Pupillary Responses Reveal Autonomic Regulation Impairments in Patients With Central Serous Chorioretinopathy

PURPOSE. This study assessed the autonomic nervous system in patients with central serous chorioretinopathy (CSC) by simultaneously measuring pupillary responses and heart rate variability (HRV). METHODS. We recruited 33 patients with CSC and 26 age- and sex-matched healthy controls. Using a pupillometry and acceleration plethysmography system, we measured the participants' pupillary light reflex and HRV simultaneously, and compared the following parameters between the two groups: the pupil diameters, diameter changes, and time and frequency domain HRV indices (high frequency power: HF; low frequency power: LF; log LF/HF ratio). Additional data from the Profile of Mood States (POMS) and pupillary responses during mental tasks were also analyzed. RESULTS. The CSC group had a significantly lower constriction amplitude and a higher redilation ratio compared with the control group, indicating parasympathetic inhibition and sympathetic activation. For the HRV measures, the CSC group demonstrated significantly lower HF and higher LF and log LF/HF ratio, indicative of higher sympathetic activity. The CSC group also showed significantly larger pupil dilation during tasks of moderate difficulty, and higher negative/lower positive POMS mood scores. Further analyses also revealed that the baseline pupil diameter was significantly larger in patients with active as opposed to chronic CSC. CONCLUSIONS. Pupillary responses and HRV measures both revealed sympathetic activation and parasympathetic attenuation in patients with CSC. Larger pupil dilation during mental tasks in CSC could be a potential marker of psychophysiological stress.

Automated summary

This study assessed the autonomic nervous system in patients with central serous chorioretinopathy (CSC) by measuring pupillary responses and heart rate variability (HRV). The results indicated parasympathetic inhibition and sympathetic activation in CSC patients, as well as larger pupil dilation during mental tasks, which could be a potential marker of psychophysiological stress.