Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

MacDougall, Hamish; Gilman, Robert Hugh; Moore, Steven T.; Morris, Tiffany; Halperin, Anthony; Bern, Caryn; Justiniano, Juan; Bowman, Natalie M.; Galdos-Cardenas, Gerson; Carnero, Andres M.; Colanzi, Rony; Pajuelo Travezaño, Monica Jhenny; Ferrufino, Lisbeth; Tornheim, Jeffrey A.; Vu, Nancy; Camacho, Marilyn

dc.contributor.author	Halperin, Anthony
dc.contributor.author	Pajuelo Travezaño, Monica Jhenny
dc.contributor.author	Tornheim, Jeffrey A.
dc.contributor.author	Vu, Nancy
dc.contributor.author	Carnero, Andres M.
dc.contributor.author	Galdos-Cardenas, Gerson
dc.contributor.author	Ferrufino, Lisbeth
dc.contributor.author	Camacho, Marilyn
dc.contributor.author	Justiniano, Juan
dc.contributor.author	Colanzi, Rony
dc.contributor.author	Bowman, Natalie M.
dc.contributor.author	Morris, Tiffany
dc.contributor.author	MacDougall, Hamish
dc.contributor.author	Bern, Caryn
dc.contributor.author	Moore, Steven T.
dc.contributor.author	Gilman, Robert Hugh
dc.date.accessioned	2019-02-06T14:45:34Z
dc.date.available	2019-02-06T14:45:34Z
dc.date.issued	2016
dc.identifier.uri	https://hdl.handle.net/20.500.12866/5078
dc.description.abstract	Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.	en_US
dc.language.iso	eng
dc.publisher	American Society of Tropical Medicine and Hygiene
dc.relation.ispartofseries	American Journal of Tropical Medicine and Hygiene (ASTMH Journal)
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Reflex, Pupillary	en_US
dc.subject	Adult	en_US
dc.subject	Autonomic Nervous System Diseases/diagnosis/pathology/physiopathology	en_US
dc.subject	Bolivia/epidemiology	en_US
dc.subject	Chagas Disease/complications/epidemiology/physiopathology	en_US
dc.subject	Diabetes Mellitus/physiopathology	en_US
dc.subject	Diabetic Retinopathy/diagnosis/epidemiology/physiopathology	en_US
dc.subject	Female	en_US
dc.subject	Humans	en_US
dc.subject	Male	en_US
dc.subject	Middle Aged	en_US
dc.title	Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.4269/ajtmh.14-0775
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn	1476-1645