Content uploaded by Bryan Marcia
Author content
All content in this area was uploaded by Bryan Marcia on Dec 22, 2024
Content may be subject to copyright.
Iridodiagnostics and Cardiovascular Diseases Review
Part One - The Pupils
Research Objectives
In this review, the author aims to highlight the potential of iridodiagnostics in detecting
cardiovascular diseases. Currently, interpretations on this topic are mostly confined to Russian
medical iridodiagnostics and a few European-Asian journals.
This review is the first of four sections, covering the three main components of human eye
topography: the pupil, collarette, and iris. The fourth section explores inherited and acquired
traits linked to cardiovascular weakness in constitutional classifications.
The human eye is connected to the autonomic nervous system (ANS), which controls involuntary
bodily functions, through both the sympathetic and parasympathetic branches. This study
investigates pupillary deformations, protrusions, collarette and iris anomalies, and their potential
connections to cardiovascular pathologies, as explored by several past authors and researchers.
The balance between the sympathetic and parasympathetic systems is crucial for regulating heart
rate and other physiological functions. Any disruption in this balance can lead to cardiac issues.
Methods
This study builds on previous research and my own case studies, primarily utilizing
iridodiagnostic biometric software developed based on Evgeeny Velchover's extensive medical
research in Russian Medical Iridodiagnostics.
The pupillary datasets were analyzed using Bexel Irina statistical software and Russian Medical
Iridodiagnostic software, measuring various parameters such as pupil size, shape, and symmetry.
The results were then compared to identify significant differences in pupillary abnormalities. A
mathematical percentage analysis of the human pupil in relation to the heart sector is applied, as
referenced in all the abstracts cited in this paper.
The pupillary sectors assessed are located in the 2:00-3:30 sector of the left eye and the 8:30-
10:00 sector of the right eye. These specific areas are associated with various cardiovascular
anomalies, which are highlighted in the diagnostic report generated by the software.
Research suggests that the left eye is more frequently used for diagnosing cardiovascular heart
diseases, while the right eye may reveal additional cardiovascular abnormalities, including
hereditary conditions [1].
The pupil
The human pupil is closely linked to the autonomic nervous system (ANS), which regulates
involuntary bodily functions, including those of the pupil. The ANS consists of two main
branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).
Both branches affect the pupil, and their interaction controls its size, a process known as the
pupillary light reflex. Heart failure (HF) is a condition characterized by heightened sympathetic
nervous system activity and abnormal parasympathetic nervous system responsiveness.
Previous research has explored the potential of pupillometry—the measurement of pupil size and
reactivity—as a tool to assess autonomic dysfunction in cardiovascular diseases, such as
myocardial infarction. This technique may provide valuable insights into the autonomic changes
associated with cardiac events and could serve as a non-invasive diagnostic or monitoring tool.
During a myocardial infarction, the heart muscle is deprived of oxygen due to a blockage in the
coronary arteries. This event can trigger changes in the body's autonomic nervous system, which
regulates various involuntary functions, including pupil size, shape, and reflexes.
In past studies, the role of sympathetic activation in heart failure (HF) was explored. Research
into heart failure (HF) highlights the role of excessive sympathetic activation. These studies
emphasized that sympathetic nervous system activation in HF is not just a consequence of
reduced cardiac output but a significant factor influencing the disease. These studies concluded
that while sympathetic activation is a natural response to stress and potential threats, overreaction
can be detrimental, especially in conditions such as ventricular fibrillation. Understanding and
managing sympathetic activation in HF is crucial to preventing further deterioration and adverse
outcomes [2][3].
Another study examined the role of sympathetic activation in heart failure (HF), emphasizing
that the sympathetic nervous system in HF is not merely a result of reduced cardiac output but a
significant factor influencing the disease [4].
VA Smirnov (1953) suggests that pupillary deformations in patients with peripheral nerve and
internal organ diseases arise from inflammatory processes in the peripheral nervous system and
internal organs. These processes affect the highly sensitive pupillary muscles, leading to
degenerative changes [5].
Pathological and histological studies by KV Kiselev (1936) [5] indicate that pupil strain observed
in patients with progressive paralysis correlates with degenerative changes in the ciliary
ganglion, as confirmed during dissection. This loss of ciliary components is likely due to reflex
influences from the affected areas of the central nervous system (CNS).
It is important to note that, in some cases, pupil deformation may not result from a displacement
of the stroma in the pupillary zone, but rather from the "melting" of specific areas of the
pupillary border or pigment fringe. These instances should be classified as false-positive pupil
deformations.
The Dynamic VS Static Pupil
Dynamic measurements of the pupil are currently used to assess pupillary reactions to light. The
pupillary light reflex (PLR), a dynamic measurement, focuses on how the pupil responds to light
and is essential for detecting pathological changes associated with various neurological
conditions. This method has been previously classified as pathological changes in the body
effecting the central nervous system, such as traumatic brain injury, stroke, multiple sclerosis,
lesions, drug impairment or neurodegenerative diseases like Parkinson's disease including
monitoring brain function.
The recovery time of the pupils after exposure to light can also be influenced by how well the
sympathetic and parasympathetic systems are working together. One study found that the
pupillary light reflex (PLR) can be a significant marker in predicting heart failure outcomes. In
this context, a shorter recovery time in the pupillary light reflex was associated with a more
effective overall autonomic response, involving both sympathetic and parasympathetic
components, which in turn was linked to a lower risk of all-cause mortality in heart failure
patients [4].
In contrast, static or “fixed” assessments involve examining pupil images under controlled
lighting conditions, which help identify neurophysiological changes linked to health conditions
related to abnormalities in the autonomic nervous system.
Classical ophthalmology literature does not address static pupil conditions. This study, however,
focuses exclusively on the static analysis of the pupil. The author argues that combining both
static and dynamic pupil assessments would offer more accurate neurological evaluations and
enable clinicians to track long-term pupillary changes.
Abnormalities in the visual system can indicate underlying neurological disorders, making eye
examinations an essential diagnostic tool. Understanding the intricate connection between the
eyes and the brain is fundamental for comprehending human perception, behavior, and overall
neurological health. The human pupil acts as the primary objective indicator for clinicians to
evaluate the severity of a patient's neurological condition.
Examining both static and dynamic anisocoria is equally crucial for neurological diagnosis,
particularly as the dynamic method can assist in pinpointing the location of a lesion along nerve
pathways, while the static method can diagnose and monitor long term physical tissue changes
with ease and accuracy.
Pupillary Protrusion and Sympathetic Nervous System.
Pupil protrusion refers to the condition where the pupil of the eye appears to bulge outward,
either due to changes in the surrounding structures, certain eye abnormalities and autonomic
nervous system activity. This condition is not commonly found in classical ophthalmological or
neurological literature.
The acute activation of the sympathetic nervous system is crucial for addressing immediate
challenges; however, prolonged or excessive sympathetic activity can contribute to
cardiovascular problems, such as hypertension and heart failure.
Pupillary constriction (miotic) is triggered by parasympathetic nervous system innervation,
whereas pupil dilation (mydriatic) occurs due to sympathetic nervous system stimulation. This
study follows the same principle in analyzing pupillary protrusion across different sectors and its
relationship to the sympathetic nervous system.
The results of the iridodiagnostic software's pupillary assessment are clinically significant when
there is a difference of more than 3% in the flattening or protrusion of any pupillary sector.
Pupil flattening or protrusion greater than 3% in the cardiac sectors is associated with the
following diagnoses:
• Protrusion in the middle-temporal region of the left pupil indicates "overload in the right
sections of the heart."
• Protrusion in the middle-temporal region of the right pupil suggests a risk of a
“cardiospastic reaction.”
Protrusion in the middle-temporal region of the left pupil suggests conditions linked to excessive
strain or workload on the right side of the heart. "Overload of the right parts of the heart" refers
to conditions where the right section of the heart is under excessive strain or workload. The right
side of the heart pumps oxygen-depleted blood from the body to the lungs for oxygenation.
Increased pressure or volume in this area can lead to overload.
Flattening or protrusions less than 3% are also detected and recorded but not diagnosed, as such
minor deformations may still indicate potential subclinical issues. Monitoring pupil changes over
time can be valuable for both diagnosis and effective treatment.
In heart failure, enhanced sympathetic activity is a key compensatory mechanism. However, this
response ultimately exacerbates myocardial damage and worsens cardiac function.
It is important to note that the relationship between pupil abnormalities and cardiac disorders are
still being investigated, and further research is needed to establish a definitive connection and
understand the underlying mechanisms. It is a promising area of study that may contribute to our
understanding of the relationship between cardiovascular health and the autonomic nervous
system via the pupil.
Pupil Protrusion Case Study – A 64-year-old male with a history of two heart attacks, a
pacemaker, and a congenital enlarged heart was found to have a middle-temporal protrusion of
7.50%. A follow-up image taken six months later showed a reduction to 4.88%, indicating a
significant change and suggesting the potential for a monitoring system.
Original pupillary assessment – May 2003
Follow-up middle nasal protrusion – November 2003
Overall, clinical significance refers to the impact or importance of a particular condition or finding on a
patient's health. In the case of right heart overload, its significance can vary based on the underlying cause
and severity. Potential clinical implications include pulmonary hypertension, right ventricular
dysfunction, congenital heart defects, and pulmonary embolism.
The clinical significance of right heart overload depends on the underlying condition, its
severity, duration, and the individual's overall health. Accurate diagnosis and management are
essential to prevent complications and enhance heart function. Treatment options may include
medication, lifestyle changes, and, if needed, surgery.
Pupillary Flattening and Parasympathetic Nervous System
Pupil flattening refers to a sectoral contraction of the pupil and iris stroma in specific areas. This
condition is not commonly discussed in traditional ophthalmological literature but is addressed in
several iridodiagnostic books and manuscripts.
First described by R. Schnabel in 1959 [6], examining pupil deformation can aid in making rapid
and accurate diagnoses. Josef Deck explains that pupillary flattening is primarily caused by
vagotonic influences, which are effects mediated by the vagus nerve, a key component of the
parasympathetic nervous system. When vagal tone is elevated, it typically induces a state of calm
and relaxation in the body, leading to responses such as decreased heart rate, increased
gastrointestinal activity and constriction of pupils (miosis) [7].
Mid-temporal flattening of the pupils is caused by parasympathetic innervation. Mid-temporal
flattening (parasympathetic) of the left pupil may indicate lung injury, cardiopathy, cardiac
issues, and breathing problems. A shift in the middle-temporal region of the right pupil could
suggest hypertension in the lesser circulation, accompanied by symptoms of cardiovascular
insufficiency.
Mid-temporal flattening of the pupils (at 9 o'clock on the right and 3 o'clock on the left) can
indicate specific conditions. Flattening in the right pupil is often linked to dyspnea, especially
when breathing difficulties have a nervous origin. Mild flattening on the left pupil is considered a
"lung" sign, potentially indicating lung disease, and is frequently observed with pronounced
flattening in cardiomyopathy. J. Deck suggests this may reflect cardiovascular weakness and a
tendency toward collapse [7].
In the context of pupillary flattening, vagotonic influences suggest that heightened vagal activity
can lead to changes in pupil shape or size, typically associated with relaxation or a resting state.
Parasympathetic dysfunction in heart failure
Parasympathetic dysfunction in heart failure is closely linked to an imbalance in the autonomic
nervous system (ANS), where there is an overactive sympathetic nervous system (SNS) and
reduced parasympathetic nervous system (PNS) activity. In heart failure, the body compensates
by increasing sympathetic activity to maintain cardiac function, which raises heart rate and
contractility. However, this elevated sympathetic activity is often maladaptive and can worsen
the condition over time.
Parasympathetic dysfunction plays a critical role in the worsening of heart failure by limiting the
body's ability to regulate heart function effectively and amplifying the negative effects of
sympathetic overactivity.
The parasympathetic nervous system, responsible for promoting relaxation and lowering heart
rate, plays a vital role in counteracting the effects of the sympathetic nervous system. In heart
failure, diminished parasympathetic function impairs this balance, contributing to several
problems including increased heart rate, impaired heart rate variability, sympathetic overactivity
and poor prognosis.
Acute myocardial ischemia serves as an effective model for clearly illustrating the complex
relationship between sympathetic and vagal activity.
In Fig. 1 is a schematic representation of different types of pupillary flattening’s. [8]
Case Study 2: Left Middle Temporal Flatness
This patient has coronary arteries disease and obstruction in his coronary arteries. His father had coronary arteries
disease and diabetes. Case Study Credit – Dr. M. Serdar Çukur, M.D., Ophthalmologist, Turkey.
If the iridodiagnostic software identifies flattening of the middle-temporal region of the left pupil
at three percent or more, it suggests ischemic heart disease.
Right Pupil Flattening and Protrusion
In the right eye, according to E.S. Velchover, flattening in the middle-temporal region of the pupil
indicates pulmonary conditions, cardiac issues, and abnormal nerve regulation in the heart, while
protrusion suggests a risk of a cardio-spastic reaction [5]. Some researchers believe that if flattening or
protrusion is observed in both eyes, the condition may be hereditary [1].
Decentration of Pupils
In iridodiagnostics, the phenomenon of pupil decentration is of significant importance. Under
normal conditions, the pupil is centrally located or slightly displaced medially and downward,
reflecting the eye's accommodation and convergence mechanisms. This is due to the precise and
coordinated interaction between the parasympathetic and sympathetic systems, which regulate
the pupillary muscles, including the sphincter and dilator muscles. The position of the pupil is
not influenced by excessive tension in specific muscle groups or their relaxation.
According to P. Dimkov.,1977, middle-nasal decentration of the right pupil (toward the 3 o'clock
position) is associated with pulmonary diseases, particularly emphysema. Decentration in the
middle of the left pupil (at the 9 o'clock position) is linked to heart conditions, specifically left
ventricular hypertrophy and heart failure [9].
However, it is essential to consider other pathological changes in the iris stroma when
interpreting the phenomenon of pupil decentration.
Conclusions
Past studies have explored the potential use of pupillometry—the measurement of pupil size and
reactivity—as a tool for assessing autonomic dysfunction in cardiovascular diseases, including
myocardial infarctions. Pupillometry may provide insights into the autonomic changes associated
with cardiac events and could potentially serve as a non-invasive diagnostic or monitoring tool.
The examination of pupillary responses is a valuable tool in clinical assessments. Changes in
pupil size and reactivity can offer insights into the functioning of the autonomic nervous system
and may indicate various neurological or systemic conditions.
Previous studies have also explored the potential of pupillometry, the measurement of pupil size
and reactivity, as a tool for assessing autonomic dysfunction in cardiovascular diseases, such as
myocardial infarction. Pupillometry may provide valuable insights into the autonomic changes
associated with cardiac events and could potentially serve as a non-invasive diagnostic or
monitoring tool. Static pupillary assessment has also proven to be highly valuable in detecting
cardiovascular diseases.
Further research is needed to establish a definitive link and gain a deeper understanding of the
underlying mechanisms. This emerging field holds promise and has the potential to enhance our
understanding of the connection between cardiovascular health and characteristics of the human
eye.
The pupil is an excellent focus and barometer, making it a key area of interest in fields such as
neurology, integrative medicine, chiropractic, osteopathy, physiotherapy, naturopathy,
iridodiagnostics, and craniosacral therapy.
In Part II, we will explore the collarette of the human eye in relation to cardiovascular diseases.
Conflict of Interest Statement
The author confirms that the research was conducted without any commercial or financial
relationships that could be perceived as a potential conflict of interest. With extensive experience
in Russian-based Iridodiagnostics, the author aims to share this valuable information, which is
not easily accessible to researchers in North America.
Author: Bryan K. Marcia, Ph.D. Associate Professor Emeritus (2006), Dept. of Natural
Medicine, Capital University of Integrative Medicine
Founder: Clinical Neuro-Optic Research Institute – https://cnri.edu
Keywords: cardiovascular diseases, human pupils, pupil protrusion, pupil flattening, pupil
decentration, neurology
References
1: Kriege T. - Fundamental Basis of Irisdiagnosis. - Osnabruck, 1971. P.85, Chapter 12.
2: E Gronda, V Dusi, E D’Elia, M Iacoviello, E Benvenuto, E Vanoli, Sympathetic activation in
heart failure, European Heart Journal Supplements, Volume 24, Issue Supplement_E, September
2022, Pages E4–E11, https://doi.org/10.1093/eurheartjsupp/suac030
3: Zhang DY, Anderson AS. The sympathetic nervous system and heart failure. Cardiol Clin.
2014 Feb;32(1):33-45, vii. doi: 10.1016/j.ccl.2013.09.010. PMID: 24286577; PMCID:
PMC5873965. https://pubmed.ncbi.nlm.nih.gov/24286577/
4: Pupillary Light Reflex as a New Prognostic Marker in Patients With Heart Failure - Kohei
Nozaki, Kentaro Kamiya, Yuya Matsue, Nobuaki Hamazaki, Ryota Matsuzawa, Shinya Tanaka ,
Emi Maekawa , Takuya Kishi , Atsuhiko Matsunaga, Takashi Masuda , Toru Izumi, Junya Ako -
Journal of Cardiac Failure, Volume 25, Issue 3, 2019, Pages 156-163, ISSN 1071-9164,
https://www.sciencedirect.com/science/article/abs/pii/S1071916418310029
5: Iridodiagnosis (Russian text)- E.S. Velchover, N.B. Shulpina, Z.A. Alyeva, F.N. Romashov –
Medicine, 1988 – 240 pp.
6: Schnabel R: Iridoscopie, Anleitung Krausheiten und deren Veraniagung aus der menschlichen
Iris zu erkennen. ULM. 1959, 188 pp.
7: Deck, Josef. Principles of Iris Diagnosis - Ettlingen, 01 Dec 1985.
8: Fig 1: Pupil Flattening Chart, 2004, Marcia, Bryan
9: Potebnya G.P., Lisovenko G.S., Krivenko V.V., Clinical and experimental iridology. – Kiev:
Naukova Dumka. 1995 – 254 pp
Acknowledgments
I would like to express my sincere gratude to all those who have contributed to the development and
understanding of iridodiagnoscs, a eld that combines the art of human eye analysis with the precision
of scienc inquiry. Through this research, we aim to bridge the gap between tradional methods and
modern scienc validaon, exploring the potenal of pupillary anomalies, collaree representaons,
iris paerns as valid adjuncve diagnosis for health condions. This work would not have been possible
without the dedicaon of pioneering researchers, clinicians, and parcipants whose insights and
collaboraon have shaped this study.
