Abstract
PurposeTo study the relationship between amplitude of spontaneous retinal venous pulsatility (SRVP) and retinal nerve fibre layer (RNFL) thickness in glaucomatous eyes, and to determine if this parameter may be a potential marker for glaucoma severity.Method85 subjects including 50 glaucoma (21 males, 67±10 yrs) and 35 normals (16 males, 62±11 yrs) were studied. SRVP amplitude was measured using the Dynamic Vessel Analyser (DVA, Imedos, Germany) at four regions of the retina simultaneously within one disc diameter from the optic disc—temporal-superior (TS), nasal-superior (NS), temporal-inferior (TI) and nasal-inferior (NI)). This was followed by RNFL thickness measurement using spectral domain optical coherence tomography (Spectralis OCT). The correlation between SRVP amplitude and corresponding sectoral RNFL thickness was assessed by means of non-linear regression (i.e. logarithmic). Linear regression was also applied and slopes were compared using analysis of covariance (ANCOVA).ResultsGreater SRVP amplitude was associated with thicker RNFL. Global SRVP amplitude was significantly lower in glaucoma eyes compared with normals (p<0.0001). The correlation coefficient of the linear regression between RNFL and SRVP at TS, NS, TI and NI quadrants in the glaucoma group were r = 0.5, 0.5, 0.48, 0.62. Mean SRVP amplitude and RNFL thickness for TS, NS, TI and NI quadrants were 4.3±1.5, 3.5±1.3, 4.7±1.6, 3.1±1 μm and 96±30, 75±22, 89±35 and 88±30 μm, respectively. The ANCOVA test showed that the slope of linear regression between the four quadrants was not significant (p>0.05). Since the slopes are not significantly different, it is possible to calculate one slope for all the data. The pooled slope equals 10.8 (i.e. RNFL = 10.8SRVP+41).ConclusionWhile SRVP was present and measurable in all individuals, the amplitude of SRVP is reduced in glaucoma with increasing RNFL loss. Our findings suggest the degree of SRVP may be an additional marker for glaucoma severity. Further studies are needed to determine the mechanism of reduction in SRVP, and whether changes can predict increased risk of progression.
Highlights
Spontaneous retinal venous pulsations (SRVP) result from an interaction between intraocular pressure (IOP), retinal venous pressure (RVP) and cerebrospinal fluid pressure (CSFp)
Greater SRVP amplitude was associated with thicker retinal nerve fibre layer (RNFL)
Global SRVP amplitude was significantly lower in glaucoma eyes compared with normals (p
Summary
Spontaneous retinal venous pulsations (SRVP) result from an interaction between intraocular pressure (IOP), retinal venous pressure (RVP) and cerebrospinal fluid pressure (CSFp). The threshold IOP at which vein pulsation is visible, is increased in more advanced stages of glaucoma. This suggests an alteration in pulsation properties is occurring during the development of glaucoma. Glaucoma is known to be strongly associated with optic nerve haemorrhage[10] and central retinal vein occlusion[11] suggesting a potential vascular relationship. This relationship is a complex one, and as yet the factors defining the generation of SRVPs have not been determined, nor has their relevance to glaucoma pathogenesis
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