The Photomotor Response - Dynamic Quantification by a Portable Pupillometer

Jurij Rosen; Claudio Privitera; Resul Bulmus; Makoto Nakamura; Alexander Hartmann

doi:doi:10.11648/j.ajim.20200805.17

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The Photomotor Response - Dynamic Quantification by a Portable Pupillometer

Jurij Rosen, Claudio Privitera, Resul Bulmus, Makoto Nakamura, Alexander Hartmann

Published in American Journal of Internal Medicine (Volume 8, Issue 5)

Received: 17 July 2020 Accepted: 12 August 2020 Published: 31 August 2020

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Abstract

The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.

Published in	American Journal of Internal Medicine (Volume 8, Issue 5)
DOI	10.11648/j.ajim.20200805.17
Page(s)	230-236
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Quantitative Pupillometry, Pupillary Light Reflex, Pupil Size, Pupillary Dynamics, Neurological Pupil Index, Diabetes, Cardiac Neuropathy

References

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APA Style

Jurij Rosen, Claudio Privitera, Resul Bulmus, Makoto Nakamura, Alexander Hartmann. (2020). The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. American Journal of Internal Medicine, 8(5), 230-236. https://doi.org/10.11648/j.ajim.20200805.17

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ACS Style

Jurij Rosen; Claudio Privitera; Resul Bulmus; Makoto Nakamura; Alexander Hartmann. The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. Am. J. Intern. Med. 2020, 8(5), 230-236. doi: 10.11648/j.ajim.20200805.17

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AMA Style

Jurij Rosen, Claudio Privitera, Resul Bulmus, Makoto Nakamura, Alexander Hartmann. The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. Am J Intern Med. 2020;8(5):230-236. doi: 10.11648/j.ajim.20200805.17

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@article{10.11648/j.ajim.20200805.17,
  author = {Jurij Rosen and Claudio Privitera and Resul Bulmus and Makoto Nakamura and Alexander Hartmann},
  title = {The Photomotor Response - Dynamic Quantification by a Portable Pupillometer},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {230-236},
  doi = {10.11648/j.ajim.20200805.17},
  url = {https://doi.org/10.11648/j.ajim.20200805.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.17},
  abstract = {The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.},
 year = {2020}
}

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TY  - JOUR
T1  - The Photomotor Response - Dynamic Quantification by a Portable Pupillometer
AU  - Jurij Rosen
AU  - Claudio Privitera
AU  - Resul Bulmus
AU  - Makoto Nakamura
AU  - Alexander Hartmann
Y1  - 2020/08/31
PY  - 2020
N1  - https://doi.org/10.11648/j.ajim.20200805.17
DO  - 10.11648/j.ajim.20200805.17
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 230
EP  - 236
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20200805.17
AB  - The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.
VL  - 8
IS  - 5
ER  -

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Author Information

Jurij Rosen

Department of Neurosurgery Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
Claudio Privitera

School of Optometry, University of California, Minor Hall, Berkeley, the United States
Resul Bulmus

Department of Neurosurgery Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
Makoto Nakamura

Department of Neurosurgery Cologne Merheim, University of Witten/Herdecke, Cologne, Germany
Alexander Hartmann

Department of Neurosurgery Cologne Merheim, University of Witten/Herdecke, Cologne, Germany

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APA Style

Jurij Rosen, Claudio Privitera, Resul Bulmus, Makoto Nakamura, Alexander Hartmann. (2020). The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. American Journal of Internal Medicine, 8(5), 230-236. https://doi.org/10.11648/j.ajim.20200805.17

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ACS Style

Jurij Rosen; Claudio Privitera; Resul Bulmus; Makoto Nakamura; Alexander Hartmann. The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. Am. J. Intern. Med. 2020, 8(5), 230-236. doi: 10.11648/j.ajim.20200805.17

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AMA Style

Jurij Rosen, Claudio Privitera, Resul Bulmus, Makoto Nakamura, Alexander Hartmann. The Photomotor Response - Dynamic Quantification by a Portable Pupillometer. Am J Intern Med. 2020;8(5):230-236. doi: 10.11648/j.ajim.20200805.17

Copy | Download

@article{10.11648/j.ajim.20200805.17,
  author = {Jurij Rosen and Claudio Privitera and Resul Bulmus and Makoto Nakamura and Alexander Hartmann},
  title = {The Photomotor Response - Dynamic Quantification by a Portable Pupillometer},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {230-236},
  doi = {10.11648/j.ajim.20200805.17},
  url = {https://doi.org/10.11648/j.ajim.20200805.17},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.17},
  abstract = {The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - The Photomotor Response - Dynamic Quantification by a Portable Pupillometer
AU  - Jurij Rosen
AU  - Claudio Privitera
AU  - Resul Bulmus
AU  - Makoto Nakamura
AU  - Alexander Hartmann
Y1  - 2020/08/31
PY  - 2020
N1  - https://doi.org/10.11648/j.ajim.20200805.17
DO  - 10.11648/j.ajim.20200805.17
T2  - American Journal of Internal Medicine
JF  - American Journal of Internal Medicine
JO  - American Journal of Internal Medicine
SP  - 230
EP  - 236
PB  - Science Publishing Group
SN  - 2330-4324
UR  - https://doi.org/10.11648/j.ajim.20200805.17
AB  - The pupillary light reflex (PLR) is a key component of the physical examination as it reliably tests the functional integrity of the neuromuscular loop between pupil and midbrain. Unlike the traditional manual testing the PLR with a penlight that frequently leads to incorrect interpretation due to its subjectivity, the specialized “pupillometer” tool allows objective testing and trending of pupillary data. We performed quantitative unilateral pupillometry several times in 53 healthy subjects (aged 21-74) in different background illumination levels using the NeurOptics NPi®-200 pupillometer. A number of key parameters describing the PLR were collected and analysed. We found that the individual PLR was very consistent. In general, constriction velocity (the first part of the PLR when the pupil constricts promptly after the onset of a light stimulus) was brisker than the dilation velocity (the second part of the PLR, when the pupil recovers from the constriction). Most importantly, both velocities depend on the initial pupillary resting size. We proved that pupillary parameters depend on environmental light conditions and age, but not gender, and scrutinized the nature and dynamics of anisocoric pupils. Taking together, pupillometry is becoming an important, non-invasive clinical tool for testing the autonomic nervous system. Here, we describe baseline parameters representing the physiological PLR, confirming and extending previously reported data. We thus provide the clinician important criteria to precisely assess the PLR and hence the autonomic nervous system in different pathological conditions such as diabetes, traumatic brain injury or cardiac and other autonomic neuropathies.
VL  - 8
IS  - 5
ER  -

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