{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T20:12:29Z","timestamp":1788984749839,"version":"build-2803163510"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T00:00:00Z","timestamp":1768003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Chonnam National University Hospital Biomedical Research Institute","award":["BCRI25020"],"award-info":[{"award-number":["BCRI25020"]}]},{"name":"Chonnam National University Hospital Biomedical Research Institute.","award":["BCRI25020"],"award-info":[{"award-number":["BCRI25020"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Relative afferent pupillary defect (RAPD) is a key sign of optic neuropathies but is traditionally assessed subjectively. Virtual reality (VR) headsets with integrated binocular eye tracking enable simultaneous measurement under standardized illumination. We developed and conducted a pilot evaluation of a VR headset\u2013based pupillometer that objectively quantifies RAPD using advanced pupil-tracking and automated blink-correction algorithms. This proof-of-concept study enrolled 17 patients with unilateral optic neuropathy (glaucomatous, traumatic, ischemic, or inflammatory) and 30 healthy controls. A VR headset (FOVE\n                    <jats:sup>\u00ae<\/jats:sup>\n                    , Tokyo, Japan) recorded binocular pupillary responses at 120\u00a0Hz under photopic (~\u2009130\u00a0lx) and scotopic (&lt;\u20091\u00a0lx) conditions. Two protocols captured direct and consensual light reflexes and simulated the swinging flashlight test. Measured parameters included minimum and maximum diameters, constriction percentage, constriction\/dilation velocities, and logarithmic RAPD scores. Receiver operating characteristic (ROC) analysis assessed diagnostic accuracy relative to clinical RAPD grading. Patients exhibited significantly reduced direct constriction (26.3% vs. 47.8%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), slower dilation velocity, and higher absolute RAPD scores (2.46\u2009\u00b1\u20092.00 vs. 0.27\u2009\u00b1\u20090.25 log units;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) than controls. ROC analysis demonstrated an area under the curve (AUC) of 0.903 for the absolute RAPD score, corresponding to 87% sensitivity and 91% specificity. The VR headset\u2013based pupillometer objectively quantified RAPD by simultaneously recording direct and consensual responses. Given its high diagnostic accuracy, portability, and ease of use, this study provides preliminary evidence supporting the feasibility of VR-based pupillometry as an objective, reproducible alternative to conventional subjective testing for evaluating optic neuropathies.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-29953-9","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T14:33:33Z","timestamp":1768055613000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and pilot evaluation of a binocular virtual reality Headset-Based pupillometer for quantitative assessment of pupillary light reflexes"],"prefix":"10.1038","volume":"16","author":[{"given":"Chan Hae","family":"Park","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daseul","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Woo","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyuhae","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwan","family":"Heo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,10]]},"reference":[{"key":"29953_CR1","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/978-3-540-32708-0_5","volume-title":"Clinical Neuro-Ophthalmology: A Practical Guide","author":"H Wilhelm","year":"2007","unstructured":"Wilhelm, H. & Wilhelm, B. Disorders of the pupil. In Clinical Neuro-Ophthalmology: A Practical Guide (eds (eds Schiefer, U., Wilhelm, H. & Hart, W.) 55\u201369 (Springer, Berlin, (2007)."},{"key":"29953_CR2","first-page":"68","volume":"29","author":"DC Broadway","year":"2016","unstructured":"Broadway, D. C. How to test for a relative afferent pupillary defect (RAPD). Community Eye Health. 29, 68\u201369 (2016).","journal-title":"Community Eye Health"},{"key":"29953_CR3","doi-asserted-by":"crossref","unstructured":"Boucher, T., Fortin, \u00c9. & Evoy, F. The standard swinging flashlight test: reliable or not. Neurology 92(15 suppl), P1.9-009(2019).","DOI":"10.1212\/WNL.92.15_supplement.P1.9-009"},{"key":"29953_CR4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/0039-6257(81)90124-7","volume":"26","author":"HS Thompson","year":"1981","unstructured":"Thompson, H. S., Corbett, J. J. & Cox, T. A. How to measure the relative afferent pupillary defect. Surv. Ophthalmol. 26, 39\u201342 (1981).","journal-title":"Surv. Ophthalmol."},{"key":"29953_CR5","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.1136\/bjo.2010.194217","volume":"95","author":"AL Hennessy","year":"2011","unstructured":"Hennessy, A. L. et al. The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a South Indian population. Br. J. Ophthalmol. 95, 1203\u20131206 (2011).","journal-title":"Br. J. Ophthalmol."},{"key":"29953_CR6","first-page":"200","volume":"103","author":"D Lankaranian","year":"2005","unstructured":"Lankaranian, D., Altangerel, U., Spaeth, G. L., Leavitt, J. A. & Steinmann, W. C. The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma. Trans. Am. Ophthalmol. Soc. 103, 200\u2013208 (2005).","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"29953_CR7","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1167\/tvst.12.6.22","volume":"12","author":"D Bruegger","year":"2023","unstructured":"Bruegger, D. et al. Detection of relative afferent pupillary defects using eye tracking and a VR headset. Transl Vis. Sci. Technol. 12, 22 (2023).","journal-title":"Transl Vis. Sci. Technol."},{"key":"29953_CR8","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1097\/OPX.0000000000002061","volume":"100","author":"R Negi","year":"2023","unstructured":"Negi, R. et al. Effect of light intensity on the relative afferent pupillary defect in unilateral neuro-ophthalmic pathology. Optom. Vis. Sci. 100, 614 (2023).","journal-title":"Optom. Vis. Sci."},{"key":"29953_CR9","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1167\/tvst.12.6.2","volume":"12","author":"P Sarker","year":"2023","unstructured":"Sarker, P. et al. Test\u2013retest reliability of virtual reality devices in quantifying for relative afferent pupillary defect. Transl Vis. Sci. Technol. 12, 2 (2023).","journal-title":"Transl Vis. Sci. Technol."},{"key":"29953_CR10","first-page":"1452","volume":"31","author":"H Ishikawa","year":"2017","unstructured":"Ishikawa, H. et al. Assessment of VR-based pupillometry for clinical detection of RAPD. Eye 31, 1452\u20131458 (2017).","journal-title":"Eye"},{"key":"29953_CR11","first-page":"54","volume":"204","author":"K Kawasaki","year":"2019","unstructured":"Kawasaki, K., Ito, Y., Ishida, T., Miura, J. & Nishida, K. Validation of a VR pupillometer in unilateral optic neuropathy. Am. J. Ophthalmol. 204, 54\u201361 (2019).","journal-title":"Am. J. Ophthalmol."},{"key":"29953_CR12","first-page":"1349","volume":"30","author":"DS Chang","year":"2016","unstructured":"Chang, D. S., Arora, K. S., Boland, M. V. & Friedman, D. S. Development and validation of a pupillary assessment tool in virtual reality. 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