Role of Ocular Pulse Amplitude in Glaucoma

The ocular pulse amplitude is defined as the difference between diastolic and systolic intraocular pressure. The ocular pulse is generated by the pulsatile ocular blood flow in the choroid. It is dependent on the dynamics of the cardiovascular system, the rigidity of the ocular vessels on one side and the biomechanical properties of the eye on the other side. In addition the influence of outflow facility of the aqueous humor, the level of the intraocular pressure itself and last but not least the rigidity of the sclera on the ocular pulse amplitude is until now not clear. Dynamic contour tonometry (Pascal (R)) does not only measure intraocular pressure almost independent of corneal thickness and curvature but also allows easy and fast measurement of ocular pulse amplitude on the slit lamp. The ocular pulse amplitude in healthy subjects is between 1.2 and 4 mmHg. If the ocular pulse amplitude is larger than 1.2 mmHg spontaneous pulsations of the central retinal vein are visible on fundoscopy. In patients with ocular hypertension the ocular pulse amplitude is larger than in normal subjects but this is mainly due to higher IOP levels. In patients with manifest open-angle glaucoma the ocular pulse amplitude stays initially within the normal range. In more advanced stages of the disease and especially in patients with ocular perfusion pressure dependent optic neuropathy the ocular pulse amplitude is gradually reduced. Due to the various factors influencing ocular pulse amplitude a direct correlation between reduced ocular pulse amplitude and reduced ocular perfusion pressure has not been established as yet. New approaches investigating the variations of the ocular pressure Fourier spectral analysis are promising, especially when simultaneous analysis of the arterial blood pressure is performed. These techniques may allow a fast and easy discrimination between healthy and glaucomatous patients in the near future. If ocular pulse amplitude exhibits a massive inter-ocular asymmetry in the presence of symmetrical ocular findings of extraocular vascular pathologies (i.e. carotid stenosis) are the most likely cause and therefore should be excluded.