Retinal Blood Velocity Research Articles

Retinal oxygen extraction and hyperemic response in patients with Type II diabetes at different stages of non‐proliferative diabetic retinopathy

Purpose: Diabetic retinopathy (DR) is a worldwide cause of irreversible vision loss. Vascular factors such as reduced oxygen supply and impaired neurovascular coupling play a major role in the development of DR. We therefore investigated retinal oxygen metabolism and functional hyperemia in patients with Type II diabetes at different stages of non‐proliferative DR and healthy controls.Methods: To study retinal oxygen metabolism, a total of 67 patients with Type II diabetes (34 patients with no, 15 with mild and 18 with moderate‐to‐severe DR) and 20 healthy controls were recruited. We used the oxygen module of a Retinal Vessel Analyzer to measure retinal oxygen saturation in arteries and veins, and a custom‐built Doppler optical coherence tomography (DOCT) system to assess total retinal blood flow (TRBF). Values of retinal oxygen saturation and TRBF were then used to calculate retinal oxygen extraction. To measure the hyperaemic response, 29 patients with no, 12 with mild, 15 with moderate‐to‐severe DR and 20 healthy controls were included. Retinal blood flow was assessed before and during visual stimulation by combined measurement of retinal vessel calibres and blood velocity using the Dynamic Vessel Analyzer (Imedos, Germany) and DOCT.Results: Retinal oxygen extraction was lowest in patients with moderate‐to‐severe DR (1.78 ± 0.57 μL O2/min, p = 0.040 vs. healthy controls), followed by mild DR (1.90 ± 0.77 μL O2/min), no DR (2.14 ± 0.6 μL O2/min) and healthy controls (2.24 ± 0.57 μL O2/min). Compared to healthy controls (40.4 ± 27.2%), flicker responses were significantly decreased in patients with DR depending on the stage of DR (no DR 37.7 ± 26.0%, mild DR 26.2 ± 28.2%, moderate‐to‐severe DR 22.3 ± 13.9%; p = 0.035, ANOVA).Conclusions: Our results indicate that retinal oxygen extraction as well as hyperaemic response decreases with increasing severity of DR. Further studies are needed to assess whether these retinal functional changes can be used to identify high‐risk patients.

Neuro-vascular coupling and heart rate variability in patients with type II diabetes at different stages of diabetic retinopathy.

There is evidence that diabetes is accompanied by a break-down of functional hyperemia, an intrinsic mechanism of neural tissues to adapt blood flow to changing metabolic demands. However, to what extent functional hyperemia is altered in different stages of diabetic retinopathy (DR) in patients with type II diabetes is largely unknown. The current study set out to investigate flicker-induced retinal blood flow changes in patients with type II diabetes at different stages of DR. A total of 76 subjects were included in the present parallel-group study, of which 56 had diabetes with either no DR or different stages of non-proliferative DR (n = 29 no DR, 12 mild DR, 15 moderate to severe DR). In addition, 20 healthy subjects were included as controls. Retinal blood flow was assessed before and during visual stimulation using a combined measurement of retinal vessel calibers and blood velocity by the means of Doppler optical coherence tomography (OCT). To measure systemic autonomic nervous system function, heart rate variability (HRV) was assessed using a short-term orthostatic challenge test. In healthy controls, retinal blood flow increased by 40.4 ± 27.2% during flicker stimulation. Flicker responses in patients with DR were significantly decreased depending on the stage of the disease (no DR 37.7 ± 26.0%, mild DR 26.2 ± 28.2%, moderate to severe DR 22.3 ± 13.9%; p = 0.035, ANOVA). When assessing systemic autonomous neural function using HRV, normalized low frequency (LF) spectral power showed a significantly different response to the orthostatic maneuver in diabetic patients compared to healthy controls (p < 0.001). Our study indicates that flicker induced hyperemia is reduced in patients with DR compared to healthy subjects. Further, this impairment is more pronounced with increasing severity of DR. Further studies are needed to elucidate mechanisms behind the reduced hyperemic response in patients with type II diabetes. [https://clinicaltrials.gov/], identifier [NCT03 552562].

Dual-beam delay-encoded all fiber Doppler optical coherence tomography for in vivo measurement of retinal blood flow

In this paper, we propose and demonstrate a dual-beam delay-encoded Doppler spectral domain optical coherence tomography (OCT) system for in vivo measurement of absolute retinal blood velocity and flow with arbitrary orientation. The incident beam is split by a beam displacer into two probe beams of the single-spectrometer spectral domain OCT system with orthogonal polarization states and an optical path length delay. We validate our approach with a phantom and in vivo experiments of human retinal blood flow, respectively.

Retinal Blood Velocity Waveform Characteristics With Aging and Arterial Stiffening in Hypertensive and Normotensive Subjects.

PurposeWe aimed to explore the velocity waveform characteristics of the retinal artery associated with age and the cardio-ankle vascular index (CAVI) as a conventional arterial stiffness marker by applying the Doppler optical coherence tomography (DOCT) flowmeter.MethodsIn this cross-sectional study, DOCT flowmeter imaging was performed in 66 participants aged 21 to 83 years (17 men, 49 women) with no history of eye diseases and no systemic diseases, except for hypertension. Retinal blood velocity waveform was analyzed where several parameters in time (upstroke time, T1, T2, T3, and T4) and area under the waveform (area elevation, area declination, A1, A2, A3, and A4) were extracted. Systolic blood pressure–adjusted Pearson's coefficients were calculated to determine the correlations of each parameter with age or CAVI.ResultsCorrected upstroke time (UTc) was the waveform parameter most positively correlated with age (r = 0.497, P < 0.001). Area declination was the waveform parameter most negatively correlated with age (r = −0.682, P < 0.001) and CAVI (r = −0.601, P < 0.001).ConclusionsWe extracted the waveform parameters associated with the risks of arterial stiffening. The velocity waveform analysis of the retinal artery with DOCT flowmeter potentially could become a new method for arterial stiffness identification.Translational RelevanceDOCT flowmeter could evaluate arterial stiffening in a different way from the conventional method of measuring arterial stiffening using pressure waveform. Because the DOCT flowmeter can easily, quickly, and noninvasively provide a retinal blood velocity waveform, this system could be useful as a routine medical examination for arterial stiffening.

MiR-874 ameliorates retinopathy in diabetic rats by NF-κB signaling pathway.

Increased activity of the NF-κB signaling pathway boosts the progression of retinopathy in diabetic rats. Using a bioinformatics website, we identified a site where miR-874 binds to the NF-κB p65. Therefore, we speculated that miR-874 might improve retinopathy in diabetic rats by inhibiting the NF-κB signaling pathway. Ten healthy rats were taken as the control group. Sixty streptozotocin (STZ; 60 mg/kg)-induced diabetes model rats were randomly divided into the model group (injection of normal saline), negative control (NC) agomir group (injection of NC mimic), miR-874 agomir group (injection of miR-874 mimic), miR-874 anti-agomir group (injection of miR-874 inhibitor), EVP4593 group (injection of NF-κB signaling pathway antagonist EVP4593), and miR-874 anti-agomir+EVP4593 group (injection of miR-874 inhibitor and EVP4593). All injections were administered into the caudal vein. miR-874 could target the degradation of p65. Compared with the control group, model rats had reduced miR-874 expression, increased vascular endothelial growth factor (VEGF) and Ang2 protein expression, lowered end-diastolic velocity (EDV) and peak systolic velocity (PSV) of the central retinal artery (CRA) and blood velocity of central retinal vein (CRV) and CRA, heightened plasma viscosity (PV), blood viscosity (BV) and erythrocyte sedimentation rate (ESR) at all shear rates, decreased capillary pericytes (IPCs), increased vascular endothelial cells (VECs), and ascended p65 expression in the retina (all p < 0.05). Thus, it was shown that pathological changes appeared in the retina of diabetic rats. These indices improved in diabetic rats injected with the miR-874 mimic or EVP4593, but deteriorated in those injected with miR-874 inhibitor (all p < 0.05). EVP4593 also could alleviate the aggravation of retinopathy that was caused by miR-874 inhibition in diabetic rats. miR-874 modulates the NF-κB signaling pathway by targeting the degradation of p65 to further improve the retina of diabetic rats, thus demonstrating the beneficial effect of miR-874 on diabetic retinopathy in rats.

Spaceflight not an eye-popping experience for astronauts.

Spaceflight not an eye-popping experience for astronauts.

Measurement of Retinal Microvascular Blood Velocity Using Erythrocyte Mediated Velocimetry

Changes in retinal blood flow may be involved in the pathogenesis of glaucoma and other ocular diseases. Erythrocyte mediated velocimetry (EMV) is a novel technique where indocyanine green (ICG) dye is sequestered in erythrocyte ghosts and autologously re-injected to allow direct visualization of erythrocytes for in vivo measurement of speed. The purpose of this study is to determine the mean erythrocyte speed in the retinal microvasculature, as well as the intravisit and intervisit variability of EMV. Data from 23 EMV sessions from control, glaucoma suspect, and glaucoma patients were included in this study. In arteries with an average diameter of 43.11 µm ± 6.62 µm, the mean speed was 7.17 mm/s ± 2.35 mm/s. In veins with an average diameter of 45.87 µm ± 12.04 µm, the mean speed was 6.05 mm/s ± 1.96 mm/s. Intravisit variability, as measured by the mean coefficient of variation, was 3.57% (range 0.44–9.68%). Intervisit variability was 4.85% (range 0.15–8.43%). EMV may represent reliable method for determination of retinal blood speed, potentially allowing insights into the effects of pharmacologic agents or pathogenesis of ocular diseases.

Retinal Blood Velocity and Flow in Early Diabetes and Diabetic Retinopathy Using Adaptive Optics Scanning Laser Ophthalmoscopy.

Using adaptive optics scanning laser ophthalmoscopy (AOSLO), we measured retinal blood velocity and flow in healthy control eyes and eyes of diabetic patients with or without retinopathy. This cross-sectional study included 39 eyes of 30 patients with diabetes (DM) with mild non-proliferative diabetic retinopathy (NPDR) or without retinopathy (DM no DR) and 21 eyes of 17 healthy age-matched controls. Participants were imaged with a commercial optical coherence tomography angiography (OCTA) device (RTVue-XR Avanti) and AOSLO device (Apaeros Retinal Imaging System, Boston Micromachines). We analyzed AOSLO-based retinal blood velocity and flow, and OCTA-based vessel density of the superficial (SCP), deep retinal capillary plexus (DCP), and full retina. Retinal blood velocity was significantly higher in eyes with DM no DR and lower in NPDR across all vessel diameters compared to controls. Retinal blood flow was significantly higher in DM no DR and lower in NPDR in vessel diameters up to 60 μm compared to controls. When comparing flow outliers (low-flow DM no DR eyes and high-flow NPDR eyes), we found they had a significantly different retinal vessel density compared to the remaining eyes in the respective groups. Retinal blood velocity and flow is increased in eyes with DM no DR, while these parameters are decreased in eyes with mild NPDR compared to healthy age-matched controls. The similarity of OCTA vessel density among outliers in the two diabetic groups suggests an initial increase followed by progressive decline in blood flow and OCTA vessel density with progression to clinical retinopathy, which warrants further investigation.

Retinal Arteriole Pulse Waveform Analysis Using a Fully-Automated Doppler Optical Coherence Tomography Flowmeter: a Pilot Study.

PurposeTo evaluate the repeatability and reproducibility of the measurement of retinal arteriole pulse waveforms using a novel fully-automated Doppler optical coherence tomography (DOCT) flowmeter in healthy subjects.MethodsTwenty eyes of 20 healthy subjects were included to test the intrasession repeatability of pulse waveform analysis. DOCT measurements were performed based on a newly developed instantaneous Doppler angle measurement method. Upstroke time (UT), which is the time from the minimum to the maximum retinal blood velocity, and the resistance index (RI) of the retinal arteriole pulse waveform were measured. Coefficients of variation (CVs) and intraclass correlation coefficients (ICCs) were calculated. Interdevice reproducibility between two instruments was assessed in five eyes of five subjects.ResultsThe mean UT was 130.3 ms (range, 110.1–152.1 ms), and the mean RI was 0.66 (range, 0.51–0.82). The respective ICCs of UT and the RI for the intrasession repeatability of assessment were 0.87 and 0.78. The respective CVs of UT and the RI were 6.6 ± 3.3% and 4.7 ± 2.1%. Regarding interdevice reproducibility, there were no significant differences between the measurements derived from the instruments (P > 0.05).ConclusionsPulse waveform measurement in retinal arterioles using a fully-automated DOCT flowmeter exhibited good repeatability and interdevice reproducibility.Translational RelevanceThe above-described improved DOCT flowmeter system provides reasonably repeatable measurements of retinal arteriole pulse waveforms, potentially facilitating systemic-circulation abnormality monitoring. The examination of the circulation with the novel device can be potentially useful for evaluating systemic circulation.

The effect of sildenafil on retinal blood velocity in healthy subjects

PurposeIt has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative disorders. The retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties, yet only the retinal circulation can be directly visualized. Therefore, our aim was to assess the change induced by Sildenafil on retinal blood velocity.MethodsRetinal flow velocity was measured 0.5, 3 and 6 h following administration of 100 mg of Sildenafil using the Retinal Function Imager.ResultsNo clinical change in either systemic blood pressure or retinal flow velocities were observed. However, when controlling for heart rate and blood pressure, a significant drop in venous flow velocity 6 h following treatment (mean drop 0.3 ± 0.07; 95% CI: 0.44–0.56, P = 0.023) was revealed.ConclusionsIn healthy volunteers, retinal venous flow velocity was significantly reduced at the 6-h time point following Sildenafil treatment. No effect was observed on arterial retinal flow velocity.

Changes in Retinal Microcirculation After Intravitreal Ranibizumab Injection in Eyes With Macular Edema Secondary to Branch Retinal Vein Occlusion.

To evaluate the effects of an intravitreal ranibizumab (IVR) injection on the retinal microcirculation of eyes with macular edema secondary to a branch retinal vein occlusion (BRVO). Twenty-six eyes of 26 patients with macular edema due to a BRVO that had received a single IVR injection (0.5 mg/0.05 mL) were studied. The retinal microcirculation was assessed by laser speckle flowgraphy (LSFG) using the mean blur rate (MBR) and relative flow volume (RFV). The size of the retinal arteries and veins surrounding the optic nerve head were measured separately. All of the examinations were made before, and at 1 week, and 1 and 2 months after the IVR. The visual acuity improved significantly, and the mean central macular thickness decreased significantly during the follow-up period (both P < 0.001). The mean MBRall and MBRtissue decreased significantly at 1 week and 1 month after the IVR (both P < 0.001). The total RFV of the arteries and veins decreased significantly at 1 week and 1 month after the IVR injection in the occluded and nonoccluded quadrants (all P < 0.001). The width of the arteries and veins in the LSFG images decreased significantly at 1 week and 1 month after the IVR injection (P < 0.001). An IVR injection leads to a transient vasoconstriction of the retinal arteries and veins and a reduction of the retinal blood flow and velocity in both the occluded and nonoccluded quadrants. The changes in retinal microcirculation might be related to the improvement of the macular edema and vision.

Non-invasive imaging of retinal blood flow in myeloproliferative neoplasms.

To study the circulation in the retinal vessels in patients with blood dyscrasia due to myeloproliferative neoplasms using non-invasive retinal imaging. Prospective consecutive case series of seven treatment-naïve patients with chronic myeloid leukaemia (n=2), polycythemia vera (n=4), essential thrombocytosis (n=1) examined before and after cytoreductive treatment. We investigated retinal circulation with motion-contrast imaging, retinal oximetry and spectral-domain optical coherence tomography. Retinal venous blood velocity increased by 8.14% (CI95 3.67% to 12.6%, p=0.004) and retinal arterial oxygen saturation increased by 7.23% (CI95 2.9% to 11.6%, p=0.010) at follow-up (mean 12weeks, range 5-14weeks) where complete haematological remission had been achieved by cytoreductive treatment. Abnormal optical coherence tomography reflectivity patterns were present at baseline in patients with chronic myeloid leukaemia and were replaced by normal patterns at follow-up. Retinopathy, in the form of cotton-wool spots and retinal haemorrhages, was found at presentation in the two patients with chronic myeloid leukaemia and in one patient with polycythemia vera. The retinopathy had resolved at follow-up in all patients. With non-invasive retinal imaging, we were able to demonstrate increased retinal venous blood velocity, increased retinal arterial blood oxygenation and normalization of intravascular reflectivity patterns after successful treatment of myeloproliferative neoplasms. Larger prospective studies are needed to assess the prognostic value of these non-invasive imaging methods in predicting circulatory complications in myeloproliferative neoplasms.

Label free measurement of retinal blood cell flux, velocity, hematocrit and capillary width in the living mouse eye.

Measuring blood cell dynamics within the capillaries of the living eye provides crucial information regarding the health of the microvascular network. To date, the study of single blood cell movement in this network has been obscured by optical aberrations, hindered by weak optical contrast, and often required injection of exogenous fluorescent dyes to perform measurements. Here we present a new strategy to non-invasively image single blood cells in the living mouse eye without contrast agents. Eye aberrations were corrected with an adaptive optics camera coupled with a fast, 15 kHz scanned beam orthogonal to a capillary of interest. Blood cells were imaged as they flowed past a near infrared imaging beam to which the eye is relatively insensitive. Optical contrast of cells was optimized using differential scatter of blood cells in the split-detector imaging configuration. Combined, these strategies provide label-free, non-invasive imaging of blood cells in the retina as they travel in single file in capillaries, enabling determination of cell flux, morphology, class, velocity, and rheology at the single cell level.

Compact Laser Doppler Flowmeter (LDF) Fundus Camera for the Assessment of Retinal Blood Perfusion in Small Animals.

PurposeNoninvasive techniques for ocular blood perfusion assessment are of crucial importance for exploring microvascular alterations related to systemic and ocular diseases. However, few techniques adapted to rodents are available and most are invasive or not specifically focused on the optic nerve head (ONH), choroid or retinal circulation. Here we present the results obtained with a new rodent-adapted compact fundus camera based on laser Doppler flowmetry (LDF).MethodsA confocal miniature flowmeter was fixed to a specially designed 3D rotating mechanical arm and adjusted on a rodent stereotaxic table in order to accurately point the laser beam at the retinal region of interest. The linearity of the LDF measurements was assessed using a rotating Teflon wheel and a flow of microspheres in a glass capillary. In vivo reproducibility was assessed in Wistar rats with repeated measurements (inter-session and inter-day) of retinal arteries and ONH blood velocity in six and ten rats, respectively. These parameters were also recorded during an acute intraocular pressure increase to 150 mmHg and after heart arrest (n = 5 rats).ResultsThe perfusion measurements showed perfect linearity between LDF velocity and Teflon wheel or microsphere speed. Intraclass correlation coefficients for retinal arteries and ONH velocity (0.82 and 0.86, respectively) indicated strong inter-session repeatability and stability. Inter-day reproducibility was good (0.79 and 0.7, respectively). Upon ocular blood flow cessation, the retinal artery velocity signal substantially decreased, whereas the ONH signal did not significantly vary, suggesting that it could mostly be attributed to tissue light scattering.ConclusionWe have demonstrated that, while not adapted for ONH blood perfusion assessment, this device allows pertinent, stable and repeatable measurements of retinal blood perfusion in rats.

Relationship Between Retinal Blood Flow and Serum Adiponectin Concentrations in Patients With Type 2 Diabetes Mellitus.

To study the relationship between retinal microcirculation and serum adiponectin, an important adipocytokine secreted by adipocytes, concentrations in patients with type 2 diabetes mellitus. Using a laser Doppler velocimetry system, we simultaneously measured the retinal blood flow (RBF) values and retinal vessel diameter and blood velocity in 64 consecutive Japanese patients (mean age ± SD, 59.8 ± 10.4 years) with type 2 diabetes with no or mild nonproliferative diabetic retinopathy. We compared the values with the RBF and serum adiponectin concentrations in these patients. The patients were divided into two groups based on sex (33 males, 31 females). The plasma adiponectin concentrations were correlated positively with the retinal vessel diameter (r = 0.480; P = 0.005), retinal blood velocity (r = 0.399; P = 0.02), and RBF (r = 0.518; P = 0.002) and correlated negatively with the retinal arterial vascular resistance (r = -0.598; P = 0.0002) in males, but not females, with type 2 diabetes with early-stage diabetic retinopathy. Multiple regression analysis showed that the plasma adiponectin level was independently and positively correlated with RBF and negatively correlated with retinal arterial vascular resistance. Our results indicated that a high concentration of serum adiponectin may be associated with increased RBF, probably via the increased blood velocity and dilated vessel diameter in males with type 2 diabetes with early-phase diabetic retinopathy.

Measurement of retinal blood flow in the rat by combining Doppler Fourier-domain optical coherence tomography with fundus imaging.

A wide variety of ocular diseases are associated with abnormalities in ocular circulation. As such, there is considerable interest in techniques for quantifying retinal blood flow, among which Doppler optical coherence tomography (OCT) may be the most promising. We present an approach to measure retinal blood flow in the rat using a new optical system that combines the measurement of blood flow velocities via Doppler Fourier-domain optical coherence tomography and the measurement of vessel diameters using a fundus camera-based technique. Relying on fundus images for extraction of retinal vessel diameters instead of OCT images improves the reliability of the technique. The system was operated with an 841-nm superluminescent diode and a charge-coupled device camera that could be operated at a line rate of 20 kHz. We show that the system is capable of quantifying the response of 100% oxygen breathing on the retinal blood flow. In six rats, we observed a decrease in retinal vessel diameters of 13.2% and a decrease in retinal blood velocity of 42.6%, leading to a decrease in retinal blood flow of 56.7%. Furthermore, in four rats, the response of retinal blood flow during stimulation with diffuse flicker light was assessed. Retinal vessel diameter and blood velocity increased by 3.4% and 28.1%, respectively, leading to a relative increase in blood flow of 36.2%. The presented technique shows much promise to quantify early changes in retinal blood flow during provocation with various stimuli in rodent models of ocular diseases in rats.

Regulation of retinal oxygen metabolism in humans during graded hypoxia.

Animal experiments indicate that the inner retina keeps its oxygen extraction constant despite systemic hypoxia. For the human retina no such data exist. In the present study we hypothesized that systemic hypoxia does not alter inner retinal oxygen extraction. To test this hypothesis we included 30 healthy male and female subjects aged between 18 and 35 years. All subjects were studied at baseline and during breathing 12% O₂ in 88% N₂ as well as breathing 15% O₂ in 85% N₂. Oxygen saturation in a retinal artery (SO₂art) and an adjacent retinal vein (SO₂vein) were measured using spectroscopic fundus reflectometry. Measurements of retinal venous blood velocity using bidirectional laser Doppler velocimetry and retinal venous diameters using a Retinal Vessel Analyzer (RVA) were combined to calculate retinal blood flow. Oxygen and carbon dioxide partial pressure were measured from earlobe arterialized capillary blood. Retinal blood flow was increased by 43.0 ± 23.2% (P < 0.001) and 30.0 ± 20.9% (P < 0.001) during 12% and 15% O₂ breathing, respectively. SO₂art as well as SO₂vein decreased during both 12% O₂ breathing (SO₂art: -11.2 ± 4.3%, P < 0.001; SO₂vein: -3.9 ± 8.5%, P = 0.012) and 15% O₂ breathing (SO₂art: -7.9 ± 3.6%, P < 0.001; SO₂vein: -4.0 ± 7.0%, P = 0.010). The arteriovenous oxygen difference decreased during both breathing periods (12% O2: -28.9 ± 18.7%; 15% O₂: -19.1 ± 16.7%, P < 0.001 each). Calculated oxygen extraction did, however, not change during our experiments (12% O₂: -2.8 ± 18.9%, P = 0.65; 15% O₂: 2.4 ± 15.8%, P = 0.26). Our results indicate that in healthy humans, oxygen extraction of the inner retina remains constant during systemic hypoxia.

Retinal oxygen metabolism during normoxia and hyperoxia in healthy subjects.

To characterize retinal metabolism during normoxia and hyperoxia in healthy subjects. Forty-six healthy subjects were included in the present study, and data of 41 subjects could be evaluated. Retinal vessel diameters, as well as oxygen saturation in arteries and veins, were measured using the Dynamic Vessel Analyzer. In addition, retinal venous blood velocity was measured using bidirectional laser Doppler velocimetry, retinal blood flow was calculated, and oxygen and carbon dioxide partial pressures were measured from arterialized capillary blood from the earlobe. Measurements were done during normoxia and during 100% oxygen breathing. Systemic hyperoxia caused a significant decrease in retinal venous diameter (-13.0% ± 4.5%) and arterial diameter (-12.1% ± 4.0%), in retinal blood velocity (-43.4% ± 7.7%), and in retinal blood flow (-57.0% ± 5.7%) (P < 0.001 for all). Oxygen saturation increased in retinal arteries (+4.4% ± 2.3%) and in retinal veins (+19.6% ± 6.2%), but the arteriovenous oxygen content difference significantly decreased (-29.4% ± 19.5%) (P < 0.001 for all). Blood oxygen tension in arterialized blood showed a pronounced increase from 90.2 ± 7.7 to 371.3 ± 92.7 mm Hg (P < 0.001). Calculated oxygen extraction in the eye decreased by as much as 62.5% ± 9.5% (P < 0.001). Our data are compatible with the hypothesis that during 100% oxygen breathing a large amount of oxygen, consumed by the inner retina, comes from the choroid, which is supported by previous animal data. Interpretation of oxygen saturation data in retinal arteries and veins without quantifying blood flow is difficult. (ClinicalTrials.gov number, NCT01692821.).

Visual field loss in optic disc drusen patients correlates with central retinal artery blood velocity patterns

(1) To characterize the retrobulbar circulation in patients with optic disc drusen (ODD) using colour Doppler imaging; (2) to explore the differences in retrobulbar hemodynamics in patients with primary open-angle glaucoma (POAG). Retrospective analysis using three diagnostic groups: patients with ODD, age-matched healthy controls and age- and visual defect-matched patients with POAG. Subjects with history of ocular trauma or ocular diseases including vascular-related diseases were excluded. Kruskal-Wallis and Spearman's correlation tests were performed to compare and explore the correlations between the hemodynamic parameters and visual field damage. Sixty patients were included and equally divided between the three groups. Patients with ODD had lower systolic and diastolic flow velocities in the central retinal artery (CRA) when compared to healthy individuals, but no difference was found with the glaucoma group (p<0.005 versus healthy; p range 0.30-0.37 versus POAG). The systolic shift in flow patterns correlated with the extent of visual field defect in ODD patients (p<0.001, r=-0.78, confidence interval: -0.43 to -0.92), but not in POAG (p=0.73). Short ciliary arteries from ODD patients had lower mean systolic flow velocities when compared to both healthy individuals and patients with POAG (p<0.01 versus healthy; p≤0.04 versus POAG). The ophthalmic artery in ODD group had significantly higher mean blood velocities than in the POAG (p=0.04), while showing a significant overlap in Doppler waveform variables to the control group (p range 0.08-0.97). Similar to patients with glaucoma, individuals with ODD have low blood flow velocities in the vessels around the optic nerve head. Unlike patients with glaucoma, however, their CRA's blood flow velocity patterns correlate with the extent of the visual field defects.

Absolute Retinal Blood Flow Measurement With a Dual-Beam Doppler Optical Coherence Tomography

To test the capability of a novel dual-beam Doppler optical coherence tomography (OCT) technique for simultaneous in vivo measurement of the Doppler angle and, thus, the absolute retinal blood velocity and the retinal flow rate, without the influence of motion artifacts. A novel dual-beam Doppler spectral domain OCT (SD-OCT) was developed. The two probing beams are separated with a controllable distance along an arbitrary direction, both of which are controlled by two independent 2D optical scanners. Two sets of optical Doppler tomography (ODT) images are acquired simultaneously. The Doppler angle of each blood vessel segment is calculated from the relative coordinates of the centers of the blood vessel in the two corresponding ODT images. The absolute blood flow velocity and the volumetric blood flow rate can then be calculated. To measure the total retinal blood flow, we used a circular scan pattern centered at the optic disc to obtain two sets of concentric OCT/ODT images simultaneously. We imaged two normal human subjects at ages of 48 and 34 years. The total retinal blood flow rates of the two human subjects were calculated to be 47.01 μL/min (older subject) and 51.37 μL/min (younger subject), respectively. Results showed that the performance of this imaging system is immune to eye movement, since the two sets of ODT images were acquired simultaneously. The dual-beam OCT/ODT system is successful in measuring the absolute retinal blood velocity and the volumetric flow rate. The advantage of the technique is that the two sets of ODT images used for the calculation are acquired simultaneously, which eliminates the influence of eye motion and ensures the accuracy of the calculated hemodynamic parameters.