Open (Boston, Massachusetts) Coagulation factors and proteins; pupillometry

From the MassME newsletter

Dr. Michael Van Elzakker's group at Mass. General Brigham is seeking participants in the Greater Boston Area who have been clinically diagnosed with ME/CFS for a new study of blood samples for coagulation factors and proteins.

The study will also collect saliva samples and perform a pupillometry exam (reaction of pupils to light). The samples can be collected at home and participants will receive $20 in compensation. For more information, contact ebarringer@mgh.harvard.edu.

 

Interesting. My pupils definitely react more slowly to light and dark than normal, and I think they have since early on in the disease. Sometimes I have to wait for them to adjust, as I can't see otherwise!

 

Dr.Amalok Bansal:

"Abnormalities of the pupils to light are seen in patients with cerebral ischaemic events, certain brain neoplasms, local disturbance in neural transmission and demyelination. Checking the pupil reflexes is often undertaken to detect alterations in the brainstem pathways mediating the perception of light, accommodation to distance and near vision and changes based on ambient illumination. In patients with CFS/ME I have observed two unusual responses that are evident on prolonged illumination of the pupils. The more frequent finding seen in three quarters of patients is a rhythmic contraction and dilatation of the pupils. The second pattern is a paradoxical dilation of the pupils after an initial contraction. The latter is seen in patients with autoimmune autonomic neuropathy that is caused by IgG antibodies to the ganglionic acetylcholine receptor [44]. However, these autoantibodies are absent in the patients with CFS with this type of pupil abnormality.
Interestingly these CFS/ME patients are more frequently faint on standing, have poor tolerance of prolonged standing and other features of POTS. In my experience other symptoms of a more generalised autonomic neuropathy are absent. The cause of these changes in the pupil reflexes is unclear but a persistent state of adrenergic over activity may be involved. This may oppose the constricting action of direct pupil illumination and produce the fluctuating response in many and a more significant but delayed dilatation in others. Interestingly, a delay in pupil constriction to direct light was reported in depressed patients by Fountoulakis et al. [45] and attributed to reduced noradrenergic tone."
LINK

 

That paper by Bansal (https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-016-0493-0) is interesting as a source of material for GP education. There is a lot of good detail but also some things I think we might question the grounding for.

I don't know if we ever had a thread for it.

 

I've made a thread here.

 

This thread, Bansal (eye) pupil reaction test, discusses it.