EyeKinetix®

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 method is difficult for humans to do well, and even more difficult and time consuming to accurately quantify.

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

Relative Afferent Pupillary Defect (RAPD)

The RAPD is a measure of asymmetry which may occur with optic nerve, retinal, or cerebral vascular disease, and amblyopia, specifically when the disease or disorder is presenting asymmetrically. Pupil testing is a required part of a comprehensive eye examination, historically performed as a subjective observation (SFM), and considered by many clinicians as difficult to perform well.

Examples of disorders that may cause an RAPD

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

The RAPDx score provides a highly sensitive and specific assessment of the RAPD as tested by the swinging flashlight method. It is easily used by ancillary personnel as part of the screening of patients and is a powerful tool for clinicians needing to identify, confirm and quantify Relative Afferent Pupillary Defects.

Nicholas J. Volpe, MD

Chairman, Department of Ophthalmology, Northwestern University, Feinberg School of Medicine

I have diagnosed over a dozen patients with low-tension glaucoma with RAPDx. These patients had a relative afferent pupillary defect as their initial abnormal finding and without the benefit of automated objective 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

The EyeKinetix provides peace of mind that our patient’s pupillary reflexes are being evaluated accurately and objectively. I have found the unit to be so much faster than its predecessor, RAPDx, and much more user/operator friendly. With the speed of EyeKinetix we do not have a bottle neck at our testing stations – it allows us to maintain the preliminary testing production flow.

This instrument is going to help us save someone’s life, or quality of life, by picking up subtle APD producing pathology—that we probably were going to miss. I believe in the unit so much that I have ordered 2 of them for our office.

Mario Gutierrez, OD, FAAO

Publications

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

Effects of Age and Sex on Values Obtained by RAPDx® Pupillometer, and Determined the Standard Values for Detecting Relative Afferent Pupillary Defect

Satou T, Goseki T, Asakawa K, Ishikawa H, Shimizu K.

Translational vision science & technology. 2016 Mar 1;5(2):18-.
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Symmetry of the pupillary light reflex and its relationship to retinal nerve fiber layer thickness and visual field defect.

Unilateral periodic pupillary constriction causing alternating anisocoria

Conrad EC, Jivraj I, Kardin R, Liu GT.

Neurology. 2018 Jan 9;90(2):86-8.
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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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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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A novel computerized portable pupillometer detects and quantifies relative afferent pupillary defects.

Cohen, L. M., Rosenberg, M. A., Tanna, A. P., & Volpe, N. J. (2015).

Current eye research, 40(11), 1120-1127.
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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 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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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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