Original article
Assessment of optic disk blood flow in patients with open-angle glaucoma

https://doi.org/10.1016/S0002-9394(00)00636-XGet rights and content

Abstract

PURPOSE: To characterize optic disk blood flow in patients with open-angle glaucoma compared with age-matched healthy control subjects.

METHODS: In this prospective cross-sectional study, 90 eyes of 90 patients with open-angle glaucoma and 61 eyes of 61 age-matched healthy control subjects were evaluated. Flow in the optic disk cup and the neuroretinal rim were assessed with scanning laser Doppler flowmetry. Fundus pulsation amplitude in the cup and the macula were assessed with laser interferometry. Visual field mean deviation was measured with the Humphrey 30 to 2 program.

RESULTS: Flow in the neuroretinal rim (−18%, P = .002), and in the cup (−46%, P < .001) and fundus pulsation amplitude in the cup (−33%, P < .001) and in the macula (−24%, P < .001) were significantly lower in patients with open-angle glaucoma compared with healthy control subjects. A significant association between blood flow measurements in the cup and fundus pulsation amplitudes in the cup was observed in both study cohorts. A significant association was also observed between the mean defect from visual field testing and ocular hemodynamic parameters.

CONCLUSIONS: Reduced optic disk perfusion in patients with open-angle glaucoma is evidenced from two independent methods in the present study. Moreover, our data indicate that reduced ocular blood flow in these patients is linked to visual field changes. It remains to be established whether compromised optic disk and choroidal blood flow contributes to optic disk damage in glaucomatous eyes or is a secondary functional phenomenon.

Section snippets

Methods

In a prospective cross-sectional study, 90 eyes of 90 patients with open-angle glaucoma were studied. Open-angle glaucoma was diagnosed as the presence of optic disk damage and visual field defects and a history of untreated intraocular pressure of more than 21 mm Hg, as evidenced from at least three independent measurements. Exclusion criteria were diabetes mellitus, age-related macular degeneration, and untreated systemic hypertension defined as systolic blood pressure greater than 170 mm Hg

Results

There were no significant differences in age, gender, or systemic hemodynamics between the two study groups (Table 1). Intraocular pressure was higher in patients with glaucoma than in healthy control subjects.

Using scanning laser Doppler flowmetry in patients with open-angle glaucoma, 55 (61%) and 53 (59%) blood flow readings with a coefficient of variation of less than 20% were obtained at the neuroretinal rim and the cup, respectively. In healthy control subjects, 37 measurements (61%)

Discussion

The present study confirms previous reports that optic disk perfusion is significantly reduced in patients with primary open-angle glaucoma.6, 9, 10 It extends these findings in so far that optic disk perfusion abnormalities were observed with two independent techniques, namely scanning laser Doppler flowmetry and topical fundus pulsation measurement. In addition, the present study is the first to establish a relationship between pulsatile blood flow in the optic disk and microvascular flow in

References (35)

  • S.M Drance

    Glaucomaa look beyond intraocular pressure

    Am J Ophthalmol

    (1997)
  • Z Butt et al.

    Color Doppler imaging in untreated high- and normal-pressure open-angle glaucoma

    Invest Ophthalmol Vis Sci

    (1997)
  • H.F Duijm et al.

    A comparison of retinal and choroidal hemodynamics in patients with primary open-angle glaucoma and normal-pressure glaucoma

    Am J Ophthalmol

    (1997)
  • J.E Grunwald et al.

    Optic nerve and choroidal circulation in glaucoma

    Invest Ophthalmol Vis Sci

    (1998)
  • G Michelson et al.

    Perfusion of the juxtapapillary retina and the neuroretinal rim area in primary open angle glaucoma

    J Glaucoma

    (1996)
  • L Schmetterer et al.

    Diabetic retinopathy and associated functional alterations in diabetic retinopathy

    Diabetologia

    (1999)
  • L Schmetterer et al.

    Topical measurement of fundus pulsations

    Opt Eng

    (1995)
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