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Background: Advanced Pupillary Light Reflex (PLR) assessment with an automated infrared pupillometer (AIP) is becoming standard. Although cataract prevalence and risk for neurologic illness both increase with age there is no literature on the influence of cataract when assessing PLR using AIP. Objective: Our aim is to explore the effect of cataract on pupillary response to light. Methods and Materials: Mixed model analyses were performed by enrolling 3,650 patients with PLR readings from AIP. The Neurological Pupil Index (NPi), and each component of the PLR was examined separately. Results: 3,207 patients did not have cataract, 59 had unilateral, and 271 bilateral cataract. Generalized linear mixed effect model of 87,290 right eye, and 76,587 left eye AIP measurements found no effect of cataract on any PLR measures: NPi (p=0.221 and p=0.655); latency (p=0.483 and p=0.865); initial pupil size (p=0.661 and 0.712); minimum pupil size (p=0.708 and p=0.720); constriction velocity (p=0.646 and 0.347); nor dilation velocity (p=0.716 and 0.194) for the right and left eye groups respectively. Paired t-test found no difference in NPi (p=0.146). Among those with unilateral cataract (n=59). Conclusions: The presence of cataract does not alter the PLR findings assessed with a pupillometer.

Background: Screening is a valuable tool in emergency medicine for triaging, activation of protocols, and resource allocation. The Dallas Emergency Department Screening Tool to Identify Stroke (DESTINY) was developed to screen for all stroke subtypes, with improved sensitivity for posterior circulation stroke and large vessel occlusion (LVO). The main purpose of this study was to evaluate how reliably the tool could be taught and used by ED Nurses. Methods: This is Phase 1 of a multi-phase study to evaluate the DESTINY tool. A vascular neurologist retrospectively reviewed 409 stroke code activations between January and December of 2018. Thirty descriptive vignettes were composed: right anterior circulation stroke (n=5), left anterior circulation stroke (n=5), posterior circulation stroke (n=5), TIA and stroke mimic (n=6), non-LVO stroke (n=5), and hemorrhagic stroke (n= 4). Fifteen emergency medicine registered nurses used the DESTINY tool to screen the vignettes following the stroke education and DESTINY training module. Results: Individual Pearson Correlation Coefficients (PCC) were calculated for each nurse compared to the vascular neurologist (range: 0.43860 to 0.96966; mean: 0.8746 ± 0.1484). All individual PCC were statistically significant except for one [PCC of 0.43860 (p = 0.0153)]. Cronbach’s Alpha scores were very similar across multiple raters (standardized alpha for nurse raters: 0.9853). Omnibus test to compare DESTINY scores by stroke type demonstrated left anterior LVO and mimic/TIA stroke had few outlier observations, however, poorly differentiated hemorrhagic from ischemic stroke Conclusion: As demonstrated by high interrater reliability, the DESTINY tool can be effectively taught to ED nurses using clinical vignettes. The DESTINY tool is good at differentiating non-LVO, anterior LVO, mimics, and TIAs; while the ability to distinguish between anterior LVO/posterior LVO and ischemic/hemorrhagic stroke was sub-optimal. Utilizing the lessons learned in the early version of the DESTINY screening tool we expect that the high-reliability scores will continue to improve in future prospective studies.