Pupillary Response Research Articles

Examining the inter -rater and inter-trial reliability of the NeuroOptics-3000 pupilometer to measure pupillary light response parameters

Examining the inter -rater and inter-trial reliability of the NeuroOptics-3000 pupilometer to measure pupillary light response parameters

260 Pediatric Penetrating Head Trauma: Do Children Need to be Taken to Pediatric Trauma Centers?

INTRODUCTION: Gun violence has become the leading cause of death in children. Debate exists regarding the optimal treatment setting for pediatric trauma patients at either Adult Trauma Centers (ATC) or Pediatric Trauma Centers (PTC). METHODS: A retrospective analysis of the National Trauma Data Bank (NTDB) was performed from 2017-2020. Inclusion criteria included age 18 years or younger, firearm related mechanism, and associated ICD-10 code corresponding to intracranial injury. Patient characteristics and outcomes were compared across groups. RESULTS: 2,662 cases met inclusion criteria. Overall mortality was 52.1%. 57.4% of patients presented to ATC, 12.8% to PTC, and 29.7% to dual-certified centers. The median age of patients treated at ATC was 17, 13 at PTC, and 16 at dual-certified centers. While mortality was lower for patients presenting to PTC relative to ATC and dual-certified centers (38.2% vs. 55.6% vs. 52.9%, respectively, p < 0.001), PTC patients had higher GCS scores (7.8 vs. 6.5 vs. 6.7, p < 0.001) and lower rates of bilaterally fixed and dilated pupils at presentation (38.9% vs 53% vs 6.7%, p < 0.001). In a logistic regression analysis controlling for baseline pupillary response, GCS, age, ISS, and treatment center type, no significant association was seen between center type and mortality (p = 0.550). CONCLUSIONS: Although mortality was significantly higher for patients presenting to ATC, when baseline injury severity was controlled for, no statistically significant effect was seen with respect to mortality. These results show that the bulk of pediatric GSW are already being treated at ATC and suggest that there is no significant difference in mortality relative to PTC.

Pupillary Responses Reflect Dynamic Changes in Multiple Cognitive Factors During Associative Learning in Primates.

Associative learning involves complex interactions of multiple cognitive factors. While adult subjects can articulate these factors verbally, for model animals such as macaques, we rely on behavioral outputs. In our study, we used pupillary responses as an alternative measure to capture these underlying cognitive changes. We recorded the dynamic changes in the pupils of three male macaques when they learned the associations between visual stimuli and reward sizes under the classical Pavlovian experimental paradigm. We found that during the long-term learning process, the gradual changes in the pupillary response reflect the changes in the cognitive state of the animals. The pupillary response can be explained by a linear combination of components corresponding to multiple cognitive factors. These components reflect the impact of visual stimuli on the pupils, the prediction of reward values associated with the visual stimuli, and the macaques' understanding of the current experimental reward rules. The changing patterns of these factors during interday and intraday learning clearly demonstrate the enhancement of current reward-stimulus association and the weakening of previous reward-stimulus association. Our study shows that the dynamic response of pupils can serve as an objective indicator to characterize the psychological changes of animals, understand their learning process, and provide important tools for exploring animal behavior during the learning process.

Automated Analysis Pipeline for Extracting Saccade, Pupil, and Blink Parameters Using Video-Based Eye Tracking.

The tremendous increase in the use of video-based eye tracking has made it possible to collect eye tracking data from thousands of participants. The traditional procedures for the manual detection and classification of saccades and for trial categorization (e.g., correct vs. incorrect) are not viable for the large datasets being collected. Additionally, video-based eye trackers allow for the analysis of pupil responses and blink behaviors. Here, we present a detailed description of our pipeline for collecting, storing, and cleaning data, as well as for organizing participant codes, which are fairly lab-specific but nonetheless, are important precursory steps in establishing standardized pipelines. More importantly, we also include descriptions of the automated detection and classification of saccades, blinks, "blincades" (blinks occurring during saccades), and boomerang saccades (two nearly simultaneous saccades in opposite directions where speed-based algorithms fail to split them), This is almost entirely task-agnostic and can be used on a wide variety of data. We additionally describe novel findings regarding post-saccadic oscillations and provide a method to achieve more accurate estimates for saccade end points. Lastly, we describe the automated behavior classification for the interleaved pro/anti-saccade task (IPAST), a task that probes voluntary and inhibitory control. This pipeline was evaluated using data collected from 592 human participants between 5 and 93 years of age, making it robust enough to handle large clinical patient datasets. In summary, this pipeline has been optimized to consistently handle large datasets obtained from diverse study cohorts (i.e., developmental, aging, clinical) and collected across multiple laboratory sites.

Adaptation to numerosity affects the pupillary light response

We recently showed that the gain of the pupillary light response depends on numerosity, with weaker responses to fewer items. Here we show that this effect holds when the stimuli are physically identical but are perceived as less numerous due to numerosity adaptation. Twenty-eight participants adapted to low (10 dots) or high (160 dots) numerosities and subsequently watched arrays of 10–40 dots, with variable or homogeneous dot size. Luminance was constant across all stimuli. Pupil size was measured with passive viewing, and the effects of adaptation were checked in a separate psychophysical session. We found that perceived numerosity was systematically lower, and pupillary light responses correspondingly smaller, following adaptation to high rather than low numerosities. This is consistent with numerosity being a primary visual feature, spontaneously encoded even when task irrelevant, and affecting automatic and unconscious behaviours like the pupillary light response.

The dynamics of experiencing Gestalt and Aha in cubist art: pupil responses and art evaluations show a complex interplay of task, stimuli content, and time course.

Gestalt perception refers to the cognitive ability to perceive various elements as a unified whole. In our study, we delve deeper into the phenomenon of Gestalt recognition in visual cubist art, a transformative process culminating in what is often described as an Aha moment. This Aha moment signifies a sudden understanding of what is seen, merging seemingly disparate elements into a coherent meaningful picture. The onset of this Aha moment can vary, either appearing almost instantaneously, which is in line with theories of hedonic fluency, or manifesting after a period of time, supporting the concept of delayed but more in-depth meaningful insight. We employed pupillometry to measure cognitive and affective shifts during art interaction, analyzing both maximum pupil dilation and average dilation across the trial. The study consisted of two parts: in the first, 84 participants identified faces in cubist paintings under various conditions, with Aha moments and pupil dilation measured. In part 2, the same 84 participants assessed the artworks through ratings in a no-task free-viewing condition. Results of part 1 indicate a distinctive pattern of pupil dilation, with maximum dilation occurring at both trial onset and end. Longer response times were observed for high-fluent, face-present stimuli, aligning with a delayed but accurate Aha-moment through recognition. Additionally, the time of maximum pupil dilation, rather than average dilation, exhibited significant associations, being later for high-fluent, face-present stimuli and correct detections. In part 2, average, not the time of maximum pupil dilation emerged as the significant factor. Face-stimuli and highly accessible art evoked stronger dilations, also reflecting high clearness and negative valence ratings. The study underscores a complex relationship between the timing of recognition and the Aha moment, suggesting nuanced differences in emotional and cognitive responses during art viewing. Pupil dilation measures offer insight into these processes especially for moments of recognition, though their application in evaluating emotional responses through artwork ratings warrants further exploration.

Are the P600 and P3 ERP components linked to the task-evoked pupillary response as a correlate of norepinephrine activity?

During language comprehension, anomalies and ambiguities in the input typically elicit the P600 event-related potential component. Although traditionally interpreted as a specific signal of combinatorial operations in sentence processing, the component has alternatively been proposed to be a variant of the oddball-sensitive, domain-general P3 component. In particular, both components might reflect phasic norepinephrine release from the locus coeruleus (LC/NE) to motivationally significant stimuli. In this preregistered study, we tested this hypothesis by relating both components to the task-evoked pupillary response, a putative biomarker of LC/NE activity. 36 participants completed a sentence comprehension task (containing 25% morphosyntactic violations) and a non-linguistic oddball task (containing 20% oddballs), while the EEG and pupil size were co-registered. Our results showed that the task-evoked pupillary response and the ERP amplitudes of both components were similarly affected by both experimental tasks. In the oddball task, there was also a temporally specific relationship between the P3 and the pupillary response beyond the shared oddball effect, thereby further linking the P3 to NE. Because this link was less reliable in the linguistic context, we did not find conclusive evidence for or against a relationship between the P600 and the pupillary response. Still, our findings further stimulate the debate on whether language-related ERPs are indeed specific to linguistic processes or shared across cognitive domains. However, further research is required to verify a potential link between the two ERP positivities and the LC/NE system as the common neural generator.

Quicker Exogenous Orienting and Slower Endogenous Orienting in Autistic People.

Research is equivocal on whether attention orienting is atypical in autism. This study investigated two types of attention orienting in autistic people and accounted for the potential confounders of alerting level, co-occurring symptoms of attention-deficit/hyperactivity disorder (ADHD) and anxiety, age, and sex. Twenty-seven autistic participants (14 males; 9-43 years) and 22 age- and sex-matched non-autistic participants (13 males; 9-42 years) completed the exogenous and endogenous Posner tasks. Response time and pupillometric data were recorded. Autistic participants were faster at orienting attention to valid cues in the exogenous task and slower at disengaging from invalid cues in the endogenous task compared to non-autistic participants. With increasing age, autistic participants showed faster exogenous and endogenous orienting, whereas non-autistic participants showed faster exogenous orienting but stable speed of endogenous orienting. Higher ADHD symptoms were associated with slower exogenous orienting in both groups, whereas higher anxiety symptoms were associated with faster exogenous orienting only in autistic participants. No group differences were noted for alerting levels, sex, or pupillary responses. This study provides new evidence of superior exogenous orienting and inefficient endogenous orienting in autistic people and suggests that age and co-occurring symptoms are important to consider when assessing attention orienting in autism.

Circadian photoentrainment varies by season and depressed state: associations between light sensitivity and sleep and circadian timing.

Altered light sensitivity may be an underlying vulnerability for disrupted circadian photoentrainment. The photic information necessary for circadian photoentrainment is sent to the circadian clock from melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs). The current study tested whether the responsivity of ipRGCs measured using the post-illumination pupil response (PIPR) was associated with circadian phase, sleep timing, and circadian alignment, and if these relationships varied by season or depression severity. Adult participants (N = 323, agem = 40.5, agesd = 13.5) with varying depression severity were recruited during the summer (n = 154) and winter (n = 169) months. Light sensitivity was measured using the PIPR. Circadian phase was assessed using Dim Light Melatonin Onset (DLMO) on Friday evenings. Midsleep was measured using actigraphy. Circadian alignment was calculated as the DLMO-midsleep phase angle. Multilevel regression models covaried for age, gender, and time since wake of PIPR assessment. Greater light sensitivity was associated with later circadian phase in summer but not in winter (β = 0.23; p = 0.03). Greater light sensitivity was associated with shorter DLMO-midsleep phase angles (β = 0.20; p = 0.03) in minimal depression but not in moderate depression (SIGHSAD < 6.6; Johnson-Neyman region of significance). Light sensitivity measured by the PIPR was associated with circadian phase during the summer but not in winter, suggesting ipRGC functioning in humans may affect circadian entrainment when external zeitgebers are robust. Light sensitivity was associated with circadian alignment only in participants with minimal depression, suggesting circadian photoentrainment, a possible driver of mood, may be decreased in depression year-round, similar to decreased photoentrainment in winter.

Effect of recurrent task-induced acute stress on task performance, vagally mediated heart rate variability, and task-evoked pupil response

Advances in wearable sensor technologies can be leveraged to investigate behavioral and physiological responses in task-induced stress environments. Reliable and valid multidimensional assessments are required to detect stress given its multidimensional nature. This study investigated the effect of recurrent task-induced acute stress on task performance, vagally mediated heart variability measures (vmHRV) and task-evoked pupillary response (TEPR). Task performance, vmHRV measures, and TEPR were collected from 32 study participants while they performed a computer-based task in a recurrent task-induced acute stress environment. Mixed-effects modeling was used to assess the sensitivity of each outcome variable to experimental conditions. Repeated measures correlation tests were used to examine associations between outcome variables. Task performance degraded under stress. vmHRV measures were lower in the stress conditions relative to the no stress conditions. TEPR was found to be higher in the stress conditions compared to the no stress conditions. Task performance was negatively associated with the vmHRV measures, and degraded task performance was linked to increased TEPR in the stress conditions. There were positive associations between vmHRV measures. TEPR was negatively associated with vmHRV measures. Although task-induced stress degrades task performance, recurrent exposure to that stress could alter this effect via habituation. Further, our findings suggest that vmHRV measures and TEPR are sensitive enough to quantify psychophysiological responses to recurrent task-induced stress.

Evaluating the utility of quantitative pupillometry in a neuro-critical care setting for the monitoring of intracranial pressure: A prospective cohort study

IntroductionAssessment of the pupillary light reflex (PLR) is key in intensive care monitoring of neurosurgical patients, particularly for monitoring intracranial pressure (ICP). Quantitative pupillometry using a handheld pupillometer is a reliable method for PLR assessment. However, many variables are derived from such devices. We therefore aimed to assess the performance of these variables at monitoring ICP. MethodsSedated patients admitted to neurocritical care in a tertiary neurosurgical centre with invasive ICP monitoring were included. Hourly measurement of ICP, subjective pupillometry (SP) using a pen torch device, and quantitative pupillometry (QP) using a handheld pupillometer were performed. Results561 paired ICP, SP and QP pupillary observations from nine patients were obtained (1122 total pupillary observations). SP and QP had a moderate concordance for pupillary size (κ=0.62). SP performed poorly at detecting pupillary size changes (sensitivity=24%). In 40 (3.6%) observations, SP failed to detect a pupillary response whereas QP did. Moderate correlations with ICP were detected for maximum constriction velocity (MCV), dilation velocity (DV), and percentage change in pupillary diameter (%C). Discriminatory ability at an ICP threshold of >22 mmHg was moderate for MCV (AUC=0.631), DV (AUC=0.616), %C (AUC=0.602), and pupillary maximum size (AUC=0.625). ConclusionQP is superior to SP at monitoring pupillary reactivity and changes to pupillary size. Although effect sizes were moderate to weak across assessed variables, our data indicates MCV and %C as the most sensitive variables for monitoring ICP. Further study is required to validate these findings and to establish normal range cut-offs for clinical use.

Non-image-forming vision as measured through ipRGC-mediated pupil constriction is not modulated by covert visual attention

Abstract In brightness, the pupil constricts, while in darkness, the pupil dilates; this is known as the pupillary light response (PLR). The PLR is driven by all photoreceptors: rods and cones, which contribute to image-forming vision, and intrinsically photosensitive retinal ganglion cells (ipRGCs), which mainly contribute to non-image-forming vision. Rods and cones cause immediate pupil constriction upon light exposure, whereas ipRGCs cause sustained constriction throughout light exposure. Recent studies have shown that covert attention modulated the initial PLR; however, it remains unclear whether the same holds for the sustained PLR. We tested this by leveraging ipRGCs’ responsiveness to blue light, causing the most prominent sustained constriction. While replicating previous studies by showing that pupils constricted more when either directly looking at, or covertly attending to, bright as compared to dim stimuli (with the same color), we also found that the pupil constricted more when directly looking at blue as compared to red stimuli (with the same luminosity). Crucially, however, in two high-powered studies (n = 60), we did not find any pupil-size difference when covertly attending to blue as compared to red stimuli. This suggests that ipRGC-mediated pupil constriction, and possibly non-image-forming vision more generally, is not modulated by covert attention.

Listening effort for L2 accents: Adults’ adaptation to Mandarin accented english

Using task-evoked pupillary response (TEPR) and dual-task procedures, prior research has shown that adults recruit additional cognitive resources when processing fully intelligible L2-accented speech compared to speech in their own L1 accent (McLaughlin and Van Engen, 2020; Brown et al., 2020). In this study, we investigated the relationship between three prosodic measures (relative word duration variance, pitch stability, and pitch range) and changes in listening effort for L1 and L2 speakers over the course of an experiment. Using growth curve analysis, we found significant interactions between each of the three measures and trial number, indicating that prosodic factors influence speech adaptation. However, these interactions were in opposite directions for the L1 and L2 speakers. Thus, adult monolingual English listeners rely on prosodic information to adapt to a particular speaker’s voice, but use that information differently based on speaker identity.

The effect of talker intelligibility on adaptation to an unfamiliar accent

Listening effort, as indexed by task-evoked pupil response, increases as the intelligibility of second language (L2) speech decreases, and this processing cost is mitigated by experience with talkers of the same accent (Porretta and Tucker, 2019). Prior research has shown that listeners can adapt to unfamiliar L2-accented speech and generalize the adaptation to different L2-accented talkers with the same L1 (Bradlow and Bent, 2008). The current study investigates what type of L2-accented speech exposure (high or low intelligibility) best reduces later listening effort to a novel talker of the same accent. We hypothesize that exposure to highly intelligible L2 speech supports adaptation to the features of an accent because it allows listeners to map accented tokens to the talker’s intended lexical representations. Alternatively, adaptation to a less intelligible talker may require exposure to other low-intelligibility speech, which is characterized by features that deviate more significantly from L1 norms. To test this, participants were exposed to simple sentences spoken in English by either L1 talkers, highly intelligible L2 talkers, or less intelligible L2 talkers. At test, all participants listened to different sentences spoken by a previously unheard L2 talker while listening effort was measured via pupillometry. Data collection is ongoing.

Analysis of pupillary responses in pediatric patients with vitamin D deficiency.

To evaluate the effects of vitamin D deficiency on pupillary responses in the pediatric population. The study was conducted using data from the right eyes of 52 children with vitamin D deficiency and 52 healthy children. Measurements were taken under static and dynamic conditions with automatic pupillometry. Static measurements were performed at scotopic, mesopic, and photopic light intensities. The mean pupil dilation speed was calculated by observing the changes in pupil dilation over time according to dynamic measurements. Differences between patient and control groups were analyzed for the static and dynamic measurements and the mean pupil dilation speed. While the two groups were similar in terms of scotopic, mesopic, the first dynamic measurements, and the pupil dilation speed data (p > 0.05), a significant difference was found in the photopic conditions (p = 0.001). The mean pupil diameter of the patient group was 4.46 ± 0.928mm and 3.95 ± 0.556mm in the control group under photopic conditions. Pediatric patients with vitamin D deficiency have significantly larger pupil diameters in photopic conditions than healthy children. These results suggest that there is an autonomic dysfunction in vitamin D deficiency in the pediatric population, especially pointing to the parasympathetic system.

Ocular accommodation and wavelength: The effect of longitudinal chromatic aberration on the stimulus-response curve.

The longitudinal chromatic aberration (LCA) of the eye creates a chromatic blur on the retina that is an important cue for accommodation. Although this mechanism can work optimally in broadband illuminants such as daylight, it is not clear how the system responds to the narrowband illuminants used by many modern displays. Here, we measured pupil and accommodative responses as well as visual acuity under narrowband light-emitting diode (LED) illuminants of different peak wavelengths. Observers were able to accommodate under narrowband light and compensate for the LCA of the eye, with no difference in the variability of the steady-state accommodation response between narrowband and broadband illuminants. Intriguingly, our subjects compensated more fully for LCA at nearer distances. That is, the difference in accommodation to different wavelengths became larger when the object was placed nearer the observer, causing the slope of the accommodation response curve to become shallower for shorter wavelengths and steeper for longer ones. Within the accommodative range of observers, accommodative errors were small and visual acuity normal. When comparing between illuminants, when accommodation was accurate, visual acuity was worst for blue narrowband light. This cannot be due to the sparser spacing for S-cones, as our stimuli had equal luminance and thus activated LM-cones roughly equally. It is likely because ocular LCA changes more rapidly at shorter wavelength and so the finite spectral bandwidth of LEDs corresponds to a greater dioptric range at shorter wavelengths. This effect disappears for larger accommodative errors, due to the increased depth of focus of the eye.

Dysregulated 24 h melatonin secretion associated with intrinsically photosensitive retinal ganglion cell function in diabetic retinopathy: a cross-sectional study.

The aim of this study was to explore whether diabetic retinopathy is associated with alterations of the circadian system, and to examine the role of reduced intrinsically photosensitive retinal ganglion cell (ipRGC) function. Participants with type 2 diabetes, with diabetic retinopathy (n=14) and without diabetic retinopathy (n=9) underwent 24 h blood sampling for melatonin and cortisol under controlled laboratory conditions. ipRGC function was inferred from the post-illumination pupil response (PIPR). Habitual sleep duration, efficiency and variability were assessed by actigraphy. Participants with diabetic retinopathy compared to participants without diabetic retinopathy had smaller PIPR (p=0.007), lower 24 h serum melatonin output (p=0.042) and greater day-to-day sleep variability (p=0.012). By contrast, 24 h cortisol profiles, sleep duration and efficiency were similar in both groups. Six individuals with diabetic retinopathy had no detectable dim-light melatonin onset. PIPR correlated with 24 h mean melatonin levels (r=0.555, p=0.007). ipRCG dysfunction in diabetic retinopathy is associated with disruptions of the 24 h melatonin rhythm, suggesting circadian dysregulation in diabetic retinopathy.

Are depressive symptoms linked to a reduced pupillary response to novel positive information?-An eye tracking proof-of-concept study.

Depressive symptoms have been linked to difficulties in revising established negative beliefs in response to novel positive information. Recent predictive processing accounts have suggested that this bias in belief updating may be related to a blunted processing of positive prediction errors at the neural level. In this proof-of-concept study, pupil dilation in response to unexpected positive emotional information was examined as a psychophysiological marker of an attenuated processing of positive prediction errors associated with depressive symptoms. Participants (N = 34) completed a modified version of the emotional Bias Against Disconfirmatory Evidence (BADE) task in which scenarios initially suggest negative interpretations that are later either confirmed or disconfirmed by additional information. Pupil dilation in response to the confirmatory and disconfirmatory information was recorded. Behavioral results showed that depressive symptoms were related to difficulties in revising negative interpretations despite disconfirmatory positive information. The eye tracking results pointed to a reduced pupil response to unexpected positive information among people with elevated depressive symptoms. Altogether, the present study demonstrates that the adapted emotional BADE task can be appropriate for examining psychophysiological aspects such as changes in pupil size along with behavioral responses. Furthermore, the results suggest that depression may be characterized by deviations in both behavioral (i.e., reduced updating of negative beliefs) and psychophysiological (i.e., decreased pupil dilation) responses to unexpected positive information. Future work should focus on a larger sample including clinically depressed patients to further explore these findings.

Pupil dilation reveals the intensity of touch.

Touch is important for many aspects of our daily activities. One of the most important tactile characteristics is its perceived intensity. However, quantifying the intensity of perceived tactile stimulation is not always possible using overt responses. Here, we show that pupil responses can objectively index the intensity of tactile stimulation in the absence of overt participant responses. In Experiment 1 (n = 32), we stimulated three reportedly differentially sensitive body locations (finger, forearm, and calf) with a single tap of a tactor while tracking pupil responses. Tactile stimulation resulted in greater pupil dilation than a baseline without stimulation. Furthermore, pupils dilated more for the more sensitive location (finger) than for the less sensitive location (forearm and calf). In Experiment 2 (n = 20) we extended these findings by manipulating the intensity of the stimulation with three different intensities, here a short vibration, always at the little finger. Again, pupils dilated more when being stimulated at higher intensities as compared to lower intensities. In summary, pupils dilated more for more sensitive parts of the body at constant stimulation intensity and for more intense stimulation at constant location. Taken together, the results show that the intensity of perceived tactile stimulation can be objectively measured with pupil responses - and that such responses are a versatile marker for touch research. Our findings may pave the way for previously impossible objective tests of tactile sensitivity, for example in minimally conscious state patients.

Homonymous Quadrantanopia as the First Manifestation of Cerebral Infarction: A Case Report

Abstract&#x0D; Introduction : Homonymous quadrantanopia, a visual impairment caused by lesions in the occipital lobe is typically due to vascular or traumatic injuries with tumors, abscesses, demyelination, or toxic substances in the white matter in rarer cases. Cerebral infarction in the occipital lobe is often diagnosed by ophthalmologists since initial symptoms involve visual disturbances without neurological symptoms.&#x0D; Case Illustration : A 52-year-old woman complained visual disturbance in the upper left visual field. Ophthalmologic examination showed normal visual acuity (6/6), pupillary response, and fundus appearance. The patient had history of hypertension for the past three years. Laboratory findings revealed hypercholesterolemia (240 mg/dl) and increased fasting blood sugar levels (102 mg/dl). A Brain CT scan identified infarction in the right occipital lobe and perimetry revealed left superior homonymous quadrantanopia.&#x0D; Discussion : The left superior homonymous quadrantanopia is caused by an infarction in the inferior calcarine of the occipital lobe due to the occlusion of a branch of the posterior cerebral artery. Atherosclerotic factors, such as hypertension, dyslipidemia, and hyperglycemia, are identified as the main causes of this condition. Normal pupillary responses and optic nerve appearance distinguish visual impairment caused by anterior lesions of the lateral geniculate body. Larger infarcts of the occipital lobe may result in neurological symptoms such as migraine with aura and visual hallucinations.&#x0D; Conclusion : The clinical manifestation of homonymous quadrantanopia should emphasizes the importance of ophthalmologic examinations, laboratory tests, perimetry, and imaging to estimate the location and etiology of the lesion.