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