NeurOptics | Understanding the Relationship Between the Neurologic Pupil Index and Constriction Velocity Values
pupil, pupil exam, pupil examination, pupil pressure measurement, pupil reaction, pupillary, pupillary light reflex, pupillometer, pupillometry, stroke, TBI, trauma, constriction velocity, critical care, critical care nursing, intraocular pressure, modified rankin scale, neurocritical care, neurologist, neuroscience nursing, neurosurgeon, medical devices, NIH Stroke Scoring Scale, NIHSS, ophth, ophthalmic, ophthalmic surgery, ophthalmologist, ophthalmology, opthal, optometrist to ophthalmologist, PERL
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Understanding the Relationship Between the Neurologic Pupil Index and Constriction Velocity Values

Understanding the Relationship Between the Neurologic Pupil Index and Constriction Velocity Values

 

Category: Critical Care

 

Ifeoluwa Shoyombo1, Venkatesh Aiyagari2,3, Sonja E. Stutzman2, Folefac Atem4, Michelle Hill5, Stephen A. Figueroa2,3, Chad Miller5, Amber Howard2 & DaiWai M. Understanding the Relationship Between the Neurologic Pupil Index and Constriction Velocity Values

 

Abstract

The pupillary light reflex (PLR) describes the response when light hits the retina and sends a signal (cranial nerve II) to the Edinger-Westphal Nucleus which via cranial nerve III results in pupillary constriction. The Neurological Pupil indexTM (NPi) and pupil constriction velocity (CV) are two distinct variables that can be observed and measured using a pupillometer. We examine NPi and CV in 27,462 pupil readings (1,617 subjects). NPi values <3.0 and a CV < 0.8 mm/sec were considered abnormal. Regression was used to clarify the effect of pupil size and repeated measures. An odds ratio of abnormal CV given normal NPi (and vice versa) was computed using the glimmixed (SAS) regression. Of 27,462 readings, 49.2% revealed bilaterally normal NPi wtih brisk CV, and 10.8% revealed bilaterally abnormal NPi and slow CV; 9.1% with unilaterally normal NPi and brisk CV where the opposite pupil had an abnormal NPi and slow CV. The remaining 30.9% revealed that one or both PLR had either a normal NPi with slow CV, or abnormal NPi with brisk CV. Brisk CV does not rule out an abnormal PLR; slow CV does not rule in abnormal PLR. Practitioners should consider these implications when interpreting pupillometry readings.