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Mishra A, Ashraf M, Zaka-ur-Rab S, Khan N. Retinal nerve fiber layer and ganglion cell complex thickness analysis in patients having relative afferent pupillary defect. Indian J Ophthalmol 2022; 70:4337-4342. [PMID: 36453341 PMCID: PMC9940509 DOI: 10.4103/ijo.ijo_754_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/18/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To determine the retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC) thickness in patients having relative afferent pupillary defect (RAPD) measured by optical coherence tomography (OCT). Methods This cross-sectional study was conducted on 30 patients with posterior segment disease and glaucoma presenting with RAPD. The control group comprised 30 patients with the aforementioned diseases without RAPD. RAPD was graded using neutral density filters placed over the unaffected eye. Peripapillary RNFL thickness and macular GCC were measured using the Cirrus HD-OCT machine. Results There were 45 males and 15 females. There was a statistically significant (P < 0.05) difference in the mean of average RNFL thickness in patients having RAPD (64.73 ± 15.16 μm in the affected eyes) as compared to sick control (82.73 ± 11.33 μm in the affected eyes). It was further observed that there was a decrease in RNFL thickness with advancing grades of RAPD. There was a statistically significant (P < 0.05) difference in the mean of average GCC thickness in patients having RAPD (51.57 ± 14.96 μm in the affected eyes) as compared to sick control (76.36 ± 8.06 μm in the affected eyes). Conclusion Our study suggests that there is a significant reduction in RNFL thickness and GCC thickness in RAPD patients as compared to the sick control group.
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Affiliation(s)
- Aradhna Mishra
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Mohammad Ashraf
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Simi Zaka-ur-Rab
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Nida Khan
- Retina Service, Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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A 30 s test for quantitative assessment of a relative afferent pupillary defect (RAPD): the infrared pupillary asymmetry (IPA). J Neurol 2019; 266:969-974. [PMID: 30746557 DOI: 10.1007/s00415-019-09223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Detection of a relative afferent pupillary defect (RAPD) by the swinging-light test can be challenging in clinical practice (dark eyes, anisocoria, dark environment). We developed a new method of RAPD quantification based on the recording of the infrared pupillary asymmetry (IPA) with a standard optical coherence tomography (OCT) device. METHODS The diagnostic value of the IPA for detection of the RAPD was determined by receiver-operating characteristic (ROC) curves and area under the curve (AUC). RESULTS Twenty-nine subjects were included in this study (17 controls and 12 unilateral optic neuropathies). The IPA was significantly greater in unilateral optic neuropathies (0.39) compared to controls (0.18, p = 0.001). The diagnostic value was good with a ROC-AUC of 0.843. Importantly, the IPA correlated significantly with the inter-eye percentage difference of the macular ganglion cell-inner plexiform layer (mGCIPL) thickness (R = 0.53, p = 0.01). Assessment of the IPA took less than 30 s. CONCLUSION The present data show that the IPA is a practical and rapid test that can be applied in a clinical setting. The IPA may be a valuable functional outcome measure for clinical trials, complementing structural retinal OCT data in a biological meaningful way. The IPA should be further investigated for suitability for optic neuritis treatment trials.
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Besada E, Frauens BJ, Makhlouf R, Shechtman D, Rodman J, Demeritt M, Hardigan P. More sensitive correlation of afferent pupillary defect with ganglion cell complex. JOURNAL OF OPTOMETRY 2018; 11:75-85. [PMID: 28676353 PMCID: PMC5904827 DOI: 10.1016/j.optom.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study investigated the correlation between the relative afferent pupillary defect (RAPD) and retinal nerve fiber layer thickness (RNFLT) in optic neuropathy. METHODS RAPD assessment was performed using a log unit neutral density filter bar. Spectral domain optical coherence tomography RTVue-100 (Optovue) was used to examine the subjects. The optic nerve head pattern (ONH) was subdivided and identified for the purpose of the study into circumpapillary RNFLT (cpRNFLT) and peripheral circumpapillary RNFLT (pcpRNFLT). The cpRNFLT, pcpRNFLT and ganglion cell complex (GCC) parameters were analyzed. RESULTS Eighteen females and twenty three males with asymmetric optic neuropathy and a RAPD participated. Thirty-three subjects had glaucoma and eight had optic neuropathy other than glaucoma. Significant correlations (p<0.02) were obtained for the RAPD and the percentage difference loss of the GCC and RNFLT parameters. The grouped mean percentage difference loss for RNFLT was significantly different from that of the GCC (p<0.001). At a 0.6log unit RAPD, the average mean percentage difference loss was 23% for the CRNFLT, 15% for the GCC, 12% for the global loss volume percentage and 6% for the focal loss volume percentage (FLV%). CONCLUSIONS Significant correlations between RNFLT loss for cpRNFLT, pcpRNFLT and GCC parameters with RAPD were observed. Approximately a 35% higher sensitivity was obtained using GCC compared to CRNFL parameters. The expected change in GCC average for every 0.3log unit increment was approximately 8.49μm. The FLV% corresponded more sensitively to a RAPD but appeared to be influenced by disease severity.
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Affiliation(s)
- Eulogio Besada
- Nova Southeastern University College of Optometry, United States.
| | - Barry J Frauens
- Nova Southeastern University College of Optometry, United States
| | - Rim Makhlouf
- Nova Southeastern University College of Optometry, United States
| | - Diana Shechtman
- Nova Southeastern University College of Optometry, United States
| | - Julie Rodman
- Nova Southeastern University College of Optometry, United States
| | - Marlon Demeritt
- Nova Southeastern University College of Optometry, United States
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Takizawa G, Miki A, Maeda F, Goto K, Araki S, Ieki Y, Kiryu J, Yaoeda K. Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease. Clin Ophthalmol 2015; 9:1895-903. [PMID: 26487800 PMCID: PMC4607058 DOI: 10.2147/opth.s91278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study was to compare the asymmetrical light reflex of the control subjects and patients with optic nerve disease and to evaluate the relationships among the relative afferent pupillary defect (RAPD), visual acuity (VA), central critical fusion frequency (CFF), ganglion cell complex thickness (GCCT), and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) using spectral-domain optical coherence tomography. Materials and methods Using a pupillography device, the RAPD scores from 15 patients with unilateral optic nerve disease and 35 control subjects were compared. The diagnostic accuracy of the RAPD amplitude and latency scores was compared using the area under the receiver operating characteristic curve. Thereafter, we assessed the relationships among the RAPD scores, VA, central CFF, GCCT, and cpRNFLT. Results The average RAPD amplitude score in patients with optic nerve disease was significantly higher than that of the control subjects (P<0.001). The average RAPD latency score in patients with optic nerve disease was significantly higher than that of the control subjects (P=0.001). The area under the receiver operating characteristic curve for the RAPD amplitude score was significantly higher than that for the latency score (P=0.010). The correlation coefficients for the RAPD amplitude and latency scores were 0.847 (P<0.001) and 0.874 (P<0.001) for VA, −0.868 (P<0.001) and −0.896 (P<0.001) for central CFF, −0.593 (P=0.020) and −0.540 (P=0.038) for GCCT, and −0.267 (P=0.337) and −0.228 (P=0.413) for cpRNFLT, respectively. Conclusion Our results suggest that pupillography is useful for detecting optic nerve disease.
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Affiliation(s)
- Go Takizawa
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Atsushi Miki
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan ; Department of Sensory Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan ; Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Fumiatsu Maeda
- Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan
| | - Katsutoshi Goto
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Syunsuke Araki
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Yoshiaki Ieki
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Junichi Kiryu
- Department of Ophthalmology, Kawasaki Medical School, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Kiyoshi Yaoeda
- Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan ; Yaoeda Eye Clinic, Nagaoka, Japan
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Ozeki N, Yuki K, Shiba D, Tsubota K. Pupillographic evaluation of relative afferent pupillary defect in glaucoma patients. Br J Ophthalmol 2013; 97:1538-42. [DOI: 10.1136/bjophthalmol-2013-303825] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moura ALA, Nagy BV, La Morgia C, Barboni P, Oliveira AGF, Salomão SR, Berezovsky A, de Moraes-Filho MN, Chicani CF, Belfort R, Carelli V, Sadun AA, Hood DC, Ventura DF. The pupil light reflex in Leber's hereditary optic neuropathy: evidence for preservation of melanopsin-expressing retinal ganglion cells. Invest Ophthalmol Vis Sci 2013; 54:4471-7. [PMID: 23737476 DOI: 10.1167/iovs.12-11137] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate the pupillary light reflex (PLR) of patients with severe loss of vision due to Leber's Hereditary Optic Neuropathy (LHON) in the context of a proposed preservation of melanopsin-expressing retinal ganglion cells (mRGCs). METHODS Ten LHON patients (7 males; 51.6 ± 14.1 years), with visual acuities ranging from 20/400 to hand motion perception and severe visual field losses, were tested and compared with 16 healthy subjects (7 males; 42.15 ± 15.4 years) tested as controls. PLR was measured with an eye tracker and the stimuli were controlled with a Ganzfeld system. Pupil responses were measured monocularly, to 1 second of blue (470 nm) and red (640 nm) flashes with 1, 10, 100, and 250 cd/m² luminances. The normalized amplitude of peak of the transient PLR and the amplitude of the sustained PLR at 6 seconds after the flash offset were measured. In addition, optical coherence topography (OCT) scans of the peripapillary retinal nerve fiber layer were obtained. RESULTS The patient's peak PLR responses were on average 15% smaller than controls (P < 0.05), but 5 out of 10 patients had amplitudes within the range of controls. The patients' sustained PLRs were comparable with controls at lower flash intensities, but on average, 27% smaller to the 250 cd/m² blue light, although there was considerable overlap with the PLR amplitudes of control. All patients had severe visual field losses and the retinal nerve fiber layer thickness was reduced to a minimum around the optic disc in 8 of the 10 patients. CONCLUSIONS The PLR is maintained overall in LHON patients despite the severity of optic atrophy. These results are consistent with previous evidence of selective preservation of mRGCs.
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Affiliation(s)
- Ana Laura A Moura
- Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil.
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Cettomai D, Hiremath G, Ratchford J, Venkatesan A, Greenberg BM, McGready J, Pardo CA, Kerr DA, Frohman E, Balcer LJ, McArthur JC, Calabresi PA. Associations between retinal nerve fiber layer abnormalities and optic nerve examination. Neurology 2010; 75:1318-25. [PMID: 20810997 DOI: 10.1212/wnl.0b013e3181f735bd] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Retinal nerve fiber layer (RNFL) abnormalities detected by optical coherence tomography (OCT) are useful markers for axonal loss and visual dysfunction in multiple sclerosis (MS), but their role in routine clinical management is not well-studied. METHODS Clinical and OCT examinations were performed on 240 patients attending a neurology clinic. Using OCT 5th percentile to define abnormal RNFL thickness, we compared eyes classified by neurologists as having optic atrophy to RNFL thickness, and afferent pupillary defect (APD) to RNFL thickness ratios of eye pairs. RESULTS Mean RNFL thickness was less in eyes classified by neurologists as having optic atrophy (79.4 ± 21 μm; n=63) vs those without (97.0 ± 15 μm; n=417; p < 0.001, t test) and in eyes with an APD (84.1 ± 16 μm; n=44) than without an APD (95.8 ± 17 μm; n=436; p < 0.001). Physicians' diagnostic accuracy for detecting pallor in eyes with an abnormal RNFL thickness was 79% (sensitivity=0.56; specificity=0.82). Accuracy for detecting a RAPD in patients with mean RNFL ratio (affected eye to unaffected eye) <0.90 was 73% (sensitivity=0.30; specificity=0.86). Ability to detect visual pathway injury via assessment of atrophy and APD differed between neurologists. CONCLUSIONS OCT reveals RNFL abnormality in many patients in whom eyes are not classified by neurologic examiners as having optic atrophy. Further study is needed to define the role of OCT measures in the context of examinations for optic atrophy and APD by neuroophthalmologists. OCT-measured RNFL thickness is likely to have an important future role in the clinical setting.
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Affiliation(s)
- D Cettomai
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Tatsumi Y, Nakamura M, Fujioka M, Nakanishi Y, Kusuhara A, Maeda H, Negi A. Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect in asymmetric glaucoma. Br J Ophthalmol 2006; 91:633-7. [PMID: 17050576 PMCID: PMC1954756 DOI: 10.1136/bjo.2006.105494] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM The relative afferent pupillary defect (RAPD) is an important clinical sign of asymmetrical retinal ganglion cell and axonal damage. Although glaucoma essentially affects bilateral eyes, a subset of patients manifests asymmetrical glaucomatous optic neuropathy (GON), which exhibits an RPAD in the more advanced eyes. However, the degree to which axonal loss occurs before an RAPD is clinically detectable has not been substantiated. The purpose of this study is to assess the relationship between the depth of a clinically detectable RAPD and the reduction ratio of retinal nerve fiber layer (RNFL) thickness in the more advanced eyes relative to that in the contralateral less advanced eyes of patients with asymmetrical GON. METHODS Enrolled were 29 consecutive glaucoma patients with the clinically detectable RAPD. An RAPD was quantified by placing log-scaled neutral density filters over the less advanced eyes while performing the swinging flashlight test. Average RNFL thickness was determined using the Fast RNFL thickness programme of optical coherence tomography 3000. Correlation coefficient and Linear regression analyses were used in assessing the relationship between the RAPD and the ratio of RNFL thickness in the more advanced eyes relative to that in the less advanced. RESULTS RAPD ranged from 0.6 to 2.4 log units. The log-scaled RAPD had a statistically significantly inversed correlation with the average RNFL thickness ratio (r(s) = -0.729, p<0.0001). Linear regression analysis found an equation that the average RNFL thickness ratio in the more affected eyes relative to that in the less advanced (%) = (0.827-0.169xRAPD (log units))x100 (R(2) = 0.557, p<0.0001). CONCLUSIONS When an RAPD is clinically detected, the RNFL thickness in the more advanced eyes was in average reduced to about 73% of that in the less advanced.
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Affiliation(s)
- Yasuko Tatsumi
- Department of Organs Therapeutics, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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