Examining pupil characteristics and relative afferent pupil defect prevalence in Syrian patients

Purpose: This study aims to explore pupil characteristics in a cohort of Syrian patients across different age groups and under varying luminance conditions, both pre- and post-pupil dilation. Additionally, the research seeks to ascertain the prevalence of the relative afferent pupillary defect (RAPD) within this patient population and to compare multiple test results to the established gold standard for diagnosing RAPD. Materials and methods: This is a cross-sectional study encompassing 178 patients who sought medical attention at the Al-Mowasat University Hospital clinics in Damascus, Syria, from March 1, 2020 to June 1, 2021. The research process involved a comprehensive review of the patients’ complaints and medical records, coupled with measurements of pupil diameters and amplitudes under conditions of low and high luminance using the automatic pupil measurement program of the Sirius topography device. The study investigated the incidence of anisocoria, abnormal pupil size, and RAPD. Special cases were deliberated, and data were meticulously collected, organized, and analyzed using a direct statistical approach. Results: Anisocoria exceeding 2 mm or abnormal pupil size was identified in 11 (6.18%) of the patients included in this study. The average pupil diameter at low luminance pre-dilation was measured at 3.59 ± 1.36 mm, while at high luminance, it was 1.93 ± 0.80 mm. Females exhibited a higher average pupil diameter compared to males ( P < 0.001). A significant decreasing trend in pupil diameter with age was observed across three age groups ( P < 0.001). A very strong positive correlation was discovered between constriction amplitude and pupil diameter, both pre- and post-dilation. Moreover, the dilation amplitude was observed to increase with age alongside a decrease in pupil diameter. The incidence of RAPD based on clinical examination was determined to be 7.9%, serving as the gold standard for comparison. The pupillometer test displayed accuracy with a matching rate of 98.2% compared to the gold standard. Among RAPD patients, older individuals with larger pupil diameters predominated in the sample. Conclusions: Highlighting the size and reactivity of pupils is crucial, especially in the elderly population, as these characteristics can serve as key indicators of underlying pathologies. The objective assessment and regular monitoring of these parameters are essential for the early detection and management of potential conditions. Notably, the pupillometer demonstrates superior accuracy in detecting RAPD compared to swinging high-luminance tests both before and after dilation. This underscores the importance of incorporating advanced technology for precise and reliable evaluation of pupillary responses, particularly in clinical settings where accurate diagnostic information is critical for optimal patient care.