Age-Related Changes in Dynamic Iris Behavior Assessed Using a Programmable Closed-Loop Iris Control System

PURPOSE: The purpose of this study was to develop and test a programmable closed-loop system for tracking, modulating, and assessing dynamic iris behavior, including in the mid-dilated position. METHODS: A programmable closed-loop iris control system was developed by customizing an ANTERION OCT device (Heidelberg Engineering, Heidelberg, Germany). Custom software was developed to store camera and optical coherence tomography (OCT) images, track pupillary diameter (PD), control a light-emitting diode (LED), and modulate ambient lighting to maintain the iris in a dilated, constricted, or mid-dilated position in real-time. Study participants underwent 3 consecutive 65-second scan sessions. Dynamic iris behavior in the form of peak constriction velocity (PCV) and mid-dilated iris activity (MDIA) were calculated and analyzed offline. RESULTS: Among 58 participants, 56 (96.6%) were eligible for analysis based on achieving and maintaining mean PD within ±10% of the calculated mid-dilated PD. Mean participant age was 49.8 ± 18.9 years. Mean PCV was 3.92 ± 0.83 mm/s, and mean MDIA was 0.37 ± 0.15 mm. The mean difference between the calculated and achieved mid-dilated PD was 0.166 ± 0.192 mm. There were significant negative correlations between PCV and age (slope = −0.022, P < 0.001) and MDIA and age (slope = −0.004, P < 0.001). Success rates were lower (69.0%) but relationships between dynamic iris behavior and age were similar based on achieving and maintaining mean PD within ±5% of the calculated mid-dilated PD. CONCLUSIONS: A programmable closed-loop iris control system can modulate dynamic iris behavior and maintain the iris in a mid-dilated position. Pupillary constriction velocity and iris activity in the mid-dilated position decrease with age. TRANSLATIONAL RELEVANCE: This system can be applied to study dynamic disease processes involving the iris and establish novel biometric measures that could serve as risk factors for acute and chronic primary angle closure glaucoma (PACG).