A Unilateral Cataract Produces a Relative Afferent Pupillary Defect in the Contralateral Eye

Byron L. Lam, H. Stanley Thompson

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The relative afferent pupillary defect (RAPD) was measured with neutral density filters in ten patients, each of whom had a dense cataract in one eye only. In each instance, the cataract reduced visual acuity to counting fingers or worse, whereas visula acuity in the other eye was 20/25 or better. All patients with mature or nuclear cataracts had a measurable RAPD in the other eye (mean, 0.44 log unit). In each instance, after extraction of the cataract, the RAPD disappeared. Thus, a decrease cataract causes an RAPD in the contralateral eye by increasing the pupillomotor effectiveness of the stimulus light and that this is the reason why even a brunescent cataract does not cause an RAPD in the same eye. In addition, two clinical cases are reported. One case records the development of a cataract in an eye with a preexisting RAPD resulting from optic neuritis; as the cataract became more opaque, the afferent defect became smaller and finally was reversed. The other case shows that a traumatic cataract can produce an RAPD in the contralateral eye. Thus, when an afferent pupillary defect is seen in an eye with a cataract, a visual pathway defect in that eye should definitely be suspected.

Original languageEnglish (US)
Pages (from-to)334-338
Number of pages5
Issue number3
StatePublished - Jan 1 1990


ASJC Scopus subject areas

  • Ophthalmology

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