Lankaranian Dara, Altangerel Undraa, Spaeth George L, Leavitt Jacqueline A, Steinmann William C
William and Anna Goldberg Glaucoma Service and Research Laboratories, Wills Eye Hospital/Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Trans Am Ophthalmol Soc. 2005;103:200-7; discussion 207-8.
To evaluate the validity of different methods of relative afferent pupillary defect (RAPD) detection and assess the usefulness of detecting an RAPD in glaucoma patients.
For this prospective observational study, we enrolled 70 of 153 consecutive glaucoma patients coming for examination. Exclusion criteria were cloudy corneas, recent surgery, fixed pupils, and other diseases producing RAPDs. Inclusion criteria were any type of glaucoma and absence of any exclusion criterion. Patients were examined for an RAPD by the swinging flashlight method (SFM), a magnifier-assisted swinging flashlight method (MAM), and automated pupillography. The SFM and MAM results were compared with those obtained by pupillography. Receiver operating characteristic curves and the area under the curve (AUC) were determined. Correlations of other optic disc and visual field indices of glaucoma damage with RAPD were determined.
We confirmed RAPDs in 39 (56%) of the subjects by pupillography, finding a sensitivity of 41% and 84% and a specificity of 90% and 76% for SFM and MAM, respectively. The AUC was 0.86 for MAM and 0.61 for SFM. The correlations (r) between RAPD with intereye differences in the optic disc and visual field indices of glaucoma damage were moderate.
A modified swinging flashlight test with magnification increases the sensitivity of the test in detecting an RAPD. Because the detection of an RAPD may precede apparent optic disc and visual field damage, looking for an RAPD may be an important part of the assessment of patients with glaucoma.
评估不同相对传入性瞳孔障碍（RAPD）检测方法的有效性，并评估检测青光眼患者RAPD的有用性。
在这项前瞻性观察研究中，我们从153名前来检查的连续青光眼患者中纳入了70名。排除标准为角膜混浊、近期手术、固定瞳孔以及其他可产生RAPD的疾病。纳入标准为任何类型的青光眼且不存在任何排除标准。通过摆动手电筒法（SFM）、放大镜辅助摆动手电筒法（MAM）和自动瞳孔描记术对患者进行RAPD检查。将SFM和MAM的结果与瞳孔描记术获得的结果进行比较。确定受试者工作特征曲线及曲线下面积（AUC）。确定青光眼损害的其他视盘和视野指标与RAPD的相关性。
通过瞳孔描记术在39名（56%）受试者中确认存在RAPD，发现SFM和MAM的敏感性分别为41%和84%，特异性分别为90%和76%。MAM的AUC为0.86，SFM的AUC为0.61。RAPD与青光眼损害的视盘和视野指标的双眼差异之间的相关性（r）为中等。
带放大功能的改良摆动手电筒试验提高了检测RAPD的敏感性。由于RAPD的检测可能先于明显的视盘和视野损害，因此寻找RAPD可能是青光眼患者评估的重要组成部分。
