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The utility of relative afferent pupillary defect as a screening tool for glaucoma: prospective examination of a large population-based study in a south Indian population
  1. Amy L Hennessy1,2,
  2. Joanne Katz2,
  3. Rengappa Ramakrishnan3,
  4. Ramasamy Krishnadas4,
  5. Ravilla D Thulasiraj4,
  6. James M Tielsch2,
  7. Alan L Robin1,2
  1. 1Glaucoma Specialists, Baltimore, Maryland, USA
  2. 2Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, Maryland, USA
  3. 3Aravind Eye Hospital-Tirunelveli, Tirunelveli, Tamil Nadu, India
  4. 4Aravind Eye Hospital-Madurai, Madurai, Tamil Nadu, India
  1. Correspondence to Dr Amy L Hennessy, The Glaucoma Center, PC, 4175 N Hanson Ct, Suite 200, Bowie, MD 20716, USA; hennessy.amy{at}


Background Previous authors have suggested that an afferent pupillary defect (APD) may serve as an effective screening tool for some specific eye diseases, especially glaucomatous optic neuropathy, since the disease usually presents asymmetrically. Its success as a screening tool for glaucoma has never been previously prospectively evaluated in a large population.

Methods In this study, the authors carry out assessments for the presence of APD as it relates to the diagnosis of glaucoma in an existing population-based eye study in southern India. The authors calculate the sensitivity and specificity for APD, both at the level of a village/household screening and in a more comprehensive/hospital setting, as it pertains to its ability to predict glaucomatous optic neuropathy.

Results and discussion The authors find that APD assessed via the swinging flashlight test is a poor screening tool for glaucoma in this setting.

  • Glaucoma screening
  • afferent pupillary defect
  • Aravind
  • swinging flashlight
  • pupil
  • optic nerve
  • public health
  • epidemiology

Statistics from


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Johns Hopkins School of Public Health, Baltimore, Maryland, and Aravind Eye Hospital, Madurai, Tamil Nadu, India.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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