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The afferent pupillary defect in asymmetric glaucoma
R H Brown1, J D Zilis, M G Lynch
1Department of Ophthalmology, University of Texas Health Science Center, Dallas 75235-9057.
Archives of Ophthalmology (Chicago, Ill. : 1960)
|November 1, 1987
Summary
The presence of a relative afferent pupillary defect (APD) in glaucoma patients indicates significant asymmetric optic nerve damage. Automated perimetry can quantify this damage, improving glaucoma assessment.
Area of Science:
- Ophthalmology
- Neuroscience
Background:
- Glaucoma diagnosis often relies on detecting asymmetric optic nerve damage.
- Relative afferent pupillary defect (APD) is a clinical sign associated with optic nerve dysfunction.
Observation:
- This study investigated 27 glaucoma patients using the OCTOPUS 2000 perimeter.
- Patients were categorized based on the presence or absence of APD, alongside asymmetric optic nerve cupping.
Findings:
- Patients with APD exhibited significantly greater visual field sensitivity differences (mean 48.2%) compared to those without APD (mean 5.5%).
- A sensitivity difference of 13% or greater consistently indicated the presence of an APD.
- APD depth correlated with visual field asymmetry but not optic nerve cup-disc ratio asymmetry.
Implications:
- The presence of an APD signifies a threshold of asymmetric optic nerve damage has been surpassed.
- Automated perimetry can quantify this threshold, potentially enhancing the diagnostic accuracy for glaucoma patients.
- APD serves as a crucial indicator for advanced asymmetric optic nerve damage in glaucoma.