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Clinical science
Resting nailfold capillary blood flow in primary open-angle glaucoma
  1. Clara C Cousins1,
  2. Jonathan C Chou1,
  3. Scott H Greenstein1,
  4. Stacey C Brauner1,
  5. Lucy Q Shen1,
  6. Angela V Turalba1,
  7. Patricia Houlihan1,
  8. Robert Ritch2,
  9. Janey L Wiggs1,
  10. Paul A Knepper3,
  11. Louis R Pasquale1,4
  1. 1 Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
  3. 3 Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  4. 4 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Louis R Pasquale, Massachusetts Eye and Ear, Boston MA 02114, USA; louis_pasquale{at}meei.harvard.edu

Abstract

Background/Aims An altered haemodynamic profile for various ocular posterior segment capillary beds has been documented in primary open-angle glaucoma (POAG). POAG may also involve abnormal non-ocular blood flow, and the nailfold capillaries, which are not affected by elevated intraocular pressure (IOP), are readily assessable.

Methods We measured resting nailfold capillary blood flow in 67 POAG and 63 control subjects using video capillaroscopy. Masked readers tracked blood column voids between consecutive, registered image sequence frames, measured vessel diameter and calculated blood flow. We used multiple logistic regression to investigate the relation between nailfold capillary blood flow and POAG. In secondary analyses, we stratified cases by maximum IOP and concurrent topical beta-blocker use.

Results Mean (±SD) blood flow in picolitres per second was 26.8±17.6 for POAG cases and 50.1±24.2 for controls (p<0.0001). After adjustment for demographic and clinical factors including blood pressure and pulse, every picolitre per second increase in resting nailfold blood flow was associated with a 6% (95% CI 0.92 to 0.96) reduced odds of POAG (p<0.0001). Similar relations between nailfold capillary blood flow and POAG were found for cases stratified by maximum known IOP and for cases stratified by concurrent topical beta-blocker use.

Conclusion Reduced resting nailfold capillary blood flow is present in POAG independent of covariates such as blood pressure, pulse and IOP.

  • nailfold video capillaroscopy
  • primary open-angle glaucoma
  • capillaries
  • blood flow

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

https://doi.org/10.1136/bjophthalmol-2018-311846

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    Footnotes

    • Presented at This work was submitted in part for the 2018 American Glaucoma Society Meeting in New York City.

    • Contributors All authors contributed to drafting this work or revising it critically for important intellectual content and provided approval for it to be published. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CCC, JCC, SHG, SCB, LQS, AVT, PH and LRP acquired the data. CCC, JCC, RR, JLW, PAK and LRP analysed the data. CCC, RR, JLW, PAK and LRP contributed to the conception and design of the work.

    • Funding This work was supported by the National Eye Institute (grant number EY 015473) and the Harvard Glaucoma Center of Excellence (no grant number).

    • Competing interests LRP is a consultant for Bausch+Lomb and is on the advisory board for Eyenovia. He has received an honorarium for an unrestricted CME event sponsored by Alcon. He has received travel support from The Glaucoma Foundation (New York, New York). LQS is a consultant for Genentech and has received research support from Topcon Research Foundation.

    • Patient consent Obtained.

    • Ethics approval The Massachusetts Institutional Review Board approved this study (approval no. 

      558105-28).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The raw data of nailfold capillary blood flow measurements are available upon request.

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