RAPD, Relative Afferent Pupillary Defect, Marcus-Gunn pupil

[@aldanicaolano2970]

I'm a Neurology resident in the Philippines. And because of detection of an RAPD, we were able to diagnose a "silent" ACOM aneurysm.. Due to the pulsations of the aneurysm, it was compressing on the ipsilateral optic nerve.

[@rebbekandahuma2173]

Wow.

[@helmuthahn1352]

Respect

[@rajapandian-e5f]

What is the history, you checked for rapd, doctor

[@modernmedicine2562]

The dome has to be pretty big and pulsation strong enough to compress those fibers and give consistent findings. Not sure if its actually "silent". Probably just incidental unruptured aneurysm.

[@Ashley2000-h3y]

Just super great mindes 🎉thx 4ur share

[@amrhsyrf]

if only our professors are as enthusiastic and clear with their explanations as you are. thanks very much for sharing your knowledge with us. lots of love from a UK medical student

[@misscamillacakes]

I literally wish you taught me neurology. The average ability for doctors to be good teachers is LOW. Thank you :)

[@sammycrown5540]

My Hsv2 test results came out NEGATIVE after using Dr.Anii herbal medicine for just 2weeks, thank God I’m now cured from this genital Herpes virus, 👀 you can as well contact Dr.Anii John and get your permanent healing

[@allkinds1069]

I was confused but you clearly explained it, thank you. In summary: When you shine the light into the RAPD eye, it will dilate AND the other eye will dilate.

[@markwatts6072]

I don't usually comment on videos but I must say this is excellent teaching!

[@primordialbeing]

how are these videos even free, this is priceless teaching. Thank you Dr. Lee.

[@natiaturabelidze4330]

DR. Lee is a real master of teaching and making complicated things understandable in a professional manner. profitably spent minutes vs. struggling hours with textbooks. I don't know why my former professors at the medical school got paid at all....

[@drsalam3494]

lol true

[@vathsav6065]

Y don't we have these kinda teachers in our college......!!!!🔥🔥🔥

[@lukehamilton5142]

Wow. After nearly 10 years in practice (GP), that's the best explanation of Marcus Gunn I have ever seen.

[@tungtrinh-fg5zk]

Hi Doctor Lee. I'm an ophthalmology resident in Viet Nam. This video is very helpful, It helps me know more about RPDA and Reverse RAPD. Thank you so much and I hope you can give more lectures or cases about Neuro-Ophthalmology and always keep this passion for teaching.

[@abdullahmonla527]

Thanx so much, speaking on behalf all fresh postgraduates, and those doing postgrad studies! I admire you doctor for your care to share to all out there, thank you so much please keep posting and the info flowing

[@ThuyTien-zm7lc]

Wow, amazing explanations. I stopped searching for some kind of lesson about RAPD at the moment I found this one. Thank you

[@pcchoon]

much respect from the UK Dr. Lee

[@georgekendall2053]

This was world-class teaching mate, THANK YOU, you've cleared up something I've always struggled with 🙏

[@SephyCallum]

My teachers are nowhere near as competent at teaching as you are. Calm and clear and step by step plus visual aids. BEST WAY TO LEARN!

[@uroshjovanotti]

This is a brilliant explanation. I am fascinated with the ease and simplicity with which Dr. Lee explains complex neuro-ophthalmological problems.

[@ArlindaOfficial]

what a great explanation! thanks so much, doc

[@muhammedvally4722]

Fantastic teaching! Your 1 video has probably helped countless number of students globally. Thank you Dr!

[@hifabiola]

It's really clear and helpful concept explanation, your channel is really a youtube gem. thank you for teaching with such passion dr.Lee.

[@willempieterse5153]

Hello Andrew, I was in both your lectures at OSSA 2022, Thanks so much for your great talk about Meds to could blind patients...You have made my day...so practical

[@alyquick1599]

Dr Lee. You're a total legend. Thank you

[@frankdatankallday4745]

These are great tips. Experience plays a big role in detection. Knowing how to do something and understanding it are two different things. It is okay to be wrong sometimes. That is how we learn.

[@yiyi8883]

it's 2021 and i'm still watching this video. Never got what exactly RAPD is before until now. Thx Dr. Lee

[@vincentgiovannucci4048]

Amazing lecture, from an Optometrist in Boston, Ma. You are an ace.

[@sallygibson826]

Another brilliant video. Thank you.

[@deepamjdash]

Amazing teacher ! will definitely watch him more after my exams :)

[@bayanahmed853]

thank you Dr.Lee your the best doctor I have seen before , I search for long time to Find this short video to learn me more in quick time , I hope be like you in future

[@syamalasreedharanpillai5278]

The perfect opthalmology lectures

[@khadijag8926]

Great explanation

[@rocwithme7898]

I might actually pass my neuro exam thanks to you!

[@h.zabbasi3154]

You're such an amazing teacher Sir! Thank you so much for your efforts

[@kavimanimaran3750]

Thank you doctor for crystal clear explanation

[@esmeraldaelhamzawy9114]

I just love the way you explain ophthalmology ❤️❤️❤️

[@juanitoalcachofa1183]

This guy is brilliant. Thank you from a med student.

[@sarariaz4355]

Never heard such a beautiful description of RAPD. Thank you

[@PteSunnyDing]

Thanks Doctor. Lee, this explained RAPD so much better than my lecture did

[@mariawende9223]

thank you very much Doc, your explanations are easy to understand

[@sammycrown5540]

My Hsv2 test results came out NEGATIVE after using Dr.Anii herbal medicine for just 2weeks, thank God I’m now cured from this genital Herpes virus, 👀 you can as well contact Dr.Anii John and get your permanent healing

[@mahfa7513]

Thanks for your time to make this video great

[@geniusmedicose4792]

Truly champion sir God bless you for all visual and pupil pathway defects ❤❤❤❤❤ 🇵🇰😊

[@badarzaman2828]

Omg .... Thanks u so much PROFF.. for saving my energy on every time when i reach at this topic...

[@maltescharf5735]

absolutely great explanation, thank you

[@mrabs6651]

You taught this so clearly and very simply huhuhu thank you so much!

[@dresraaabdullah8380]

I wish my tutors were like you... medical school would be 4 years! thank you for sharing this. you have great talents👍🏼

[@kassiejohnston5314]

You are the best Andy! I am sharing this with all my students! -Kassie

[@blacktongs]

I love the energy, subscribed because of this video! Thanks Doc!

[@ikor117]

Insane clarity of explanation! Thank you!!

[@dalailama1922]

Thank you very much! medical student from Czechia

[@courageidahortv7840]

Excellent description!!! Thank you so much.

[@chayra7517]

You’re saving my life, Dr. Lee.

[@Absolue8]

Thank you so much, Dr Lee! You are such a great teacher !

[@divmehta66]

Beautifully explained ☺️ love from India! Please post more !

[@sammycrown5540]

My Hsv2 test results came out NEGATIVE after using Dr.Anii herbal medicine for just 2weeks, thank God I’m now cured from this genital Herpes virus, 👀 you can as well contact Dr.Anii John and get your permanent healing

[@dawnr7798]

I’m no where near the level of a physician but I do have formal medical training (primarily emergency medicine). Even I can understand this, which is a testament to excellent teaching skills. I have Adies tonic pupil so I’m just trying to understand this better.

[@johnpaulsaquing3182]

Thank you so much Dr. Lee!

[@TheAtheist22]

Amazing presentation. Thank you Dr Lee.

[@mysticajayamahaimaduwa6408]

wow such a clear nice explanation .Thanks

[@massagetherapyforinjuriesf8197]

I am learning more with this Master Teacher than any Doctor in English speaking..and we all love you Doctor…

[@sammycrown5540]

My Hsv2 test results came out NEGATIVE after using Dr.Anii herbal medicine for just 2weeks, thank God I’m now cured from this genital Herpes virus, 👀 you can as well contact Dr.Anii John and get your permanent healing

[@hasanelzend8052]

Excellent presentation thanks a lot

[@__Hatsuhinode]

Thanks for your help!👏 Best regards from Chile!

[@digvijaychavan319]

Thank you Dr Lee. Please keep on posting new videos

[@glitchmaster30]

Genius - thank you Dr Lee

[@nu.wa.n]

Dear god man, you are good at teaching this concept.

[@AestheticMEDICO]

Incredible Dr. Lee

[@umutkaradeniz2806]

Awesome explanation

[@Adi-oq5hj]

Thank you! Great explanation

[@enkhtsogtganbaatar5638]

thank you very much, that was super helpful to understand

[@rabehissa]

this man is a legend.

[@AH-tm9no]

Excellent explanation!! Thank you soo much!!!

[@abdullah-al-joha4007]

Thank you dr.lee for clearing concept

[@hjw14]

Great short lecture on RAPD!

[@marciaturley2565]

You are an amazing teacher!

[@muthuswamykannan912]

So good...clear. Easy to understand.. thanks a lot

[@kileerr1533]

Well explained, thanks so much !

[@dhakshimuhundhakumar4627]

Beautifully explained - thank you!

[@beehavika]

Gotta explain RAPD on friday :-( im nervous, thanku dr lee! Love from 🇮🇩

[@katem3113]

2:29 anyone else see a smiley face?

[@GEO-rm4wp]

Haha yea

[@nikitakhazov2403]

nice

[@jorgef005]

amazing explanation

[@jk50262]

this is amazing ! just make it so easy to understand RAPD! thanks you Dr. Lee

[@mattnstewart262]

this was really well explained, thank you!

[@anjali-pr5mz]

This was best explanation ❤❤

[@suramyajain6615]

Awesome explanation 🤩🤩🤩🤩

[@lillazyboi]

Would there also be a reduction in constriction when conducting a direct response in the APD eye ?

[@snussher]

Hey doc, this makes a lot of sense but I have 2 questions. 1: You say at 3:07 that "the direct response in the left eye is less than the consensual response in the right eye". I don't quite get this, both eyes aren't responding as well they should, and I would've thought that the direct response in the affected eye is equally as impaired as the consensual response in the unaffected eye 2: Also, I've heard that its mainly the nasal retina that contributes to the pupillary reflex, not the the temporal retina (something that was put in UWorld). When you said that you might not see a lesion because there may not be a "relative" compared to the other eye, what if we had a lesion at the optic chiasm? Both nasal retinal pathways sit here, so could we potentially not see an RAPD because we just knocked out both pathways equally? Similarly, if the nasal retina contributes more, and I I took out the left optic tract (which contains the right nasal retinal fibres), would I potentially see an RAPD but in the opposite eye?

[@Benzmusics9]

Both eyes are not defective since in the example dr. said that it is the “afferent” of the “left” eye which is defective. Consensual response means the efferent response of the opposite eye that receive the afferent input from the that eye (this is possible because there’s crossing of the pathway at midbrain as stated in the clip). And the direct response means the efferent response of that eye that also received the afferent input from that very same eye. In this way, the “right consensual response” should be normal since the reflex loop compose of right afferent and left efferent one (which is normal because every thing on the right is normal and the defective part of the left is afferent one, not the efferent). But the “left direct response” will show abnormal sign because in this reflex loop it composes of both afferent and efferent of left eye (and the left efferent part is abnormal). The key is that you have to know the afferent (input) and efferent (output or response) of these reflex loop and you have to specially acknowledge the bilateral property of the pathway (that is input on one side will produce response on both side).

[@ashishgautam7395]

i think he has mistaken totally ..may be tongue slip

[@allthingsincluded.2983]

I have the exact same 2 questions as you and, 3: If there's an efferent pupillary pathway defect and we shine light in defected eye say right (it obviuosly is fixed n dilated so won't respond) but will a consensual pupillary reflex/constriction be seen in left eye cuz afferent pathway is intact?

[@drmanikanthag6247]

Thank you Dr Lee, very nice explanation

[@nu.wa.n]

what a boss. beautifully explained.

[@1704putera]

this guy is good at explanations

[@mmgcrex4208]

Great video and explanation, thank you!! I wish I has tutor like you during my residency! :)

[@philltchigiya1229]

You are amazing! With love from Zimbabwe!

[@shaqayeqrudd7030]

Great explanation!

[@m.3809-i7l]

great explanation

[@jorgebrun6113]

what a great explanation!

[@nishanthaliyadipita9732]

Thank you very much for comprehensive explanation making it easy to understand. Can there be RAPD in complete damage to optic tract preserving the chiasm?( As nasal fibres cross to other side)

[@rirylee543]

It had sure became much easier ! Thank you so much

[@jr07toujoursj]

Glory to this man! thanks doc!

[@نورعبدالوهابمحمد]

so great explanation

[@DocAMoya]

You're the man

[@Mystichomey]

Omg... Sir is a gem❤❤❤

[@homeofneurologyandmedicalv7318]

Great lecture Wow

[@85musicmaniac]

Great explanation. Thank you

[@pinklavender1719]

Thank you for enlightening me!! Great job!

[@mangalleimamoirangthem7504]

This is too good. 💕💕💕