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Associating the magnitude of relative afferent pupillary defect (RAPD) with visual field indices in glaucoma patients
  1. Ulrich Schiefer1,4,
  2. Janko Dietzsch1,
  3. Klaus Dietz2,
  4. Bärbel Wilhelm3,
  5. Anna Bruckmann4,
  6. Helmut Wilhelm4,
  7. Veronique Kitiratschky4,
  8. Kai Januschowski4
  1. 1Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
  2. 2Department of Medical Biometry, Tübingen, Germany
  3. 3STZ eyetrial at the Centre for Ophthalmology, Tübingen, Germany
  4. 4University Eye Hospital, Tübingen, Germany
  1. Correspondence to Professor Dr Ulrich Schiefer, University Eye Hospital, Institute for Ophthalmic Research, University of Tuebingen, Schleichstr. 12-16, 72076 Tübingen, Germany; ulrich.schiefer{at}


Purpose To identify the variable with the strongest association between the magnitude of the relative afferent pupillary defect (RAPD) and visual field indices in patients with glaucomatous optic neuropathy.

Methods Seventy-nine consecutive subjects with manifest glaucomatous optic neuropathy at least in one eye were enrolled in this retrospective study. RAPD was assessed with the swinging flashlight test and quantified with a neutral density filter. Perimetry was performed using the fast thresholding strategy German Adaptive Threshold Estimation. The values of the central differential luminance sensitivity (DLS), of the MD (mean defect) and of the ‘loss volume’ (LVOL) based on the individually modelled 3D hill of vision—the latter two within the eccentricities of 10°, 20° and 30°, respectively—were entered into a linear regression model without intercept as a function of RAPD.

Results An absolute value of RAPD of 0.3 log10 units or more was present in 20 out of 79 glaucoma subjects (25%). The magnitude of RAPD was most closely associated with LVOL-30° (R2=0.77), followed by MD-30° (R2=0.73), MD-20° (R2=0.71), LVOL-20° (R2=0.67), MD-10° (R2=0.58), LVOL-10° (R2=0.54) and central DLS (R2=0.04).

Conclusions The prevalence of RAPD in glaucoma patients is comparatively small (25%). The magnitude of RAPD in glaucoma subjects is associated most closely with the LVOL within 30° eccentricity (which is the maximum visual field region tested in this study) and most loosely with central DLS, underscoring the impact of the entire (30°) visual field area on the afferent pupillary system.

  • RAPD
  • global visual field indices
  • loss volume
  • glaucoma
  • asymmetry
  • field of vision
  • pupil
  • clinical trial
  • physiology
  • visual pathway
  • optic nerve

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  • Competing interests None.

  • Patient consent Not obtained, due to the retrospective character of this study.

  • Ethics approval Not obtained, due to the retrospective character of this study.

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