Gilbert T. Feke

Bidirectional LDV system for absolute measurement of blood speed in retinal vessels

A laser Doppler technique which provides a means of obtaining absolute measurements of the speed of red blood cells (RBCs) flowing in individual retinal vessels is described. Doppler-shift frequency spectra of laser light scattered from the RBCs are obtained for two directions of the scattered light. Each spectrum exhibits a cutoff frequency that is directly related to the maximum RBC speed (V(max)). The difference in cutoff frequencies is used to obtain an absolute measure of V(max) that is independent of the exact orientation of the vessel and of the relative direction of the incident and scattered beams with respect to the flow direction. Preliminary measurements obtained using a prototype instrument are presented.

Laser Doppler measurements of blood velocity in human retinal vessels

We have measured Doppler shift frequency spectra (DSFS) of laser light scattered from red blood cells (RBCs) flowing through individual human retinal vessels. Each spectrum exhibits a cutoff frequency which is directly related to the maximum RBC velocity at the measurement site. Meaningful DSFS can be measured in times as short as 0.1 s. DSFS obtained from suspensions of polystyrene spheres and RBCs flowing through glass capillary tubes are used to illustrate the basic principles of the technique and to aid in the interpretation of the in vivo measurements. Our measurements show that maximum RBC velocities in retinal arteries vary markedly during each cardiac cycle.

Laser Doppler Technique for Absolute Measurement of Blood Speed in Retinal Vessels

We describe an electrooptical laser Doppler system and technique of data analysis that provides absolute measurements of the speed of red blood cells flowing at discrete, selectable sites in the retinal vasculature. We present in vitro test measurements of the instrumentation as well as an example of an in vivo measurement from a patient with retinal vascular disease. We also present experimental data leading to the derivation of the relationship between the blood speeds measured in retinal arteries during the minimum diastolic and maximum systolic phases of the cardiac cycle and the time-averaged blood speed. Mean blood flow rate is calculated using the time-averaged speed and the cross-sectional area of the vessel at the measurement site. We discuss the criteria for selection of the measurement sites and assess the reproducibility of the measurements. We conclude that measurements on retinal arteries are less susceptible to experimental artifacts and provide more information than do measurements on retinal veins. The system is currently being used clinically in studies of retinal circulatory alterations in patients with diabetic retinopathy, arterial occlusive disease, retinal detachment, and carotid artery disease.

Evaluation of micrometric and microdensitometric methods for measuring the width of retinal vessel images on fundus photographs

The width of retinal vessel images on fundus photographs was determined by projection micrometry and microdensitometry. These methods were evaluated on 12 retinal vessels using the negatives of 570-nm monochromatic fundus photographs. For projection micrometry, the intraobserver reproducibility of vessel width measurements was 1.6%–2.9%, depending upon the experience of the observer. Significant interobserver differences in the measured widths were demonstrated. For microdensitometry, three distinct measurement criteria were used. Significant differences in width as measured by the three criteria were found, but there were no interoperator differences for each criterion. The intraoperator reproducibility of vessel width measurements by microdensitometry was 2.1%–2.5%. Significant differences were found in the vessel widths determined by the micrometry and densitometry methods, and results obtained by micrometry are discussed in terms of edge-detection phenomena.

Retinal Circulatory Changes after Scleral Buckling Procedures

The noninvasive laser Doppler technique was used to study retinal circulatory characteristics in five patients who underwent uncomplicated scleral buckling procedures. In each patient, the systolic/diastolic variation of the red blood cell speed in the retinal arteries (flow pulsatility ratio) was lower in the eye that had received an intrascleral implant and an encircling band than in the fellow eye. In one patient, an increase in flow pulsatility ratio accompanied an increase in retinal blood flow after removal of the scleral buckling elements. In another patient, the flow pulsatility ratio in the eye that had received a solid implant and an encircling band was less than the ratio in the fellow eye that had received an absorbable implant alone. Our results indicated that reduced retinal blood flow may be common after scleral buckling procedures, and may be a significant factor in otherwise inexplicable postoperative complications.

Effect of Timolol on Human Retinal, Choroidal and Optic Nerve Head Circulation

In a double-masked, randomized, placebo-controlled study, we evaluated the effect of topical timolol maleate 0.5% on the retinal, choroidal, and optic nerve head circulation in 5 healthy volunteer subjects. Changes in the pulsatile component of choroidal blood flow (PCBF) were determined from measurements of the ocular pulse wave. Changes in the retinal arterial blood flow rate (RBF) and optic nerve head capillary blood speed (CBS) were determined by laser Doppler velocimetry and monochromatic photography. In timolol-treated eyes, PCBF decreased by 32 +/- 12% (p = 0.0007). Changes in RBF and CBS were not statistically significant. In the contralateral placebo-treated eyes, PCBF decreased by 15 +/- 8% (p = 0.006) and RBF increased by 18 +/- 10% (p = 0.002). The change in CBS was not statistically significant.

Color Doppler Ultrasound Analysis of Ocular Circulation After Topical Calcium Channel Blocker

PURPOSE To investigate the effect of topical administration of the calcium channel blocker verapamil on intraocular pressure and retrobulbar hemodynamics. METHODS In this randomized, prospective, double-masked study, we examined the effects of single-dose topical administration of verapamil in ten normal human volunteers by using color Doppler ultrasound imaging to measure hemodynamic parameters. Limitations of this study include single-dose application of verapamil and relatively small sample size. RESULTS No systemic effect on heart rate or blood pressure was detected after administration of topical verapamil. The intraocular pressure significantly decreased compared with baseline two hours after topical 0.125% and 0.25% verapamil (P = .015 and .040, respectively). Pourcelots ratio, an index of vascular resistance, measured in the central retinal artery was significantly reduced after topical application of 0.125% verapamil (P = .008). The change in Pourcelots ratio primarily resulted from an increased end diastolic velocity in the central retinal artery. No significant differences compared with baseline values were detected in the color Doppler ultrasound measurements of the posterior ciliary arteries and the central retinal vein two hours after topically administered verapamil. CONCLUSIONS Topical administration of verapamil decreases intraocular pressure and alters ocular hemodynamics, reducing the vascular resistance index in the central retinal artery.

Laser Doppler Measurements of the Effect of Panretinal Photocoagulation on Retinal Blood Flow

The laser Doppler technique was used to measure the pulsatile characteristics of the retinal arterial blood flow in diabetic patients with severe retinopathy immediately before argon laser panretinal photocoagulation (PRP) and again one to two months after PRP. In each measurement the relative variation of the maximum red blood cell velocity, Vmax, in a major branch retinal artery was determined throughout the cardiac cycle. Flow pulsatility was defined as the ratio of Vmax at maximum systole to Vmax at minimum diastole. Following PRP, each eye showed a decrease in flow pulsatility as well as a decrease in retinal arterial and venous diameters. The measurements are consistent with an autoregulatory response of the retinal circulation to increased inner retinal oxygen concentration following PRP. Laser Doppler measurements may be a useful means of assessing the effectiveness of a particular PRP treatment.

Retinal haemodynamics in patients with age-related macular degeneration

ObjectiveTo investigate whether there is an association between the magnitude of retinal haemodynamic abnormalities in patients with age-related macular degeneration (AMD) and the degree of severity of the AMD.MethodsA retinal laser Doppler system (Canon CLBF 100) was used to measure retinal arterial haemodynamic parameters in 25 eyes of 25 patients with AMD and nine eyes of nine age-matched control subjects. Severity of AMD was classified into Mild (n=11), Moderate (n=7), or Severe (n=7). The pulsatility ratio (PR), the pulsatility index (PI), and the resistivity index (RI) were determined.ResultsPR, PI, and RI in the patients with AMD were each significantly higher than in the control group, and increased monotonically with increasing severity of AMD. However, there were no differences in mean blood velocity, arterial diameter, or blood flow rate among the groups. This suggests that the increased blood flow pulsatility in the retinal arteries of the eyes with AMD is not due to increased distal vascular resistance, but instead is likely due to a loss of compliance in the arterial vasculature leading to the eye.ConclusionOur results suggest that an increasing vascular rigidity in the systemic arterial circulation is directly associated with an increasing severity of AMD.

Retinal blood flow alterations associated with scleral buckling and encircling procedures.

The bidirectional laser Doppler technique and monochromatic photography were used to measure the absolute blood flow rate in the major temporal retinal arteries in seven patients following unilateral scleral buckling and encircling procedures, and in two patients before and after removal of scleral buckling elements. In the seven patients who had undergone uncomplicated scleral buckling procedures the arterial flow rates were on average 50% lower (p = 0.01) in the surgically treated eyes than in the contralateral eyes. Removal of scleral buckling elements in two patients produced increases of 73% and 44% in arterial blood flow rates.