Pupillographic Investigation of the Relative Afferent Pupillary Defect Associated with a Midbrain Lesion

Kawasaki, Aki; Miller, Neil R.; Kardon, Randy H.

doi:10.1016/j.ophtha.2009.06.053

Cited by 7 publications

(6 citation statements)

References 15 publications

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“…However, there is no compensation for decreasing retinal illuminance due to changes in pupil size. This may lead to differences in pupil response parameters when compared to the results generated with Maxwellian presenting devices (Gamlin et al 2007;Kawasaki et al 2010). From previous studies, it is known that pharmaceutical dilation of the pupil increases the PIPR and that constriction has the inverse effect.…”

Section: Discussionsupporting

confidence: 83%

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Pupillary response to direct and consensual chromatic light stimuli

Traustason

Brøndsted

Sander

et al. 2015

Acta Ophthalmologica

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Purpose To assess whether the direct and consensual postillumination (ipRGC‐driven) pupil light responses to chromatic light stimuli are equal in healthy subjects. Methods Pupil responses in healthy volunteers were recorded using a prototype binocular chromatic pupillometer (IdeaMedical, Copenhagen), which is capable of both direct and consensual pupillometry measurements. The device uses a pair of dual monochromatic narrow bandwidth LED light sources, red (660 nm) and blue (470 nm). Pupil light responses were recorded with infrared video cameras and analysed using custom‐made circuitry and software. Subjects were randomized to receive light stimuli at either the right or left eye after 5 min of dark adaptation. Pupil light responses were recorded in both eyes for 10 seconds before illumination, during illumination and 50 seconds after illumination with red and blue light. Three variables were defined for the recorded pupil responses: the maximal constriction amplitude (CAmax), the pupil response during illumination and postillumination pupil response (PIPR). Results No difference was found in the pupil response to blue light. With red light, the pupil response during illumination was slightly larger during consensual illumination compared to direct illumination (0.54 and 0.52, respectively, p = 0.027, paired Wilcoxon's test, n = 12), while no differences were found for CAmax or the PIPR. Conclusions No difference was found between direct and consensual pupil response to either red or blue light in the postillumination period. Direct and consensual responses can readily be compared when examining the postillumination pupil response to blue light as estimation of photosensitive retinal ganglion cell activation.

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Section: Discussionsupporting

confidence: 83%

“…; Kawasaki et al. ). From previous studies, it is known that pharmaceutical dilation of the pupil increases the PIPR and that constriction has the inverse effect.…”

Section: Discussionmentioning

confidence: 98%

Pupillary response to direct and consensual chromatic light stimuli

Traustason

Brøndsted

Sander

et al. 2015

Acta Ophthalmologica

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“…Examples of lab custom-made binocular pupillometers have been proposed in the literature and used in different studies and types of application. [20212223] To our knowledge, there are only two computerized pupillometers on the market capable of performing automatic RAPD analysis. One, RAPDx (Konan Medical Inc., Irvine, CA, USA) is a binocular desktop system that administrates a multichromatic swinging flashlight test for a duration varying from a minimum of 38 s to up approximately 7 min.…”

mentioning

confidence: 99%

Quantification of RAPD by an automated pupillometer in asymmetric glaucoma and its correlation with manual pupillary assessment

Pillai

Sinha

Aggarwal

et al. 2019

Indian J Ophthalmol

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Purpose: The relative afferent pupillary defect (RAPD) is an important sign of asymmetrical retinal ganglion cell damage. The purpose of this study was to quantify RAPD by a pupillometer (RAPiDo, Neuroptics) and assess its correlation with asymmetric glaucoma and manual pupillary assessment. Methods: A total of 173 subjects were enrolled in the study and categorized into glaucoma, n = 130, and control, n = 43. Subjects were all recruited in the Glaucoma Clinic of the Aravind Eye Hospital in Madurai during their follow-up. They were 18 years and older, with best corrected visual acuity of 6/36 or better. Exclusion criteria included all retinal pathologies, optic atrophies, ocular injuries, severe uveitis, cloudy corneas, dense cataracts, or use of mydriatics or miotic drugs. RAPD was assessed in all subjects using an automated pupillometer and the results were compared with the swinging flash light test conducted on the same subjects by an experienced ophthalmologist. We looked at the correlation between RAPD and the intereye difference in cup-to-disc ratio (CDR), mean deviation (MD) of visual field testing, and retinal nerve fiber layer (RNFL) thickness. Sensitivity and specificity were assessed by area under the receiver operator characteristic (AUROC) analysis. Results: Glaucoma patients had significant RAPD (0.55 ± 0.05 log units) when compared with the controls (0.25 ± 0.05 log units), P < 0.001. Significant intereye differences in CDR, MD, and RNFL between glaucoma and control ( P < 0.001) were seen. There was a good correlation between the magnitude and sign of RAPD and these intereye differences in CDR ( r = 0.52, P < 0.001), MD ( r = 0.44, P < 0.001) and RNFL thickness ( r = 0.59, P < 0.001). When compared with the experienced ophthalmologist, AUROC was 0.94, with 89% sensitivity and 91.7% specificity. Conclusion: The good correlation between the magnitude of RAPD, as measured by the automated pupillometer, and intereye differences in MD, CDR, and RNFL thickness in glaucomatous, and the good sensitivity and specificity when compared with the experienced ophthalmologist, suggest that pupillometry may be useful as a screening tool to assess asymmetric glaucoma.

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“…2 The afferent pupillomotor signal carried in the optic tract passes through the brachium of the superior colliculus to synapse in the pretectal olivary nucleus of the dorsal midbrain. 2 The afferent pupillomotor signal carried in the optic tract passes through the brachium of the superior colliculus to synapse in the pretectal olivary nucleus of the dorsal midbrain.…”

Section: Relative Afferent Pupillary Defectmentioning

confidence: 99%

“…Three common mechanisms result in a poor light reflex: (1) damage to the iris sphincter muscle, (2) interruption in the oculoparasympathetic pathway, and (3) pharmacologic effect. These mechanisms of unilateral mydriasis are discussed in further detail in this section.…”

Section: One Large Pupil That Fails To Contract To Lightmentioning

confidence: 99%