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Editors Selection IGR 17-4

Clinical Examination Methods: New developments: Multifocal pupillography

Comment by Chris Johnson on:

24796 Multifocal pupillographic visual field testing in glaucoma, Maddess T; Bedford SM; Goh XL et al., Clinical and Experimental Ophthalmology, 2009; 37: 678-686

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Evaluation of visual function in patients with ocular or neurologic disorders is challenging, and is dependent on the cooperation, reliability and observational skills of the patient. There are many tests to distinguish pathologic visual loss from malingering, and there are also many quality control assessment procedures that can be used to minimize variability and erroneous responses. However, a test that is less susceptible to these influences, such as measurements of pupil responses, is certainly desirable and may be the only viable method of evaluating young patients or those who are cognitively impaired. I hesitate to call it an 'objective' test like Maddess et al. (1475) do, because it still requires the patient's cooperation and understanding, the examiner must interpret the results, and other factors may also influence the test procedure. That being said, the authors of this paper have now introduced a rapid pupil measurement procedure that is able to evaluate both eyes simultaneously to obtain visual field information, which may be considered to be a positive step forward.

Multifocal pupillography still requires the patient's cooperation and understanding

Many questions arise when a new diagnostic procedure is introduced: How does the device perform for others outside of the laboratory that developed it? What is the dynamic range of the instrument? What confounding variables and artifactual conditions can influence the outcome of the test? How does it perform for patients with early manifestations of glaucoma or who are at risk of developing glaucoma? What are the details and principles of operation behind the functioning of the instrument? What are its capabilities and limitations? How robust is the instrument to all of the variations in test conditions that can occur in an eye clinic? Answers to these questions will be forthcoming in future research and will assist in defining the role of this instrument as a diagnostic tool for routine clinical use.

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