Abstract
Introduction. Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply. Objective. To examine the influence of chronic CAD on retinal blood flow, retinal morphology, and visual function. Methods. Patients with unilateral CAS ≥ 50% (ECST criteria) or CAO were grouped according to the grade of the stenosis and to the flow direction of the ophthalmic artery (OA). Retinal perfusion was measured by transorbital duplex ultrasound, assessing central retinal artery (CRA) blood flow velocities. In addition, optic nerve and optic nerve sheath diameter were measured. Optical coherence tomography (OCT) was performed to study retinal morphology. Visual function was assessed using high- and low-contrast visual paradigms. Results. Twenty-seven patients were enrolled. Eyes with CAS ≥ 80%/CAO and retrograde OA blood flow showed a significant reduction in CRA peak systolic velocity (no-CAD side: 0.130 ± 0.035 m/s, CAS/CAO side: 0.098 ± 0.028; p = 0.005; n = 12). OCT, optic nerve thicknesses, and visual functional parameters did not show a significant difference. Conclusion. Despite assessable hemodynamic effects, chronic high-grade CAD does not lead to gaugeable morphological or functional changes of the retina.
Highlights
Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply
This study confirms that chronic high-grade CAS/CAO in combination with a retrograde ophthalmic artery (OA) blood flow leads to a significant blood flow reduction in the ipsilateral central retinal artery (CRA)
Our data suggest that these hemodynamic changes without a clinically manifest pathology do not result in changes in ON thickness (ONSD and optic nerve diameter (OND)), the retinal morphology (RNFL thickness, total macular volume (TMV), ganglion cell and inner plexiform layer (GCIPL) volume, and optic nerve head volume (ONHV)), or functionality (HCVA, photopic and mesopic Low-contrast visual acuity (LCVA))
Summary
Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply. Ultrasound allows reliable dynamic assessment of orbital blood flow, measured as central retinal artery (CRA) flow velocity It can be used for structural analysis of optic nerve sheath diameter (ONSD) and is a proven diagnostic tool to evaluate papilledema in intracranial pressure with comparable results to MRI examinations [9]. Optical coherence tomography (OCT) allows reliable quantification of retinal layers and is able to detect retinal axonal and neuronal loss even in the absence of clinical visual symptoms in multiple sclerosis and other CNS diseases [10,11,12] In this pilot study, we analyze the effects of CADinduced chronic reduced retinal blood flow on optic nerve thickness and retinal morphology and function
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