title: 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: BACKGROUND
  Previous authors have suggested that an afferent pupillary defect (APD) may serve as an effective screening tool for some specific eye diseases, especially glaucomatous optic neuropathy, since the disease usually presents asymmetrically. Its success as a screening tool for glaucoma has never been previously prospectively evaluated in a large population.
  
  
  METHODS
  In this study, the authors carry out assessments for the presence of APD as it relates to the diagnosis of glaucoma in an existing population-based eye study in southern India. The authors calculate the sensitivity and specificity for APD, both at the level of a village/household screening and in a more comprehensive/hospital setting, as it pertains to its ability to predict glaucomatous optic neuropathy.
  
  
  CONCLUSIONS
  The authors find that APD assessed via the swinging flashlight test is a poor screening tool for glaucoma in this setting.
authors.affiliation: The Glaucoma Center, PC, 4175 N Hanson Ct, Suite 200, Bowie, MD 20716, USA. hennessy.amy@gmail.com
authors.forename: Amy L
authors.initials: AL
authors.lastname: Hennessy
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Rengappa
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Krishnadas
authors.forename: Ravilla D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological / Q000706:statistics & numerical data*; D018450:Disease Progression; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D009898:Optic Disk; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011681:Pupil Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014794:Visual Fields