Aviation-related respiratory

gas disturbance affect dark

adaptation : reappraisal
(Elsevier Journal, 2006 :
Desmond M. Connolly PHD,
Sarah L. Hosking)

THE GROUP
First leuteunant Imam Hafidh, MD
Second Leuteunant Herdy Adriano,
MD
Sri murtiningrum, MD

Abstract
This study examine the time course
of early scotopic (NV) threshold
sensitivity during dark adaptation
Mild moderate
hypoxia
Moderate Hypokapnia &
Hyperoxia
Measuring detection
time displacement
relative to normoxia

1.introduction
Flying in the darkness >>accident,
even in a good weather (wilson
1999)
At night cockpit illuminated
@mesopic ambient lighthead
movement challange pilot/air crew
This papper concern human visual
visual performance
sensitivity during aviation at night
during resp disturbance

INFLIGHT
Hypoxi
a
Hyperventilat
ion

Compromise threshold
sensitivity during dark
adaptation
Adaptation to combat hypoxia

Hypocapnia
Enhance visual sensitivity

Hyperoxia

However, little is known of the impact

of respiratory disturbance upon
mesopic visual performance

This study, a Hypobaric

chamber was use to
investigate delay time
to early scotopic
sensitivity under resp
disturbancemesopic
vision

2. Method
2.1Subects
Informed consent
5 healthy male (22-35 years old) criteria
check!
Undergone Hypoxia Fam training
2.2 Equipment
- Hypobaric Chamber
- Stimuli : internal green light with neutra density
filters and black stimulus plate
- Non invasive monitoring HR, Saturation O2 and
BP

2.3 procedure
voluntary seated at rest in Hypobaric
Chamber
All monitoring device were placed
At ground lv: 15 minutes to adapt the
resp in steady state5 minutes dark
adapt (left eye patched)on dark cond
given the intial dim light to the dimmest
light could be presentedlight
restoredrest for 30 minutesThe
alltitude 10.000-15.000 (30484572m)same procedure

2.4 Analysis
The 25 control dark adaptation
(under Normoxia)allowed variability
in stimulus detection time (using
ANOVA)
For each dark adaptation conducted
under Resp disturbance the
detection time displacement relative
of determined for all stimulus
intensity

Negative (-)
Represent a
hastening of
add to the
dark

Positive (+)
represent a
delayed
adaptation to
the dark
Reduced
visual
sensitivity

Increased
visual
sensitivity

 Analysed for stastitical significance

to 95% of confident limit
(p<0,05%)using
paired T: tes
Null Hypotesis
Sample population
experiencing no effect
from the immposed
respiratory condition
Result p< dari 0,01

Result
1

Respiratory and
Cardivascular
Responses

Variation in dark adaptation under

normoxia
-From 25 normoxic stim detection
ranged from 85-93 second
-Except the brightest (3.0 ND) 103 s
(cone)and the dimmest (4.6ND) 147 s
(rod)

Dark adaptation under Resp

disturbance:
-Achieved stasticaly and
significantly in hastening or
delaying stimulus detection
-Hypoxia : signifficantly
delayed dark addaptation at
the majority of the stim
intensity
-Hyperventilation (Ground lv)
and Hypokapnia (15000ft) :
hasten dark addaptation
-Hyperoxia (Ground lv) :
Hasten dark addaptation

Hypoxia
condition
(Breathing air at
15000ft/4572m)

Time of dark
adaptation slower

Hyperventilati
on
(Hypocapnia)
at Ground Lv

Time of dark
adaptation relative
to normoksia,
hasten the
adaptation

Hyperventilati
on
(Hypocapnia)
at 15000ft

Time of dark
adaptation relative
to normoksia
hasten the
adaptation

Hyperoxia
(100% O2) at
Ground Lv

Time of dark
adaptation hasten
the adaptation

4. Discussion
4.1 Hypoxia
Earlier studies : Hypoxia delayed
Cone Rod inflection (Mesopic) and
early scotopic adaptation
Now studies : Hypoxia delaying the
onset of scotopic sensitivity
2 minutes at 3048 m (10.ooo
ft)
3 minutes at 4572 m ( 15.000
f)

4.2 Hyperventilation
The mechanism :
Hyperventilatio
n

Hypocapnia

Increase nerve
cell excitabillity

Wald et al 1942 : found that the effect of

hyperventilation to enhance sensitivity was
lost when adding 2 % CO2 to the breathing
mask

Barnes, 1998
Effect of Hypocapnia on the outter
retina maybe considerable bennefit to
photoreceptor during dark adaptation
The retinal Ph gradient and changes
induced by light while change in Ph
Are known to affect retinal cell function
and sensitivity

4.3 Hyperoxia
The increase in arterial oksigen
tension, when breathing
normobaric (100% Oksigen)

Enhance the delivery O2

from the choroid to the
photoreceptor

Current Study :
100% O2 Hastens Rod adaptation to
dark at 1 atm (Ground Lv)

The inflection poin achieved :

4,5 minutes sooner at 3048 m
(10.000 ft)
9,5 minutes sooner at 4572 m
( 15.000 ft)

Conclussion and Relevance to

Aviation
Hypoxia : impairs visual sensitivity
and delays Rod Adaptation to dark
Hypocapnia and hyperoxia : enhance
visual sensitivity and hasten dark
adaptation
The delay time to onset and
rapid progression of early
scotpic sensitivity is affected by
both Oksigen (O2) and
Carbondioxide (CO2)

Hyperoxia : breathing 100 % O2 at 1

atm Hasten the onset of early
progressive of scotopic sensitivity
(dark adaptation)
The mechanism whereby
Hypocapnia enhances visual
sensitivity related to enhanced
elimination of H+ near the
photoreceptors

In Practise
Hyperventilation counters the
effect of Hypoxia
Hasten Scotopic Vission
May be regarded as protective
of visual sensitivity in dim light

Suggestion
Pilot and air crew
should consider using
supplementary oksigen
(O2) if they are reliant
upon viewing scotopic
external scene (less
than full moonlight)
when flying at night

THANK YOU......
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