Measurement of pupil reactivity using fast pupillometry

A high-resolution binocular video-oculography system: assessment of pupillary light reflex and detection of an early incomplete blink and an upward eye movement

Background

The pupillary light reflex characterizes the direct and consensual response of the eye to the perceived brightness of a stimulus. It has been used as indicator of both neurological and optic nerve pathologies. As with other eye reflexes, this reflex constitutes an almost instantaneous movement and is linked to activation of the same midbrain area. The latency of the pupillary light reflex is around 200 ms, although the literature also indicates that the fastest eye reflexes last 20 ms. Therefore, a system with sufficiently high spatial and temporal resolutions is required for accurate assessment. In this study, we analyzed the pupillary light reflex to determine whether any small discrepancy exists between the direct and consensual responses, and to ascertain whether any other eye reflex occurs before the pupillary light reflex.

Methods

We constructed a binocular video-oculography system two high-speed cameras that simultaneously focused on both eyes. This was then employed to assess the direct and consensual responses of each eye using our own algorithm based on Circular Hough Transform to detect and track the pupil. Time parameters describing the pupillary light reflex were obtained from the radius time-variation. Eight healthy subjects (4 women, 4 men, aged 24–45) participated in this experiment.

Results

Our system, which has a resolution of 15 microns and 4 ms, obtained time parameters describing the pupillary light reflex that were similar to those reported in previous studies, with no significant differences between direct and consensual reflexes. Moreover, it revealed an incomplete reflex blink and an upward eye movement at around 100 ms that may correspond to Bell’s phenomenon.

Conclusions

Direct and consensual pupillary responses do not any significant temporal differences. The system and method described here could prove useful for further assessment of pupillary and blink reflexes. The resolution obtained revealed the existence reported here of an early incomplete blink and an upward eye movement.

Electronic supplementary material

The online version of this article (doi:10.1186/s12938-015-0016-6) contains supplementary material, which is available to authorized users.

System and measurement method for binocular pupillometry to study pupil size variability

BACKGROUND

An objective and noninvasive examination of pupil size variability can be used to assess the activity of the autonomous nervous system. We designed a system that enables binocular, fast, and accurate recordings of different types of pupil variabilities, which are synchronous with other biosignals. This type of measurement system is needed to extend the scope of pupillometry applications.

METHODS

In the proposed system, the left and right eyes are independently and interchangeably illuminated to generate alternating images, which are successively acquired by a single camera. The system is composed of four functional modules: the image acquisition module, the image processing unit, the light stimulator, and the controller. The proposed image processing algorithm approximates the shape of the pupil using the best-fit ellipse. The user control panel (controller) precisely sets the stimuli parameters and controls the entire measurement procedure.

RESULTS

The computer-based binocular system records the pupil size during the pupil light reflexes (direct and indirect) and spontaneous pupil size fluctuations, at a sampling rate up to 75 Hz, with a resolution better than 0.02 mm. Our initial laboratory tests confirmed that the new system is fast and precise (system accuracy better than 0.5% and repeatability better than 4%).

CONCLUSIONS

The proposed system's unique geometry and construction, and the method it uses to detect images from each eye, allows us to monitor the right and left eyes using a single camera with no overlap between the images. The system does not require a very experienced operator, because it is relatively simple and easy to use. Importantly, it is comfortable for the subjects. Additionally, the presented system can operate with other bio-measurement systems using a synchronous signal. These system capabilities can expand the scope of pupillometry research applications.

An open-source, FireWire camera-based, Labview-controlled image acquisition system for automated, dynamic pupillometry and blink detection

The dynamic, accurate measurement of pupil size is extremely valuable for studying a large number of neuronal functions and dysfunctions. Despite tremendous and well-documented progress in image processing techniques for estimating pupil parameters, comparatively little work has been reported on practical hardware issues involved in designing image acquisition systems for pupil analysis. Here, we describe and validate the basic features of such a system which is based on a relatively compact, off-the-shelf, low-cost FireWire digital camera. We successfully implemented two configurable modes of video record: a continuous mode and an event-triggered mode. The interoperability of the whole system is guaranteed by a set of modular software components hosted on a personal computer and written in Labview. An offline analysis suite of image processing algorithms for automatically estimating pupillary and eyelid parameters were assessed using data obtained in human subjects. Our benchmark results show that such measurements can be done in a temporally precise way at a sampling frequency of up to 120 Hz and with an estimated maximum spatial resolution of 0.03 mm. Our software is made available free of charge to the scientific community, allowing end users to either use the software as is or modify it to suit their own needs.

Clinical utility of an automated pupillometer for assessing and monitoring recipients of liver transplantation

Pupil examination has been used as a basic measure in critically ill patients and has great importance for the prognosis and management of disease. An automated pupillometer is a computer-based infrared digital video system by which the accuracy and precision of the pupil examination are markedly improved. We conducted an observational study of pupil assessment with automated pupillometry in clinical liver transplantation settings, including pretransplant evaluations and posttransplant surveillance. Our results showed that unconscious patients (grade 4 hepatic encephalopathy) had a prolonged latency phase (left side: 283 +/- 80 milliseconds; right side: 295 +/- 96 milliseconds) and a reduced pupillary constrictive ratio (left direct response: 0.23 +/- 0.10; left indirect response: 0.21 +/- 0.07; right direct response: 0.20 +/- 0.08; right indirect response: 0.21 +/- 0.08) in comparison with normal and conscious patients. After liver transplantation, the recovery of pupillography in these patients was slower than that in conscious patients. However, the surviving recipients without major complications all had a gradual recovery of pupillary responses, which occurred on the first or second posttransplant day. We also reported 4 cases of futile LT in the absence of pretransplant pupillary responses and other pupillary abnormalities revealed by automated pupillometry in our study. In conclusion, patients with grade 4 hepatic encephalopathy had a sluggish pupil response and a delayed recovery pattern after LT. An automated pupillometer is potentially a supplementary device for pretransplant screening and posttransplant monitoring in patients undergoing LT, but further prospective studies are required.