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Long-term Fluctuation of Relative Afferent Pupillary Defect in Subjects With Normal Visual Function

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      Purpose

      To determine whether the relative afferent pupillary defect (RAPD) remains constant over time in normal subjects.

      Methods

      Seventeen normal subjects were tested with infrared pupillography and automated perimetry in four sessions over 3 years. The changes in RAPD and visual field asymmetry between testing sessions were compared.

      Results

      The range of RAPD was 0.0 to 0.3 log unit, and the difference in the mean deviation between the eyes on automated static perimetry was 0 to 3 dB. Eight subjects repeatedly had an RAPD in the same eye. There was no correlation between the RAPD and the visual field asymmetry at the same visit. Changes in the magnitude of the RAPD between any two sessions were typically small (median, 0.08 log unit; 25th percentile, 0.04 log unit; 75th percentile, 0.15 log unit).

      Conclusions

      Some normal subjects may show a persistent but small RAPD in the absence of detectable pathologic disease. Therefore, an isolated RAPD in the range of 0.3 log unit that is not associated with any other significant historical or clinical finding should probably be considered benign.
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      References

        • Loewenfeld IE.
        The light reflex.
        in: The pupil. Iowa State University Press and Wayne State University Press, Ames1993: 185-189
        • Brenton RS
        • Phelps CD
        • Rojas P
        • Woolson RF.
        Interocular differences of the visual field in normal subjects.
        Invest Ophthalmol Vis Sci. 1986; 27: 799-805
        • Aylward GW
        • Jeffrey BG
        • Billson FA.
        Normal variation and the effect of age on the parametric analysis of the intensity response of the scotopic electroretinogram, including the scotopic threshold response.
        Clin Vis Sci. 1990; 5: 353-362
        • MacMillan ES
        • Cummins D
        • Heron G
        • Dutton GN.
        The simultaneous interocular brightness sense test: a test of optic nerve function.
        Arch Ophthalmol. 1994; 112: 1190-1197
        • Kawasaki A
        • Moore PA
        • Kardon RH.
        Variability of the relative afferent pupillary defect.
        Am J Ophthalmol. 1995; 120: 622-633
        • Lowenstein O.
        Alternating contraction anisocoria: a pupillary syndrome of the anterior midbrain.
        Arch Neurol Psychiatry. 1954; 72: 742-757
        • Loewenfeld IE.
        Damage to the intercalated pretectal neuron: consensual deficit.
        in: The pupil. Iowa State University Press and Wayne State University Press, Ames1993: 945-955
        • Forman S
        • Behrens MM
        • Odel JG
        • Spector RT
        • Hilal S.
        Relative afferent pupillary defect with normal visual function.
        Arch Ophthalmol. 1990; 108: 1074-1075
        • Ellis CJK.
        Afferent pupillary defect in pineal region tumor.
        J Neurol Neurosurg Psychiatry. 1984; 47: 739-741
        • Eliot D
        • Cunningham Jr, ET
        • Miller NR.
        Fourth nerve paresis and ipsilateral relative afferent pupillary defect without visual sensory disturbance: a sign of contralateral dorsal midbrain disease.
        J Clin Neuro-ophthalmol. 1991; 11: 169-172