An Objective Method for Measuring Relative Afferent Pupillary Defect in Glaucomatous Optic Neuropathy—Stimulus Optimization

Kalaboukhova, Lada; Fridhammar, Vanja; Lindblom, Bertil

doi:10.1080/01658100600599477

Cited by 8 publications

(14 citation statements)

References 6 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21–24 With the introduction of infrared video pupillography, studies have generally reported a detection rate of 29–68% overall, and of 82% for asymmetric glaucoma. 25–28 In our study, the mean absolute between-eye score for controls was 0.14, and 0.34 was the cutoff at 2 standard deviations. At this cutoff, an RAPD was present in 47% of glaucoma patients and 3% of controls, suggesting that the amount of asymmetry needed to segregate the two groups may be too large and therefore using just an RAPD between eyes will miss nearly half the individuals with glaucoma.…”

Section: Discussionmentioning

confidence: 49%

Development and Validation of an Associative Model for the Detection of Glaucoma Using Pupillography

Chang¹,

Arora²,

Boland³

et al. 2013

American Journal of Ophthalmology

View full text Add to dashboard Cite

Purpose To develop and validate an associative model using pupillography that best discriminates those with and without glaucoma. Design A prospective case-control study. Methods 148 patients with glaucoma (mean age 67±11) and 71 controls (mean age 60±10) were enrolled in a clinical setting. This prototype pupillometer is designed to record and analyze pupillary responses at multiple, controlled stimulus intensities, while using varied stimulus patterns and colors. We evaluated three approaches: 1) comparing the responses between the two eyes, 2) comparing responses to stimuli between the superonasal and inferonasal fields within each eye, and 3) calculating the absolute pupil response of each individual eye. Associative models were developed using stepwise regression or forward selection with Akaike information criterion and validated with 5-fold cross validation. We assessed the associative model using sensitivity, specificity and the area under the receiver operating characteristic curve (AUROC). Results Persons with glaucoma had a more asymmetric pupil response between the two eyes (p<0.001), between superonasal and inferonasal visual field within the same eye (p=0.014), and also had a smaller amplitude, slower velocity and longer latency of pupil response compared to controls (all p<0.001). A model including age and these three components resulted in an AUROC of 0.87 (95% CI 0.83 to 0.92) with 80% sensitivity and specificity in detecting glaucoma. This result remained robust after cross-validation. Conclusions Using pupillography, we were able to discriminate persons with glaucoma from those with normal eye exams. With refinement, pupil testing may provide a simple approach for glaucoma screening.

show abstract

Section: Discussionmentioning

confidence: 49%

Development and Validation of an Associative Model for the Detection of Glaucoma Using Pupillography

Chang¹,

Arora²,

Boland³

et al. 2013

American Journal of Ophthalmology

View full text Add to dashboard Cite

show abstract

“…4,27–38 Studies generally have reported a higher detection rate of RAPD in patients with glaucoma using IVP (29%–68% overall, and 82% for asymmetric glaucoma) compared with studies using the SFT (9%–46%). 31,33–37 The findings of these studies are as follows: (1) RAPD is more likely to be present in patients with glaucoma than in controls. 33–35 (2) Patients with glaucoma have greater asymmetry in the IVP between the 2 eyes (as measured by pupil area ratio) 4,32 and greater differences in response to light between the superior and inferior visual field within the same eye.…”

Section: Resultsmentioning

confidence: 94%

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

“…1). It has been described previously (Kalaboukhova et al 2006). In short, it consists of two digital highresolution video cameras [JAI M40 (60 Hz); JAI A-S, Copenhagen, Denmark), one for each eye; two white diode lamps (each is a set of 15 small diodes, ø 1.25 mm) (Nerlite S-40 Spot Illuminator, RVSI ⁄ NER, Weare, New Hampshire, USA) for alternating light stimulation; and a background infrared illumination device (Sony HVL-IRH2, Sony, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

“…Measurements were made with a custom-built infrared pupillometer using previously determined stimulus parameters (Kalaboukhova et al 2006). Measurements were made with a custom-built infrared pupillometer using previously determined stimulus parameters (Kalaboukhova et al 2006).…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we measured RAPD in patients with bilateral or unilateral glaucomatous optic neuropathy and compared these measurements with those of healthy subjects. Measurements were made with a custom-built infrared pupillometer using previously determined stimulus parameters (Kalaboukhova et al 2006). Sensitivity and specificity for detecting glaucoma and variability of the method were estimated.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation