July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Determination of ocular blood-flow velocity by plane-wave ultrasound and correlation with ocular perfusion pressure
Author Affiliations & Notes
  • Raksha Urs
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Jeffrey A Ketterling
    2. F.L. Lizzi Center for Biomedical Engineering, Riverside Research, New York, New York, United States
  • Billy Y Yiu
    Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
  • Alfred Yu
    Electrical and Computer Engineering, University of Waterloo, Waterloo, Ontario, Canada
  • Ioannis Michalopoulos
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Lama Al-Aswad
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Dana Blumberg
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • C Gustavo De Moraes
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Jeffrey M Liebmann
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • George Cioffi
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Ronald H Silverman
    Ophthalmology, Columbia University Medical Center, Teaneck, New Jersey, United States
  • Footnotes
    Commercial Relationships   Raksha Urs, None; Jeffrey Ketterling, None; Billy Yiu, None; Alfred Yu, None; Ioannis Michalopoulos, None; Lama Al-Aswad, None; Dana Blumberg, None; C Gustavo De Moraes, None; Jeffrey Liebmann, None; George Cioffi, None; Ronald Silverman, None
  • Footnotes
    Support  Supported by NIH Grants EY025215 and P30 EY019007 and an unrestricted grant to the Department of Ophthalmology of Columbia University from Research to Prevent Blindness.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5536. doi:https://doi.org/
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      Raksha Urs, Jeffrey A Ketterling, Billy Y Yiu, Alfred Yu, Ioannis Michalopoulos, Lama Al-Aswad, Dana Blumberg, C Gustavo De Moraes, Jeffrey M Liebmann, George Cioffi, Ronald H Silverman; Determination of ocular blood-flow velocity by plane-wave ultrasound and correlation with ocular perfusion pressure. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5536. doi: https://doi.org/.

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

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Abstract

Purpose : Impaired ocular blood-flow is believed to be a risk factor in glaucoma. While OCT-A is effective in imaging the vascular network in the retina and choroid, it does not quantify flow nor image the retrobulbar vessels supplying the eye. Plane-wave (PW) ultrasound offers a means for imaging flow dynamics in the choroid and retrobulbar vessels. In this report we describe pulsatile flow characteristics in the choroid, central retinal artery (CRA) and vein (CRV) and short posterior ciliary artery (SPCA) in a cohort of patients with primary open angle glaucoma (POAG).

Methods : We performed ultrafast PW imaging with a Verasonics Vantage 128 ultrasound system using an 18 MHz linear array probe. Choroidal imaging was performed in a horizontal plane just superior to the optic nerve at a frame rate of 1 kHz. For the major retrobulbar vessels, the optic nerve head region was imaged at 6 kHz frame rate. Imaging was performed twice for both eyes of 16 POAG patients. Fourier analysis produced spectrograms of flow velocity over the 3-second period of data acquisition. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI) and pulsatile index (PI) were determined and correlated with mean ocular perfusion pressure (MOPP=2/3×(MAP-IOP)) (MAP=mean arterial pressure, IOP=intraocular pressure).

Results : IOP averaged 13.0±4.8 mmHg, MAP averaged 97.8±16.0 mmHg and MOPP averaged 56.4±10.4 mmHg over all eyes. MOPP was not significantly correlated with choroidal flow, but strongly correlated with PSV and EDV in the CRA (PSV: R=0.48, p=.006; EDV: R=0.47, p=.006) and CRV (PSV: R=0.56, p=.001; EDV: R=0.54, p=.002).

Conclusions : While flow velocities in the CRA and CRV were strongly correlated with MOPP, choroidal flow was not significantly altered, suggesting autoregulatory mechanisms. Although we did not find significant changes in the SPCA, this may be due to greater measurement uncertainty due to the variability of vessel orientation and hence velocity estimates due to uncertainty in the cosine correction term. PW ultrasound allows estimation of ocular flow velocities at intensity levels compliant with FDA guidelines. Measurement of MOPP and retrobulbar flow may prove a useful clinical parameter in glaucoma.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Directional power Doppler image of the optic nerve head region and spectrograms of central retinal artery and vein depicting flow-velocity variation as a function of time

Directional power Doppler image of the optic nerve head region and spectrograms of central retinal artery and vein depicting flow-velocity variation as a function of time

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