The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a south Indian population

Hennessy, Amy; Katz, Joanne; Ramakrishnan, Rengappa; Krishnadas, R; Thulasiraj, R. D.; Tielsch, James M.; Robin, Alan L.

doi:10.1136/bjo.2010.194217

Cited by 14 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 31 articles from 30 studies met inclusion criteria (Fig 1). 4,15–44 Studies were conducted in more than 11 countries and published in different languages. We did not translate non-English articles, and 2 articles without an English abstract were excluded from this review.…”

Section: Resultsmentioning

confidence: 99%

Accuracy of Pupil Assessment for the Detection of Glaucoma

Chang

Boland

et al. 2013

Ophthalmology

View full text Add to dashboard Cite

Objective To assess the accuracy of using pupillary light reflex (PLR) in detecting glaucoma. Clinical Relevance Glaucoma is a specific disease of the optic nerve and is often more severe in 1 eye. When large enough, this asymmetry in disease severity can cause a relative afferent pupillary defect (RAPD). Better detection of RAPDs may be one way to identify persons with glaucoma. Methods We searched Medline and Embase through June 2012 and searched bibliographies for relevant studies for additional references. Two authors independently reviewed all articles and selected studies that assessed PLRs in patients with glaucoma. We analyzed data using mixed-effect bivariate summary receiver operating characteristic meta-analysis models. Results A total of 30 studies were included in this review. An RAPD was observed in 9% to 82% of patients with glaucoma. Eleven studies with a total of 7271 participants were included in the analysis, and the pooled estimate corresponded to a sensitivity of 0.63 (95% confidence interval [CI], 0.43–0.80) and a specificity of 0.93 (95% CI, 0.85–0.97). After excluding 2 studies that used the swinging flashlight test, the sensitivity increased to 0.74 (95% CI, 0.59–0.85) with a specificity of 0.85 (95% CI, 0.77–0.90). Study designs and different pupil measurement techniques explained part of the heterogeneity between studies. Conclusions Patients with glaucoma frequently have an abnormal PLR and comparing the responses between the 2 eyes can in part distinguish between those with glaucoma and those without the disease. Newer instruments and analytic approaches to assess pupil function may improve the performance of pupil screening.

show abstract

Section: Resultsmentioning

confidence: 99%

Accuracy of Pupil Assessment for the Detection of Glaucoma

Chang

Boland

et al. 2013

Ophthalmology

View full text Add to dashboard Cite

show abstract

“…[5,26,27,29] Automated pupillometry records the precise amplitudes and latencies of pupil responses to stimulation using the same light intensity, analyzes these pupil responses, and converts the results of this analysis to RAPD scores without examiner bias. In this way, the technique offers more reliable assessment of RAPD.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional pupillographic evaluation of relative afferent pupillary defect in age-related macular degeneration

Takayama

Ito²,

Kaneko³

et al. 2016

Medicine

View full text Add to dashboard Cite

To evaluate, using pupillography, the difference between eyes affected by age-related macular degeneration and their contralateral normal eyes with regard to the mean relative afferent pupillary defect (RAPD) score. Also, to ascertain any correlations between this difference in RAPD score and differences in visual acuity or age-related macular degeneration (AMD) dimensions. Measurements were made using the RAPDx pupillographer (Konan Medical, Nishinomiya, Japan), which analyzes pupil response to light stimulation. Both best corrected visual acuity (converted to logMAR) and greatest linear dimension (GLD; calculated on the basis of fluorescence angiography images) were measured. The correlations between RAPD difference and logMAR difference, and GLD difference were then analyzed. The study included 32 patients (18 men, 14 women; mean age = 74.8 ± 9.7 years) who had AMD in 1 eye and a normal fundus in the contralateral eye. Mean resting pupil diameter, mean latency onset of constriction, mean velocity of constriction, and recovery were not significantly different in AMD eyes compared with normal eyes. The mean amplitude of constriction was smaller (P = 0.028), and the mean latency of maximum constriction was shorter (P = 0.0013) in AMD eyes than in normal eyes. Regarding RAPD scores, there was a significant correlation between visual acuity difference and RAPD score differences of both amplitude (P < 0.001, r = 0.53) and latency (P = 0.034, r = 0.33). GLD difference was also significantly correlated with differences in both amplitude (P = 0.021, r = 0.36) and latency (P = 0.033, r = 0.33) scores. RAPD outcomes were correlated with visual acuity and AMD dimension. Automated pupillography may be a useful tool in monitoring the progression of AMD and assessing changes in retinal function that result from novel interventions.

show abstract

“…In other studies using pupillometric devices, Kalaboukhova et al 11 reported the presence of RAPD in 29% of glaucoma patients, Jonas et al 12 reported its presence in 41%, and Lankaranian et al 5 reported it in 56%. Using the swinging flash light test, Skorkovska et al 13 reported a rate of RAPD in glaucoma patients of 34%, Schiefer et al 2 a rate of 25%, Charalel et al 14 a rate of 66.7%, and Hennessy et al 15 a rate of 9.1%. The differences can be accounted for by the study methodologies, cut-off criteria, and subject populations.…”

Section: Discussionmentioning

confidence: 99%

Pupillographic evaluation of relative afferent pupillary defect in glaucoma patients

Ozeki¹,

Yuki

Shiba

et al. 2013

Br J Ophthalmol

View full text Add to dashboard Cite

show abstract

The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a south Indian population

Abstract: The authors find that APD assessed via the swinging flashlight test is a poor screening tool for glaucoma in this setting.

Cited by 14 publications

References 20 publications

Accuracy of Pupil Assessment for the Detection of Glaucoma

Accuracy of Pupil Assessment for the Detection of Glaucoma

Cross-sectional pupillographic evaluation of relative afferent pupillary defect in age-related macular degeneration

Pupillographic evaluation of relative afferent pupillary defect in glaucoma patients

Contact Info

Product

Resources

About