Abstract
Purpose
Previous studies have shown decreased retrobulbar blood flow in normal tension glaucoma (NTG) compared to healthy controls. This study evaluates the ability of colour Doppler imaging (CDI) to identify patients with NTG.
Methods
Sixty-two patients with untreated NTG (mean age 57±14 years) and 40 age-matched controls (mean age 58±9 years) were included in a prospective cross-sectional institutional study. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive indices (RI=(PSV–EDV)/PSV) of the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary arteries (PCAs) were measured by means of CDI. Using receiver operating characteristic (ROC) curves, sensitivity was determined at 90% specificity.
Results
Patients with NTG showed significantly decreased PSV (P<0.0001) and EDV (P<0.0001) of the CRA, significantly decreased EDV of the nasal (P=0.004) and temporal (P=0.002) PCA, and significantly increased RI of the temporal (P=0.003) PCAs compared to healthy controls. Sensitivity values at 90% specificity were calculated: PSV of the CRA, 30.6%; EDV of the CRA, 48.4%; EDV of the nasal PCA, 43.9%; EDV of the temporal PCA, 45.9%; and RI of the temporal PCA, 39.3%.
Conclusions
The power to identify NTG using CDI reaches 48% sensitivity at 90% specificity. Further longitudinal studies are needed to determine the prognostic value of CDI in glaucoma.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Arend O, Plange N, Sponsel WE, Remky A . Pathogenetic aspects of the glaucomatous optic neuropathy: fluorescein angiographic findings in patients with primary open-angle glaucoma. Brain Res Bull 2004; 62: 517–524.
Flammer J, Orgül S . Optic nerve blood-flow abnormalities in glaucoma. Prog Retin Eye Res 1998; 17(2): 267–289.
Hayreh SS . The 1994 von sallman lecture: the optic nerve circulation in health and disease. Exp Eye Res 1995; 61: 259–272.
Arend O, Remky A, Plange N, Kaup M, Schwartz B . Fluorescein leakage of the optic disc in glaucomatous optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2005; 243: 659–664.
Béchetoille A, Bresson-Dumont H . Diurnal and nocturnal blood pressure drops in patients with focal ischemic glaucoma. Graefes Arch Clin Exp Ophthalmol 1994; 232: 675–679.
Emre M, Orgül S, Gugleta K, Flammer J . Ocular blood flow alteration in glaucoma is related to systemic vascular dysregulation. Br J Ophthalmol 2004; 88: 662–666.
Flammer J . The vascular concept of glaucoma. Surv Ophthalmol 1994; 38: S3–S6.
Hayreh SS, Podhajsky P, Zimmermann MB . Role of nocturnal arterial hypotension in optic nerve head ischemic disorders. Ophthalmologica 1999; 213: 76–96.
Leske MC, Podgor MJ . Intraocular pressure, cardiovascular risk variables, and visual field defects. Am J Epidemiol 1983; 118: 280–287.
Tielsch JM, Katz J, Sommer A, Quigley HA, Javitt JC . Hypertension, perfusion pressure, and primary open-angle glaucoma. A population-based assessment. Arch Ophthalmol 1995; 113: 216–221.
Plange N, Kaup M, Huber K, Remky A, Arend O . Fluorescein filling defects of the optic nerve head in normal tension glaucoma, primary open-angle glaucoma, ocular hypertension and healthy controls. Ophthal Physiol Opt 2006; 26: 26–32.
Arend O, Remky A, Cantor LB, Harris A . Altitudinal visual field asymmetry is coupled with altered retinal circulation in patients with normal pressure glaucoma. Br J Ophthalmol 2000; 84: 1008–1012.
Plange N, Remky A, Arend O . Color Doppler imaging and fluorescein filling defects of the optic disc in normal tension glaucoma. Br J Opthalmol 2003; 87: 731–736.
Butt Z, O'Brien C, McKillop G, Aspinall P, Allan P . Color doppler imaging in untreated high- and normal pressure open-angle glaucoma. Invest Ophthalmol Vis Sci 1997; 38(3): 690–696.
Harris A, Sergott RC, Spaeth GL, Katz JL, Shoemaker JA, Martin BJ . Color doppler analysis of ocular vessel blood velocity in normal-tension glaucoma. Am J Ophthalmol 1994; 118: 642–649.
Huber KK, Plange N, Arend O, Remky A . Doppler-sonographie bei Normaldruckglaukom. Klin Monatsbl Augenheilk 2006; 223: 156–160.
Kaiser HJ, Schoetzau A, Stümpfig D, Flammer J . Blood-flow velocities of the extraocular vessels in patients with high-tension and normal-tension primary open-angle glaucoma. Am J Ophthamol 1997; 123: 320–327.
Rankin SJ, Walman BE, Buckley AR, Drance SM . Color doppler imaging and spectral analysis of the optic nerve vasculature in glaucoma. Am J Ophthalmol 1995; 119: 685–693.
Vécsei PV, Hommer A, Reitner A, Kircher K, Egger S, Schneider B, Bettelheim HC . Farbduplex der retrobulbären arterien bei normaldruck- und offenwinkelglaukom. Klin Monatsbl Augenheilk 1998; 212: 444–448.
Rankin SJ, Drance SM, Buckley AR, Walman BE . Visual field correlations with color doppler studies in open angle glaucoma. J Glaucoma 1996; 5: 15–21.
Liu CJ, Chiou H-J, Chiang S-C, Chou JC, Chou Y-H, Liu J-H . Variations in ocular hemodynamics in patients with early and late glaucoma. Acta Ophthalmol Scand 1999; 77: 658–662.
Plange N, Kaup M, Arend O, Remky A . Asymmetric visual field loss and retrobulbar hemodynamics in primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2006; 244: 978–983.
Huber K, Plange N, Remky A, Arend O . Comparison of colour Doppler imaging and retinal scanning laser fluorescein angiography in healthy volunteers and normal pressure glaucoma patients. Acta Ophthalmol Scand 2004; 82(4): 426–431.
Harris A, Williamson TH, Martin B, Shoemaker JA, Sergott RC, Spaeth GL et al. Test/retest reproducibility of color Doppler imaging assessment of blood flow velocitiy in orbital vessels. J Glaucoma 1995; 4: 281–286.
Williamson TH, Harris A . Color doppler ultrasound imaging of the eye and orbit. Surv Ophthalmol 1996; 40: 255–267.
European Glaucoma Society. Terminology and guidelines for glaucoma. In: Traverso CE, Grehn F, HolloG, Lachkar Y, Migdal C, Thygesen J (eds). Editrice DOGMA S.r.l., 2nd edn Savona: Italy, 2003, pp 24–32.
Spencer JA, Giussani DA, Moore PJ, Hanson MA . In vitro validation of Doppler indices using blood and water. J Ultrasound Med 1991; 10: 305–308.
Plange N, Kaup M, Weber A, Arend KO, Remky A . Retrobulbar haemodynamics and morphometric optic disc analysis in primary open-angle glaucoma. Br J Ophthalmol 2006; 90: 1501–1504.
Rosengarten B, Aldinger C, Kaufmann A, Kaps M . Comparison of visually evoked peak systolic and end diastolic flow velocity using a control system approach. Ultrasound Med Biol 2001; 27: 1499–1503.
Yamazaki Y, Hayamizu F . Comparison of flow velocity of ophthalmic artery between primary open angle glaucoma and normal tension glaucoma. Br J Ophthalmol 1995; 79: 732–734.
Galassi F, Sodi A, Ucci F, Renieri G, Pieri B, Baccini M . Ocular hemodynamics and glaucoma prognosis: a color doppler imaging study. Arch Ophthalmol 2003; 121: 1711–1715.
Schmetterer L, Dallinger S, Findl O, Strenn K, Graselli U, Eichler H-G, Wolzt M . Noninvasive investigations of the normal ocular circulation in humans. Invest Ophthalmol Vis Sci 1998; 39: 1210–1220.
Senn BC, Kaiser HJ, Schötzau A, Flammer J . Reproducibility of color Doppler imaging in orbital vessels. Ger J Ophthalmol 1997; 5: 386–391.
Harizman N, Zelefsky JR, Ilitchev EV, Tello CA, Ritch R, Liebmann JM . Detection of glaucoma using operator-dependent versus operator independent classification in the HRT-III. Br J Ophthalmol 2006; 90: 1390–1392.
Yamazaki Y, Drance SM . The relationship between progression of visual field defects and retrobulbar circulation in patients with glaucoma. Am J Ophthalmol 1997; 124: 287–295.
Satilmis M, Orgul S, Doubler B, Flammer J . Rate of progression of glaucoma correlates with retrobulbar circulation and intraocular pressure. Am J Ophthalmol 2003; 135: 664–669.
Martinez A, Sanchez M . Predictive value of colour Doppler imaging in a prospective study of visual field progression in primary open-angle glaucoma. Acta Ophthalmol Scand 2005; 83: 716–722.
Remky A, Kaup M, Weber A, Plange N . Effects of trabeculectomy on retrobulbar hemodynamics in glaucoma patients. Invest Ophthalmol Vis Sci 2006; 47, E-abstract 4794.
Acknowledgements
Design and conduct of the study by NP, MK, OA, and AR; collection, management, analysis and interpretation of the data by NP, MK, AW, AH, OA, and AR; and preparation and approval of the manuscript by NP, MK, AW, AH, OA, and AR.
Author information
Authors and Affiliations
Corresponding author
Additional information
Property interests: none
Financial disclosures: none
Funding/support: none
Rights and permissions
About this article
Cite this article
Plange, N., Kaup, M., Weber, A. et al. Performance of colour Doppler imaging discriminating normal tension glaucoma from healthy eyes. Eye 23, 164–170 (2009). https://doi.org/10.1038/sj.eye.6702943
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.eye.6702943
Keywords
This article is cited by
-
Association of ocular blood flow and contrast sensitivity in normal tension glaucoma
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)
-
Colour Doppler analysis of ophthalmic vessels in the diagnosis of carotic artery and retinal vein occlusion, diabetic retinopathy and glaucoma: systematic review of test accuracy studies
BMC Ophthalmology (2016)
-
Ocular perfusion pressure and ophthalmic artery flow in patients with normal tension glaucoma
BMC Ophthalmology (2016)
-
Color Doppler imaging and pattern visual evoked potential in normal tension glaucoma and hypertension glaucoma
Documenta Ophthalmologica (2009)
