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May 1989

Evaluation of the Relative Afferent Pupillary Defect in Pseudotumor Cerebri in Regard to Surgical Intervention-Reply

Author Affiliations

Iowa City, Iowa
Miami, Fla
Salt Lake City, Utah

Arch Ophthalmol. 1989;107(5):635. doi:10.1001/archopht.1989.01070010652008

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In Reply.  —We agree with Dr Frenkel that an RAPD when considered alone, without paying attention to other indicators of optic nerve dysfunction, may be misleading or confusing. The RAPD reflects the difference between the two eyes and can be used to judge progression in bilateral disease if the visual acuity and visual field are also known. Unilateral visual field loss and the RAPD follow each other closely.Despite its usual bilaterality, papilledema due to pseudotumor cerebri rarely damages vision equally in both eyes. If a new RAPD appears, or if it changes in either direction or disappears, then subjective correlates should be looked for (visual acuity, color vision, flicker fusion, visual fields).We have, of course, used the RAPD only as a measure of difference in pupillomotor input between the two eyes and have kept this so constantly in mind that it seemed obvious and unworthy of special mention

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