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Devices, systems, and methods perform diagnostic and/or treatment procedures on an eye using a pupilometer to determine a change in pupil size, a processor and a variable illumination source. In response to a change in pupil size as determined by the pupilometer, the processor may determine an optic

Devices, systems, and methods perform diagnostic and/or treatment procedures on an eye using a pupilometer to determine a change in pupil size, a processor and a variable illumination source. In response to a change in pupil size as determined by the pupilometer, the processor may determine an optical light output sufficient to induce a pupillary response and mitigate the change in pupil size. The system directs the desired optical light output to the eye with the variable illumination source optionally to prevent the pupil size from exceeding certain limits so as to improve torsional tracking of markers of the eye.

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1. A method for mitigating a change in pupil size of an eye of a patient while an ophthalmological procedure is performed on the eye of the patient, the method comprising: obtaining a first image of the eye with an imaging device at a first lighting condition at the eye;obtaining a second image of t

1. A method for mitigating a change in pupil size of an eye of a patient while an ophthalmological procedure is performed on the eye of the patient, the method comprising: obtaining a first image of the eye with an imaging device at a first lighting condition at the eye;obtaining a second image of the eye with the imaging device at the first lighting condition at the eye;determining the change in pupil size by using the first and second images;determining, with a processor, a desired optical light output corresponding to a second lighting condition at the eye different from the first lighting condition, in response to the change in pupil size, the desired optical light output configured to induce a desired pupillary response mitigating the change in pupil size; anddirecting the desired optical light output from a variable illumination source to the eye while the ophthalmological procedure is performed on the eye of the patient, thereby providing the second lighting condition at the eye that mitigates the change in pupil size during performance of the ophthalmological procedure,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 2. The method of claim 1, wherein determining the change in pupil size comprises registering the first and second images. 3. The method of claim 1, wherein the ophthalmological procedure comprises the laser ablation treatment, and wherein the laser ablation treatment comprises centering and aligning an ablation profile with the first image of the eye. 4. The method of claim 3, wherein centering and aligning further comprises centering and torsionally aligning the ablation profile with the first image of the eye. 5. The method of claim 3, further comprising tracking a reference point of the eye from a first image to a second image of the eye; registering the first and second image of the eye by matching a common reference point in the first and second images; andcentering and aligning the ablation profile with the second image of the eye. 6. The method of claim 5, wherein the reference point comprises a member selected from the group consisting of an iris feature and a pupil center location. 7. The method of claim 1, wherein the change in pupil size comprises a change in pupil size that exceeds a pre-determined tolerance of the pupil size in the first image. 8. The method of claim 7, wherein the pupil size tolerance is approximately ±10% of the first pupil size. 9. The method of claim 1, wherein determining the desired optical light output comprises determining an optical light output within a pre-determined range of optical light outputs. 10. The method of claim 9, wherein the pre-determined range is sufficient for performing a procedure on the eye. 11. The method of claim 10, wherein the pre-determined range is within a certain optical output tolerance of a reference optical output. 12. The method of claim 11, wherein the certain optical output tolerance is ±50% of the reference optical output. 13. The method of claim 1, wherein determining the desired optical light output in response to the change in pupil size further comprises: determining an increase in optical light output to induce pupil constriction in response to an increase in pupil size so as to mitigate the increase in pupil size. 14. The method of claim 13, wherein determining the desired optical light output in response to the change in pupil size further comprises: determining a decrease in optical light output to induce pupil dilation in response to a decrease in pupil size so as to mitigate the decrease in pupil size. 15. The method of claim 14, wherein the induced dilation corresponds roughly to the measured decrease in pupil size, and wherein the induced constriction corresponds roughly to the measured increase in pupil size, so as to induce a pupillary response with the directed desired optical output so as to mitigate the change in pupil size. 16. The method of claim 15, wherein the induced pupil dilation or constriction substantially maintains the size of the pupil to substantially the size of the pupil in the first image so as to mitigate changes in pupil size during at least a portion of a diagnostic or treatment procedure. 17. The method of claim 16, wherein the induced pupil dilation or constriction maintains the size of the pupil to a size within ±10% of the size of the pupil in the first image. 18. A method for performing an ophthalmological procedure on an eye of a patient, the eye having a pupil, the method comprising: determining a trend in pupil size change during performance of the ophthalmological procedure at a first lighting condition at the eye;determining, with a processor, a desired light output corresponding to a second lighting condition at the eye different from the first lighting condition in response to the trend in pupil size change at the first lighting condition, such that the desired light output induces a desired pupillary response to mitigate the trend in pupil size change during performance of the ophthalmological procedure; anddirecting the desired light output from a variable illumination source to the eye while the ophthalmological procedure is performed on the eye of the patient thereby providing the second lighting condition at the eye that mitigates the trend in pupil size change during performance of the ophthalmological procedure,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 19. The method of claim 18, wherein the trend is based on a member selected from the group consisting of an average pupil change response during a procedure, a median pupil change response during a procedure, and a mode of pupil change response during a procedure. 20. The method of claim 18, wherein the trend of pupil size changes is based in part on patient and/or procedure variables. 21. The method of claim 20, wherein patient variables include any of age, gender, physiological indicators, and refractive characteristics of the eye. 22. The method of claim 20 wherein procedure variables include any of length of treatment, depths of ablations, intensity of laser, and type of procedure. 23. A method for performing an ophthalmological procedure on an eye, the eye having a pupil, the method comprising: determining a change in pupil size with an optical sensor at a first substantially constant lighting condition;determining, with a processor, a desired optical light output corresponding to a second lighting condition different from the first lighting condition in response to the change in pupil size at the first lighting condition, such that the desired light output induces a desired pupillary response mitigating the change in pupil size; anddirecting the desired optical light output from a variable illumination source to the eye while the ophthalmological procedure is performed on the eye of the patient thereby providing the second lighting condition at the eye that mitigates the change in pupil size during performance of the ophthalmological procedure,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 24. A method for performing an ophthalmological procedure on an eye refractive errors of a patient, the eye having a pupil, the method comprising: directing a desired optical light output from a variable illumination source to the eye corresponding to a second lighting condition at the eye thereby mitigating a change in pupil size by varying the optical light output according to a function, wherein the function is based on a relationship between: a change in pupil size at a first lighting condition, wherein the first lighting condition is substantially constant and different from the second lighting condition; anda duration of the ophthalmological procedure; andperforming the ophthalmological procedure concurrent with directing the desired optical light output,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 25. The system of claim 24, wherein the relationship comprises a standard slope of change in pupil size over time during the ophthalmological procedure. 26. The system of claim 25, wherein the ophthalmological procedure is the laser ablation treatment of the eye. 27. A system for performing an ophthalmological procedure on an eye of a patient, the eye having a pupil, the system comprising: a pupilometer generating a pupil size signal;an illumination source having a variable optical light output; anda processor coupled with the pupilometer and the illumination source, the processor configured to transmit an optical light output command signal to the illumination source in response to a detected change in pupil size at a first substantially constant lighting condition based on the pupil size signal, wherein the optical light output command signal corresponds to a change in lighting condition from the first lighting condition to a second lighting condition different from the first lighting condition, so as to mitigate a change in pupil size during performance of the ophthalmological procedure,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 28. The system of claim 27, wherein the pupilometer and the illumination source are in optical communication with the eye, and wherein the processor comprises tangible media embodying machine-readable code for determining the optical light output command signal in response to the pupil size signal. 29. The system of claim 28, wherein the processor is coupled with the pupilometer such that pupil size signal from the pupilometer is receivable by the processor. 30. The system of claim 29, wherein the pupilometer comprises an optical sensor and a processor. 31. The system of claim 29, wherein the processor of the pupilometer and the processor of the system are the same processor. 32. The system of claim 30, wherein the pupilometer comprises an imaging device and a processor. 33. The system of claim 29, wherein the processor is coupled with the illumination source such that the processor controls the optical light output of the illumination source. 34. The system of claim 33, wherein the processor comprises a dynamic feedback mechanism configured to direct optical light output in response to changes in pupil size as determined by the processor from the received pupil size signals. 35. The system of claim 27, wherein the processor is configured to control optical light output based on a relationship between: changes in pupil size; and optical light output. 36. The system of claim 27, wherein the illumination source comprises an illumination source having differing levels of brightness. 37. The system of claim 27, wherein the illumination source comprises a member selected from the group consisting of an ambient light, a halogen ring, an illuminated viewing target, and an LED. 38. The system of claim 27, wherein the illumination source comprises one or more illumination sources. 39. The system of claim 27, wherein the illumination source comprises one or more static illumination sources. 40. The system of claim 28, wherein the tangible media comprises electronic recordings of a plurality of pupil sizes and associated brightness levels. 41. The system of claim 27, further comprising a tracking system configured to track a feature of the eye during a laser eye surgical procedure. 42. The system of claim 41, wherein the tracking system is configured to track cyclotorsional movement of the eye during a laser eye surgical procedure. 43. A system for performing an ophthalmological procedure on an eye of a patient, the eye having a pupil, the system comprising: an illumination source having a variable optical light output; anda processor coupled with the illumination source, the processor configured to transmit an optical light output command signal to the illumination source so as to produce a desired lighting condition at the eye according to a function of pupil size change over time during performance of the ophthalmological procedure on the eye, wherein the function is based on a relationship between:a change in pupil size at a first substantially constant lighting condition; anda duration of the performance of the ophthalmological procedure on the eye,wherein the ophthalmological procedure comprises a wavefront measurement of the eye, a laser ablation treatment of the eye, or a wavefront measurement and a laser ablation treatment of the eye. 44. The system of claim 43, wherein the relationship comprises a standard slope of pupil size over time during the performance of the ophthalmological procedure on the eye. 45. The method of claim 1, wherein the ophthalmological procedure comprises the wavefront measurement of the eye. 46. The method of claim 1, wherein the ophthalmological procedure comprises the laser ablation treatment of the eye.