article · Journal of Clinical Monitoring and Computing
Automated pupillometry provides objective and reproducible assessments of pupil light reactivity in critically ill patients. While the neurological pupillary index is established as a prognostic tool in brain injury and cardiac arrest, limited evidence compares it with the quantitative pupillary index. An observational study assessed 73 adult patients in a neuro-intensive care unit using two commercially available pupillometers, the Neuroptics NPi-300 and the NeuroLight. Measurements of pupil diameter, pupillary reactivity, and both specialised indices were evaluated across both eyes. The devices showed very strong statistical correlation for pupil diameter and reactivity, and a good correlation between the two distinct indices. However, notable differences and limits of agreement indicate that the neurological pupillary index and the quantitative pupillary index may not be clinically interchangeable in intensive care monitoring.
Accurate monitoring of pupil function is critical for tracking neurological deterioration in intensive care patients. While hospitals deploy different automated pupillometers, healthcare teams need to know whether data from different systems can be compared directly. Demonstrating that these indices are not readily interchangeable helps clinicians avoid errors when interpreting automated eye monitoring data across different devices.
This work directly assesses two devices that are already commercially available on the market, comparing their performance for neuro-critical care staff. It highlights an applied operational challenge for clinical adoption: device makers and hospitals must recognise that their proprietary numerical indices cannot be used interchangeably without translation frameworks. Further standardisation between device manufacturers may be needed before data can be shared seamlessly across systems.
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Automated pupillometry provides a standardised, quantitative, highly reproducible measurement of the pupillary light reactivity and other pupillary variables. The Neurologic pupillary index (NPi) has shown good prognostic value in patients with acute brain injury and cardiac arrest. However, few data on the comparison of NPi with a recently introduced index (quantitative pupillary index, QPI) are available. To compare the performance of two commercially available automated pupillometry devices, and in particular QPI and NPi, in a cohort of neuro-critically ill patients. Single-center observational study, including adult (> 18 years) patients admitted to a neuro-intensive care unit over a 6-month period. Pupillary reactivity was assessed in both eyes of each patient using the two pupillometers currently available, the Neuroptics NPi-300 (Neuroptics, Irvine, CA, USA) and the NeuroLight (ID-Med, Marseilles, France). A total of 73 patients were included in the final analysis, with a median age of 65 years (interquartile range [IQR] 54-77). The mean bias between the two pupillometers was 0.44 mm (95% Limit of Agreement [LoA] - 0.43 mm to 1.31 mm) for pupil diameter, 0.57% (95% LoA - 7.63% to 8.77%) for pupillary reactivity, and - 0.82 (95% LoA - 2.70 to 1.05) for NPi vs. QPI comparison. A very strong correlation was found between the two devices in terms of pupil diameter measurement (ρ = 0.91; 95% Confidence Interval [CI] 0.86 to 0.95; p < 0.0001) and pupil reactivity (ρ = 0.92; 95% CI 0.87 to 0.95; p < 0.0001). NPi and QPI were well correlated (ρ = 0.75; 95% CI, 0.62-0.84; p < 0.0001). In this cohort study, a significant statistical correlation between the measurements provided by two available pupilometers was found; however, NPi and QPI might not be clinically interchangeable.
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DOI: 10.1007/s10877-026-01490-4
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