Response to Zanier and Citerio, Evaluating a Pupillometry App Considering Sedation's Impact: A Step Unexplored (DOI: 10.1089/neu.2023.0431).

We would like to thank the authors for their interest in our recent manuscript. We agree that the effects of analgesic and sedative administration are among the most relevant complicating factors for the use of any form of pupillometry in the intensive care unit setting. As discussed extensively in the limitations section of our manuscript, a variety of studies have demonstrated the effects of opioid and sedative medications on the pupillary light reflex. To address these concerns, we have performed an additional review of the medication administration records for the patients with severe traumatic brain injury in our study. We reviewed opioid administration prior to pupillometry measurements in our study cohort. In 8 recordings, the last opioid given was hydromorphone. In 21 recordings, the last opioid given was oxycodone. In the remaining 69 recordings, the last opioid given was fentanyl. The median time from most recent opioid administration to pupillary light reflex recording was 1244 minutes (20.7 hours), with an interquartile range of 5484 minutes. Given the long latency period between most recent opioid administration and recording of the pupillary light reflex, their effects on our analysis of the pupillary light reflex are likely minimal.