Pupil fields in a patient with early-onset postgeniculate lesion

  • Ken AsakawaEmail author
  • Hitoshi Ishikawa
Letter to the Editor

Dear Editor,

Pupil perimetry is becoming more common for its utility as an objective method to evaluate visual fields using pupillary response. The pupillary response has two main pathways: an afferent and an efferent limb. The afferent pathway leaves the optic tract before the lateral geniculate body and terminates in the midbrain. Wilhelm et al. reported that there are pupillary response abnormalities in patients with homonymous visual field defects caused by postgeniculate lesions [1]. These findings challenge the neural pathway of the pupillary response. One of the possibilities is that retrograde trans-synaptic degeneration (RTSD) were observed within a few years after the onset of occipital damage using optical coherence tomography (OCT) [2, 3]. To clarify these findings, we have recorded the pupil fields in a patient with an “early-onset” postgeniculate lesion using a newly developed head-mounted perimeter.

A 40-year-old man noticed a loss of visual fields on the right side and...



The authors thank Robert E. Brandt, Founder, CEO, and CME, of MedEd Japan, for editing the manuscript.


This study was supported by a grant from Kitasato University School of Allied Health Sciences Grant in-Aid for Research Project, grant number 2018-1041. Also, this study was funded by CREWT Medical Systems. The funders provided the device without fee for 2 years.

Compliance with ethical standards

The tenets of the Declaration of Helsinki for research involving human subjects were followed, and informed consent was obtained. The protocol was approved by the Institutional Ethics Committee of Kitasato University (No. B17-031).

Conflict of interest

Ken Asakawa, received support for this study from CREWT Medical Systems; Hitoshi Ishikawa, none.

Informed consent

The patient has consented to the submission of the Letter to the Editor to the journal.


  1. 1.
    Wilhelm H, Wilhelm B, Petersen D, Schmidt U, Schiefer U (1996) Relative afferent pupillary defects in patients with geniculate and retrogeniculate lesions. Neuroophthalmology 16:219–224CrossRefGoogle Scholar
  2. 2.
    Jindahra P, Petrie A, Plant GT (2009) Retrograde trans-synaptic retinal ganglion cell loss identified by optical coherence tomography. Brain 132:628–634CrossRefGoogle Scholar
  3. 3.
    Dinkin M (2017) Trans-synaptic retrograde degeneration in the human visual system: slow, silent, and real. Curr Neurol Neurosci Rep 17:16CrossRefGoogle Scholar
  4. 4.
    Asakawa K, Nanno M, Ishikawa H, Shoji N (2018) Evaluation of pupil fields using a newly developed head-mounted perimeter in healthy subjects. J Glaucoma 27:807–815CrossRefGoogle Scholar
  5. 5.
    Berson DM (2003) Strange vision: ganglion cells as circadian photoreceptors. Trends Neurosci 26:314–320CrossRefGoogle Scholar
  6. 6.
    Lucas RJ, Hattar S, Takao M, Berson DM, Foster RG, Yau KW (2003) Diminished pupillary light reflex at high irradiances in melanopsin-knockout mice. Science 299:245–247CrossRefGoogle Scholar
  7. 7.
    Gamlin PD, McDougal DH, Pokorny J, Smith VC, Yau KW, Dacey DM (2007) Human and macaque pupil responses driven by melanopsin-containing retinal ganglion cells. Vis Res 47:946–954CrossRefGoogle Scholar
  8. 8.
    Kardon R, Anderson SC, Damarjian TG, Grace EM, Stone E, Kawasaki A (2009) Chromatic pupil responses: preferential activation of the melanopsin-mediated versus outer photoreceptor-mediated pupil light reflex. Ophthalmology 116:1564–1573CrossRefGoogle Scholar
  9. 9.
    Maeda F, Kelbsch C, Straßer T, Skorkovská K, Peters T, Wilhelm B, Wilhelm H (2017) Chromatic pupillography in hemianopia patients with homonymous visual field defects. Graefes Arch Clin Exp Ophthalmol 255:1837–1842CrossRefGoogle Scholar
  10. 10.
    Wilhelm BJ, Wilhelm H, Moro S, Barbur JL (2002) Pupil response components: studies in patients with Parinaud’s syndrome. Brain 125:2296–2307CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthoptics and Visual ScienceKitasato University, School of Allied Health SciencesSagamiharaJapan
  2. 2.Department of OphthalmologyKitasato University, School of MedicineSagamiharaJapan

Personalised recommendations