The influence of brightness, age and refractive errors on pupil size

Abstract

Objectives: In this study, we aimed to investigate the influence of age, gender and refractive status on pupil size under different illuminance conditions in presbyopic healthy people. Methods: A total of 75 volunteers (49 females and 26 males) were included in the study. The medical records of each participant was reviewed. Patients were divided into three groups according to their age and refractive errors. Pupil responses were evaluated with the automated pupillometry function of the Sirius Topographer. Relationship between pupil size and age, sex, laterality, dominant eye, refrative errors were analyzed by statistical analyses. Results: In the early aged presbyopia group of patients the mean value of the hyperopic group was higher than the other two groups in photopic measurements. In scotopic condition, the mean value of the myopic group was found to be higher than the emmetropic and hyperopic groups. No difference was observed in the comparison of mesopic measurements in all three groups. In the patients with established presbyopia, myopic pupil diameter was higher compared to emmetropic and hyperopic pupils in all illuminances. There was a difference only in the scotopic condition when comparing the emmetropic and hyperopic groups. Pupil size did not change with age in all three conditions in emmetropic eyes. Pupil diameter decreased in all three conditions with age in hyperopics. Photopic and mesopic pupil size increased with age in myopics. Conclusion: The results of this study support that the effects of patient age and refractive status on pupil diameter are important in optimal lens design.

Keywords

• hyperopics
• myopics
• presbyopics
• pupil size
• sirius cornea topography

References

1. Sulutvedt U, Zavagno D, Lubell J, Leknes S, de Rodez Benavent SA, Laeng B. Brightness perception changes related to pupil size. Vision Res 2021;178:41–7.
2. Whang AJ, Chen YY, Tseng WC, Tsai CH, Chao YP, Yen CH, Liu CH, Zhang X. Pupil size prediction techniques based on convolution neural network. Sensors (Basel) 2021;21:4965.
3. Zele AJ, Gamlin PD. Editorial: the pupil: behavior, anatomy, physiology and clinical biomarkers. Front Neurol 2020;11:211.
4. Oster J, Huang J, White BJ, Radach R, Itti L, Munoz DP, Wang CA. Pupillary responses to differences in luminance, color and set size. Exp Brain Res 2022;240:1873–85.
5. Cakmak HB, Cagil N, Simavli H, Duzen B, Simsek S. Refractive error may influence mesopic pupil size. Curr Eye Res 2010;35:130–6.
6. Robl C, Sliesoraityte I, Hillenkamp J, Prahs P, Lohmann CP, Helbig H, Herrmann WA. Repeated pupil size measurements in refractive surgery candidates. J Cataract Refract Surg 2009;35:2099–102.
7. Salz JJ, Trattler W. Pupil size and corneal laser surgery. Curr Opin Ophthalmol 2006;17:373–9.
8. Alarcón A, Rubiño M, Pééérez-Ocón F, Jiménez JR. Theoretical analysis of the effect of pupil size, initial myopic level, and optical zone on quality of vision after corneal refractive surgery. J Refract Surg 2012;28:901–6.

9. Monsálvez-Romín D, González-Méijome JM, Esteve-Taboada JJ, García-Lázaro S, Cerviño A. Light distortion of soft multifocal contact lenses with different pupil size and shape. Cont Lens Anterior Eye 2020; 43:130–6.
10. Kiel M, Grabitz SD, Hopf S, Koeck T, Wild PS, Schmidtmann I, Lackner KJ, Münzel T, E Beutel ME, Pfeiffer N, Schuster AK. Distribution of pupil size and associated factors: results from the population-based Gutenberg health study. J Ophthalmol 2022;9520512: 1–8.
11. Birren J, Casperson RC, Botwinick J. Age changes in pupil size. J Gerontol 1950;5:216–21.
12. Winn B, Whitaker D, Elliott DB, Phillips NJ. Factors affecting light-adapted pupil size in normal human subjects. Invest Ophthalmol Vis Sci 1994;35:1132–7.
13. Lee YS, Kim HJ, Lim DK, Kim MH, Lee KJ. Age-specific influences of refractive error and illuminance on pupil diameter. Medicine (Baltimore) 2022;101:e29859.
14. Guillon M, Dumbleton K, Theodoratos P, Gobbe D, Wooley CB, Moody K. The effects of age, refractive status, and luminance on pupil size. Optom Vis Sci 2016;93:1093–100.
15. Hirsch MJ, Weymouth FW. Pupil size in ametropia. J Appl Physiol 1949;1:646–8.
16. Salz JJ, Trattler W. Pupil size and corneal laser surgery. Curr Opin Ophthalmol 2006;17:373–9.
17. Yazdani N, Sharif M, Karimpour N, Asieh ME. Assessment of the pupil size in emmetropic and myopic eyes. Reviews in Clinical Medicine 2020;7:110–3.
18. Truong JQ, Joshi NR, Ciuffreda KJ. Influence of refractive error on pupillary dynamics in the normal and mild traumatic brain injury (mTBI) populations. J Optom 2018;11:93–102.