To the Editor.
—I read with interest the article by Corbett et al1 in the October 1988 Archives. Their use of the relative afferent pupillary defect (RAPD) in Table 2 of their article was completely appropriate. However, I do believe that the generalized use of the RAPD as a sign of worsening disease or as an indicator of surgical success may at times be misleading and should be de-emphasized, because its greatest value is limited to cases where there are asymmetrical changes in this bilateral disease. The authors stated that: quantitative measurements of the relative afferent pupillary defect were made at each visit... the clinical ophthalmologic examination, especially of visual fields and acuity and afferent pupillary testing, is essential to the accurate diagnosis and optimal management of all patients with pseudotumor cerebri... change in an afferent pupillary defect is one of several ways to measure success of optic nerve
Frenkel REP. Evaluation of the Relative Afferent Pupillary Defect in Pseudotumor Cerebri in Regard to Surgical Intervention. Arch Ophthalmol. 1989;107(5):634-635. doi:10.1001/archopht.1989.01070010652007