Bill Harvey: Born stubborn

At last year’s AAO conference, I remember hearing about a soon-to-be-launched fields screener that used pupil response to light stimuli to detect whether targets had been seen and so achieve the holy grail of an objective field test. My initial worry about this was that older people with more risk of field loss would also have greatly compromised pupil responses.

A paper out last week, however, implies my scepticism to have been misplaced (DOI: 10.1002/ehf2.12933). It appears there is increasing evidence that the area of the pupil is strongly related to the health of the heart and ‘patients with small pupil area had significantly higher rates of cardiovascular death.’ Also, patients with known heart disease have better prognosis if their pupil area is larger. Accurate pupil measurements were possible even on older patients. I am revising my view of pupils.