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. 2015 Oct 9:9:1895-903.
doi: 10.2147/OPTH.S91278. eCollection 2015.

Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease

Go Takizawa  1 , Atsushi Miki  2 , Fumiatsu Maeda  3 , Katsutoshi Goto  1 , Syunsuke Araki  1 , Yoshiaki Ieki  1 , Junichi Kiryu  1 , Kiyoshi Yaoeda  4
Affiliations

Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease

Go Takizawa et al. Clin Ophthalmol. .

Abstract

Purpose: The aim of this study was to compare the asymmetrical light reflex of the control subjects and patients with optic nerve disease and to evaluate the relationships among the relative afferent pupillary defect (RAPD), visual acuity (VA), central critical fusion frequency (CFF), ganglion cell complex thickness (GCCT), and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) using spectral-domain optical coherence tomography.

Materials and methods: Using a pupillography device, the RAPD scores from 15 patients with unilateral optic nerve disease and 35 control subjects were compared. The diagnostic accuracy of the RAPD amplitude and latency scores was compared using the area under the receiver operating characteristic curve. Thereafter, we assessed the relationships among the RAPD scores, VA, central CFF, GCCT, and cpRNFLT.

Results: The average RAPD amplitude score in patients with optic nerve disease was significantly higher than that of the control subjects (P<0.001). The average RAPD latency score in patients with optic nerve disease was significantly higher than that of the control subjects (P=0.001). The area under the receiver operating characteristic curve for the RAPD amplitude score was significantly higher than that for the latency score (P=0.010). The correlation coefficients for the RAPD amplitude and latency scores were 0.847 (P<0.001) and 0.874 (P<0.001) for VA, -0.868 (P<0.001) and -0.896 (P<0.001) for central CFF, -0.593 (P=0.020) and -0.540 (P=0.038) for GCCT, and -0.267 (P=0.337) and -0.228 (P=0.413) for cpRNFLT, respectively.

Conclusion: Our results suggest that pupillography is useful for detecting optic nerve disease.

Keywords: central critical fusion frequency; circumpapillary retinal nerve fiber layer; ganglion cell complex; spectral-domain optical coherence tomography; visual acuity.

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Figures

Figure 1
Figure 1
The relative afferent pupillary defect (RAPD) scores of the optic nerve disease group and the control group. Note: The RAPD amplitude and latency scores of the optic nerve disease group were significantly higher than that of the control group (P<0.001 and P=0.001, respectively).
Figure 2
Figure 2
The receiver operating characteristic (ROC) curves of the relative afferent pupillary defect (RAPD) amplitude and latency scores. Notes: Open circles show the RAPD amplitude score, and closed circles show the RAPD latency score. The area under the ROC curves (AUC) of the amplitude score was significantly higher than that of the latency score (P=0.010). AUC: RAPD amplitude score: 1.000 (95% confidence interval [CI]: 0.929–1.000), RAPD latency score: 0.812 (95% CI: 0.677–0.909).
Figure 3
Figure 3
The relationship between the relative afferent pupillary defect (RAPD) and differences in visual acuity (VA). Notes: Closed circles show patients in whom the right side was affected, and open circles show patients with left optic neuropathy. RAPD amplitude score: R=0.847, P<0.001 (A), RAPD latency score: R=0.874, P<0.001 (B).
Figure 4
Figure 4
The relationship between the relative afferent pupillary defect (RAPD) and differences in the central critical fusion frequency (CFF). Notes: Closed circles show patients in whom the right side was affected, and open circles show patients with left optic neuropathy. RAPD amplitude score: R=−0.868, P<0.001 (A), RAPD latency score: R=−0.896, P<0.001 (B).
Figure 5
Figure 5
The relationship between the relative afferent pupillary defect (RAPD) and differences in the ganglion cell complex thickness (GCCT). Notes: Closed circles show patients in whom the right side was affected, and open circles show patients with left optic neuropathy. RAPD amplitude score: R=−0.593, P=0.020 (A), RAPD latency score: R=−0.540, P=0.038 (B).
Figure 6
Figure 6
The relationship between the relative afferent pupillary defect (RAPD) and differences in the circumpapillary retinal nerve fiber layer thickness (cpRNFLT). Notes: Closed circles show patients in whom the right side was affected, and open circles show patients with left optic neuropathy. RAPD amplitude score: R=−0.267, P=0.337 (A), RAPD latency score: R=−0.228, P=0.413 (B).
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