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A. Miki, A. Iijima, M. Takagi, T. Usui, S. Hasegawa, H. Abe, T. Bando; Pupillography of Relative Afferent Pupillary Defects in Amblyopia. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4878.
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Relative afferent pupillary defects (RAPDs) in amblyopia have been reported and it is widely accepted that amblyopes can have an RAPD. We investigated whether this could be confirmed by the use of automated swinging flashlight test with binocular pupillography.
We examined eighteen patients with unilateral amblyopia (6 male and 12 female, aged 7-57 years) using binocular infrared video pupillography (Vision module, Newopto, Kawasaki, Japan) in a darkened room. Five patients had detectable fundus abnormalities, and one patient was diagnosed as having cone dystrophy OU using ERG. The remaining twelve patients had functional amblyopia associated with anisometropia and/or strabismus. Light stimuli with white light-emitting diodes were presented to the right and left eyes alternatively. The right and left horizontal pupillary diameters were simultaneously recorded 30 times per second. The sum of contraction amplitudes of both eyes was compared.
One patient's data had to be excluded because of poor recording due to his narrow palpebral fissure. Among the patients with functional amblyopia, only one patient with moderate amblyopia was found to have an RAPD in the amblyopic eye, which was reproduced on a different day. Other even denser amblyopes with worse visual acuities did not have an RAPD. On the other hand, all the organic amblyopes showed RAPDs in the eyes with worse visual acuity.
Only one patient with functional amblyopia had an RAPD in the affected eye. This study has shown that only a small portion of unilateral amblyopes has an RAPD in the affected eye, which is not necessarily associated with dense amblyopia.
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