Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
J Neuroophthalmol. 2021 Jun 1;41(2):239-245. doi: 10.1097/WNO.0000000000000919.
Despite automated pupillometry's (AP) improved detection of relative afferent pupillary defects (RAPDs) compared with the Swinging Flashlight Test (SFT), AP remains uncommon in clinical practice. This study examined barriers to routine use of AP in evaluation of acute vision loss.
(1) Ophthalmologists and optometrists' perceptions of AP were captured via electronic survey. (2) Ophthalmologists were presented with clinical vignettes to assess their use of AP in clinical decision-making. (3) Patients presenting with decreased vision to an ophthalmology urgent care clinic underwent manual SFT and AP screening to evaluate ophthalmologists' perceptions of the device.
Surveys indicated that clinicians were "neutral" to "somewhat likely" to use AP. In clinical vignettes, more physicians proceeded with workup for optic nerve pathology when presented with an RAPD by AP than SFT (77% vs 26%, P = 0.003). When SFT and AP results were discordant, more physicians proceeded with workup for optic nerve disease when AP was positive and SFT was negative than vice versa (61% vs 18%, P = 0.008). In the clinical study of 21 patients, 50% of RAPDs detected by AP were not detected by SFT, although ophthalmologists rated AP's usefulness as only "neutral" to "somewhat useful."
Clinicians value pupillary examination and trust AP over SFT; however, widespread adoption and perceived value of AP may depend on its impact on clinical outcomes. Within a comprehensive diagnostic device, AP may be an important tool, but is not necessary to screen for optic nerve disease or evaluate acute vision loss.
尽管自动化瞳孔测量（AP）在检测相对传入性瞳孔缺陷（RAPD）方面优于摆动闪光灯测试（SFT），但在临床实践中，AP 仍然不常见。本研究探讨了在评估急性视力丧失时常规使用 AP 的障碍。
（1）通过电子调查获取眼科医生和视光师对 AP 的看法。（2）向眼科医生提供临床病例，以评估他们在临床决策中使用 AP 的情况。（3）在眼科急症护理诊所就诊的视力下降患者接受手动 SFT 和 AP 筛查，以评估眼科医生对该设备的看法。
调查表明，临床医生对 AP 的使用态度是“中立”到“有些可能”。在临床病例中，当 AP 检测到 RAPD 时，更多的医生进行视神经病变的检查（77% vs 26%，P = 0.003）。当 SFT 和 AP 结果不一致时，当 AP 阳性而 SFT 阴性时，更多的医生进行视神经疾病的检查，而不是相反（61% vs 18%，P = 0.008）。在 21 例患者的临床研究中，50%的 AP 检测到的 RAPD 未被 SFT 检测到，尽管眼科医生对 AP 的有用性评价仅为“中立”到“有些有用”。
临床医生重视瞳孔检查，信任 AP 优于 SFT；然而，AP 的广泛采用和感知价值可能取决于其对临床结果的影响。在综合诊断设备中，AP 可能是一个重要的工具，但不是筛查视神经疾病或评估急性视力丧失所必需的。
