Automated ultrasonographic pupillary assessment: a new neuro-ophthalmological assessment tool

Abstract

Objective: To evaluate correlations between ultrasonographic pupillary assessment (UPA) and automated UPA in neurocritical patients.

Methods: This was a prospective, observational study of 20 adult patients admitted to the intensive care unit with neurological pathology. Between UPA and automated UPA, 40 pupillary measurements were made. The time required to conduct UPA and automated UPA on a single patient was consistently < 3 minutes. Automated UPA required a markedly shorter operational time than UPA.

Results: There were strong positive associations between UPA and automated UPA measurements, with the following correlations: right eye at rest, r = 0.9973; left eye at rest, r = 0.9989; right eye post-pupillary light response, r = 0.9975; left eye post-pupillary light response, r = 0.9955. Bland-Altman analyses confirmed the strong agreement between the two methods under both conditions, with most measurements falling within the limits of agreement. Both the right and left pupillary diameters at rest demonstrated consistency, and the post-pupillary light response measurements for both eyes indicated good agreement, with a few outliers.

Conclusions: Automated UPA was strongly correlated with UPA in neurocritical patients. Automated UPA is a rapid, feasible, and noninvasive method that enables the precise evaluation of pupillary size and light response.

Keywords: Ocular ultrasonography; auto pupillary assessment; automated ultrasonographic pupillary assessment.; ocular ultrasound; pupillary assessment; pupillometry.

Figure 1.

Ultrasound equipment and linear probe (L17-7EQ). (a) Probe under normal conditions. (b) Probe during the pupillary light response (PLR).

Figure 2.

Ultrasonographic pupillary assessment (UPA). (a) Probe starting position. (b) UPA at rest. (c) UPA post-pupillary light response (PLR). (d) Automated UPA at rest. (e) Automated UPA post-PLR.

Figure 3.

Scatterplots showing the correlations between ultrasonographic pupillary assessment (UPA) and automated UPA. (a, b) Correlations between UPA and automated UPA for right pupillary diameter (PD) at rest (a) and post-pupillary light response (PLR; b). (c, d) Correlations between UPA and automated UPA for left PD at rest (c) and post-PLR.

Figure 4.

Bland–Altman graphs showing the agreement between ultrasonographic pupillary assessment (UPA) and automated UPA. (a, b) Graphs demonstrating the agreement between UPA and automated UPA for right pupillary diameter (PD) at rest (a) and post-pupillary light response (PLR; b). (c, d) Graphs demonstrating the agreement between automated UPA for left PD at rest (c) and post-PLR (d). Solid lines represent the averages of the differences; dashed lines indicate the limits of agreement (mean ± 1.96 × standard deviation).