title: Computerized binocular pupillography of the swinging flashlight test detects afferent pupillary defects.
abstract: OBJECTIVE
  To investigate the ability of a portable pupillometer, capable of 20-second binocular recordings of the swinging flashlight test (SFT), to detect relative afferent pupillary defects (rAPDs).
  
  
  METHODS
  Pupillary response curves were recorded from both eyes in healthy volunteers (n = 22) with and without simulated rAPDs (using neutral density filters (NDFs)) and in abnormal patients (n = 24) with clinically graded rAPDs. The light stimulus (0.2 sec on and 1 sec off, or 2 sec on and 0.4 sec off) alternated between both eyes, simulating the SFT. Constriction amplitude (CA), constriction velocity (CV), and pupillary release were calculated by computer algorithm. In abnormal patients, NDFs were used to neutralize inter-eye differences.
  
  
  RESULTS
  Significant correlation (Spearman's rho 0.71, 0.73) between NDF strength and absolute inter-eye differences was seen for CA and CV in simulated rAPDs. All abnormal patients (15/15) having rAPDs greater than 0.5 log units were distinguished from normals using either the upper bound of the one-sided 95% confidence interval (95% CI) value of CA or CV as determined from 22 healthy volunteers. Inter-eye variability in some normals prevented confident distinction of six abnormal patients with 0.3 log unit rAPDs. Using NDFs, subtle rAPDs were predicted in three patients having questionable rAPDs on clinical examination. CA and CV were more sensitive than pupillary release for all comparisons.
  
  
  CONCLUSIONS
  This binocular pupillometer identified all of our patients with > 0.5 log unit rAPDs. Using NDFs, all of our abnormal patients were accurately identified and their rAPDs quantified. Variability in some normals makes them indistinguishable from patients with subtle rAPDs.
authors.affiliation: Departments of Ophthalmology and Neurology, University of Pennsylvania School of Medicine, The Scheie Eye Institute, Philadelphia, Pennsylvania 19104, USA. nickvolp@mail.med.upenn.edu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Volpe
authors.forename: Laila
authors.initials: L
authors.lastname: Dadvand
authors.forename: Shane K
authors.initials: SK
authors.lastname: Kim
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.forename: Mark L
authors.initials: ML
authors.lastname: Moster
authors.forename: Steven L
authors.initials: SL
authors.lastname: Galetta
mesh_terms: D000293:Adolescent; D000328:Adult; D003936:Diagnosis, Computer-Assisted; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D011680:Pupil / Q000528:radiation effects; D011681:Pupil Disorders / Q000175:diagnosis*; D015348:Vision, Binocular; D055815:Young Adult