Acta Scientific Ophthalmology (ASOP)

Research Article Volume 3 Issue 10

Anisocoria and Pupil-Size Normative Data in Israeli Children

Daniel Bahir1* and Itay Ben-Zion2

1Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
2Ophthalmology Department, The Baruch Padeh Medical Center Poriya, Tiberias, Israel

*Corresponding Author: Daniel Bahir, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.

Received: August 23, 2020; Published: September 28, 2020



Purpose: To present normative data collected by Plusoptix S12 photoscreener, among children in Israeli kindergartens, to determine a good estimate of average pupil size and incidence of anisocoria among pediatric population.

Methods: This is a retrospective study of 101,417 Israeli children between ages 4 - 5 years old, examined using the Plusoptix S12 photoscreener. The examinations were carried out at kindergartens in major cities in Israel. Data collected included age, sizes of both pupils and magnitude of anisocoria obtained between the years 2013 - 2018.

Results: The size of the pupil, in our study group, was measured separately for the right and left eyes. The calculated results were 5.83 mm ± 0.87, and 5.82 mm ± 0.88 respectively. 13.26% (13,448 children) were found with anisocoria ≥ 0.4, of these 6.23% (6,314 subjects) had anisocoria of 0.5 - 0.9 mm, and 0.66% (669 subjects) had anisocoria of > 1.0 mm.

Conclusion: The presented data, the largest study group to the best of our knowledge, gives an estimate of normative pupil size, and anisocoria prevalence. There was no difference in pupil size between sexes, or between different cities. Further examinations in other geographic areas and in other age groups should be continued.

Keywords:Anisocoria; Pupil Size; Plusoptix S12 Photoscreener



  1. Lam BL., et al. “Effect of light on the prevalence of simple anisocoria”. Ophthalmology5 (1996): 790-793.
  2. Lam BL., et al. “The prevalence of simple anisocoria”. American Journal of Ophthalmology 1 (1987): 69-73.
  3. Loewenfeld IE. “Simple central” anisocoria: a common condition, seldom recognized”. Section on Otolaryngology American Academy of Ophthalmology and Otolaryngology 83.5 (1977): 832-839.
  4. De Juan V., et al. “Advantages, limitations, and diagnostic accuracy of photoscreeners in early detection of Amblyopia: a review”. Clinical Ophthalmology 10 (2016): 1365-1373.
  5. Vaughan JM., et al. “The accuracy of the PlusoptiX S12 and the Spot photoscreening measurements when screening for astigmatism in an ethnically diverse population”. Journal of American Association for Pediatric Ophthalmology and Strabismus 4 (2017): e46-e47.
  6. Fogel-Levin M., et al. “A comparison of plusoptiX A12 measurements with cycloplegic refraction”. Journal of AAPOS 4 (2016): 310-314.
  7. Elflein HM. “Amblyopie: Epidemiologie, Ursachen, Risikofaktoren”. Ophthalmologe 4 (2016): 283-288.
  8. Tailor V., et al. “Childhood amblyopia: Current management and new trends”. British Medical Bulletin 1 (2016): 75-86.
  9. Teed RG., et al. “Amblyopia Therapy in Children Identified by Photoscreening”. Ophthalmology1 (2010): 159-162.
  10. Silverstein E and Donahue SP. “Preschool Vision Screening: Where We Have Been and Where We Are Going”. American Journal of Ophthalmology 194 (2018): xviii-xxiii.
  11. O’Leary J and Vautier A. “Guest editorials”. Nursing Administration Quarterly 1 (2003): 3-6.
  12. Bregman J and Donahue SP. “Validation of photoscreening technology in the general pediatrics office: A prospective study”. Journal of AAPOS 2 (2016): 153-158.
  13. Arnold RW., et al. “The positive predictive value of smartphone photoscreening in pediatric practices”. Journal of Pediatric Ophthalmology and Strabismus 6 (2018): 393-396.
  14. Romano PE. “Binocular Vision Amblyopia”; Photoscreening Devices, Accommodation (Convergence) following Myopic PRK and Atropine for Amblyopia...or Epigenetic Myopia”. Binocular Vision and Strabology Quarterly, Simms-Romano 1 (2013): 80-87.
  15. Clausen MM and Arnold RW. “Pediatric eye/vision screening. Referral criteria for the pediavision plus optix s 04 photoscreener compared to visual acuity and digital photoscreening. Kindergarten computer photoscreening”. Binocular Vision and Strabismus Quarterly 2 (2007): 83-89.
  16. Zhang X., et al. “Diagnostic test accuracy of Spot and Plusoptix photoscreeners in detecting amblyogenic risk factors in children: a systemic review and meta-analysis”. Ophthalmic and Physiological Optics 4 (2019): 260-271.
  17. Silbert J., et al. “Pupil size and anisocoria in children measured by the plusoptiX photoscreener”. Journal of AAPOS 6 (2013): 609-611.
  18. Boev AN., et al. “Quantitative pupillometry: Normative data in healthy pediatric volunteers”. Journal of Neurosurgery 6 (2005): 496-500.
  19. Cetinkaya A., et al. “The impact of dark adaptation on photoscreening”. The Journal is the official publication of the American Association for Pediatric Ophthalmology and Strabismus 5 (2002): 315-318.
  20. Ettinger ER., et al. “Anisocoria: Variation and clinical observation with different conditions of illumination and accommodation”. Investigative Ophthalmology and Visual Science 3 (1991): 501-509.


Citation: Daniel Bahir and Itay Ben-Zion. “Anisocoria and Pupil-Size Normative Data in Israeli Children”.Acta Scientific Ophthalmology 3.10 (2020): 37-39.


Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF1.042
JCR- IF0.24

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 15, 2022.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US