What does using the pupillary light reflex in your practice mean for Functional Neurologists?

The pupillary light reflex and autonomic innervation has a long-standing history for medical personnel to rapidly gauge brain injury and impairment. We all know this even if we don’t recognize it. When a fictitious person is rushed into the ER in a TV show, they check the pupils. When someone is pulled over for impaired driving and given a field sobriety test, they check the pupils. Heck, even this hilarious video has a fake trainer rush in and the actor instinctively knows to check the pupils as a point of good acting.

But what does this mean for you? It’s all well and good that this is such a routine operation, but it can seem a bit gimmicky if not properly done. Much like a check engine light, you know something’s wrong, but it most always takes a code reader to narrow down the diagnosis and determine how troublesome the problem is.

You Need More Than A Check Engine Light For The Brain.

The pupillary light reflex is a lot like that check engine light. Sure, you can use a penlight to get a quick glimpse that there is a problem but how bad is the problem? What’s the expectation for repair? Will the problem have a measurable increase in performance when it gets fixed? The pupillary light reflex offers a much more detailed approach to this automotive analogy believe it or not.

Quantitative pupillometers are devices that measure the pupil’s diameter over a determined period of time. These are not to be confused with the identically named devices used in optometry to measure inter-pupillary distance for appropriately sizing glasses. Quantitative pupillometers elevate the penlight standard of care to a more objective and defined approach. Consider the questions below from when you last evaluated a patient’s pupils without a quantitative pupillometer.

As you can see with quantitative pupillometry you get exact and actionable values. By way of example let’s compare this to a blood pressure cuff. When taking blood pressure you wouldn’t just record “high blood pressure” in a patient chart would you? No, you would record 173/94 as a point of reference for a future visit or therapy check. We all understand that these values are high but without context how high are they? Is the patient progressing in a positive direction? Are they getting worse? So, why is it commonplace to use such subjective terminology when evaluating neurological activity? The pupillary light reflex when measured with a quantitative pupillometer is an inherently valuable metric if used in a similar way to the blood pressure cuff.

Upgrade Your Care & Clinic With Quantitative Pupillometry.

So, what does using the pupillary light reflex in your practice actually mean for Functional Neurologists? It means you have that code scanner for the human brain now. Specifically, for the autonomic nervous system and autonomic innervation in both its sympathetic and parasympathetic forms. This can be critical when trying to rapidly and reliably evaluate your patients during their visits. Such a simple test can truly have a massive impact on your ability to deliver better care to your patients. Here’s what you can do with it:

• Validate your therapies from your most common to most critical of cases.
• Track patient progress during these therapies with objective autonomic data.
• Grow your patient’s confidence with actionable data you can review with them.

You may be surprised to know that the steps to start using PLR and autonomic innervation are relatively straight forward. First, you need to implement using quantitative pupillometry as a part of your typical patient workflow. A great cadence is to make it a part of your exam while gathering vitals and other patient data. Once you’ve acquired this data you can run a simple check with your patient by looking at the specific parameters to determine if they’re within expectations. Once you wrap up your care and treatment for the patient you can send them on their way and evaluate the data more rigorously. Depending on where they’re at in their treatment you can either track progression by determining how parameters are progressing as the patient recovers or you can validate your patient’s performance as a part of their final treatment and evaluation.

A Tool You Can Use Immediately.

If you’re looking for a quantitative pupillometer to use for autonomic innervation, then Reflex – PLR Analyzer is a convenient and accurate device to start using in your practice today. It’s actually an App for iPhone that you can download today and start a 14-day free trial to test it out with your patients. Reflex allows functional neurologists to have a multi-use neurological assessment tool at their fingertips, allowing them to validate treatments, grow patient confidence, and increase patient loyalty. All with a rapid test method in an excellent formfactor to allow you to hold the phone’s camera up to the patient’s eye and take the measurement. Reflex also offers two options to streamline in-exam and post-exam evaluations.

1. Reflex Sore is a single metric that allows you to quickly gauge how similar or different the patient is to their baseline.
2. Web Portal Trending allows you to analyze all the individual parameters of your patients’ multiple tests on one table and chart.

In any sense quantitative pupillometry is a proven biomechanical and ocular method to gain additional insight into how the brain is performing under injury and otherwise. It can help you significantly upgrade your care and be on par with current neurology standard with only a few extra seconds of evaluation.

Would you like to learn more? We have a fully curated resource page here.

Feel free to contact us on our contact page to get more information or email us at msouthern@brightlamp.org.

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