Measuring the Pupillary Light Reflex Using Portable Instruments in Applied Settings
, Chris O’Connor 3, Ana Antunes 4 and Robert J. Snowden 4,*
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsGiven the work concerns technical equipment, this is an important paper that will be of interest to many vision researchers. It is extremely well written and I do think it should be published in the journal. It is more excellent work from the Snowden lab. I only have a few tiny recommendations, of the typo kind.
Abstract; The “PLR” and “PTSD” need to be given their full name.
Line 26. It’s only a preference but the phrase, “with the pupil itself thought to give away our innermost thoughts” would be better as “with variations in pupil size being associated with an array of processes”.
Line 57. The authors state that, “Dysfunction of the PNS therefore can lead to long-term physical and mental health problems”. There is an issue of cause and effect here. Would be better expressed as “Dysfunction of the PNS is associated with long-term physical and mental health problems”.
Line 120. The authors should be consistent with reference formatting, i.e., the space after author names (e.g., Winn et al.[25]). There are also other inconsistent spacing throughout. E.g, Lines 122, 159.
Line 163, Replace “look at” with “examine” or “assess”.
Between Lines 191-193. Those abbreviations have already been defined previously (e.g., “BPD”) so no need to repeat.
Author Response
Given the work concerns technical equipment, this is an important paper that will be of interest to many vision researchers. It is extremely well written and I do think it should be published in the journal. It is more excellent work from the Snowden lab. I only have a few tiny recommendations, of the typo kind.
COMMENT. Thank you for such a kind comment.
Abstract; The “PLR” and “PTSD” need to be given their full name.
COMMENT. This has been done.
Line 26. It’s only a preference but the phrase, “with the pupil itself thought to give away our innermost thoughts” would be better as “with variations in pupil size being associated with an array of processes”.
COMMENT. This has been done.
Line 57. The authors state that, “Dysfunction of the PNS therefore can lead to long-term physical and mental health problems”. There is an issue of cause and effect here. Would be better expressed as “Dysfunction of the PNS is associated with long-term physical and mental health problems”.
COMMENT. This has been done.
Line 120. The authors should be consistent with reference formatting, i.e., the space after author names (e.g., Winn et al.[25]). There are also other inconsistent spacing throughout. E.g, Lines 122, 159.
COMMENT. This has been done.
Line 163, Replace “look at” with “examine” or “assess”.
COMMENT. This has been done.
Between Lines 191-193. Those abbreviations have already been defined previously (e.g., “BPD”) so no need to repeat.
COMMENT. This has been done.
Reviewer 2 Report
Comments and Suggestions for AuthorsGray et al. conducted an interesting study to evaluate and compare the reliability of two portable instruments for measuring the pupillary reflex (PLR), namely the NeuroLight Algiscan and an iPhone, and to analyze the correlation between PLR measurement and age, anxiety and post traumatic stress disorder (PTSD). However, I have some concerns that prevent the publication of the manuscript in the present form.
Introduction
The introduction is too long and too distracting. It should be shortened, focusing on the subject of the article (i.e. the parts regarding the relationship between PPD and age, anxiety and trauma are too long). The authors should also report some references on the various clinical uses of automated pupillometry in clinical contexts for brain (PMID: 38928617 - 38833515) and non-brain (PMID: 34945155 - 36066019) diseases.
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Furthermore, the second objective of the study is unclear. It should be better specified to facilitate readers' understanding.
Methods
- The authors must specify whether there were exclusion criteria for enrollment in the study (e.g. eye diseases? Diagnosis of dysautonomia or diabetes? Taking drugs affecting the autonomic nervous system?).
- PLR measurement methods are unclear: Did any included subjects undergo three different PLR assessments with each of the two different instruments? When were the State-Trait Trauma Questionnaire and the International Trauma Questionnaire administered to patients?
- The type of statistical analyzes carried out by the authors is not mentioned. They must be specified in a separate paragraph.
Minor concerns
- PTSD should be expanded at its first introduction, both in the abstract and in the text.
Author Response
Gray et al. conducted an interesting study to evaluate and compare the reliability of two portable instruments for measuring the pupillary reflex (PLR), namely the NeuroLight Algiscan and an iPhone, and to analyze the correlation between PLR measurement and age, anxiety and post traumatic stress disorder (PTSD). However, I have some concerns that prevent the publication of the manuscript in the present form.
Introduction
The introduction is too long and too distracting. It should be shortened, focusing on the subject of the article (i.e. the parts regarding the relationship between PPD and age, anxiety and trauma are too long)
COMMENT. In light of this comment we examined this section for possible shortening. However, we found little room for this without losing what we regarded as important information for the reader. We wanted to illustrate that the findings with age were well-established but those for anxiety and PTSD were less well established. These three sections together consists of only 1 page. We therefore ask if we can retain this section as it is.
The authors should also report some references on the various clinical uses of automated pupillometry in clinical contexts for brain (PMID: 38928617 - 38833515) and non-brain (PMID: 34945155 - 36066019) diseases.
COMMENT. Examples of these have been added as suggested (p 3).
Furthermore, the second objective of the study is unclear. It should be better specified to facilitate readers' understanding.
COMMENT. We have tried to make this clearer as suggested (p 5).
Methods
- The authors must specify whether there were exclusion criteria for enrollment in the study (e.g. eye diseases? Diagnosis of dysautonomia or diabetes? Taking drugs affecting the autonomic nervous system?).
COMMENT. We did not take any of these measures as we wanted to sample the general population that would be seen in such “field” settings. Therefore, there were no such exclusions. This information has been added. (p 6).
- PLR measurement methods are unclear: Did any included subjects undergo three different PLR assessments with each of the two different instruments?
COMMENT. For all participants, we attempted to take three readings with each of the instruments. The order of the which instrument was used first was counter-balanced across participants. We have rewritten this sentence to try and make this clear. (p 7).
When were the State-Trait Trauma Questionnaire and the International Trauma Questionnaire administered to patients?
COMMENT. They were administered after the pupillometry. This has been made clearer in the text (P 7).
- The type of statistical analyzes carried out by the authors is not mentioned. They must be specified in a separate paragraph.
COMMENT. We apologise for not specifying this information. A paragraph has now been added at the end of the Methods section (P 7).
Minor concerns
- PTSD should be expanded at its first introduction, both in the abstract and in the text.
COMMENT. This has been done.
Reviewer 3 Report
Comments and Suggestions for AuthorsThe authors describe the use of 2 measuring devices on test subjects under real-life conditions.
The paper could be improved by a clearer statement of the limitations in the discussion. How many investigators were there, or did this have an influence? Finally, the different group sizes are small, the times of the measurements and different settings and thus lighting conditions, as well as the current state of the test person (e.g. tired) could have an influence.
Author Response
The authors describe the use of 2 measuring devices on test subjects under real-life conditions.
The paper could be improved by a clearer statement of the limitations in the discussion. How many investigators were there, or did this have an influence? Finally, the different group sizes are small, the times of the measurements and different settings and thus lighting conditions, as well as the current state of the test person (e.g. tired) could have an influence.
COMMENT. A paragraph considering limitation has been added as suggested (P 10).
We did not make a note of which of our team tested each participant as we did not feel that this was an issue. The hand-held instruments are easy to use and merely require the instrument to be held over the eye. The instrument then indicates it has located the pupil and a measurement is then taken by simply pressing a button and holding the instrument steady for a few seconds.
We are not sure what the “different group sizes” refers to. There was no formation of groups.
Such variations as mentioned as part of why we wanted to test the instruments in the field setting.
