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Relative afferent pupillary defects in multiple sclerosis.

T A Cox1

  • 1Department of Ophthalmology, University of British Columbia, Vancouver.

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|August 1, 1989
PubMed
Summary

Relative afferent pupillary defects (RAPD) were identified in 18% of multiple sclerosis patients. These defects were more frequent in those with definite MS, optic neuritis, or optic atrophy, but less common post-optic neuritis than previously reported.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Neuro-ophthalmology

Background:

  • Relative afferent pupillary defect (RAPD) is a key indicator of optic nerve dysfunction.
  • Multiple sclerosis (MS) frequently affects the optic nerves, potentially causing visual pathway abnormalities.

Purpose of the Study:

  • To determine the prevalence of RAPD in a cohort of patients with multiple sclerosis.
  • To investigate the association between RAPD and clinical characteristics of MS, including optic neuritis and optic atrophy.

Main Methods:

  • Retrospective chart review of 386 patients diagnosed with MS at a specialized clinic.
  • Assessment of pupillary responses to identify relative afferent pupillary defects.
  • Correlation of RAPD findings with clinical history of optic neuritis, presence of optic atrophy, and visual evoked potentials.

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Main Results:

  • A relative afferent pupillary defect was detected in 69 out of 386 patients (18%).
  • RAPD was more prevalent in patients with clinically definite MS, recent or unilateral optic neuritis, and unilateral or asymmetric optic atrophy.
  • The frequency of RAPD following optic neuritis in this cohort was lower than observed in prior studies.

Conclusions:

  • Relative afferent pupillary defects are present in a significant minority of MS patients.
  • RAPD correlates with specific clinical manifestations of MS, particularly optic nerve involvement.
  • The lower-than-expected frequency of RAPD post-optic neuritis warrants further investigation into diagnostic criteria and patient selection in previous studies.