (i.e., those aged 10-18 years) may indicate a low level of structural and functional maturity of the accommodative and convergence system at this age.
Conclusion: The patterns of relationships revealed in the study provide grounds for regarding pupillography data as an objective criterion for assessing the pupil response to accommodation and convergence and the balance of ANS innervation in children and adolescents of various age groups.
Keywords: pupillography, accommodation, pupil response to accommodation and convergence, children and adolescents
1.Katargina LA, editor. [Accommodation: A guide for physicians]. Moscow: Aprel; 2012. Russian.
2.Von Noorden GK, Campos EC, editors. Binocular Vision and Ocular Motility. Theory and management of strabismus. 6th ed. St. Louis; Sydney: Mosby; 2008.
3.Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh & Hoyt’s Clinical Neuro-ophthalmology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
4.Velkhover ES, Ananin VF. [Introduction to iridology. Pupillodiagnosis]. Moscow: UDN; 1991. Russian.
5.Velkhover ES, Shulpina NB, Aliieva ZA, Romashov FN. [Iridodiagnosis]. Moscow: Meditsina; 1988. Russian.
6.Boychuk IM, Bushuyeva NN, Romanenko DV. [Pupil reaction with concomitant horizontal and vertical deviation]. Int J Neuro-Ophthalmology. 2010;34:236.
7.Bradley MM, Miccoli L, Escrig MA, Lang PJ. The pupil as a measure of emotional arousal and autonomic activation. Psychophysiology. 2008 Jul;45(4):602-7.
8.Bushuyeva NN, Chramenko NI, Boichuk IM, Duhair SMH. Computer pupillography in patients with disturbances of cerebral vessels. Neuro-Ophthalmology Society (EUNOS) 11th Meeting Oxford (Oxford, April 10-13, 2013). Neuroophthalmology. 2013; 37(sup1): 1–109.
9.Bushuyeva NN, Boychuk IM, Duhairmh Shaker MH. Particuliarities of pupillogrames in children and adults with hypermetropic amblyopia. Acta Ophthalmologica Scandinavica. 2006;84:52.
10.Girkin CA. Evaluation of the pupillary light response as an objective measure of visual function. Ophthalmol Clin North Am. 2003 Jun;16(2):143-53.
11.Kelbsch C, Strasser T, Chen Y, et al. Standards in Pupillography . Front Neurol. 2019 Feb 22;10:129.
12.Levatin P. Pupillary escape in diseases of the retina or optic nerve. Arch Ophthalmol. 1959;62:768-9.
13.Loewenfeld IS. The Pupil: Anatomy, Physiology, and Clinical Applications. Oxford: Butterworth-Heinemann; 2 edition, 1999.
14.Wilhelm H, Wilhelm B. Clinical Applications of Pupillography. J Neuro-Ophthalmol. 2003 Mar;23(1):42-9.
15.Moiseienko RO, Golubchikov MV, Mikhalchuk VM, et al. [Ophthalmological care in Ukraine in 2014-2017: Analytical and statistical reference book]. Kropivnytskyi: Polium;2018. Ukrainian.
16.Vein AM, editor. [Autonomic nervous system abnormalities: Clinical signs, diagnosis and treatment]. Moscow: Meditsinskoe informatsionnoe agenstvo; 2003. Russian.
17.Bushuieva NM, Boychuk IM, Dukhayer Shakir, Khramenko NI, Ponomarchuk VS. [Method of computer pupillography]. Ukrainskyi medychnyi almanakh. 2006;9(2):24-7. Ukrainian.
18.Bushuieva NM, Boychuk IM, Khramenko NI. [Method for diagnosing disorders of accommodation based on pupillographic studies of pupillary response]. Arkhiv klinicheskoi i eksperimentalnoi meditsiny. 2001;10(2);132-3. Russian.
19.Glanz S. [Biomedical statistics]. Moscow: Praktika;1998. Russian.
20.Zaitsev VM, Lifliandskii VG, Maeinkin VI. [Tutorial in applied medical statistics]. St Peterburg:Foliant;2008. Russian.
21.Kasthurirangan S, Glasser A. Age related changes in the characteristics of the near pupil response. Vision Res. 2006 Apr;46(8-9):1393-403.
22.Kasthurirangan S, Glasser А. Characteristics of pupil responses during far-to-near and near-to-far accommodation. Ophthal Physiol Opt. 2005 Jul;25(4):328-39.
23.Mathôt S. Pupillometry: Psychology, Physiology, and Function. J Cogn. 2018 Feb 21;1(1):16.
24.Adhikari P, Pearson CA, Anderson AM, et al. Effect of age and refractive error on the melanopsin mediated post-illumination response (PIPR). Sci Rep. 2015 Dec 1;5:17610.
25.Hammond CJ, Snieder H, Spector TD, et al. Factors affecting pupil size after dilatation: the twin eye study. Br J Ophthalmol. 2000 Oct;84(10):1173-6.
26.Telek HH, Erdol H, Turk A. The Effects of Age on Pupil Diameter at Different Light Amplitudes. Beyoglu Eye J. 2018;3(2):80-5.
27.Kankipati L, Girkin CA, Gamlin PD. Post-illumination pupil response in subjects without ocular disease. Invest Ophthalmol Vis Sci. 2010 May;51(5):2764-9.
28.Kardon R. Regulation of light through the pupil. In: Levin LA, Nilsson SFE, Ver Hoeve J, Wu SM, editors. Adler’s Physiology of the Eye. New York: Elsevier; 2011. pp. 502–525.
29.Tekin K, Sekeroglu MA, Kiziltoprak H, et al. Static and dynamic pupillometry data of healthy individuals. Clin Exp Optom. 2018 Sep;101(5):659-665.
30.Volkova EM. [Effect of accommodative nervous system tone on accommodation function in myopia]. Abstract of Cand Sc (Med) Thesis. Yaroslavl: Yaroslavl State Medical Academy;2007. Russian.
31.McDougal DH, Gamlin PDR. Pupillary control pathways. In: Allan IB, Akimichi K, Gordon MS, Gerald W, editors. The Senses: A Comprehensive Reference. New York: Academic Press; 2008. pp. 521–536.
32.Gamlin PDR. Neural mechanisms for the control of vergence eye movements. Ann N Y Acad Sci. 2002 Apr;956:264-72.
The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.