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
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.
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.
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
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.
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....
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
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.
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
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
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.
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
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
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
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?
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).
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?
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.
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)
Thanks for your fantastic explanation, but I don't agree with the idea that RAPD can not caused by cornea diseases or cataract. Opacities in refractive media, such as cornea，lens or vitreous body, can also lead to RAPD, I think. Likewise, we use the light filter in the front of eye to measure the grading of RAPD, which can optimize the RAPD.
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
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.
Wow.
Respect
What is the history, you checked for rapd, doctor
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.
Just super great mindes 🎉thx 4ur share
how are these videos even free, this is priceless teaching. Thank you Dr. Lee.
I literally wish you taught me neurology. The average ability for doctors to be good teachers is LOW. Thank you :)
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
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.
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....
lol true
I don't usually comment on videos but I must say this is excellent teaching!
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
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.
This is a brilliant explanation. I am fascinated with the ease and simplicity with which Dr. Lee explains complex neuro-ophthalmological problems.
Wow, amazing explanations.
I stopped searching for some kind of lesson about RAPD at the moment I found this one.
Thank you
Fantastic teaching! Your 1 video has probably helped countless number of students globally. Thank you Dr!
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
Amazing lecture, from an Optometrist in Boston, Ma. You are an ace.
Wow. After nearly 10 years in practice (GP), that's the best explanation of Marcus Gunn I have ever seen.
It's really clear and helpful concept explanation, your channel is really a youtube gem. thank you for teaching with such passion dr.Lee.
much respect from the UK Dr. Lee
what a great explanation! thanks so much, doc
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
Another brilliant video. Thank you.
You're such an amazing teacher Sir! Thank you so much for your efforts
Dr Lee. You're a total legend. Thank you
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.
The perfect opthalmology lectures
Y don't we have these kinda teachers in our college......!!!!🔥🔥🔥
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!
Thank you doctor for crystal clear explanation
I might actually pass my neuro exam thanks to you!
absolutely great explanation, thank you
This guy is brilliant. Thank you from a med student.
it's 2021 and i'm still watching this video. Never got what exactly RAPD is before until now. Thx Dr. Lee
Amazing teacher ! will definitely watch him more after my exams :)
This was world-class teaching mate, THANK YOU, you've cleared up something I've always struggled with 🙏
Great explanation
Omg .... Thanks u so much PROFF.. for saving my energy on every time when i reach at this topic...
Thanks Doctor. Lee, this explained RAPD so much better than my lecture did
You taught this so clearly and very simply huhuhu thank you so much!
Awesome explanation
Never heard such a beautiful description of RAPD. Thank you
I just love the way you explain ophthalmology ❤️❤️❤️
thank you very much Doc, your explanations are easy to understand
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
Insane clarity of explanation! Thank you!!
Thanks for your time to make this video great
Excellent presentation thanks a lot
Truly champion sir God bless you for all visual and pupil pathway defects ❤❤❤❤❤ 🇵🇰😊
wow such a clear nice explanation .Thanks
I love the energy, subscribed because of this video! Thanks Doc!
Excellent description!!! Thank you so much.
Thank you so much, Dr Lee! You are such a great teacher !
Genius - thank you Dr Lee
Thank you very much! medical student from Czechia
amazing explanation
I am learning more with this Master Teacher than any Doctor in English speaking..and we all love you Doctor…
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
You are an amazing teacher!
Thank you so much Dr. Lee!
I wish my tutors were like you... medical school would be 4 years! thank you for sharing this. you have great talents👍🏼
Beautifully explained ☺️ love from India! Please post more !
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
This was best explanation ❤❤
Amazing presentation. Thank you Dr Lee.
Great short lecture on RAPD!
Thank you! Great explanation
Dear god man, you are good at teaching this concept.
You are the best Andy! I am sharing this with all my students! -Kassie
Awesome explanation 🤩🤩🤩🤩
Excellent explanation!! Thank you soo much!!!
You’re saving my life, Dr. Lee.
Incredible Dr. Lee
So good...clear.
Easy to understand.. thanks a lot
thank you very much, that was super helpful to understand
great explanation
You're the man
Thank you dr.lee for clearing concept
Well explained, thanks so much !
Beautifully explained - thank you!
Thanks for your help!👏 Best regards from Chile!
Great lecture Wow
Great explanation!
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?
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).
i think he has mistaken totally ..may be tongue slip
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?
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.
this was really well explained, thank you!
what a boss. beautifully explained.
so great explanation
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)
Thank you Dr Lee. Please keep on posting new videos
Glory to this man! thanks doc!
what a great explanation!
this man is a legend.
It had sure became much easier ! Thank you so much
this is amazing ! just make it so easy to understand RAPD! thanks you Dr. Lee
amazing explanation Dr :D
Great explanation doc!!
this guy is good at explanations
Great video and explanation, thank you!! I wish I has tutor like you during my residency! :)
Great explanation. Thank you
very helpful! thank you
Omg... Sir is a gem❤❤❤
Dr Lee is so great at explaining all of this!!! Go Neuro-Oph!!!
Thank you for enlightening me!! Great job!
2:29 anyone else see a smiley face?
Haha yea
nice
Thanks for your fantastic explanation, but I don't agree with the idea that RAPD can not caused by cornea diseases or cataract. Opacities in refractive media, such as cornea，lens or vitreous body, can also lead to RAPD, I think. Likewise, we use the light filter in the front of eye to measure the grading of RAPD, which can optimize the RAPD.