Correlation between finger blood flow and changes in optic nerve head blood flow following therapeutic intraocular pressure reduction

PURPOSE: To correlate finger blood flow and changes in optic nerve head (ONH) blood flow following therapeutic intraocular pressure (IOP) reduction in open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: Seventeen open-angle glaucoma patients and nineteen ocular hypertension patients underwent therapeutic IOP reduction followed by a minimum of 4 weeks of follow-up. Optic nerve head blood flow measurements were obtained by scanning laser Doppler flowmetry using full-field perfusion image analysis. Finger blood flow was measured using the Transonic laser Doppler Flowmeter. Finger blood flow was measured at baseline, after immersion in warm water (40 degrees C) for 2 minutes (Flow Max), and after immersion in cold water (4 degrees C) for 10 seconds (Flow Min). Patients were identified as vasospastic if their Flow Max/Flow Min >7. Statistical comparisons were performed using two-tailed distribution paired T-test and Pearson's correlation factor. RESULTS: For similar mean percentage intraocular pressure reduction, vasospastic patients had greater improvements in rim blood flow than did non-vasospastic patients [+35% versus +13%] (P = 0.01). While there was no difference in rim blood flow changes in the vasospastic versus the non-vasospastic OAG group, the vasospastic ocular hypertension group showed 18% increase in rim blood flow whereas the non-vasospastic ocular hypertension group showed an 8% decrease. A significant negative correlation was also found in the open-angle glaucoma group between rim blood flow change and Flow Max (-0.681, P = 0.003). In contrast, no such correlation was found in the ocular hypertension group (+0.144, P = 0.556). CONCLUSION: OAG patients had a significant negative correlation between changes in rim blood flow and maximum finger Doppler flow. Among ocular hypertension patients, increased rim blood flow was only found in the vasospastic group, though this increase was not statistically significant. These results suggest that open-angle glaucoma and ocular hypertension patients with the most severe vasospastic disease may show the greatest improvements in rim blood flow after sustained intraocular pressure reduction.     

青光眼视网膜血氧饱和度与结构功能损害程度的相关分析

目的比较青光眼与正常人视网膜血氧饱和度的差异,分析青光眼患者中视网膜血氧饱和度与结构功能损害程度的相关性。方法病例对照研究。选取原发性开角型青光眼患者28例（35眼）为青光眼组,记录患者年龄、性别、眼压、血压、杯盘比,并进行中心30°阈值视野检测和光学相干断层扫描（OCT）检测视乳头旁视网膜神经纤维层（RNFL）厚度,并纳入27例（41眼）正常人作为对照组,采用视网膜血氧饱和度分析仪测量青光眼患者和正常人视网膜血管血氧饱和度。2组动静脉血氧饱和度差异比较采用独立样本t检验。采用Pearson或Spearman秩相关分析对青光眼组视网膜血氧饱和度与年龄、眼压、血压、杯盘比、视野平均缺损（MD）、视野指数（VFI）、视乳头旁RNFL厚度进行相关分析。结果青光眼组与正常对照组的视网膜动脉血氧饱和度差异无统计学意义,青光眼组静脉血氧饱和度较对照组高（t=4.017,P＜0.001）,动静脉血氧饱和度差值较小（t=-4.431,P＜0.001）。青光眼组视网膜动脉血氧饱和度、静脉血氧饱和度、动静脉血氧饱和度差值与年龄、眼压、血压均无线性相关性。视网膜动脉血氧饱和度与杯盘比、视野MD、VFI、视乳头旁RNFL厚度等均无线性相关。视网膜静脉血氧饱和度与杯盘比、视野MD值呈正相关（杯盘比：r=0.418,P=0.012;视野MD：r=0.504,P=0.002）,与RNFL厚度、VFI呈负相关（RNFL：r=-0.514,P=0.002;VFI：r=-0.470,P=0.004）。视网膜动静脉血氧饱和度差值与杯盘比、视野MD均呈负相关（杯盘比：r=-0.390,P=0.021;视野MD：r=-0.478,P=0.004）,与VFI、视乳头旁RNFL厚度呈正相关（VFI：r=0.449,P=0.007;RNFL：r=0.385,P=0.022）。结论随着青光眼加重,静脉血氧饱和度增加,动静脉血氧饱和度差值降低。青光眼患者视网膜耗氧量降低可能与视网膜神经组织萎缩有关。     

Blood flow in the peripapillary retina in exfoliation glaucoma

Purpose: The aim of this article is to study peripapillary retinal blood flow in patients with progressive and stable exfoliation glaucoma (ExG). Methods: Fifty‐eight eyes with ExG were included; 25 of them had progressive and 33 stable glaucoma. Retinal blood flow in the peripapillary retina was measured with scanning laser Doppler flowmetry. Acquired flow maps were analysed with the automatic full‐field perfusion image analyser. Multiple logistic regression was used to model progression of glaucoma. Results: Mean retinal flow (MF; correlation coefficient, P‐value; R = 0.36, P = 0.006) and retinal minimum diastolic flow (R = 0.33, P = 0.011) were positively correlated with visual field mean defect (MD). Factors associated with progressive glaucoma were mean intraocular pressure (OR = 1.198 for each mmHg; P = 0.050) and visual field MD (OR = 1.134 for each dB; P = 0.013). Age (P = 0.35), MF (P = 0.58), or presence of cardiovascular disease (P = 0.17) were not associated with glaucoma progression. Conclusion: No difference in peripapillary retinal blood flow between progressive and stable ExG could be found.     

臂间收缩压差对原发性青光眼视野进展的影响

目的：探讨臂间收缩压差（IASBPD）对眼压已控制的原发性青光眼患者视野损害进展的影响。方法： 前瞻性临床研究。选择2013年8月至2018年11月就诊于长沙爱尔眼科医院的原发性青光眼患者69例 （69眼）,均行5次以上视野检查。根据Humphrey视野计的青光眼进展引导分析（GPA）结果分为视野 进展组和视野无进展组,对所有受检者进行多次双臂序贯血压测量。采用两独立样本t检验、Fisher's 精确概率法及Logistic回归进行数据分析。结果：最终纳入患者34例（34眼）,其中视野进展组15例 （15眼）,无进展组19例（19眼）,2组的IASBPD分别为（10.6±9.0）mmHg（1 mmHg=0.133 kPa）、 （5.3±2.8）mmHg,视野进展组较无进展组高5.26 mmHg（95%可信区间为0.14～10.37 mmHg）,差 异有统计学意义（t=-2.177,P=0.045）。2组间脉压差、平均动脉压、舒张期眼灌注压差异均无统 计学意义（t=0.946、-1.118、-1.967,P>0.05）。Logistic回归分析结果显示IASBPD≥10 mmHg 是视野进展的一个危险因素（OR=20.310,P=0.022）。将患者分为IASBPD<10 mmHg组（26眼）和 IASBPD≥10 mmHg组（8眼）,2组的视野进展率分别为30.8%和87.5%,2组的视网膜神经纤维层厚 度进展率分别为42.3%和87.5%,差异均具有统计学意义（P=0.011、0.030）。结论：IASBPD增大可能 是眼压已控制的原发性青光眼患者视野进展的危险因素之一。     

Evaluating pulsatile ocular blood flow analysis in normal and treated glaucomatous eyes

PURPOSE: To evaluate pulsatile ocular blood flow (POBF) analysis in normal subjects and glaucoma patients by comparison of POBF measurements with functional (as determined by visual field [VF]) and structural (as determined by optical coherence tomography [OCT]) measures. DESIGN: Prospective, cross-sectional study. METHODS: Forty-one eyes of 24 consecutive glaucoma patients and 20 eyes of 10 healthy subjects were studied; POBF analysis was performed on all subjects at the same visit as VF testing and OCT retinal nerve fiber layer (NFL) thickness measurement. The mean results of normal and glaucomatous eyes were compared for each method. Correlation between measurements obtained with each modality and the discriminating power using receiver operator characteristic curves was tested. RESULTS: The mean POBF (standard deviation [SD]) in the normal group was 1,010.4 (292.8) microl/min and 989.3 (305.5) microl/min in the glaucoma group (P =.90). Significant differences between groups were found for VF mean deviation and pattern standard deviation (P =.02, P =.004, respectively) and OCT mean NFL thickness (P <.0001). No correlation was found between POBF parameters and intraocular pressure, VF, or OCT variables except for intraocular pressure in glaucoma group (r = -.43, P =.003). The area under the receiver operator characteristic curves was higher for VF indexes and OCT mean NFL thickness than POBF parameters for distinguishing between normal and glaucomatous eyes. CONCLUSIONS: The wide range of normal values and the low discriminating power of POBF between normal and glaucomatous eyes limits the clinical use of the device for glaucoma patients.     

Difference of optic disc topography between a low-tension group and a high-tension group in normal-tension glaucoma patients

PURPOSE: Glaucomatous visual field loss and optic disc damage differ by intraocular pressure (IOP) levels. In this study, we compared the optic disc topography in the high-tension group and the low-tension group in normal-tension glaucoma (NTG). METHOD: We selected NTG patients with mean deviation (MD) > or = -10.00 dB and the highest recorded IOP of < 14 mmHg or > or = 17 mmHg without glaucoma treatment. We classified NTG eyes into the following two groups: 1) a low-tension group with the highest recorded IOP of < 14 mmHg, 2) a high-tension group with the highest recorded IOP of > or = 17 mmHg. The optic disc parameters in the low-tension group eyes were compared with those in the high-tension group eyes using a Heidelberg Retina Tomograph. RESULTS: Nineteen eyes of nineteen patients were selected for each group. The cup/disc area ratio in the global sector, and the rim volume in the nasal sector of the low-tension group had deteriorated more than in the high-tension group. CONCLUSIONS: The disc topography is different between the low-tension group and the high-tension group in the nasal sector, suggesting that different pathogenetic mechanisms exist in the optic disc damage in NTG.     

夜间血压下降对开角型青光眼视神经损伤的影响

目的：探讨夜间血压下降与开角型青光眼和正常眼压性青光眼患者视神经损伤进展的关系。

方法：对我院眼科门诊确诊的开角型青光眼和正常眼压性青光眼患者51例51眼分别进行视野、OCT检查,进行平均视神经纤维层厚度、24h动态血压监测、24h眼压监测等检查,分析夜间血压过度下降与视野进展率的关系。

结果：根据夜间血压下降值(dip)进行分组,三组间有显著性差异的数值为平均缺损(MD)差值(P=0.032)、眼压峰值(P=0.003)、视野缺损计分差值(P=0.041)。在视野缺损进展组、视野缺损改善组、视野缺损不变组间,dip有显著性差异(P=0.028)。视野缺损进展组夜间血压下降值明显高于其他两组。夜间血压过度降低组视野缺损进展率明显高于不过度降低组(视野缺损进展率分别为50%,7%)。影响视神经纤维层(RNFL)厚度的相关因素为夜间最低平均动脉压和dip(P=0.011,P=0.032,R²=0.081); 影响MD值的相关因素为眼压波动(P=0.026,R²=0.115); 影响模式标准差(PSD)值的相关因素为眼压波动和dip(P=0.020,P=0.044,R²=0.141)。

结论：与开角型青光眼相比,正常眼压性青光眼患者中夜间血压过度下降的发生率较高。夜间血压过度降低组中视野损伤进展明显。视野缺损进展组夜间血压降低更明显。眼压波动与dip是正常眼压性青光眼和高眼压开角型青光眼的患者视神经损伤与视野缺损高危因素。     

Retinal autoregulation in open-angle glaucoma

The macular blood flow response to an induced change in intraocular pressure (autoregulation) was studied using the blue field entopic phenomenon in 11 open angle glaucoma patients, eight glaucoma suspects and 13 normal volunteers. A suction cup was used to raise the intraocular pressure (IOP) above its resting state (IOPrest). IOPmax, the highest acutely increased IOP for which blood flow can be maintained constant by autoregulation, was 24.9 +/- 1.5 mmHg (+/- 1 SD) in the glaucoma patients, 30.8 +/- 4.6 mmHg in the glaucoma suspects and 29.9 +/- 3.6 mmHg in the normal subjects. The values for IOPmax - IOPrest were 3.7 +/- 4.3 mmHg, 4.7 +/- 3.3 mmHg, and 14.3 +/- 3.1 mmHg, respectively. After the release of the suction cup, a hyperemic response was observed by 16 of 17 normal eyes, 10 of 14 glaucoma suspect eyes and only 9 of 19 glaucomatous eyes. These results suggest an abnormal autoregulation of macular retinal blood flow in open-angle glaucoma.     

Image of optic nerve disc with laser scanning tomography and results of static perimetry in children with juvenile glaucoma

The aim of our research was to estimate the correlation between optic nerve head parameters examined with laser scanning ophthalmoscope and results of central, visual field (MD and PSD) in the youth and the evaluation the role of this correlation in juvenile glaucoma early diagnosis. MATERIAL: Three groups of patients. Group I consisted of 32 eyes (16 children) with juvenile glaucoma in which trabeculectomy was performed. There were 72 eyes of 32 children with glaucoma juvenile suspect in the group II. Control group (III) contained 20 eyes of 10 children without glaucoma. The age of patients ranged from 9 to 18 years. The mean intraocular pressure was 16 mmHg in the I group, 18 mmHg in the II group and 15.6 mmHg in the III group. Simple Regression Analysis of mean values of biomorphometric parameters of optic nerve head for Mean Defect of central visual field was used in all three groups. RESULTS: The statistically significant correlation between Vol. B and MD was observed in the I group. There was no such correlation in the II group, but correlation between Av. Sl. and MD was presented. In the III group mean value of MD was the smallest one and correlated with Vol. B. Statistically significant correlation between mean values of PSD and Vol. B was observed in the I and II group, between PSD and Vol. A in group III. CONCLUSION: There was the correlation between optic nerve head parameters and mean deviation of retinal sensitivity of central visual field in the youth. This examination can be helpful in early diagnosis of primary juvenile glaucoma.     

No Apparent Association Between Ocular Perfusion Pressure and Visual Field Damage in Normal-Tension Glaucoma Patients

Purpose To investigate the correlation of ocular perfusion pressure (OPP) with general and localized visual field damage in normal-tension glaucoma (NTG) patients. Methods Correlations between OPP, blood pressure, age, intraocular pressure, refractive error, and extent of visual field damage in the eye with the worst mean deviation (MD) were investigated retrospectively in 94 eyes of 94 NTG patients. Visual fields were analyzed statistically with respect to 15 sectors betwen two age-matched groups of subjects with high or low OPP. Results Significant positive correlations were found between OPP and age (P < 0.001), blood pressure and age (P < 0.05), and MD and refractive error (P < 0.01). OPP had no significant correlation with MD or mean sensitivity in the visual field in any of the visual field sectors. Conclusion OPP and systemic blood pressure have no evident effect on the extent or pattern of visual field damage in NTG.     

Color doppler imaging in glaucoma patients with asymmetric visual field loss

With color Doppler imaging, we attempted to determine whether glaucoma patients with asymmetric visual field losses had evidence of asymmetric blood flow velocities in the central retinal artery despite similar intraocular pressure (IOP) curves in both eyes. We found that eyes with more severe visual field damage had an increased local resistance to blood flow in the central retinal artery. Thus vascular factors might have important roles in the pathogenesis of primary open-angle glaucoma.     

Intraocular pressure and the rate of visual field loss in chronic open-angle glaucoma

We measured the rate of change of visual field threshold values over time (mean follow-up, 44.9 +/- 17.4 months) by trend analysis in 40 eyes of 40 patients with chronic open-angle glaucoma. Twenty-eight eyes had stable visual fields, and two eyes had significant visual field improvement. Ten eyes had significant visual field deterioration and showed a correlation between indices of intraocular pressure (standard error of the mean, P = .02; standard deviation, P = .04; and range, P = .05) and the rate of visual field loss in the superonasal region of the visual field, such that the greater the variation of intraocular pressure the greater the rate of loss. The group losing visual fields had a higher mean visual field threshold value and significantly less optic disk pallor and cupping at the start of the study than the stable visual field group. Thus, a significant rate of visual field loss occurred at an earlier stage of the disease and showed a correlation with intraocular pressure in this stage.     

Sequential office pressure measurements in the management of glaucoma

PURPOSE: To evaluate the usefulness of day-long sequential office measurements of intraocular pressure (IOP) to make therapeutic decisions in patients with progressive glaucomatous damage despite apparently 'controlled' IOP. METHODS: We reviewed the records of 93 consecutive glaucoma patients (185 eyes) who underwent sequential office IOP measurements (every hour from 7 AM to 5 PM on a single day). These included 53 patients with normal-tension glaucoma (NTG), 12 glaucoma suspects (GS), and 28 patients with primary open-angle glaucoma (POAG) whose visual field deteriorated despite apparently 'controlled' IOP. Only one eye per patient was included in the study. RESULTS: The pattern of the day-long IOP curve was similar in the 3 groups of patients. IOPs were highest in the early morning hours in all groups. The mean +/- SD of the IOP range was 5 +/- 2 mm Hg. An IOP > 21 mm Hg was found in 3 eyes (3%), whereas a range of IOPs > 5 mm Hg was detected in 33 eyes (35%). In the NTG group, there was a significant correlation between visual field deterioration and the peak and range of IOP (P = 0.0002 and P = 0.05, respectively). CONCLUSIONS: Day-long sequential office IOP measurements are useful in selected patients who demonstrate progressive glaucomatous damage. Early morning measurements are most frequently highest. The range of IOP may be as important, or more important than, the peak IOP level.     

超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼

目的:探讨超声乳化人工晶状体(intraocular lens,IOL)植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效.方法:采用临床随机对照的研究方法,将临床收集的80例96眼原发性慢性闭角型青光眼患者分为观察组(40例46眼)和对照组(40例50眼).观察组给予超声乳化IOL植入联合房角分离术治疗,对照组仅给予超声乳化IOL植入术治疗.比较两组患者手术前后最佳矫正视力、眼压、视野平均缺损(mean deviation,MD)、平均视敏度值(mean sensitivity,MS)和中央前房深度改善状况,并记录患者术中、术后并发症发生状况.结果:两组患者术前最佳矫正视力、眼压、视野和中央前房深度比较,差异均无统计学意义(P>0.05);术后6mo,观察组最佳矫正视力、眼压、视野和中央前房深度与对照组相比,差异均有统计学意义(P<0.05);两组患者均无严重并发症,且差异无统计学意义(x2=2.095,P=0.351).结论:超声乳化IOL植入联合房角分离术治疗原发性慢性闭角型青光眼的疗效优于单纯超声乳化IOL植入.     

Relationship between optic nerve head microcirculation and visual field loss in glaucoma

PURPOSE: To study the relationship between optic nerve head blood flow velocity and visual field loss in patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). METHODS: This study included 44 eyes of 44 patients with POAG and 44 eyes of 44 patients with NTG. To evaluate optic nerve head blood flow velocity, the square blur rate (SBR) was measured by means of laser speckle flowgraphy. The correlation between SBR and Humphrey visual field indices was evaluated with linear regression analysis. RESULTS: In the NTG group, the average SBR at the superior and inferior temporal neuroretinal rim was positively correlated with mean deviation (MD) (r = 0.349, p = 0.020). The SBR at the superior or inferior temporal neuroretinal rim was positively correlated with the sum of the total deviations in the corresponding hemifields (r = 0.299, p = 0.049; r = 0.354, p = 0.019, respectively). The correlations between SBR and MD did not differ statistically between the NTG and POAG groups; however, no significant correlation between SBR and visual field indices was observed in the POAG group. CONCLUSION: These results suggested that the change in the circulation of the optic nerve head may be related to visual field damage in the NTG group but may be less involved in visual field damage in the POAG group.     

mGCC和pRNFL厚度及视野对新生血管性青光眼的诊断价值

目的:分析黄斑区节细胞复合体(mGCC)和视乳头周围视网膜神经纤维层(pRNFL)厚度及视野对新生血管性青光眼(NVG)的诊断价值。方法:回顾性研究。收集2018-01/2021-10本院收治的NVG患者92例100眼,按病理分期分为新生血管性青光眼前期患者31例32眼、开角型青光眼期患者31例36眼及闭角型青光眼期患者30例32眼。选择同期于我院接受健康体检者50例100眼者作为对照组。采用Pearson相关性分析mGCC、pRNFL厚度与MD的相关性,以受试者工作特征(ROC)曲线研究各指标诊断效能。结果:新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期mGCC-平均(a)、mGCC-上方(s)、mGCC-下方(i)厚度均低于对照组(均P<0.001),新生血管性青光眼前期、开角型青光眼期mGCC-a、mGCC-s、mGCC-i均高于闭角型青光眼期(均P<0.001),新生血管性青光眼前期mGCC-a、mGCC-s、mGCC-i均高于开角型青光眼期(均P<0.001)。新生血管性青光眼前期、开角型青光眼期和闭角型青光眼期pRNFL-a、pRNFL-颞侧(t)、...     

Intraocular pressure measurements with the Proview self-tonometer in comparison of Goldmann applanation tonometry in healthy and glaucomatous eyes

BACKGROUND: The aim of this study was to compare the results of intraocular pressure (IOP) measurements obtained using the pressure phosphene tonometer Proview with those from Goldmann applanation tonometer (GAT) in normal and glaucomatous eyes. PATIENTS AND METHODS: The IOP in 150 eyes of 62 healthy volunteers and 88 patients with glaucoma or ocular hypertension was measured prospectively in a sitting position. After being trained to use the Proview device, Goldmann applanation tonometry was performed first. Then the patient took a reading with the Proview self-tonometer. RESULTS: For all investigated eyes the measurements with the Proview were on average 5.5 mmHg higher than those by GAT. Only 34 % of the readings from the two devices were within a difference range of +/- 3 mmHg. On comparing the group of glaucomatous patients with slight visual field defects with the group of healthy subjects and patients with ocular hypertension without visual field defects we determined almost the same mean difference between the Proview and GAT (mean difference in the group with visual field defects = 4.7 +/- 4.1 mmHg; without defects = 4.8 +/- 2.9 mmHg). CONCLUSIONS: The tonometer Proview did not show a close agreement to GAT. Therefore, the PPT does not offer an alternative method for measuring IOP. We do not recommend the Proview for self-tonometry at home or for clinical management of patients with glaucoma. Slight visual field defects seem to have no influence on intraocular pressure measurement with the self-tonometer.     

Optic nerve damage in highly myopic eyes with chronic open-angle glaucoma

PURPOSE: To compare the amount of optic nerve damage in relation to intraocular pressure in highly myopic eyes with chronic open-angle glaucoma versus non-highly myopic eyes with chronic open-angle glaucoma. METHODS: The comparative clinical observational study included 1841 eyes of 1100 patients with chronic open-angle glaucoma. The highly myopic study group consisted of 25 eyes with a myopic refractive error equal to or higher than -8 diopters. It was subdivided into eyes with an optic disc size larger than 2.7 mm2 and eyes with an optic disc smaller than 2.7 mm2. The control group included the remaining, non-highly myopic eyes (n=1816). For all patients, a morphometric analysis of color stereo optic disc photographs was performed. Main outcome measures were morphometric optic disc measurements and intraocular pressure. RESULTS: In the highly myopic, large-optic-disc study group compared with the control group, maximal and minimal intraocular pressure readings were significantly (p<0.05) lower and neuroretinal rim area corrected for optic disc size was slightly (p=0.16) smaller. Comparing the total highly myopic study group with a control group adjusted for optic disc area, neuroretinal rim area was significantly (p=0.039) smaller in the study group with no significant difference in intraocular pressure measurements between the groups. CONCLUSIONS: At a given intraocular pressure in chronic open-angle glaucoma, optic nerve damage may be more pronounced in highly myopic eyes with large optic discs than in non-highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes than in non-highly myopic eyes.     

Relationship between ocular perfusion pressure and retrobulbar blood flow in patients with glaucoma with progressive damage

PURPOSE: To evaluate the relationship between ocular perfusion pressure and color Doppler measurements in patients with glaucoma. MATERIALS AND METHODS: Twenty patients with primary open-angle glaucoma with visual field deterioration in spite of an intraocular pressure lowered below 21 mm Hg, 20 age-matched patients with glaucoma with stable visual fields, and 20 age-matched healthy controls were recruited. After a 20-minute rest in a supine position, intraocular pressure and color Doppler measurements parameters of the ophthalmic artery and the central retinal artery were obtained. Correlations between mean ocular perfusion pressure and color Doppler measurements parameters were determined. RESULTS: Patients with glaucoma showed a higher intraocular pressure (P <.0008) and a lower mean ocular perfusion pressure (P <.0045) compared with healthy subjects. Patients with deteriorating glaucoma showed a lower mean blood pressure (P =.033) and a lower end diastolic velocity in the central retinal artery (P =.0093) compared with normals. Mean ocular perfusion pressure correlated positively with end diastolic velocity in the ophthalmic artery (R = 0.66, P =.002) and central retinal artery (R = 0.74, P <.0001) and negatively with resistivity index in the ophthalmic artery (R = -0.70, P =.001) and central retinal artery (R = -0.62, P =.003) in patients with deteriorating glaucoma. Such correlations did not occur in patients with glaucoma with stable visual fields or in normal subjects. The correlations were statistically significantly different between the study groups (parallelism of regression lines in an analysis of covariance model) for end diastolic velocity (P =.001) and resistivity index (P =.0001) in the ophthalmic artery, as well as for end diastolic velocity (P =.0009) and resistivity index (P =. 001) in the central retinal artery. CONCLUSIONS: The present findings suggest that alterations in ocular blood flow regulation may contribute to the progression in glaucomatous damage.     

Diurnal intraocular pressure. Correlation to automated perimetry

Patients referred to a centralized glaucoma laboratory obtained intraocular pressure measurements every two hours from 5:00 am to 3:00 pm. Analysis revealed 400 eyes with visual field defects and 400 eyes without visual field defects as determined by Octopus perimetry of the central 20 degrees. The diurnal variation in intraocular pressure was 6.2 mmHg +/- 3.6 for those with visual field defects and 5.5 mmHg +/- 2.7 for those without visual field defects. There was no statistical significance in the mean diurnal variation between the two groups (P = 0.91). The highest intraocular pressure tended to occur at either 5:00 am to 7:00 am or 11:00 am to 1:00 pm in both groups. The lowest intraocular pressure tended to occur between 7:00 am to 9:00 am or 1:00 pm to 3:00 pm in both groups. No significant differences were noted in the distribution between the two groups with regard to the time of the highest or lowest intraocular pressure. In the group with visual field defects, 30% had an intraocular pressure of less than 23 mmHg and 23% had an intraocular pressure of greater than or equal to 23 mmHg at all five time periods.