EyeKinetix™ (Coming Soon)

Checking pupils for RAPDs is an important part of the comprehensive eye exam and is recommended in the AAO’s Preferred Practice Patterns® for POAG suspects and patients however the swinging flashlight test is difficult for humans to do well, and even more difficult and time consuming to accurately quantify.

Importantly, there is evidence that very small RAPDs may be clinically significant.

Relative Afferent Pupillary Defect (RAPD)

The RAPD response is a measure of asymmetry which may occur with optic nerve, retinal, or cerebral vascular disease, and amblyopia, specifically when there is a difference in the disease process between the two eyes. Pupil testing is a required part of a comprehensive eye examination, historically performed as a subjective observation, and considered by many clinicians as difficult to perform well.

Disorders that may cause an RAPD

  • Glaucoma
  • Alzheimers
  • Parkinson’s
  • Traumatic optic neuropathy
  • Autism
  • Optic neuritis / MS
  • Optic nerve tumor
  • Retinal detachment
  • Optic nerve infections or inflammations
  • Retinal detachment
  • Intraocular tumor
  • Severe macular degeneration
  • Retinal infection

I’ve been using RAPDx since 2011 and have diagnosed over a dozen patients with low-tension glaucoma. These patients had a relative afferent pupillary defect as their initial abnormal finding and without the benefit of automated pupillography, my index-of-suspicion for ocular disease would have been lower and I might have missed the diagnosis.

Craig Thomas, OD

RAPDx is beneficial in my practice to easily and precisely quantify afferent pupillary abnormalities as well as accurate and quantitative documentation of follow-up progress in patients with diseases of the anterior visual pathways. In addition, RAPDx helps me detect subtle RAPDs in the early diagnosis of diseases, such as glaucoma, and to document the absence of an RAPD in non-organic, unilateral, vision loss.

Swaraj Bose, MD

Neuro-Ophthalmology & Orbit

“The biggest problem with RAPD testing is that eyecare providers don’t do it … I estimate that pupillary testing is documented only about 10% of the time. It used to be gonioscopy took the prize for being done seldom and badly …”

Lankaranian, Spaeth et al 2007

Routine physician assessment of an RAPD has been clinically difficult with any measure of precision. Now with RAPDx, our techs can simply and objectively provide an entirely new level of detail in detection of an APD. Every doc will want one to enhance detection of neuro-affected diseases. This can be very interesting in looking at disease progression at a very early stage.

Theodore Krupin, MD


Symmetry of the pupillary light reflex and its relationship to retinal nerve fiber layer thickness and visual field defect.

Symmetry of the pupillary light reflex and its relationship to retinal nerve fiber layer thickness and visual field defect.

Chang DS, Boland MV, Arora KS, Supakontanasan W, Chen BB, Friedman DS.

Invest Ophthalmol Vis Sci. 2013 Aug 19;54(8):5596-601. doi: 10.1167/iovs.13-12142.
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Estimation of Retinal Ganglion Cell Loss in Glaucomatous Eyes With a Relative Afferent Pupillary Defect

Estimation of Retinal Ganglion Cell Loss in Glaucomatous Eyes With a Relative Afferent Pupillary Defect

Tatham AJ, Meira-Freitas D, Weinreb RN, Marvasti AH, Zangwill LM, Medeiros FA.

Invest Ophthalmol Vis Sci. 2014;55:513–522. DOI:10.1167/iovs. 13-12921

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Accuracy of pupil assessment for the detection of glaucoma: a systematic review and meta-analysis.

Chang DS, Xu L, Boland MV, Friedman DS.

Ophthalmology. 2013 Nov;120(11):2217-25. doi: 10.1016/j.ophtha.2013.04.012. Epub 2013 Jun 25.
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Detecting glaucoma using automated pupillography.

Detecting glaucoma using automated pupillography.

Tatham AJ, Meira-Freitas D, Weinreb RN, Zangwill LM, Medeiros FA.

Ophthalmology. 2014 Jun;121(6):1185-93. doi: 10.1016/j.ophtha.2013.12.015. Epub 2014 Jan 30.
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Pupil-based detection of asymmetric glaucomatous damage – comparison of the Konan RAPDx pupillograph, swinging flashlight method, and magnifier-assisted swinging flashlight method

Mohsin Ali, BS; Lan Lu, MD; Patricia Martinez, MD; Bruno Faria, MD; Lalita Gupta; Alice Zhang, BS;Eileen Hwang, BA, PhD; Marlene Moster, MD; George Spaeth, MD.  

ARVO poster 2013.

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Detecting Glaucoma with Pupillography

Chang DS, Arora K S, Quigley HA, Jampel HD, Ramulu P, Boland MV, Welsbie D, Friedman DS,  Supakontanasan W

Invest Ophthalmol Vis Sci 53:ARVO E-Abstract 5621, 2012.
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Pupillographic evaluation of relative afferent pupillary defect in glaucoma patients.

Ozeki N, Yuki K, Shiba D, Tsubota K.

Br J Ophthalmol. 2013 Dec;97(12):1538-42. doi: 10.1136/bjophthalmol-2013-303825. Epub 2013 Sep 24.
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