The post-illumination pupil response of melanopsin-expressing intrinsically photosensitive retinal ganglion cells in diabetes

. Purpose: This study investigates the clinical utility of the melanopsin-expressing intrinsically photosensitive retinal ganglion cell (ipRGC) controlled post-illumination pupil response (PIPR) as a novel technique for documenting inner retinal function in patients with Type II diabetes without diabetic retinopathy. Methods: The PIPR was measured in seven patients with Type II diabetes, normal retinal nerve fibre thickness and no diabetic retinopathy compared to healthy age-similar controls. A 488- and 610-nm, 7.15-diameter stimulus was presented in Maxwellian view to the right eye and the left consensual pupil light reflex was recorded. Results: The group data for the blue PIPR (488 nm) identified a trend of reduced ipRGC function in patients with diabetes with no retinopathy. The transient pupil constriction was lower on average in the diabetic group. The relationship between duration of diabetes and the blue PIPR amplitude was linear, suggesting that ipRGC function decreases with increasing diabetes duration. Conclusion: This is the first report to show that the ipRGC-controlled PIPR may have clinical applications as a non-invasive technique for determining the progression of inner neuroretinal changes in patients with diabetes before they are ophthalmoscopically or anatomically evident. The lower transient pupil constriction amplitude indicates that outer retinal photoreceptor inputs to the pupil light reflex may also be affected in diabetes.