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S.K. Kim, N.J. Volpe, M. Maguire, G. Ying, M.L. Moster, S.L. Galetta; Video Versus Graphic Representation of the Swinging Flashlight Test: Enhancing Examiner Accuracy in the Detection of Afferent Pupillary Defects . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1960.
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Purpose: To compare the ability of different examiners to identify and quantify afferent pupillary defects (APDs) presented as videos and as graphs (pupillary diameter vs. time) of the swinging flashlight test (SFT). Methods: Video recordings and graphs (N = 60) of the SFT in normals and in patients with APDs: mild (< 0.6 log unit), moderate (0.6 - 0.9 log unit), or severe (>0.9 log unit) were presented to ophthalmic caregivers (N = 21) divided into 2 groups: residents (R) and neuro-ophthalmologists (N). For each video or graph, the examiners made a diagnosis of normal, mild, moderate, or severe APD. A scoring system was developed to assess accuracy. Results: In all groups, the mean accuracy score using graphs was higher than that of videos (p < 0.01). Using videos, the groups recognized moderate APDs 66.4% (R) and 88.1% (N) of the time. Using graphs, identification of moderate APDs improved in both groups: 88.6% (R) and 96.4% (N). For videos, a gross error (failing to detect a severe APD) was made 5% (R) and 0% (N) of the time. For graphs, a gross error was made 1.7% (R) and 0% (N) of the time. Conclusions: There was a direct correlation between the experience of the examiner, and the ability to identify moderate and severe APDs. The ability to detect moderate APDs increased in both groups when response curves were utilized. The disparity between the accuracy of experts and non-experts in identifying moderate APDs decreased when graphs were used, suggesting that graphic representation of the SFT obtained through pupillography may be an important diagnostic tool.
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