Active Gaze Guidance and Pupil Dilation Effects Through Subject Engagement in Ophthalmic Imaging

Modern ophthalmic imaging methods such as optical coherence tomography (OCT) typically require expensive scanner components to direct the light beam across the retina while the patient’s gaze remains fixed. This proof-of-concept experiment investigates whether the patient’s natural eye movements can replace mechanical scanning by guiding the gaze along predefined patterns. An infrared fundus camera setup was used with nine healthy adults (aged 20–57) who completed tasks comparing passive viewing of moving patterns to actively tracing them by drawing using a touchpad interface. The active task involved participant-controlled target movement with real-time color feedback for accurate pattern tracing. Results showed that active tracing significantly increased pupil diameter by an average of 17.8% (range 8.9–43.6%; p < 0.001) and reduced blink frequency compared to passive viewing. More complex patterns led to greater pupil dilation, confirming the link between cognitive load and physiological response. These findings demonstrate that patient driven gaze guidance can stabilize gaze, reduce blinking, and naturally dilate the pupil. These conditions might enhance the quality of scannerless OCT or other imaging techniques benefiting from guided gaze and larger pupils. There could be benefits for children and people with compliance issues, although further research is needed to consider cognitive load.