Abstract：
BACKGROUND: Neurodegenerative diseases share retinal abnormalities. Chromatic pupillometry allows in vivo assessment of photoreceptor functional integrity, including melanopsin-expressing retinal ganglion cells. This exploratory meta-analysis assesses retinal photoreceptor functionality in Alzheimer\'s vs. Parkinson\'s disease and conducts an in-depth review of applied pupillometric protocols.
METHODS: Literature reviews on PubMed and Scopus from 1991 to August 2023 identified chromatic pupillometry studies on Alzheimer\'s disease (AD; n = 42 patients from 2 studies) and Parkinson\'s disease (PD; n = 66 from 3 studies). Additionally, a pre-AD study (n = 10) and an isolated REM Sleep Behavior Disorder study (iRBD; n = 10) were found, but their results were not included in the meta-analysis statistics.
RESULTS: Melanopsin-mediated post-illumination pupil response to blue light was not significantly impaired in Alzheimer\'s (weighted mean difference = -1.54, 95% CI: 4.57 to 1.49, z = -1.00, p = 0.319) but was in Parkinson\'s (weighted mean difference = -9.14, 95% CI: 14.19 to -4.08, z = -3.54, p < 0.001). Other pupil light reflex metrics showed no significant differences compared to controls. Studies adhered to international standards of pupillometry with moderate to low bias. All studies used full-field stimulation. Alzheimer\'s studies used direct while Parkinson\'s studies used consensual measurement. Notably, studies did not control for circadian timing and Parkinson\'s patients were on dopaminergic treatment.
CONCLUSIONS: Results affirm chromatic pupillometry as a useful method to assess melanopsin-related retinal cell dysfunction in Parkinson\'s but not in Alzheimer\'s disease. While adhering to international standards, future studies may analyze the effects of local field stimulation, dopaminergic treatment, and longitudinal design to elucidate melanopsin dysfunction in Parkinson\'s disease.
METHODS: Literature reviews on PubMed and Scopus from 1991 to August 2023 identified chromatic pupillometry studies on Alzheimer\'s disease (AD; n = 42 patients from 2 studies) and Parkinson\'s disease (PD; n = 66 from 3 studies). Additionally, a pre-AD study (n = 10) and an isolated REM Sleep Behavior Disorder study (iRBD; n = 10) were found, but their results were not included in the meta-analysis statistics.
RESULTS: Melanopsin-mediated post-illumination pupil response to blue light was not significantly impaired in Alzheimer\'s (weighted mean difference = -1.54, 95% CI: 4.57 to 1.49, z = -1.00, p = 0.319) but was in Parkinson\'s (weighted mean difference = -9.14, 95% CI: 14.19 to -4.08, z = -3.54, p < 0.001). Other pupil light reflex metrics showed no significant differences compared to controls. Studies adhered to international standards of pupillometry with moderate to low bias. All studies used full-field stimulation. Alzheimer\'s studies used direct while Parkinson\'s studies used consensual measurement. Notably, studies did not control for circadian timing and Parkinson\'s patients were on dopaminergic treatment.
CONCLUSIONS: Results affirm chromatic pupillometry as a useful method to assess melanopsin-related retinal cell dysfunction in Parkinson\'s but not in Alzheimer\'s disease. While adhering to international standards, future studies may analyze the effects of local field stimulation, dopaminergic treatment, and longitudinal design to elucidate melanopsin dysfunction in Parkinson\'s disease.
摘要：
背景：神经退行性疾病共有视网膜异常。彩色瞳孔测量允许在体内评估光感受器功能的完整性，包括表达黑素的视网膜神经节细胞。这项探索性荟萃分析评估了阿尔茨海默氏症患者的视网膜感光功能与帕金森病，并对应用的瞳孔测量方案进行了深入审查。
方法：1991年至2023年8月关于PubMed和Scopus的文献综述确定了阿尔茨海默病（AD；2项研究中的n=42例患者）和帕金森病（PD；3项研究中的n=66）的彩色瞳孔测量研究。此外,发现了AD前研究（n=10）和单独的REM睡眠行为障碍研究（iRBD;n=10），但他们的结果未纳入荟萃分析统计.
结果：黑色素蛋白介导的光照后瞳孔对蓝光的反应在阿尔茨海默病中没有明显受损（加权平均差=-1.54，95％CI：4.57至1.49，z=-1.00，p=0.319），但在帕金森氏症中（加权平均差=-9.14，95％CI：14.19至-4.08，z=-3.54，<0.001）。与对照组相比，其他瞳孔光反射指标没有显着差异。研究遵循中等至低偏差的国际瞳孔测量标准。所有研究都使用了全场刺激。阿尔茨海默氏症的研究直接使用，而帕金森的研究使用共识测量。值得注意的是,研究未对昼夜节律时间进行控制，帕金森病患者正在接受多巴胺能治疗。
结论：结果证实，彩色瞳孔测量法是评估帕金森氏症而不是阿尔茨海默病的黑素相关视网膜细胞功能障碍的有用方法。在坚持国际标准的同时，未来的研究可能会分析局部场刺激的影响，多巴胺能治疗，和纵向设计，以阐明帕金森病中的黑视蛋白功能障碍。
方法：1991年至2023年8月关于PubMed和Scopus的文献综述确定了阿尔茨海默病（AD；2项研究中的n=42例患者）和帕金森病（PD；3项研究中的n=66）的彩色瞳孔测量研究。此外,发现了AD前研究（n=10）和单独的REM睡眠行为障碍研究（iRBD;n=10），但他们的结果未纳入荟萃分析统计.
结果：黑色素蛋白介导的光照后瞳孔对蓝光的反应在阿尔茨海默病中没有明显受损（加权平均差=-1.54，95％CI：4.57至1.49，z=-1.00，p=0.319），但在帕金森氏症中（加权平均差=-9.14，95％CI：14.19至-4.08，z=-3.54，<0.001）。与对照组相比，其他瞳孔光反射指标没有显着差异。研究遵循中等至低偏差的国际瞳孔测量标准。所有研究都使用了全场刺激。阿尔茨海默氏症的研究直接使用，而帕金森的研究使用共识测量。值得注意的是,研究未对昼夜节律时间进行控制，帕金森病患者正在接受多巴胺能治疗。
结论：结果证实，彩色瞳孔测量法是评估帕金森氏症而不是阿尔茨海默病的黑素相关视网膜细胞功能障碍的有用方法。在坚持国际标准的同时，未来的研究可能会分析局部场刺激的影响，多巴胺能治疗，和纵向设计，以阐明帕金森病中的黑视蛋白功能障碍。
