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A 30 s test for quantitative assessment of a relative afferent pupillary defect (RAPD): the infrared pupillary asymmetry (IPA)

  • Nathalie Stéphanie Meneguette
  • J. Emanuel Ramos de Carvalho
  • Axel PetzoldEmail author
Original Communication

Abstract

Background

Detection of a relative afferent pupillary defect (RAPD) by the swinging-light test can be challenging in clinical practice (dark eyes, anisocoria, dark environment). We developed a new method of RAPD quantification based on the recording of the infrared pupillary asymmetry (IPA) with a standard optical coherence tomography (OCT) device.

Methods

The diagnostic value of the IPA for detection of the RAPD was determined by receiver-operating characteristic (ROC) curves and area under the curve (AUC).

Results

Twenty-nine subjects were included in this study (17 controls and 12 unilateral optic neuropathies). The IPA was significantly greater in unilateral optic neuropathies (0.39) compared to controls (0.18, p = 0.001). The diagnostic value was good with a ROC–AUC of 0.843. Importantly, the IPA correlated significantly with the inter-eye percentage difference of the macular ganglion cell-inner plexiform layer (mGCIPL) thickness (R = 0.53, p = 0.01). Assessment of the IPA took less than 30 s.

Conclusion

The present data show that the IPA is a practical and rapid test that can be applied in a clinical setting. The IPA may be a valuable functional outcome measure for clinical trials, complementing structural retinal OCT data in a biological meaningful way. The IPA should be further investigated for suitability for optic neuritis treatment trials.

Keywords

Optical coherence tomography Infrared pupillary asymmetry IPA Relative afferent pupillary defect RAPD 

Notes

Funding

Nathalie Stéphanie Meneguette was sponsored by a Du Pré Grant from the MS International Federation.

Compliance with ethical standards

Conflicts of interest

Axel Petzod is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. He is member of the steering committee for the OCTiMS study (Novartis) and performed OCT QC for the PASSOS study (Novartis) and received consulting fees. J. Emanuel Ramos de Carvalho and Nathalie Stéphanie Meneguette declare that they have no conflict of interest.

Supplementary material

415_2019_9223_MOESM1_ESM.xls (28 kb)
Supplementary material 1 (XLS 27 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nathalie Stéphanie Meneguette
    • 1
    • 2
  • J. Emanuel Ramos de Carvalho
    • 2
    • 3
  • Axel Petzold
    • 2
    • 4
    • 5
    Email author
  1. 1.Department of Neurology and OphthalmologyFederal University of the State of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Department of Neuro-ophthalmologyMoorfields Eye HospitalLondonUK
  3. 3.Department of Ophthalmology, Amsterdam UMCAMC AmsterdamAmsterdamThe Netherlands
  4. 4.The National Hospital for Neurology and NeurosurgeryLondon, WC1N 3BGUK
  5. 5.Departments of Neurology & Ophthalmology, Neuro-ophthalmology Expertise CentreAmsterdam UMCAmsterdamThe Netherlands

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