title: The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma.
abstract: OBJECTIVE
  To evaluate the validity of different methods of relative afferent pupillary defect (RAPD) detection and assess the usefulness of detecting an RAPD in glaucoma patients.
  
  
  METHODS
  For this prospective observational study, we enrolled 70 of 153 consecutive glaucoma patients coming for examination. Exclusion criteria were cloudy corneas, recent surgery, fixed pupils, and other diseases producing RAPDs. Inclusion criteria were any type of glaucoma and absence of any exclusion criterion. Patients were examined for an RAPD by the swinging flashlight method (SFM), a magnifier-assisted swinging flashlight method (MAM), and automated pupillography. The SFM and MAM results were compared with those obtained by pupillography. Receiver operating characteristic curves and the area under the curve (AUC) were determined. Correlations of other optic disc and visual field indices of glaucoma damage with RAPD were determined.
  
  
  RESULTS
  We confirmed RAPDs in 39 (56%) of the subjects by pupillography, finding a sensitivity of 41% and 84% and a specificity of 90% and 76% for SFM and MAM, respectively. The AUC was 0.86 for MAM and 0.61 for SFM. The correlations (r) between RAPD with intereye differences in the optic disc and visual field indices of glaucoma damage were moderate.
  
  
  CONCLUSIONS
  A modified swinging flashlight test with magnification increases the sensitivity of the test in detecting an RAPD. Because the detection of an RAPD may precede apparent optic disc and visual field damage, looking for an RAPD may be an important part of the assessment of patients with glaucoma.
authors.affiliation: William and Anna Goldberg Glaucoma Service and Research Laboratories, Wills Eye Hospital/Jefferson Medical College, Philadelphia, Pennsylvania, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Lankaranian
authors.forename: Undraa
authors.initials: U
authors.lastname: Altangerel
authors.forename: George L
authors.initials: GL
authors.lastname: Spaeth
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Leavitt
authors.forename: William C
authors.initials: WC
authors.lastname: Steinmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D005901:Glaucoma / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D009898:Optic Disk / Q000473:pathology; D011446:Prospective Studies; D011681:Pupil Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014794:Visual Fields