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Sleep deprivation‐induced oculomotor dysfunction: implications for surgical and medical performance

Oculomotor function (voluntary eye movement) is controlled by the complex interplay of many regions within the brain, including cortical (e.g. frontal and parietal eye fields) and subcortical (e.g. superior colliculus, putamen and cranial nerves III/IV/VI) (Sharma et al. 2011). Coordinated functions include those of the upper eyelids (levator palpebrae superioris; eyelid elevation), pupil (accommodation), lens (light refraction), and the movements of the eyeball itself, participating in eye saccades, smooth pursuit, fixation, accommodation, the vestibulo-ocular reflex and the optokinetic reflex (Joyce & Peterson, 2019). One factor shown to affect oculomotor function is sleep deprivation. Such effects were highlighted by studies correlating impaired human functions due to sleep loss with serious disastrous incidents. A study by Stone et al. (2019) published in a previous issue of The Jounral of Physiology has gone beyond the established correlation between sleep loss and impaired oculomotor performance, pinpointing the exact functions impacted and quantitatively investigating the degree of impairment (Stone et al. 2019). Stone et al. (2019) also demonstrated the relationship between impaired features of eye movements and sleep loss and circadian misalignment (SLCM) (Stone et al. 2019). The authors were able to address the multi-dimensional nature of the functional impairments, as well as document large changes in the components of pursuit, saccades and visual motion processing as a function of time awake and circadian phase. They also foresaw potential applications of oculometric biomarkers in assessing the pattern of oculometric impairment due to SLCM. This Journal Club article aims to evaluate Stone et al. (2019), as well as derive its significance, implications and gaps in knowledge, with regard to one of the most heatedly debated topics in the medical field – long medical training hours, resident wellness, and its impact on the trainee and quality of patient care.