Micheline C. Deschênes

Postmenopausal Hormone Therapy Increases Retinal Blood Flow and Protects the Retinal Nerve Fiber Layer

PURPOSE To investigate whether postmenopausal hormone therapy (HT) increases retinal and ONH blood flow (BF) and protects ONH topography and the function of retinal ganglion cells in postmenopausal women (PMW). The effect of estradiol (E(2)) treatment on retinal tissue perfusion was also investigated in ovariectomized rats, an animal model for menopause. METHODS Sixty-four healthy PMW were recruited, 29 of whom never used HT ( HT) and 35 of whom had used HT (+HT) continuously since the onset of menopause. Blood flow of the inferotemporal retinal artery (ITRA), peripapillary retina, and ONH rim were measured in one eye. The ONH stereometric parameters and the pattern electroretinogram (PERG) were also measured. In ovariectomized rats, the retinal tissue perfusion was assessed using the BF tracer N-isopropyl-p-[(14)C]-iodoamphetamine ([(14)C]-IMP) in rats treated with either E(2) (n = 7) or placebo (n = 5). RESULTS Compared with the HT group, the +HT group presented significantly greater BF of the ITRA (P = 0.006), greater rim volume for the entire ONH region (P = 0.032), and greater rim volume (P = 0.042), height variation contour (P = 0.011), mean thickness (P = 0.033), and cross-sectional area (P = 0.020) of the retinal nerve fiber layer for the inferotemporal region of the ONH when adjusted for age, ocular perfusion pressure, and age at menarche. In ovariectomized rats, E(2) treatment significantly increased retinal perfusion in a range of 22% to 45%. CONCLUSIONS These findings indicate that estrogens and HT increase retinal blood flow and protect the retinal nerve fiber layer.

The effects of driving experience on responses to a static hazard perception test.

Novice drivers exhibit deficits in hazard perception that are likely to increase their risk of collisions. We developed a static hazard perception test that presents still images to observers and requires them to indicate the presence of a traffic conflict that would lead to a collision. Responses to these scenes were obtained for young adult novice (N=29) and experienced drivers (N=27). Additionally, participants rated the hazard risk and clutter of each scene. Novice drivers rated traffic conflicts as less hazardous and responded more slowly to them. Using a subset of 21 scenes, we were able to discriminate novice and experienced young adult drivers with a classification accuracy of 78% and a scale reliability (Cronbachs alpha) of .91. The potential applications of this research include the development of standardized hazard perception tests that can be used for driver evaluation, training and licensure.

The effects of systemic medications on ocular blood flow

This article reviews the effects of systemic medications and some native vasoactive molecules on ocular blood flow (OBF). Some evidence exists for a positive effect of centrally acting calcium-channel blockers, nitric oxide precursors, adenosine, histamine, estrogens, and ginkgo biloba extract, while evidence for a negative effect on OBF exists for endothelin-1 and indomethacin. Some other molecules appear to have mixed effects, depending on the ocular vascular bed studied or the study protocol. In addition, medically induced changes in systemic blood pressure (BP) have an important impact on OBF, and the direction and magnitude of this effect may depend on the disease status of the patient and of the eye, as well as the absolute level of BP achieved. There are relatively few studies of the effects of systemic medications on OBF in glaucoma patients, and little is known of the long-term impact of such therapies on the preservation of optic nerve structure and function.

Impairment of ocular blood flow during regional orbital anesthesia.

BACKGROUND Regional anesthesia for ophthalmic surgery has been associated with ischemic complications, such as central retinal vascular occlusion, optic atrophy and ischemic optic neuropathy. Impairment of pulsatile ocular blood flow (POBF) may occur with regional orbital anesthesia. In this study we quantified POBF in patients undergoing regional orbital anesthesia. METHODS Eleven patients (12 eyes) with a mean age of 76.5 years having regional orbital anesthesia for cataract or retinal surgery at a private refractive surgical centre in Calgary had POBF monitoring before, during and 15 minutes after induction of anesthesia. RESULTS There were no significant changes in intraocular pressure or heart rate during the induction phase or 15 minutes after induction of regional orbital anesthesia. However, ocular blood flow indices, including pulse amplitude, pulse volume and POBF, were significantly reduced following attainment of regional orbital blockade (p < 0.05). With time there was recovery in these variables, but they all remained significantly reduced from baseline 15 minutes later. INTERPRETATION Ocular blood flow appears to be significantly impaired during regional orbital anesthesia, induced as described. There could be benefit in monitoring POBF to reveal otherwise undetectable deleterious effects on retinal circulation in patients having retrobulbar injections, orbital compression or digital manipulation of the globe.

Early macular dysfunction detected by focal electroretinographic recording in non-insulin-dependent diabetics without retinopathy

The focal electroretinogram, which measures the functional integrity of the distal retina of the macula, was recorded with a hand-held stimulator-ophthalmoscope in 26 eyes from patients with non-insulin-dependent diabetes mellitus with normal fundus photography, and in 52 control eyes of similar age range. Implicit time and amplitude of the responses were studied as a function of the age, glycemic control through glycosylated hemoglobin measurement and duration of diabetes. Implicit time and amplitude were significantly delayed (F=5.05, p=0.028) and reduced (F=11.26, p=0.013) in diabetic patients without diabetic retinopathy compared to control subjects. Moreover, there was a significant relationship between the implicit time (r=0.57, p=0.002) and amplitude (r=−0.65, p=0.0004) with the duration of diabetes but not with hemoglobin Alc. These results strongly suggest an early macular dysfunction in noninsulin-dependent diabetes mellitus before the appearance of diabetic retinopathy.