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

Abstract

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.

The Reliability and Validity of a Handheld Relative Afferent Pupillary Tester in Diagnosing Optic Neuropathy

“…We also find that the APD Tester™ overcomes the difficulties that previous authors have noted in the examination of subjects with dark irises, small pupils, or pupils that react slowly to direct or consensual light [3,4,8]. The ability to swiftly shine a light in either pupil while observing with a magnified view of both pupils enables convenient detection of RAPD in post-traumatic, post-surgical, or diseased eyes, with small pupils or dark irises [3].…”

“…RAPD detection may also play an important role in glaucoma patient assessment, because RAPD detection may precede visual field and optic disc damage [4]. Additionally, Tabatabaei et al, [5] report that higher grade of RAPD can predict final visual acuity in patients with traumatic optic neuropathy, Takayama et al, [8] find that RAPD outcomes are correlated rarely with visual acuity and AMD dimension and Folk et al, [13] find that pupillary defect is proportional to the extent of retinal detachment.…”

“…The standard technique for diagnosing RAPD is the alternating light test of Levatin, also known as the swinging flashlight test [1,3,[6][7][8][9]. While the patient looks at a distant target, the examiner shines a light alternately in each eye while observing pupillary response.…”

“…Using only the swinging flashlight test, Lankaranian et al, suggested that almost half of the RAPD cases in a subject population will be missed [4]. Once RAPD has been detected, the detection may be quantified using such methods as neutral density filters [6,11], crossed polarized filters [11], the Sbisa bar [6], automated pupillometry [8] and pupillography [6]. The primary limitation with these methodologies and the swinging flashlight test is the examiner's inability to simultaneously view both eyes in evaluation of pupillary response.…”

Diacron reactive oxygen metabolites and biological antioxidant potential tests for patients with age-related macular degeneration

“…FA was recorded for all patients in the nAMD group using cSLO (Heidelberg Retina Angiograph, HRA2; Heidelberg Engineering, Dossenheim, Germany), as previously described [24][25][26]. To evaluate the area of the CNV lesion, we traced the border of the area of hyperfluorescein in images captured at 5 min, and counted the pixels using the NAVIS bundled software (Nidek Co. Ltd., Aichi, Japan).…”