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Automated Pupillometry Using a Prototype Binocular Optical Coherence Tomography System

  • Reena Chopra
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
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  • Pádraig J. Mulholland
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom

    Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
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  • Axel Petzold
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom

    Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Lola Ogunbowale
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
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  • Gus Gazzard
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
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  • Fion D. Bremner
    Affiliations
    Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Roger S. Anderson
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom

    Centre for Optometry and Vision Science Research, School of Biomedical Sciences, Ulster University, Coleraine, United Kingdom
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  • Pearse A. Keane
    Correspondence
    Inquiries to Pearse A. Keane, Moorfields Eye Hospital National Health Service Foundation Trust, 162 City Rd, London EC1V 2PD, United Kingdom
    Affiliations
    National Institute for Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, United Kingdom
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Published:February 27, 2020DOI:https://doi.org/10.1016/j.ajo.2020.02.013

      Purpose

      To determine the test-retest reliability and diagnostic accuracy of a binocular optical coherence tomography (OCT) prototype (Envision Diagnostics, El Segundo, California, USA) for pupillometry.

      Design

      Assessment of diagnostic reliability and accuracy.

      Methods

      Fifty participants with relative afferent pupillary defects (RAPDs) confirmed using the swinging flashlight method (mean age 49.6 years) and 50 healthy control subjects (mean age 31.3 years) were examined. Participants twice underwent an automated pupillometry examination using a binocular OCT system that presents a stimulus and simultaneously captures OCT images of the iris-pupil plane of both eyes. Participants underwent a single examination on the RAPDx (Konan Medical, Irvine, California, USA), an automated infrared pupillometer. Pupil parameters including maximum and minimum diameter, and anisocoria were measured. The magnitude of RAPD was calculated using the log of the ratio of the constriction amplitude between the eyes. A pathological RAPD was above ±0.5 log units on both devices.

      Results

      The intraclass correlation coefficient was >0.90 for OCT-derived maximum pupil diameter, minimum pupil diameter, and anisocoria. The RAPDx had a sensitivity of 82% and a specificity of 94% for detection of RAPD whereas the binocular OCT had a sensitivity of 74% and specificity of 86%. The diagnostic accuracy of the RAPDx and binocular OCT was 88% (95% confidence interval 80%-94%) and 80% (95% confidence interval 71%-87%) respectively.

      Conclusions

      Binocular OCT-derived pupil parameters had excellent test-retest reliability. The diagnostic accuracy of RAPD was inferior to the RAPDx and is likely related to factors such as eye movement during OCT capture. As OCT becomes ubiquitous, OCT-derived measurements may provide an efficient method of objectively quantifying the pupil responses.
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