Evaluation of static and dynamic pupillometry parameters in patients with central serous chorioretinopathy

Objective: The aim of this study was to compare static and dynamic pupillometry parameters in patients with central serous chorioretinopathy (CSCR) and a healthy control group in order to determine whether autonomic dysfunction exists in CSCR patients. Materials and Methods: This prospective study included a total of 52 participants: 26 patients diagnosed with acute central serous chorioretinopathy who visited our outpatient clinic, and 26 healthy controls who came for routine eye check-ups. All participants underwent detailed ophthalmological examinations, including best-corrected visual acuity testing using the Snellen chart, intraocular pressure measurement, anterior and posterior segment examinations, optical coherence tomography (OCT), enhanced depth imaging OCT (EDI-OCT), and static and dynamic pupillometry tests. The study included patients aged 30-50 years with no ocular diseases other than refractive errors, who were smokers, and had type A personality disorder and sleep disturbances. Exclusion criteria included hypertension, diabetes, neurological diseases, trauma, a history of intraocular surgery, intraocular infections or inflammation, pseudoexfoliation, glaucoma, retinal and optic nerve diseases, corneal and lens opacities that would hinder fundoscopy, and patients using medications that could affect autonomic nervous system functions. Static and dynamic pupillometry measurements were made using a MonPack3® (Metrovision, France) computer-assisted automatic quantitative pupillometer. Results: Of the participants, 36 (69.2%) were male and 16 (30.8%) were female. The mean age was similar between the two groups (34.42 ± 7.48, 34.5 ± 7.32, p=0.86). The best-corrected visual acuity was significantly lower in the CSCR group compared to the control group (p<0.001). Choroidal and central macula thicknesses were significantly higher in the acute CSCR group compared to the control group (p<0.001). Regarding static pupillometry, there were no significant differences between the groups in high photopic and mesopic pupil diameters (2.46 ± 0.41 vs. 3.02 ± 1.06, p=0.075; 3.29 ± 0.67, 3.6 ± 0.83, p=0.158, respectively). However, low photopic and scotopic pupil diameters were significantly larger in CSCR patients compared to controls (2.56 ± 0.46,3.17 ± 0.88, p=0.003; 3.92 ± 0.96, 4.45 ± 0.83, p=0.048, respectively). In dynamic pupillometry, pupil contraction amplitude, dilation duration, and dilation latency were significantly lower in CSCR patients compared to controls (1.82 ± 0.32, 1.55 ± 0.43, p=0.024; 1250.04 ± 455.93, 990.96 ± 406.71, p=0.011; 1008.12 ± 513.84, 740.73 ± 406.4, p=0.036, ,respectively). Additionally, the initial pupil diameter was larger and the contraction latency was longer in CSCR patients compared to the control group (3.66 ± 0.8, 4.26 ± 0.87, p=0.026; 143.62 ± 28.09, 159.08 ± 23.85, p=0.047, respectively). When data were compared by gender, both static and dynamic pupillometry parameters were statistically similar across genders (all p>0.05). Positive correlations were observed between scotopic and low photopic pupil diameters and central macula thickness (r=0.324, p=0.019; r=0.46, p=0.001, respectively). Positive significant correlations were also found between scotopic, mesopic, low photopic, and high photopic pupil diameters and choroidal thickness (r=0.38, p=0.005; r=0.282, p=0.042; r=0.579, p<0.001; r=0.379, p=0.006, respectively). Significant positive correlations were found between initial pupil diameter and contraction latency with central macula thickness (r=0.368, p=0.007; r=0.389, p=0.004, respectively), while negative significant correlations were observed between contraction amplitude and dilation duration with central macula thickness (r=-0.378, p=0.006; r=-0.401, p=0.003, respectively). Positive significant correlations were observed between initial pupil diameter, contraction latency, and dilation velocity with choroidal thickness (r=0.443, p=0.001; r=0.321, p=0.02; r=0.316, p=0.023, respectively), while negative significant correlations were found between contraction amplitude and dilation latency with choroidal thickness (r=-0.283,p=0.042;r=-0.275,p=0.049,respectively). Conclusion: In our study, which aimed to identify autonomic dysfunction in CSCR patients by comparing static and dynamic pupillometry parameters with healthy controls, we found no significant difference between the groups in terms of high photopic and mesopic pupil diameters, but low photopic and scotopic pupil diameters were larger in CSCR patients. In dynamic pupillometry, CSCR patients showed significantly lower pupil contraction amplitude, dilation duration, and dilation latency, while their initial pupil diameter was larger and contraction latency was longer compared to controls. These results suggest that automated pupillometry may be an easily applicable, non-invasive screening method to detect autonomic dysfunction, which is a feature of CSCR pathophysiology. Keywords: Acute central serous chorioretinopathy, dynamic pupillometry, static pupillometry