Wilhelm Helmut, Peters Tobias, Lüdtke Holger, Wilhelm Barbara
Department of Pathophysiology of Vision and Neuro-ophthalmology, Universitäts-Augenklinik, Tübingen, Germany.
J Neuroophthalmol. 2007 Dec;27(4):263-7. doi: 10.1097/WNO.0b013e31815bf865.
Observational and pupillographic studies of small numbers of normal subjects have shown that a small (<0.3 log units) relative afferent pupil defect (RAPD) is present in a minority. We have extended the investigation of the prevalence of RAPD to a larger number of normal subjects.
A total of 102 subjects were examined by observation and pupillography. The swinging flashlight test was performed using neutral density filters for quantification. During the pupillographic procedure, light-emitting diodes were placed in front of each eye, alternately flashing for 2.5 seconds with a 0.5 second break. A binocular real-time pupillometer recorded the direct and consensual pupillary responses. After artefact detection and removal, the amplitudes of pupillary response were determined and plotted against stimulus intensity. The means of the direct and the consensual responses were used for automated calculation of RAPD.
By observation, there was no RAPD in 87 (85%) subjects; there was an RAPD of 0.15 log units in 13 (13%), and an RAPD of 0.3 log units in 2 (2%). By pupillography, there was an RAPD of 0.07 log units in 53 (52%) subjects, an RAPD between 0.08 and 0.22 log units in 43 (42%) subjects, and an RAPD between 0.23 and 0.39 log units in 6 (6%) subjects.
Observation and pupillographic measurements of the swinging light test in a large normal subject cohort has confirmed that an RAPD is present in a small minority but that it does not exceed 0.39 log units. The RAPD in these subjects may be explained by inaccuracy of measurement or by asymmetries in the connections between visual pathways and pretectal nuclei in the midbrain.
对少数正常受试者的观察性研究和瞳孔描记研究表明，少数人存在较小（<0.3对数单位）的相对性传入瞳孔障碍（RAPD）。我们将RAPD患病率的调查扩展到了更多的正常受试者。
通过观察和瞳孔描记法对总共102名受试者进行了检查。使用中性密度滤光片进行摆动手电筒试验以进行量化。在瞳孔描记过程中，将发光二极管放置在每只眼前，交替闪烁2.5秒，间隔0.5秒。双目实时瞳孔计记录直接和间接瞳孔反应。在检测并去除伪迹后，确定瞳孔反应的幅度，并将其与刺激强度作图。直接和间接反应的平均值用于自动计算RAPD。
通过观察，87名（85%）受试者无RAPD；13名（13%）受试者的RAPD为0.15对数单位，2名（2%）受试者的RAPD为0.3对数单位。通过瞳孔描记法，53名（52%）受试者的RAPD为0.07对数单位，43名（42%）受试者的RAPD在0.08至0.22对数单位之间，6名（6%）受试者的RAPD在0.23至0.39对数单位之间。
对一大群正常受试者进行摆动光试验的观察和瞳孔描记测量证实，少数人存在RAPD，但不超过0.39对数单位。这些受试者中的RAPD可能是由于测量不准确或视觉通路与中脑顶盖前核之间连接的不对称所致。
