comparison of pupillometer with pupillometry function of binocular free-viewing autorefractor...
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![Page 1: Comparison of Pupillometer With Pupillometry Function of Binocular Free-Viewing Autorefractor Charles D Cohn, MD; Jay C Bradley, MD; Peter W Wu, BS; Sandra](https://reader035.vdocuments.us/reader035/viewer/2022062519/5697c0251a28abf838cd534b/html5/thumbnails/1.jpg)
Comparison of Pupillometer With Pupillometry Function of
Binocular Free-Viewing Autorefractor
Charles D Cohn, MD; Jay C Bradley, MD; Peter W Wu, BS; Sandra M. Brown, MD
The authors have no financial interest in the subject matter of this poster
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Background
• Accurate measurement of the dark-adapted pupil diameter (DAPD) has become a standard element of the pre-operative assessment for corneal and intraocular refractive surgery
• Most pupillometers in clinical use occlude one eye, which theoretically enlarges pupil size by halving the total retinal light flux
• No independent clinical data have been presented comparing a monocular device to a binocular free-viewing device
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Purpose
To assess the performance of a binocular free-viewing autorefractor with pupillometry function against a monocular occlusion pupillometer (Neuroptics Pupillometer or NOP) of known clinical performance.
Note: The NOP has been validated in previous studies to be reliable under our test conditions.1
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Devices Used
NeurOptics pupillometer (NOP)WAM-5500 Binocular Accommodation Instrument (FVAR)
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Methods
• All subjects were volunteers without strabismus, prior intraocular surgery, or trauma affecting pupillary shape
• Device test order and eye test order were randomized• All subjects were dark-adapted prior to testing• 50 patients, divided evenly into groups by age, were
tested under 1 lux and 7 lux ambient illumination with controlled distance fixation at 20 feet
• Testing with the FVAR was done with both eyes open (binocular) and repeated with one eye occluded (monocular)
• Testing with the NOP was repeated until a standard deviation <0.07 mm was obtained
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Results
• FVAR had clinically unacceptable outliers of ≥ 0.5 mm in DAPD at both illumination levels tested
• At all age decades, FVAR underestimates DAPD
• Right or left eye testing order and which device was tested first did not affect results
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Results
• The FVAR is quite sensitive to small degrees of parallax and decentration and significant effort was required to obtain measurements even in fully cooperative subjects.
• The FVAR takes only one measurement of pupil size instead of averaging several measurements and providing a standard deviation (SD)
• Pupil size is larger when occluding one eye when testing with the FVAR
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ResultsMean DAPD (in mm) as a function of age for the NOP & FVAR at 1 & 7 lux
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Results
NeurOptics vs Binocular FVAR
-0.4
-0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0 10 20 30 40 50
Subject Number
NO
P m
inu
s F
VA
R (
mm
)
Right eye
Left eye
Difference in DAPD (in mm) between NOP & Binocular FVAR
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Results
FVAR
-0.4
-0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
0 10 20 30 40 50
Subject Number
Mo
no
c m
inu
s B
ino
c D
AP
D
(mm
) 1 lux
7 lux
Difference (in mm) between right eye DAPD with left eye occluded and with both eyes open using FVAR
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Conclusions
• The WAM 5500 pupillometry function frequently disagreed with the NOP by ≥ 0.5 mm in DAPD.
• Testing the first eye with the NOP does not induce sustained pupillary constriction that biases the result of the second eye.
• The FVAR is technically more difficult to operate than the NOP
• FVAR accuracy may suffer since the device obtains only a single measurement instead of averaging several
• FVAR measurements suggest pupil size is larger with one eye occluded
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3. Kurz S, Krummenauer F, Pfeiffer N, Dick HB. Monocular versus binocular pupillometry. JCataract Refract Surg 2004;30:2551-6.
4. Scheffel M, Kuehne C, Kohnen T. Comparison of monocular and binocular infraredpupillometers under mesopic lighting conditions. J Cataract Refract Surg 2010;36:625-30.
5. Brown SM. Monocular versus binocular pupillometry. J Cataract Refract Surg 2006;32:374-5.
6. Ettinger ER, Wyatt HJ, London R. Anisocoria. Variation and clinical observation withdifferent conditions of illumination and accommodation. Invest Ophthalmol Vis Sci 1991;32:501-9.
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