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Bogucki A, John I, Zinkiewicz Ł, Jachura M, Jaworski D, Suwała K, Chrost H, Wlodarski M, Kałużny J, Campbell D, Bakken P, Pandya S, Chrapkiewicz R, Manohar SG. Machine learning approach for ambient-light-corrected parameters and the Pupil Reactivity (PuRe) score in smartphone-based pupillometry. Front Neurol 2024; 15:1363190. [PMID: 38654735 PMCID: PMC11037402 DOI: 10.3389/fneur.2024.1363190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction The pupillary light reflex (PLR) is the constriction of the pupil in response to light. The PLR in response to a pulse of light follows a complex waveform that can be characterized by several parameters. It is a sensitive marker of acute neurological deterioration, but is also sensitive to the background illumination in the environment in which it is measured. To detect a pathological change in the PLR, it is therefore necessary to separate the contributions of neuro-ophthalmic factors from ambient illumination. Illumination varies over several orders of magnitude and is difficult to control due to diurnal, seasonal, and location variations. Methods and results We assessed the sensitivity of seven PLR parameters to differences in ambient light, using a smartphone-based pupillometer (AI Pupillometer, Solvemed Inc.). Nine subjects underwent 345 measurements in ambient conditions ranging from complete darkness (<5 lx) to bright lighting (≲10,000 lx). Lighting most strongly affected the initial pupil size, constriction amplitude, and velocity. Nonlinear models were fitted to find the correction function that maximally stabilized PLR parameters across different ambient light levels. Next, we demonstrated that the lighting-corrected parameters still discriminated reactive from unreactive pupils. Ten patients underwent PLR testing in an ophthalmology outpatient clinic setting following the administration of tropicamide eye drops, which rendered the pupils unreactive. The parameters corrected for lighting were combined as predictors in a machine learning model to produce a scalar value, the Pupil Reactivity (PuRe) score, which quantifies Pupil Reactivity on a scale 0-5 (0, non-reactive pupil; 0-3, abnormal/"sluggish" response; 3-5, normal/brisk response). The score discriminated unreactive pupils with 100% accuracy and was stable under changes in ambient illumination across four orders of magnitude. Discussion This is the first time that a correction method has been proposed to effectively mitigate the confounding influence of ambient light on PLR measurements, which could improve the reliability of pupillometric parameters both in pre-hospital and inpatient care settings. In particular, the PuRe score offers a robust measure of Pupil Reactivity directly applicable to clinical practice. Importantly, the formulae behind the score are openly available for the benefit of the clinical research community.
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Affiliation(s)
| | - Ivo John
- Solvemed Inc., Lewes, DE, United States
| | | | | | - Damian Jaworski
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Karolina Suwała
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | | | - Jakub Kałużny
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Sensory Organ Studies, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Doug Campbell
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
| | - Paul Bakken
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
| | - Shawna Pandya
- Space Medicine Group, International Institute for Astronautical Sciences, Boulder, CO, United States
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Heyming T, Knudsen-Robbins C, Schomberg J, Hayakawa J, Lara B, Bacon K, Valdez B, Wickens M, Shelton SK, Romain J, Wallace E, Taraman S, Loudon W, Pearson R. Evaluation of Quantitative Pupillometry in Acute Postinjury Pediatric Concussion. Pediatr Neurol 2024; 153:103-112. [PMID: 38367484 DOI: 10.1016/j.pediatrneurol.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Although millions of children sustain concussions each year, a rapid and objective test for concussion has remained elusive. The aim of this study was to investigate quantitative pupillometry in pediatric patients in the acute, postinjury setting. METHODS This was a prospective case-control study of concussed patients presenting to the emergency department within 72 hours of injury. Pupillary measurements were gathered using NeurOptics' PLR 3000; evaluation included a symptom checklist and neurocognitive assessment. Data were analyzed using descriptive statistics and regression models. RESULTS A total of 126 participants were enrolled. One significant difference in pupillometry between concussed and control participants was found: left minimum pupil diameter in 12- to 18 year-olds (P = 0.02). Models demonstrating odds of a concussion revealed significant associations for time to 75% recovery (T75) of the left pupil in five- to 11-year-olds and average dilation velocity of the left pupil in 12- to 18-year-olds (P = 0.03 and 0.02 respectively). Models predicting symptom improvement showed one significant association: percent change of the right pupil in five-to-11-year-olds (P = 0.02). Models predicting neurocognitive improvement in 12- to 18-year-olds demonstrated significant association in T75 in the left pupil for visual memory, visual motor processing speed, and reaction time (P = 0.002, P = 0.04, P = 0.04). CONCLUSIONS The limited statistically significant associations found in this study suggest that pupillometry may not be useful in pediatrics in the acute postinjury setting for either the diagnosis of concussion or to stratify risk for prolonged recovery.
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Affiliation(s)
- Theodore Heyming
- CHOC Children's Hospital, Orange, California; Department of Emergency Medicine, University of California, Irvine, California.
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | | | - Bryan Lara
- CHOC Children's Hospital, Orange, California
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Lovett ME, MacDonald JM, Mir M, Ghosh S, O'Brien NF, LaRovere KL. Noninvasive Neuromonitoring Modalities in Children Part I: Pupillometry, Near-Infrared Spectroscopy, and Transcranial Doppler Ultrasonography. Neurocrit Care 2024; 40:130-146. [PMID: 37160846 DOI: 10.1007/s12028-023-01730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Noninvasive neuromonitoring in critically ill children includes multiple modalities that all intend to improve our understanding of acute and ongoing brain injury. METHODS In this article, we review basic methods and devices, applications in clinical care and research, and explore potential future directions for three noninvasive neuromonitoring modalities in the pediatric intensive care unit: automated pupillometry, near-infrared spectroscopy, and transcranial Doppler ultrasonography. RESULTS All three technologies are noninvasive, portable, and easily repeatable to allow for serial measurements and trending of data over time. However, a paucity of high-quality data supporting the clinical utility of any of these technologies in critically ill children is currently a major limitation to their widespread application in the pediatric intensive care unit. CONCLUSIONS Future prospective multicenter work addressing major knowledge gaps is necessary to advance the field of pediatric noninvasive neuromonitoring.
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Affiliation(s)
- Marlina E Lovett
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Jennifer M MacDonald
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Marina Mir
- Division of Pediatric Critical Care, Montreal Children's Hospital and McGill University, Montreal, Canada
| | - Suman Ghosh
- Department of Neurology, State University of New York Downstate College of Medicine, Brooklyn, NY, USA
| | - Nicole F O'Brien
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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Jiang J, Sari H, Goldman R, Huff E, Hanna A, Samraj R, Gourabathini H, Bhalala U. Neurological Pupillary Index (NPi) Measurement Using Pupillometry and Outcomes in Critically Ill Children. Cureus 2023; 15:e46480. [PMID: 37927706 PMCID: PMC10624239 DOI: 10.7759/cureus.46480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Aim/objective Neurological Pupil Index (NPi), measured by automated pupillometry (AP), allows the objective assessment of pupillary light reflex (PLR). NPi ranges from 0 (non-reactive) to 5 (normal). In this study, we aimed to compare neurologic and functional outcomes in children admitted for neurologic injury with normal (≥3) versus abnormal (<3) NPi measured during their pediatric intensive care unit (PICU) stay. Materials and methods We conducted a retrospective chart review of children between one month and 18 years admitted to our PICU with a diagnosis of neurologic injury between January 2019 and June 2022. We collected demographic, clinical, pupillometer, and outcome data, including mortality, Pediatric Cerebral Performance Category (PCPC), Pediatric Overall Performance Category (POPC), and Functional Status Score (FSS) at admission, at discharge, and at the three to six-month follow-up. We defined abnormal pupil response as any NPi <3 at any point during the PICU stay. Using the student's t-test and chi-square test, we compared the short-term and long-term outcomes of children with abnormal NPi (<3) versus those with normal NPi (≥3). Results There were 49 children who met the inclusion criteria and who had pupillometry data available for analysis. The mean (SD) Glasgow Coma Scale (GCS) in the study cohort was 5.6 (4.3), and 61% had low (<3) NPi during ICU stay. Mortality was significantly higher among patients with an abnormal NPi as compared to those with normal NPi. Children with abnormal NPi exhibited significant worsening of neurologic and functional status (ΔPCPC, ΔPOPC, and ΔFSS) from admission to discharge (mean (SD): 3.55(1.5), 3.45(1.43), 16.75(7.85), p<0.001) as compared to those with normal NPi (mean (SD): 1.45(0.93), 1.73(0.90), 3.55(2.07), p>0.05). The significant difference in neurologic and functional status persisted at the three to six-month follow-up between the two groups - children with abnormal NPi (mean (SD): 2.0(1.41), 2.08(1.38), 6.92(6.83), p<0.01) and children with normal NPi (mean (SD): 0.82(1.01), 0.94(1.03), 1.53(1.70), p>0.05). Conclusion In our retrospective cohort study, children admitted to the PICU for a neuro injury and with abnormal NPi (< 3) have higher mortality, and worse short-term and long-term neurologic and functional outcomes as compared to those with normal NPi (≥ 3) measured during the PICU course. AP provides an objective assessment of PLR and has potential applications for neuro-prognostication. More research needs to be done to elucidate the prognostic value of NPi in pediatrics.
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Affiliation(s)
- Jessie Jiang
- Medicine, Texas A&M College of Medicine, Round Rock, USA
| | - Halil Sari
- Statistics, Texas A&M College of Medicine, Round Rock, USA
| | - Rachelle Goldman
- Pediatric Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, USA
| | - Erionne Huff
- Pediatric Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, USA
| | - Ashley Hanna
- Pediatric Neurosurgery, Driscoll Children's Hospital, Corpus Christi, USA
| | - Ravi Samraj
- Pediatric Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, USA
| | | | - Utpal Bhalala
- Pediatrics, Texas A&M College of Medicine, College Station, USA
- Anesthesiology and Critical Care, Driscoll Children's Hospital, Corpus Christi, USA
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Aderman MJ, Meister MR, Roach MH, Dengler BA, Ross JD, Malvasi SR, Cameron KL. Normative Values for Pupillary Light Reflex Metrics Among Healthy Service Academy Cadets. Mil Med 2023:usad271. [PMID: 37522744 DOI: 10.1093/milmed/usad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/19/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION Assessments of the pupil's response to light have long been an integral part of neurologic examinations. More recently, the pupillary light reflex (PLR) has shown promise as a potential biomarker for the diagnosis of mild traumatic brain injury. However, to date, few large-scale normative data are available for comparison and reference, particularly, in military service members. The purpose of this study was to report normative values for eight PLR measurements among healthy service academy cadets based on sex, age, sleep, race, ethnicity, anisocoria, and concussion history. METHODS Freshmen entering a U.S. Service Academy completed a quantitative pupillometric assessment in conjunction with baseline concussion testing. PLR measurements were conducted using a Neuroptics PLR-3000 with a 121 µW light stimulus. The device measured maximum and minimum pupil diameter (mm), latency (time to maximum pupil constriction post-light stimulus [s]), peak and average constriction velocity (mm/s), average dilation velocity (mm/s), percentage pupil constriction, and T75 (time for pupil re-dilation from minimum pupil diameter to 75% maximum diameter [s]). During baseline testing, cadets also reported concussion history (yes and no) and hours slept the night before (<5.5 and ≥5.5). Normative values for each PLR measurement were calculated as mean ± SD, percentiles, and interquartile range. Mann-Whitney U tests were used to assess differences based on sex, concussion history, ethnicity, and hours slept for each PLR measurement. Kruskall-Wallis testing was used to assess differences based on age, race, and anisocoria. Alpha was set at .05 and nonparametric effect sizes (r) were calculated for statistically significant results. Effect sizes were interpreted as no effect (r < .1), small (r ≥.1-<.3), medium (r ≥.3-<.5), or large (r ≥ .5). All procedures were reviewed and approved by the local institutional review board and the U.S. Army Human Research Protection Office before the study was conducted. Each subject provided informed consent to participate in the study before data collection. RESULTS Of the 1,197 participants baselined, 514 cadets (131 female; 18.91 ± 0.96 years) consented and completed a valid baseline pupillometric assessment. Eighty participants reported at least one previous concussion and participants reported an average of 5.88 ± 1.63 h slept the previous night. Mann-Whitney U results suggest females had larger initial (z = -3.240; P = .001; r = .10) and end pupil diameter (z = -3.080; P = .002; r = .10), slower average dilation velocity (z = 3.254; P = .001; r = .11) and faster T75 values (z = -3.342; P = .001; r = .11). Age, sleep, and race stratified by sex, also displayed a significant impact on specific PLR metrics with effect sizes ranging from small to medium, while ethnicity, anisocoria, and concussion history did not display an impact on PLR metrics. CONCLUSION This study provides the largest population-specific normative values for eight PLR measurements. Initial and end pupil diameter, dilation velocity, and the T75 metrics differed by sex; however, these differences may not be clinically significant as small effect size was detected for all metrics. Sex, age, sleep, and race may impact specific PLR metrics and are worth consideration when performing PLR assessments for mild traumatic brain injury management.
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Affiliation(s)
- Michael J Aderman
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Melissa R Meister
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Megan H Roach
- DoD-VA Extremity Trauma & Amputation Center of Excellence, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Bradley A Dengler
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jeremy D Ross
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Steven R Malvasi
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship Department of Orthopaedic Surgery, Keller Army Community Hospital, West Point, NY 10996-1197, USA
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de Vries LM, Amelynck S, Nyström P, van Esch L, Van Lierde T, Warreyn P, Roeyers H, Noens I, Naulaers G, Boets B, Steyaert J. Investigating the development of the autonomic nervous system in infancy through pupillometry. J Neural Transm (Vienna) 2023; 130:723-734. [PMID: 36906867 PMCID: PMC10008146 DOI: 10.1007/s00702-023-02616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
We aim to investigate early developmental trajectories of the autonomic nervous system (ANS) as indexed by the pupillary light reflex (PLR) in infants with (i.e. preterm birth, feeding difficulties, or siblings of children with autism spectrum disorder) and without (controls) increased likelihood for atypical ANS development. We used eye-tracking to capture the PLR in 216 infants in a longitudinal follow-up study spanning 5 to 24 months of age, and linear mixed models to investigate effects of age and group on three PLR parameters: baseline pupil diameter, latency to constriction and relative constriction amplitude. An increase with age was found in baseline pupil diameter (F(3,273.21) = 13.15, p < 0.001, [Formula: see text] = 0.13), latency to constriction (F(3,326.41) = 3.84, p = 0.010, [Formula: see text] = 0.03) and relative constriction amplitude(F(3,282.53) = 3.70, p = 0.012, [Formula: see text] = 0.04). Group differences were found for baseline pupil diameter (F(3,235.91) = 9.40, p < 0.001, [Formula: see text] = 0.11), with larger diameter in preterms and siblings than in controls, and for latency to constriction (F(3,237.10) = 3.48, p = 0.017, [Formula: see text] = 0.04), with preterms having a longer latency than controls. The results align with previous evidence, with development over time that could be explained by ANS maturation. To better understand the cause of the group differences, further research in a larger sample is necessary, combining pupillometry with other measures to further validate its value.
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Affiliation(s)
- Lyssa M de Vries
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium.
- University Hospital Leuven, Louvain, Belgium.
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium.
| | - Steffie Amelynck
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
| | - Pär Nyström
- Developmental Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lotte van Esch
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Louvain, Belgium
| | - Thijs Van Lierde
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Petra Warreyn
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Herbert Roeyers
- RIDDL Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ilse Noens
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Louvain, Belgium
| | - Gunnar Naulaers
- University Hospital Leuven, Louvain, Belgium
- Woman and Child, Department of Development and Regeneration, KU Leuven, Louvain, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Herestraat 49 Box 1029, 3000, Louvain, Belgium
- University Hospital Leuven, Louvain, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Louvain, Belgium
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Pupil Size and Reactivity in Pediatric Patients With Sickle Cell Disease. J Pediatr Hematol Oncol 2023; 45:e44-e47. [PMID: 34966094 DOI: 10.1097/mph.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/20/2021] [Indexed: 02/03/2023]
Abstract
Pupil size and reactivity have been studied to objectively measure pain utilizing pupillometry measurements. Given the challenges associated with treating vaso-occlusive pain in pediatric patients with sickle cell disease, better assessment tools are needed. The objective of this study is to establish normative values for pupil size and reactivity in pediatric patients with sickle cell disease with the hope that pupillometry can be used as a tool to objectively measure pain and response to treatment with analgesic medications. Readings were performed using a NeurOptics PLR-2000 pupillometer. Forty-four males and 38 females, all black, were studied. Their median age was 11 years (range: 2 to 21). When comparing our participants with white participants in a previously published pediatric study, there was a significant difference in maximum constriction velocity ( t =3.45, P =0.009), maximum pupil size ( t =-5.57 mm, P <0.0001), and minimum pupil size ( t =-3.24, P =0.002). There was no significant difference in pupil size and reactivity between patients with sickle cell disease and black patients without the disease when compared with the previously published study. Therefore, further investigation of pupillometry within the black population during vaso-occlusive crisis and in the "well state" is warranted in pediatric patients with sickle cell disease.
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Martin JT, Pinto J, Bulte D, Spitschan M. PyPlr: A versatile, integrated system of hardware and software for researching the human pupillary light reflex. Behav Res Methods 2022; 54:2720-2739. [PMID: 34918229 PMCID: PMC9729317 DOI: 10.3758/s13428-021-01759-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 12/16/2022]
Abstract
We introduce PyPlr-a versatile, integrated system of hardware and software to support a broad spectrum of research applications concerning the human pupillary light reflex (PLR). PyPlr is a custom Python library for integrating a research-grade video-based eye-tracker system with a light source and streamlining stimulus design, optimisation and delivery, device synchronisation, and extraction, cleaning, and analysis of pupil data. We additionally describe how full-field, homogenous stimulation of the retina can be realised with a low-cost integrating sphere that serves as an alternative to a more complex Maxwellian view setup. Users can integrate their own light source, but we provide full native software support for a high-end, commercial research-grade 10-primary light engine that offers advanced control over the temporal and spectral properties of light stimuli as well as spectral calibration utilities. Here, we describe the hardware and software in detail and demonstrate its capabilities with two example applications: (1) pupillometer-style measurement and parametrisation of the PLR to flashes of white light, and (2) comparing the post-illumination pupil response (PIPR) to flashes of long and short-wavelength light. The system holds promise for researchers who would favour a flexible approach to studying the PLR and the ability to employ a wide range of temporally and spectrally varying stimuli, including simple narrowband stimuli.
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Affiliation(s)
- Joel T Martin
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK.
| | - Joana Pinto
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Daniel Bulte
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Manuel Spitschan
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
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Yıldırım Biçer G, Zor KR, Küçük E. Do static and dynamic pupillary parameters differ according to childhood, adulthood, and old age? A quantitative study in healthy volunteers. Indian J Ophthalmol 2022; 70:3575-3578. [PMID: 36190049 PMCID: PMC9789821 DOI: 10.4103/ijo.ijo_1254_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose We aimed to evaluate the normative pupillometry values and mean pupil dilatation speed in healthy individuals in different age groups in our study. Methods The study group included 180 eyes of 90 healthy volunteers in different age groups. Group 1 consisted of 30 participants between the ages of 6 and 18, group 2 consisted of 30 participants aged 19-40, and group 3 consisted of 30 participants aged 41-75. Scotopic, mesopic, photopic, and dynamic measurements were taken with automatic pupillometry of Sirius Topographer (CSO, Firenze, Italy). The mean pupil dilation speed at the 18th second was calculated according to dynamic measurements. Results Group 1 had a significantly larger pupil diameter than groups 2 and 3 in all static and dynamic parameters, and the mean pupil dilation speed was the highest among the groups (P < 0.001 for all static and dynamic parameters). In addition, group 2 had a significantly larger pupil diameter than group 3 (P < 0.001 for all static and dynamic parameters) and the mean pupil dilation speed was faster than group 3 (P = 0.027). Conclusion We have presented the static and dynamic parameters and the mean speed of pupil dilatation at the 18th second with automatic pupillometry in healthy individuals in childhood, adulthood, and old age. More studies with higher participants and younger age children are needed.
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Affiliation(s)
- Gamze Yıldırım Biçer
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Niğde, Turkey,Correspondence to: Dr. Gamze Yıldırım Biçer, Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Niğde - 51240, Turkey. E-mail:
| | - Kürşad Ramazan Zor
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Niğde, Turkey
| | - Erkut Küçük
- Department of Ophthalmology, Niğde Ömer Halisdemir University School of Medicine, Bor Yolu, Niğde, Turkey
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McGetrick ME, Schneider N, Olson DM, Aiyagari V, Miles D. Automated Infrared Pupillometer Use in Assessing the Neurological Status in Pediatric Neurocritical Care Patients: Case Reports and Literature Review. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1731074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractAutomated infrared pupillometry (AIP) is rapidly becoming an accepted standard for the evaluation of pupil size and reactivity in adult neurocritical care. Recently, pediatric centers are increasingly utilizing this technology, but data supporting its use in children are limited. Our pediatric intensive care unit instituted AIP as a standard of care for pupillary light assessments in neurocritical care patients in early 2020. In this article, we describe four cases highlighting the advantage of using objective assessments of the pupillary light reactivity response measured by the Neurological Pupil index (NPi) to detect early changes in the patient's neurological status. These cases support the applicability of AIP in pediatric neurocritical care as a noninvasive neurologic monitoring tool. The NPi may be superior to manual pupil assessments by providing a numerical scale for accurate trending clinical status of a patient's neurologic condition.
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Affiliation(s)
- Molly E. McGetrick
- Division of Critical Care, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Nathan Schneider
- The University of Texas Southwestern ODL Brain Institute, Dallas, Texas, United States
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - DaiWai M. Olson
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Venkatesh Aiyagari
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Department of Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Darryl Miles
- Division of Critical Care, Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Przekoracka K, Michalak KP, Olszewski J, Michalski A, Przekoracka‐Krawczyk A. Computerised dynamic posturography for postural control assessment in subjects wearing multifocal contact lenses dedicated for myopia control. Ophthalmic Physiol Opt 2021; 41:486-495. [DOI: 10.1111/opo.12818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Katarzyna Przekoracka
- Laboratory of Bionics and Experimental Medical Biology Department of Bionics and Bioimpendance University of Medical Sciences Poznań Poland
- Laboratory of Vision and Neuroscience NanoBioMedical Centre Adam Mickiewicz University of Poznań Poznań Poland
| | - Krzysztof Piotr Michalak
- Laboratory of Vision and Neuroscience NanoBioMedical Centre Adam Mickiewicz University of Poznań Poznań Poland
- Laboratory of Vision Science and Optometry Faculty of Physics Adam Mickiewicz University of Poznań Poznań Poland
| | - Jan Olszewski
- Laboratory of Bionics and Experimental Medical Biology Department of Bionics and Bioimpendance University of Medical Sciences Poznań Poland
| | - Andrzej Michalski
- Department of Ophthalmology University of Medical Sciences Poznań Poland
| | - Anna Przekoracka‐Krawczyk
- Laboratory of Vision and Neuroscience NanoBioMedical Centre Adam Mickiewicz University of Poznań Poznań Poland
- Laboratory of Vision Science and Optometry Faculty of Physics Adam Mickiewicz University of Poznań Poznań Poland
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Hsu J, Stec M, Ranaivo HR, Srdanovic N, Kurup SP. Concussion Alters Dynamic Pupillary Light Responses in Children. J Child Neurol 2021; 36:195-202. [PMID: 33059540 DOI: 10.1177/0883073820964040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM To investigate the impact of concussion on pupillary function in children by examining pupillometric parameters and assessing for differences in children reporting photosensitivity. METHODS Retrospective chart review was performed of pediatric patients referred for visual symptoms after concussion from 2017 to 2018 seen in a single academic outpatient clinic. Pupillometry data of 92 patients were included. Outcomes were compared to normative pediatric data from the same institution by 2-sample t tests. The association between photosensitivity and each outcome was assessed by use of linear mixed models with photosensitivity as a fixed effect and random patient effect. RESULTS Outcomes of 181 eyes in 92 concussion patients were averaged by patient and compared to normative values in scotopic conditions. Concussion patients had an average age of 13.8 ± 2.64 years. Average constriction velocity (P = .0008), maximum constriction velocity (P = .0012), and average dilation velocity (P = .0034) were faster in concussion patients, whereas 75% recovery times (P = .0027) was increased. Photosensitivity did not significantly affect measured pupillary responses. CONCLUSION Dynamic pupillary responses may be increased in pediatric concussion. Pupillometry may provide insight into the complex pathophysiological changes underlying pediatric concussion.
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Affiliation(s)
- Jerry Hsu
- Department of Ophthalmology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Jerry Hsu, MD and Magdalena Stec, OD are co-first authors of this article
| | - Magdalena Stec
- Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Jerry Hsu, MD and Magdalena Stec, OD are co-first authors of this article
| | - Hantamalala Ralay Ranaivo
- Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nina Srdanovic
- Division of Biostatistics, Department of Preventive Medicine, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sudhi P Kurup
- Department of Ophthalmology, 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Ophthalmology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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