June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Ocular Pulse Amplitude Waveform Reflects Ventricular Bigeminy and Aortic Insufficiency
Author Affiliations & Notes
  • Jean Kassem
    Neuro-Orbit-Oculoplastics, Havener Eye Institute, Columbus, OH
    Ophthalmology, The Ohio State University, Columbus, OH
  • Steven Katz
    Neuro-Orbit-Oculoplastics, Havener Eye Institute, Columbus, OH
    Ophthalmology, The Ohio State University, Columbus, OH
  • Cynthia Roberts
    Ophthalmology, The Ohio State University, Columbus, OH
    Biomedical Engineering, The Ohio State University, Columbus, OH
  • Ashraf Mahmoud
    Ophthalmology, The Ohio State University, Columbus, OH
    Biomedical Engineering, The Ohio State University, Columbus, OH
  • Robert Small
    Biomedical Engineering, The Ohio State University, Columbus, OH
    Anesthesiology, The Ohio State University, Columbus, OH
  • Subha Raman
    Biomedical Engineering, The Ohio State University, Columbus, OH
    Cardiovascular Medicine, The Ohio State University, Columbus, OH
  • Footnotes
    Commercial Relationships Jean Kassem, None; Steven Katz, None; Cynthia Roberts, Oculus Optikgerate GmbH (C), Ziemer Ophthalmic Systems AG (C), Sooft Italia (R), Carl Zeiss Meditec (F); Ashraf Mahmoud, None; Robert Small, Ziemer (F); Subha Raman, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 4673. doi:
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    • Get Citation

      Jean Kassem, Steven Katz, Cynthia Roberts, Ashraf Mahmoud, Robert Small, Subha Raman; Ocular Pulse Amplitude Waveform Reflects Ventricular Bigeminy and Aortic Insufficiency. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4673.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

Intraocular pressure (IOP) is pulsatile in nature due to the filling of the ocular blood vessels with each ventricular contraction. Ocular pulse amplitude (OPA) is defined as the difference between maximum and minimum deflections in this signal. Average values of OPA in healthy subjects range from 1-4mmHg. Normal appearance of the waveform includes regular cycles corresponding to the heartbeat. The purpose of the current investigation was to determine the source of an irregular waveform of extreme values.

 
Methods
 

Ocular pressure waveforms were digitally recorded from both eyes of a subject being examined during training to use the PASCAL Dynamic Contour Tonometer (DCT), with custom software provided by the manufacturer (Ziemer, Port, Switzerland). It was noted that the waveform had an unusual shape consistent with an early ventricular contraction every other beat, as seen in Figure 1. It was also noted that ocular pulse amplitude (OPA) was >9mmHg, which is extraordinarily high. The subject presented for a thorough examination by a cardiologist.

 
Results
 

The subject was determined to be in ventricular bigeminy, as seen in Figure 2, which was the source of the irregular appearance of the OPA waveform. In addition, it was determined that he had aortic insufficiency which explained the extreme value for OPA that corresponded to bounding carotid pulses via palpation. After replacement of the aortic valve, the bigeminy resolved and the ocular pulse waveform became regular in appearance with an OPA of 1.6-2.0mmHg

 
Conclusions
 

The ocular pulse waveform is a direct reflection of hemodynamics. Evaluating this waveform may provide an additional opportunity for screening subjects for cardiovascular abnormalities.

     
Keywords: 612 neuro-ophthalmology: diagnosis • 568 intraocular pressure • 628 optic flow  
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