The relationship between pupil response and type 1 diabetes mellitus in children: A case-control study

Abstract

Objective: This study aimed to compare pupil measurements obtained with the Sirius topography device in children with type 1 diabetes with the systemic and ocular findings of the subjects.

Methods:This study involved 41 pediatric cases of type 1 diabetes mellitus (DM) and 41 control cases. Key outcome parameters included pupil diameter and the average rate of pupillary dilation. Both static and dynamic pupillometric assessments were conducted using the Sirius Topographer (CSO, Florence, Italy).These findings were further evaluated in relation to retinal nerve fiber layer thickness and ganglion cell layer thickness measurements.

Results: A statistically significant negative correlation was identified between HbA1c levels and certain dynamic pupillometry parameters in the DM group. HbA1c was weakly and negatively correlated with 1st second pupil diameter (r=-0.204;p=0.006), moderately and negatively correlated with the 2nd second (r=-0.346; p = 0.001), 4th second (r -0.360;p= 0.001), and 6th second (r = -0.333;p=0.002), and weakly to moderately correlated with the 8th second (r=- 0.297;p=0.007) and 10th second (r =-0.319;p=0.003). These findings indicate a negative relationship, meaning that as HbA1c levels increase, dynamic pupillometry measurements tend to decrease. A weak but statistically significant positive correlation was observed between ganglion cell count and the mesopic pupil diameter, a parameter of static pupillometry, in the DM group (r=0.219;p=0.049). No significant relationship was detected between retinal nerve fiber layer thickness (RNFLT) and pupillary response measurements in the DM group (p>0.05).

Conclusions: Although dynamic pupillometry measurements in children with diabetes were not associated with the duration of the disease, a significant correlation was observed with HbA1c levels.