Pupillometry as an interdisciplinary tool in ophthalmological and neurological diagnostics: a review

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Abstract

Pupillary reflex parameters reflect the functional state of the visual pathway and the nervous system as a whole. An accurate, objective, and easily reproducible method for assessing these parameters is pupillometry—a quantitative analysis of pupillary response dynamics to light stimulation. We searched the international PubMed and EMBASE databases as well as the Russian eLIBRARY.RU database, identifying case reports, original research studies, and systematic reviews.

Current research demonstrates growing interest in pupillometry as a diagnostic method for pupillary abnormalities in ophthalmological and neurological diseases. Previously used primarily in neurology, it has been actively introduced into ophthalmological practice in recent years. Moreover, pupillometry demonstrates high sensitivity to early ophthalmological changes in conditions such as age-related macular degeneration, glaucoma, and diabetic retinopathy—changes that often precede structural damage detected by optical coherence tomography or perimetry. Additionally, in unilateral optic nerve lesions, pupillometry enables the identification of compensatory mechanisms in the healthy eye, driven by adaptation of intrinsically photosensitive retinal ganglion cells (ipRGCs).

Studies show that quantitative pupillary reflex parameters and derived indices are successfully used for diagnosis, prognosis, and treatment selection in brain lesions. Pupillometry not only helps identify post-stroke complications but also aids in suspecting stroke during emergency care, predicting outcomes of traumatic brain injury, optimizing treatment, and monitoring brain function recovery.

Automated pupillometry holds promise for the diagnosis and monitoring of both ophthalmological and neurological diseases. Further research will expand its application and improve data analysis algorithms.

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About the authors

Natalia A. Suponeva

Russian Center of Neurology and Neurosciences

Email: suponeva@neurology.ru
ORCID iD: 0000-0003-3956-6362
SPIN-code: 3223-6006

д-р мед. наук, профессор, член-корреспондент РАН

Russian Federation, Moscow

Mikhail A. Frolov

Peoples’ Friendship University of Russia

Email: frolov_ma@pfur.ru
ORCID iD: 0000-0002-9833-6236
SPIN-code: 1697-6960

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Irina V. Vorobyeva

Peoples’ Friendship University of Russia

Author for correspondence.
Email: vorobyeva_iv@pfur.ru
ORCID iD: 0000-0003-2707-8417
SPIN-code: 1693-3019

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Aleksandr M. Frolov

Peoples’ Friendship University of Russia

Email: frolov_am@pfur.ru
ORCID iD: 0000-0003-0988-1361
SPIN-code: 6338-9946

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Moscow

Dmitry V. Sergeev

Russian Center of Neurology and Neurosciences

Email: sergeev@neurology.ru
ORCID iD: 0000-0002-9130-1292
SPIN-code: 8282-3920

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Daria A. Semina

Peoples’ Friendship University of Russia

Email: semina.dariaan@yandex.ru
ORCID iD: 0009-0003-6567-8779
SPIN-code: 1722-2917

MD

Russian Federation, Moscow

Ayur L. Budazhapov

Peoples’ Friendship University of Russia

Email: 1152240351@pfur.ru
ORCID iD: 0009-0004-5980-7789

MD

Russian Federation, Moscow

Danil K. Novikov

Russian Center of Neurology and Neurosciences

Email: danil61503@gmail.com
ORCID iD: 0009-0003-5897-7594

MD

Russian Federation, Moscow

Yulia V. Ryabinkina

Russian Center of Neurology and Neurosciences

Email: ryabinkina11@mail.ru
ORCID iD: 0000-0001-8576-9983
SPIN-code: 5044-2701

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Elena V. Gnedovskaya

Russian Center of Neurology and Neurosciences

Email: gnedovskaya@neurology.ru
ORCID iD: 0000-0001-6026-3388
SPIN-code: 7248-1282

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Russian Federation, Moscow

Sergey A. Bokarev

Mother and Child Clinic, Moscow

Email: beaucuriets@gmail.com
ORCID iD: 0009-0006-6162-2665
Russian Federation, Moscow

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2. Fig. 1. Schematic diagram of pupil dilation velocity (DV) determination and its comparison with the modified Rankin scale score. Image adapted with modifications from [80]. © Scala I., et al., 2025. Distributed under a CC BY 4.0 license.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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