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Anna Bruckmann, Christian Gäßler, Janko Dietzsch, Veronique Kitiratschky, Barbara Wilhelm, Helmut Wilhelm, Ulrich Schiefer; High Correlation between Relative Afferent Pupillary Defect (RAPD) and Visual Field Loss in Patients with Glaucomatous Optic Neuropathy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5513.
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Evaluation of RAPD assessed with swinging flashlight test as a sufficient predictor for visual field damage in glaucoma patients.
205 subjects (aged 7 - 90 years) with isocoria and manifest or suspected glaucoma from the Tuebingen glaucoma outpatient service were enrolled in a retrospective study. RAPD was quantified with a neutral density filter in 0.3 log steps and the value was declared positive if the RAPD was manifest in the right and negative if the RAPD occured in the left eye. Perimetry was performed with fast thresholding strategy GATE, semi-automated kinetic perimetry or threshold related, slightly supraliminal strategy (OCTOPUS 101 perimeter, HAAG-STREIT Inc., Koeniz, Switzerland) or the Tuebingen Automated Perimeter (Oculus, Dutenhofen, Germany). Visual fields were scored according to the Aulhorn classification (AC), ranging from 0 (normal) to 5 (temporal residual visual field). ACRML was defined as the difference between the right eye’s AC and the left eye’s AC (ACRE minus ACLE).
Of 205 patients, 160 had no RAPD, 28 had RAPD in the LE and 17 in the RE. The RAPD values ranged from 0.3 to >1.8 log units. While the group with no RAPD showed an ACRMLmedian=0, the group of RAPD in the LE had an ACRMLmedian= -2, and the group of RAPD in the RE had an ACRMLmedian= 2.For the subgroup of n=45 with manifest RAPD the RAPD magnitude was correlated with ACRML (Spearman's Rho=0,81, p<0.01) (Figure 1).
Patients presenting with RAPD are more likely to have a considerable difference in visual field defects between both eyes than patients without RAPD. Beyond that one can assume that a higher value of the RAPD points to a higher difference in visual fields.
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