Quantitative Pupillometry of the Pupillary Light Reflex in Koreans

PURPOSE: To determine the normal ranges of various indexes of the pupillary light reflex measured by automated pupillometry in Koreans. METHODS: We retrospectively analyzed 90 healthy adults who did not have any ocular diseases other than refractive errors. The direct pupillary light reflex was measured with an automated dynamic pupillometer (PLR-200, NeurOptics Inc., Irvine, CA, USA). A total of 7 indices were measured as follows; the maximum and minimum pupil diameters, constriction latency, constriction ratio, maximum constriction velocity, average constriction velocity and average dilation velocity. RESULTS: There were no significant differences in quantitative indexes of the pupillary light reflex between fellow eyes. A significant decrease in maximum pupil diameter, minimum pupil diameter, maximum constriction velocity, average constriction velocity and average dilation velocity were observed with aging. In contrast, a significant increase in constriction latency was observed with aging. There were no differences in quantitative pupil measurements according to gender (p<0.001). CONCLUSIONS: Quantitative measurements of the pupillary light reflex by dynamic pupillometry showed no significant differences between fellow eyes. A significant decrease in pupil size, constriction velocity and dilation velocity, and an increase in pupil constriction latency were observed with aging.

Comparison of Automatic Pupillometer and Pupil Card for Measuring Pupil Size

PURPOSE: To compare the pupil sizes measured using the automatic pupillometer and pupil card. METHODS: We measured pupil sizes using a pupil card (Rosenbaum Card, J.G. Rosenbaum, Cleveland, OH, USA) and automated pupillometer (VIP(TM)-200, Neuroptics Inc., San Clemente, CA, USA) under different luminous intensities in 60 eyes of 60 patients who visited the ophthalmology clinic during August 2013. RESULTS: Under the photopic condition, pupil sizes measured using automated pupillometer were larger than those measured using the pupil card with statistical significance. The 2 techniques were not different under mesopic and scotopic conditions. Under all light conditions, automated pupillometer showed higher inter-rater reliability. Under the scotopic condition, pupil sizes measured using the pupil card were smaller than pupil sizes measured using the pupillometer according to increased pupil size. CONCLUSIONS: When compared with pupil card, automated pupillometer provided accurate and reliable measurement with small inter-rater variation and was easy and simple to use. However, based on comparable measurements of both techniques under mesopic and scotopic conditions, the pupil card can be used as preoperative evaluation when considering the cost of purchase and maintenance.

Clinical Utility of an Automated Pupillometer in Patients with Acute Brain Lesion

OBJECTIVE: The purpose of this study was to evaluate the clinical utility and validity of using a pupillometer to assess patients with acute brain lesions. METHODS: Pupillary examinations using an automated pupillometer (NeurOptics(R)NPi(TM)-100 Pupillometer) were performed every 4 hours and were simultaneously assessed using the Glasgow Coma Scale (GCS) and for intracranial pressure (ICP), from admission to discharge or expire in neuro-intensive care unit (NICU). Manual pupillary examinations were also recorded for comparison. By comparing these data, we evaluated the validity of using automated pupillometers to predict clinical outcomes. RESULTS: The mean values of the Neurologic Pupillary index (NPi) were different in the groups examined manually. The GCS correlated well with NPi values, especially in severe brain injury patients (GCS below 9). However, the NPi values were weakly correlated with intracranial pressure (ICP) when the ICP was lower than 30 cm H2O. The NPi value was not affected by age or intensity of illumination. In patients with a "poor" prognosis who had a Glasgow Outcome Scale (GOS) of 1 or 2, the mean initial NPi score was 0.88+/-1.68, whereas the value was 3.89+/-0.97 in patients with a "favorable" prognosis who had a GOS greater than 2 (p<0.001). For predicting clinical outcomes, the initial NPi value of 3.4 had the highest sensitivity and specificity. CONCLUSION: An automated pupillometer can serve as a simple and useful tool for the accurate measurement of pupillary reactivity in patients with acute brain lesions.

Equipamento portátil para ensaios simultâneos de teste de vigilância psicomotora e pupilometria / Portable equipment for simultaneous assays of psychomotor vigilance test and pupillometry

Neste artigo é descrito um sistema com potencial para identificar a privação do sono, que, com base no levantamento bibliográfico realizado, ainda não foi abordado na literatura. Este sistema integra simultaneamente duas metodologias, o teste de vigilância psicomotora (Psychomotor vigilance test, PVT) e a pupilometria, que se destacam no estudo da privação do sono. Entretanto, para atender às peculiaridades destas metodologias, permitindo que coexistam em um único sistema, algumas adaptações foram realizadas em seus procedimentos. Esta integração poderá garantir não só a complementariedade de indicadores que torna a identificação da privação do sono mais robusta, assim como estabelecer a equalização do estado psicofisiológico do sujeito, o que não é possível em testes realizados com defasagem temporal. Neste estudo, a validação das métricas do sistema foi realizada com sujeitos em estado de alerta. Os resultados mostraram-se coerentes com a literatura. Entretanto, algumas métricas apresentam um deslocamento em seus valores médios, que segundo as avaliações realizadas são determinadas pelas exigências técnicas do sistema. Os resultados obtidos nesta avaliação, somados à crescente demanda de ferramentas de aplicação em larga escala e que possam ser utilizadas além dos limites laboratoriais para estudos em distúrbios e privação do sono, apontam este sistema como uma potencial ferramenta. Entretanto, será necessário o estabelecimento de um experimento rigoroso, para avaliar se os indicadores oriundos das métricas do sistema permitem a identificação robusta da privação do sono.

This paper describes a system with potential for identification of sleep deprivation, which, based on our bibliographical survey, has not yet been described in the literature. The system combines two methodologies, i. e., Psychomotor vigilance test (PVT) and pupillometry, which are among the leading methods for the study of sleep deprivation. However, due to peculiarities of both methodologies, some adaptations were made in their procedures to allow them to co-exist in the same system. Such integration may not only ensure the complementarity of indexes, making the identification of sleep deprivation more solid, but also set up the equalization of the subject's psycho-physiological state, which is not possible in tests performed with a time lag. In this study, the performance of measurements provided by the system was assessed in subjects on alert. However, some measurements present a displacement with respect to their average values, which, according to assessment, are determined by system's technical requirements. The results obtained in this assessment, combined with the increasing demand for large scale application tools, able to be used outside the limits of the laboratory environment for studies in sleep deprivation disorders, point to this system as a potential tool. However, the undertaking of a rigorous experiment is necessary to assess whether the indexes obtained by the system allow the robust identification of sleep deprivation.

Comparison of Colvardpupillometer, ORBScan II and Sirius in Determining Pupil Size for Refractive Surgery

PURPOSE: To compare pupil size measured by Colvard(R)pupillometer, ORBScan II(R), Sirius(R) and analyze correlation between pupil size and night vision disturbance after refractive surgery according to measuring methods. METHODS: Two hundred eyes of one hundred patients who underwent refractive surgery were retrospectively evaluated. Pupil size was measured with Colvard(R)pupillometer, Sirius(R) in the scotopic light condition and with ORBScan II(R), Sirius(R) in the photopic light condition. Patients filled out questionnaire about night vision disturbance at postoperative three months. Correlation between pupil size according to measuring methods and night vision disturbance was evaluated. RESULTS: The mean age of patient was 26 years and number of male patients was 36. In scotopic light condition, pupil size measured with Colvard(R)pupillometer (6.76 mm) was significantly larger than that of Sirius(R) (6.53 mm) (p < 0.001). In photopic light condition, pupil size measured with ORBScan II(R) (3.98 mm) was significantly smaller than that of Sirius(R) (4.41 mm) (p < 0.001). Night vision disturbance were correlated with pupil size and Sirius(R) in the scotopic light condition had strongest correlation among three measuring method (r = 0.44). CONCLUSIONS: Sirius(R) tends to measure pupil size smaller than Colvard(R)pupillometer in the scotopic light condition. The correlation between night vision disturbance and pupil size was highest in Sirius(R).

Pupil Size in the Normal Korean Population According to Age and Illuminance

PURPOSE: To report the change of pupil sizes according to age and illuminance in the normal Korean population. METHODS: Normal Koreans outpatients who never had a history of ophthalmic disease were examined. The patients consisted of 320 eyes of 160 patients, which were classified into 8 age decades (teenage to 80's) with 40 eyes in each age group. The vertical and horizontal pupil size and area under 4 different illuminances (3,500, 1,200, 500, 5 lux) were measured using the Colvard pupillometer(R) (OASIS Medical, Glendora, CA, USA). RESULTS: The pupil size was significantly decreased as the age increased under each illuminance. The pupil area measured after dark adaptation was 47.30 mm2 in the teenage group, 43.32 mm2 in the 20's group, 41.94 mm2 in the 30's group, 40.98 mm2 in the 40's group, 40.61 mm2 in the 50's group, 38.60 mm2 in the 60's group, 37.78 mm2 in the 70's group and 35.45 mm2 in the 80's group. The decrease in pupil area was statistically significant. CONCLUSIONS: In the normal Korean population, a significant decrease in pupil size and area was observed with aging. The present study results provide good basic data for cataract and presbyopia refractive surgery.