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Practise pupil size assessment, direct and consensual responses, the swinging flashlight test and RAPD recognition.
Compare pupil size and shape in ambient light and, when relevant, in light and dark conditions. Anisocoria by itself does not diagnose an RAPD.
When one eye is illuminated, observe the direct constriction of that pupil and the consensual constriction of the fellow pupil. Compare the responses when each eye is illuminated separately.
Move the light promptly back and forth between the two eyes while watching both pupils. Normally, the degree of constriction remains similar as illumination alternates.
When one eye has weaker afferent input, moving the light from the better eye to the affected eye produces relative dilation of both pupils instead of maintaining constriction.
A pupil may be fixed or poorly reactive because of an efferent defect, yet afferent asymmetry can still be assessed by observing the fellow reactive pupil. Watch both pupils rather than relying on one pupil's size alone.
RAPD is a relative sign of asymmetric afferent input and does not usually create anisocoria by itself. This simulator is for training only.