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. 2017 Aug 31;42(3):139-145.
doi: 10.1080/01658107.2017.1367012. eCollection 2018 Jun.

Relative Afferent Pupillary Defects in Homonymous Visual Field Defects Caused by Stroke of the Occipital Lobe Using Pupillometer

Go Takizawa  1 , Atsushi Miki  1   2   3 , Fumiatsu Maeda  4 , Katsutoshi Goto  1 , Syunsuke Araki  1 , Tsutomu Yamashita  1   2 , Yoshiaki Ieki  1 , Junichi Kiryu  1 , Kiyoshi Yaoeda  3   5
Affiliations

Relative Afferent Pupillary Defects in Homonymous Visual Field Defects Caused by Stroke of the Occipital Lobe Using Pupillometer

Go Takizawa et al. Neuroophthalmology. .

Abstract

Relative afferent pupillary defects (RAPD) may be detected in patients with occipital lobe lesions. However, no previous report has used an objective technique to record the abnormal pupillary light reflex in such cases. Therefore, we measured the pupillary light reflex objectively in 15 patients with homonymous visual field defects (HVFD) due to occipital stroke using a new pupillometer. This study detected significantly smaller and slower pupillary light reflexes in the contralateral eyes than in the other eyes, which is equivalent to the presence of RAPD in patients with HVFDs caused by retrogeniculate lesions using an objective technique. Our results confirmed those of the previous reports using the swinging flashlight test more objectively.

Keywords: Amplitude; latency; pupillary light reflex pathway; pupillometer; retrograde trans-synaptic degeneration.

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Figures

Figure 1.
Figure 1.
Box plot of the relative afferent pupillary defect (RAPD) scores in the patients with homonymous visual field defects (HVFD) and control groups. Upper horizontal line of box = mean plus one standard deviation (SD); Lower horizontal line of box = mean minus one SD; horizontal bar within box = mean; Upper horizontal bar outside box = maximum; Lower horizontal bar outside box = minimum. Circle = each measured value. RAPD scores of amplitude of the HVFDs (the sign of scores of the patients with left HVFDs were inverted to merge the data, n = 15) group were significantly higher in the eye contralateral to the brain lesion than those in the control group (n = 32) (p < 0.05). Also, the RAPD scores of latency were significantly higher in the eye contralateral to the brain lesion than those of the controls (p < 0.01). * p < 0.05, ** p < 0.01.
Figure 2.
Figure 2.
The relationship between the RAPD scores and the interval of time from the stroke to examination of RAPD. The upper scatter plot shows the relationship between the RAPD score of amplitude (the sign of scores of the patients with left HVFDs was inverted to merge them with those of the right HVFDs, n = 15) and interval of time from the stroke to examination. R = 0.21 (p = 0.45). The lower scatter plot shows the relationship between the RAPD score of latency (the sign of scores of the patients with left HVFDs was inverted to merge them with those of the right HVFDs, n = 15) and interval of time from the stroke to examination. R = 0.59 (p = 0.02).
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