Journal of Neuro-Ophthalmology, March 1991, Volume 11, Issue 1

The computerized pupil.

An IBM-compatible computer graphics software program has been developed which simulates pupillary function. A light pen, electronically interfaced with the computer, simulates a pen light and, when it is placed on the computer image of the pupil, causes pupillary constriction; when it is withdrawn, the pupils redilate. A variety of abnormal pupillary responses are depicted. Anatomical diagrams and questions concerning various simulated pupillary conditions further enhances the educational experience. Medical students, residents in ophthalmology and the neurosciences, optometrists, nurses, ophthalmic assistants, and other health care professionals can utilize this program to learn a wide range of pupillary abnormalities in an interactive environment.

•••• j I .11 . jl The Computerized Pupil John D. Bullock, M. D., Blair A. Rowley, Ph. D., and Lori A. Kuehne, M. D. © 1991 Raven Press, Ltd., New York An IBM- compatible computer graphics software pro­gram has been developed which simulates pupillary function. A light pen, electronically interfaced with the computer, simulates a pen light and, when it is placed on the computer image of the pupil, causes pupillary constriction; when it is withdrawn, the pupils redilate. A variety of abnormal pupillary responses are depicted. Anatomical diagrams and questions concerning various simulated pupillary conditions further enhances the ed­ucational experience. Medical students, residents in ophthalmology and the neurosciences, optometrists, nurses, ophthalmic assistants, and other health care pro­fessionals can utilize this program to learn a wide range of pupillary abnormalities in an interactive environment. Key Words: Pupil- Computers- Neuro- ophthalmol­ogy- Medical education. From the Departments of Ophthalmology O. D. B.) and Bio­medical and Human Factors Engineering ( B. A. R., L. A. K.) Wright State University School of Medicine, Dayton, Ohio, U. s. A. This paper was presented in part at the annual meeting of the American Academy of Ophthalmology, Video Program, Octo­ber 8- 12, 1988, in Las Vegas, Nevada, U. S. A. Address correspondence and reprint requests to Dr. John D. Bullock at the Department of Ophthalmology, Wright State University School of Medicine, 5 Plumwood Road, Dayton, OH 45409, U. s. A 50 The teaching of the pupillary light reflex and the effects of various diseases, medications, and inju­ries on this reflex is an important part of basic med­ical education. Students need to understand both the normal and a wide variety of abnormal pupil­lary reactions. However, it is not possible for each student to experience clinically every pupillary ab­normality. As a method of fulfilling this need, a computer graphics software program has been de­veloped that simulates pupillary function. These simulated pupillary responses are useful as a lec­ture supplement and as self- study for students of medicine, optometry, nursing, and other health professions that may require a thorough under­standing of pupillary function. The goal in developing The Computerized Pupil was to allow students to visualize and interactively study a wide range of pupillary responses. A light pen, electronically interfaced with the computer, simulates a pen light. When it is placed on the computer screen in the area of the pupil, it causes pupillary constriction; when it is withdrawn, the pupil redilates. Normal pupillary reaction and a variety of abnormal pupillary responses are de­picted ( Figs. 1- 4). These include afferent pupillary defect; Horner syndrome; Adie's ( tonic) pupil; simple anisocoria; third nerve palsy; atropine in­stillation; pilocarpine instillation; traumatic iri­doplegia; iritis; leukocoria; conjunctivitis; subcon­junctival hemorrhage; acute angle closure glau­coma; coloboma; peripheral iridectomy; congenital Horner syndrome; and opiate- induced miosis. DESIGN AND MATERIALS The computer code for The Computerized Pupil is written in the BASIC language. Each pupillary ex · ample is written as a self- contained unit for ease of additions ~ nd deletions t~ ~ he program. The equip­ment that IS needed to utilIZe The Computerized Pu- /----------- / "'" .' . ~ IG.•. 1. Appearance of compu~ er screen illustrating the image of normal eyes and pupils of a young healthy Individual In the baseline, unstimulated situation. """, •,, 1.' "'... ". ,'" ' II, ", FIG.. 2. Computer image of both eyes when the light pen is used to stimulate the left pupil. Bilateral pupillary constriction results ( Right afferent pupillary defect). Small figure in lower right corner indicates stimulation by the light pen. ..' . ' '" FIG. 3. Computer image of both eyes when the light pen is used to stimulate the right pupil. Bilateral pupillary diiatiorywsJtttHfit1gt* t aHeloli1 pd~ ary defect). I O. BULLOCK ET AL. FIG. 4. Computer image of both eyes of an elderly patient with a total left third nerve palsy. The right pupil is somewhat miotic due to age. and the left eye demonstrates a left ptosis. a fixed dilated left pupil. a left exotropia, and a slight left hypotropia. pil software program is an IBM XT- compatible computer operating at 10 MHz with a hard disk drive, a eGA color monitor, and a computer light pen. The software can reside on one 360K 5%" floppy disk. Use of the system requires no special training or prior computer knowledge. A simple set of in­structions and objectives precedes the pupillary examples. At any time during the encounter the user may also summon a menu which provides a r Clin NClIro- ophtiUllmol, Vol. 11, No. 1, 1991 list of options including continuing to the next ex­ample, returning to a previous example, or discon­tinuing the computer program. With each pupil­lary response depicted, a teaching session is pro­vided. These are written in a clear, concise manner and contain an adequate amount of explanation for the user; references are also included. In addition, each teaching session includes a diagram of the optic pathway showing the location of various le­sions. /------"'"