Elsevier

Experimental Eye Research

Volume 61, Issue 3, September 1995, Pages 259-272
Experimental Eye Research

The 1994 von sallman lecture the optic nerve head circulation in health and disease

https://doi.org/10.1016/S0014-4835(05)80121-6Get rights and content

This is a brief overview of multifaceted anatomical, experimental and clinical studies conducted by the author since 1955 on the optic nerve head circulation in health and disease. Conclusions, based on the accumulated information provided by these studies, are summarized. The studies on the pattern of blood supply of the optic nerve head have shown that: (a) its main source of blood supply is the posterior ciliary artery circulation, with retinal circulation supplying only the surface nerve fiber layer, (b) there is marked interindividual variation in the blood supply pattern, and (c) the blood supply in the optic nerve head has a sectoral distribution. The various factors which produce interindividual variation in the blood supply of the optic nerve head are discussed, particularly those in the posterior ciliary artery circulation; this is because all available evidence indicates that it is derangement in the posterior ciliary circulation in the optic nerve head that is primarily responsible for the common ischemic disorders of the optic nerve head, e.g. anterior ischemic optic neuropathy and glaucomatous optic neuropathy. Factors that may derange the blood flow in the optic nerve head include defective autoregulation of blood flow in it, vascular changes in its feeding arteries, hematologic abnormalities, systemic arterial hypertension and hypotension, and intraocular pressure; their roles are discussed. For better understanding and management of optic nerve head ischemic disorders, there is an urgent need for an accurate clinical method of assessment of blood flow in the posterior ciliary circulation in optic nerve head, since no satisfactory method is currently available. Redness or pallor of the optic disk on ophthalmoscopy is not a true guide to the optic nerve head vascularity as it gives no information about the state of the posterior ciliary circulation. Fluorescein fundus angiography, though far superior to the optic disk color for evaluation of optic nerve head vascularity, has a number of limitations. All these topics and various controversies about them are discussed briefly.

References (97)

  • HenkindP. et al.

    Angioarchitecture of the optic nerve—I The papilla

    Am. J. Ophthalmol.

    (1969)
  • LevitzkyM. et al.

    Angioarchitecture of the optic nerve—II. Lamina cribrosa

    Am. J. Ophthalmol.

    (1969)
  • SwietliczkoI. et al.

    Fluorescein angiography in experimental ocular hypertension

    Am J. Ophthalmol.

    (1970)
  • TheodossiadisG.P.

    Uber die Vaskularisation in der Regio praelaminaris der Papilla Optica

    Klin. Monatsbl. Augenheilkd.

    (1971)
  • AndersonD.R.

    Autoregulation in glaucoma

  • ArakiM.

    Anatomical study of the vascularization of the optic nerve

    Nippon Ganka Gakkai Zasshi

    (1975)
  • ArakiM.

    The role of blood circulation of prelaminar capillaries in producing glaucomatous cupping

    Nippon Ganka Gakkai Zasshi

    (1976)
  • ArakiM. et al.

    The collateral communications of the retinal circulation with the choroidal circulation at the optic nerve head

    Nippon Ganka Gakkai Zasshi

    (1973)
  • DucournauD.

    Systematisation vasculaire de la choroide

  • ErnestJ.T.

    Autoregulation of optic-disk oxygen tension

    Invest. Ophthalmol.

    (1974)
  • ErnestJ.T.

    Pathogenesis of glaucomatous optic nerve disease

    Trans. Am. Ophthalmol. Soc.

    (1975)
  • EvansP. et al.

    Fluorescein cineangiography of the optic nerve head

    Trans. Am. Acad. Ophthalmol. Otolaryngol.

    (1973)
  • FarnettL. et al.

    The J-curve phenomenon and the treatment of hypertension: is there a point beyond which pressure reduction is dangerous?

    JAMA

    (1991)
  • FrancoisJ.

    Vascularization of the optic nerve

    Arch. Ophthalmol.

    (1977)
  • FrancoisJ. et al.

    Microcirculation of the anterior part of the optic nerve

    Ophthalmologica

    (1977)
  • FrancoisJ. et al.

    The blood supply of the optic nerve

    Adv. Ophthalmol.

    (1978)
  • FrancoisJ. et al.

    A functional importance of central retinal artery anastomoses in the anterior part of the optic nerve

    Ophthalmologica

    (1982)
  • FrancoisJ. et al.

    Vascularization of the optic pathway. I. Lamina cribrosa and optic nerve

    Br. J. Ophthalmol.

    (1954)
  • FrancoisJ. et al.

    Vascularization of the optic pathway. III. Study of intra-orbital and intra-cranial optic nerve by serial sections

    Br. J. Ophthalmol.

    (1956)
  • FrancoisJ. et al.

    Vascular supply of the optic pathway. II. Further studies by micro-arteriography of the optic nerve

    Br. J. Ophthalmol.

    (1955)
  • FryczkowskiA.W. et al.

    Scanning electron microscopy of vascular casts of the human scleral lamina cribrosa

    Int. Ophthalmol.

    (1984)
  • GeijerC. et al.

    Effects of raised intraocular pressure on retinal prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys

    Invest. Ophthalmol. Vis. Sci.

    (1979)
  • GiuffreG.

    Main posterior watershed zone of the choroid

    Doc. Ophthalmol.

    (1989)
  • HayrehS.S.

    A study of the central artery of the retina in human beings. Thesis for the Master of Surgery

    (1958)
  • HayrehS.S.

    The ophthalmic artery. III. Branches

    Br. J. Ophthalmol.

    (1962)
  • HayrehS.S.

    The central artery of the retina—its role in the blood supply of the optic nerve

    Br. J. Ophthalmol.

    (1963)
  • HayrehS.S.

    Blood supply and vascular disorders of the optic nerve

    Anal. Inst. Barraquer

    (1963)
  • HayrehS.S.

    Blood supply of the optic nerve head and its role in optic atrophy, glaucoma and oedema of the optic disc

    Br. J. Ophthalmol.

    (1969)
  • HayrehS.S.

    Pathogenesis of visual field defects—role of the ciliary circulation

    Br. J. Ophthalmol.

    (1970)
  • HayrehS.S.

    Optic disc changes in glaucoma

    Br. J. Ophthalmol.

    (1972)
  • HayrehS.S.

    Colour and fluorescence of the optic disc

    Ophthalmologica

    (1972)
  • HayrehS.S.

    Anterior ischaemic optic neuropathy—I. Terminology and pathogenesis

    Br. J. Ophthalmol.

    (1974)
  • HayrehS.S.

    Anterior ischaemic optic neuropathy—II. Fundus on ophthalmoscopy and fluorescein angiography

    Br. J. Ophthalmol.

    (1974)
  • HayrehS.S.

    The choriocapillaris

    Graefes Arch. Clin. Exp. Ophthalmol.

    (1974)
  • HayrehS.S.

    Submacular choroidal vascular pattern—experimental fluorescein fundus angiographic studies

    Graefes Arch. Clin. Exp. Ophthalmol.

    (1974)
  • HayrehS.S.

    The long posterior ciliary arteries—an experimental study

    Graefes Arch. Clin. Exp. Ophthalmol.

    (1974)
  • HayrehS.S.

    Anatomy and physiology of the optic nerve head

    Trans. Am. Acad. Ophthalmol. Otolaryngol.

    (1974)
  • HayrehS.S.

    Segmental nature of the choroidal vasculature

    Br. J. Ophthalmol.

    (1975)
  • Cited by (181)

    View all citing articles on Scopus
    View full text