Light is required every day, with very specific irradiance, duration, and timing, to reset the circadian “body clock” and to regulate many neuronal processes. This light is received, transduced, and transmitted to the brain by ipRGCs. Research is now beginning to discover the roles of ipRGCs in human eye disease, with advances identifying the roles of ipRGCs in different stages of glaucoma,20,25 RP,14,21,23,34,60 Leber hereditary optic neuropathy and dominant optic atrophy,59 diabetic retinopathy,54 and circadian health.19,61,63 It is now becoming clear that the PLR will have a role as a rapid clinical assessment tool to simultaneously determine inner and outer retinal function in patients with eye diseases including AMD. Novel pupil paradigms and metrics such as the sinusoidal stimuli protocol proposed here may be particularly helpful in discriminating functional impairment in AMD, in addition to other retinal/optic nerve disease, and research is ongoing to understand the sensitivity and specificity of these tests for detection and the monitoring of progression.
This work was supported by Australian Research Council Discovery Projects (ARC-DP140100333 to BF and AJZ). We thank Daniel S. Joyce, Michelle L. Maynard, and Prakash Adhikari for contributions to data collection.
Received December 11, 2013; accepted February 18, 2014.
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