To the Editor.—
Our recent experience in evaluating anisocoria prompts a brief comment concerning the use of the ubiquitous hand-held self-illuminated ophthalmoscope to obtain a good view of old patient photographs. With its help, a patient's driver's license photograph or other facial photograph can be studied with sufficient magnification, brightness, and clarity to reveal, for example, a preexisting pupillary inequality—such as might be found in about one quarter of the normal population.1 With the recent proliferation of identification tags and driver's licenses that include such photographs, their careful examination using a direct ophthalmoscope may aid in the accurate assessment of pupillary abnormalities and perhaps prevent unnecessary neurologic evaluation.
George Zito, Paul Gennaro. Clinical Evaluation of Anisocoria. Arch Neurol. 1982;39(9):604. doi:10.1001/archneur.1982.00510210074033