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Effects of pupil size in video head-impulse tests

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Abstract

The results of video head impulse tests (video-HITs) may be confounded by data artifacts of various origins, including pupil size and eyelid obstruction of the pupil. This study aimed to determine the effect of these factors on the results of video-HITs. We simulated ptosis by adopting pharmacological dilatation of the pupil in 21 healthy participants (11 women; age 24–58 years). Each participant underwent video-HITs before and after pupillary dilatation using 0.5% tropicamide. We assessed the changes in the vestibulo-ocular reflex (VOR) gain, corrective saccade amplitude, and frequency of eyelid flicks. After pupillary dilatation, the VOR gain decreased for both right (RAC; 1.12 \(\pm\) 0.12 vs. 1.01 \(\pm\) 0.16, p = 0.011) and left anterior canals (LACs; 1.15 \(\pm\) 0.13 vs. 0.96 \(\pm\) 0.14, p < 0.001), and right posterior canal (RPC, 1.10 \(\pm\) 0.13 vs. 0.98 \(\pm\) 0.09, p = 0.001). The corrective saccade amplitudes also decreased significantly for all four vertical canals. The frequency of eyelid flicks, however, did not change. The changes of VOR gain were positively correlated with the lid excursion in RPC (r = 0.629, p = 0.002) and LPC (r = 0.549, p = 0.010). Our study indicates that eyelid position and pupil size should be considered when interpreting the results of video-HITs, especially for the vertical canals. Pupils should be shrunk in a very well-lit room, and artifacts should be prevented by taping or lifting the eyelids as required during video-HITs.

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Acknowledgements

This study was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (2022R1A4A1018869).

Author information

Authors and Affiliations

  1. Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea

    Ho-Jin Yoon, Jeong-Heon Lee, Joo-Hyeong Lee, Sun-Uk Lee & Byung-Jo Kim

  2. Neurotology and Neuro-Ophthalmology Laboratory, Korea University Anam Hospital, Seoul, South Korea

    Jeong-Heon Lee, Joo-Hyeong Lee, Euyhyun Park & Sun-Uk Lee

  3. Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea

    Euyhyun Park

  4. BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, South Korea

    Byung-Jo Kim

  5. Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea

    Ji-Soo Kim

  6. Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea

    Ji-Soo Kim

Authors
  1. Ho-Jin Yoon
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Contributions

H-JY analyzed and interpreted the data and wrote the manuscript. J-HL, J-HL, EP, B-JK and J-SK analyzed and interpreted the data, and revised the manuscript. S-UL designed and conceptualized the study, interpreted the data, and revised the manuscript.

Corresponding author

Correspondence to Sun-Uk Lee.

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Conflicts of interest

Drs. Yoon, Jung-Hun Lee, Joo-Hyeong Lee, E, Park, and S.U. Lee report no disclosures. Dr. B.J. Kim serves as an Editor-in-Chief of the Journal of Clinical Neurology. Dr. J.S. Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, and Clinical and Translational Neuroscience.

Study ethics

This study followed the tenets of the Declaration of Helsinki and was performed according to the guidelines of the Institutional Review Board of Korea University Medical Center (2023AN0246).

Supplementary Information

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Supplementary file1 (DOCX 15 KB)

Video. Head-impulses in the left anterior–right posterior (LARP) plane. At baseline, the measurements of the pupil are not interrupted by the eyelids. However, the eyelid flicks (red rectangles) and blinking artifacts (green rectangle) hamper the measurements of the eye movements after pupil dilatation. Blue and black lines represent the vertical eye position and velocity of the right eye, respectively. (MP4 5401 KB)

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Yoon, HJ., Lee, JH., Lee, JH. et al. Effects of pupil size in video head-impulse tests. J Neurol 271, 819–825 (2024). https://doi.org/10.1007/s00415-023-12026-0

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  • DOI: https://doi.org/10.1007/s00415-023-12026-0

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