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Editors Selection IGR 17-1

Clinical Examination Methods: RNFL and Retinal Venous Pulsations

Comment by William Morgan on:

61426 Correlation of retinal nerve fibre layer thickness and spontaneous retinal venous pulsations in glaucoma and normal controls, Golzan SM; Morgan WH; Georgevsky D et al., PLoS ONE, 2015; 10: e0128433

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The study of retinal venous pulsation and its association with glaucoma is attracting increasing interest because of the strong association between absent venous pulsation, the severity of glaucoma and its proclivity to progression. This paper offers is a novel technique for measuring retinal venous pulsation. Typically, 50% of glaucoma subjects have spontaneous venous pulsation, which means that threshold measurements like venous pulsation pressure using ophthalmodynamometry can only be taken in half the glaucoma population and in a lesser proportion of the normal population. This newer technique uses high-quality video footage of the retinal vessels and automated image analysis algorithms to measure retinal venous transverse diameter, frame by frame and thereby calculate a pulsation amplitude in microns. Hence, a measurement can be derived for all patients and across different regions of vessels. This paper y describes the association between reduced venous pulsation amplitude and the presence and severity of glaucoma. It discusses in some detail the potential reasons why this phenomenon occurs. One plausible reason is simply that there is reduced blood flow in regions where there is less nerve fiber layer (NFL) tissue due to reduced demand, and perhaps this is associated directly with reduced pulsation amplitudes. Interestingly, the y-intercepts (NFL) in the relation between pulsation amplitude and NFL thickness appear to be lower in the glaucoma group compared to the normal group, hinting that this in fact may not be the case.

Alterations in venous pulsation amplitudes occurring in glaucoma are not simply due to reduction in tissue requirement induced blood flow

This paper describes a measurement technique, which is potentially applicable to all subjects. It hints at the possibility that alterations in venous pulsation amplitudes occurring in glaucoma are not simply due to reduction in tissue requirement induced blood flow.

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