Perfusion of the juxtapapillary retina and optic nerve head in acute ocular hypertension

Chronically elevated intraocular pressure (IOP) is often associated with glaucomatous optic nerve atrophy. Impaired blood flow may play a role in the pathogenesis of this disease. We present data concerning juxtapapillary retinal and optic nerve-head blood flow during acute increases in IOP. With the combination of a laser Doppler flow-meter and a scanning-laser system (Scanning Laser Doppler Flowmeter, SLDF; Heidelberg Engineering) the perfusion of the retina and the optic nerve head was quantified and visualized. Juxtapapillary retinal and optic nerve-head blood flow was measured simultaneously by SLDF during variations in IOP induced by a suction cup in nine healthy volunteers. The ocular pressure was increased for 2 min to IOP +15 mmHg, then to IOP +30 mmHg, and finally, to IOP +45 mmHg. Ocular perfusion pressure (PP) was calculated as the mean arterial blood pressure minus the IOP. The declines in juxtapapillary retinal flow as expressed in present per 10-mmHg IOP elevation ranged from 3.6% to 14.1% (median 7.4%). Over all measurements we found a significant linear relationship between juxtapapillary retinal blood flow and PP (r=0.55, P<0.0001). The observed decrease in optic nerve-head blood flow with increasing IOP was significantly greater as compared with the retinal blood flow decrease (8.4%/10 mmHg versus 7.4%/10 mmHg, P<0.05). SLDF enables the quantification and visualization of perfused capillaries of the retina and the optic nerve head in high resolution. Acute elevations of IOP led to a decrease in juxtapapillary retinal and optic nerve-head blood flow of 7.4% and 8.4%/10-mmHg IOP increase, respectively.