Évaluation fonctionnelle des maculopathies et la rétinopathie diabétique par cartographie pupillaire chromatique multifocale

PURPOSE: To evaluate the performance of an innovative, noninvasive, rapid chromatic multifocal dynamic pupillometry protocol (mPFTCo) in detecting functional retinal changes in three chronic diseases: age-related maculopathy (ARM), age-related macular degeneration (AMD), and diabetic retinopathy (DR). METHODS: A cohort of 222 participants (68 controls, 18 ARM, 79 AMD, 57 DR) was tested with mPFTCo. This one-minute test per eye used a multifocal stimulus covering 40° of the visual field, divided into nine regions, each periodically modulated in luminance, with chromatic alternation (blue, red, green, gray) every 15s. Regional and spectral pupillary responses were analyzed to characterize functional deficits. Group comparisons were performed using Student's t-tests and ROC curve analyses. RESULTS: Compared with controls, significant regional alterations were observed in all three diseases. In AMD, pupillary responses were reduced in central and paracentral regions, particularly under red stimulation (P<0.001). In ARM, a moderate paracentral deficit was observed with blue and green stimulation (P<0.005). In DR, a diffuse deficit affected the entire visual field across all colors (P<0.001). This brief, objective, well-tolerated test showed excellent diagnostic performance (AUC=1). CONCLUSION: mPFTCo enables rapid, noninvasive topographic assessment of retinal function. It effectively discriminates between pathological profiles and identifies subclinical alterations not detected by conventional visual tests, representing a promising tool for screening, monitoring, and functional evaluation of treatments in routine clinical practice.