Robert Arnar Karlsson

Oxygen saturation in human retinal vessels is higher in dark than in light

PURPOSEnAnimal studies have indicated that retinal oxygen consumption is greater in dark than light. In this study, oxygen saturation is measured in retinal vessels of healthy humans during dark and light.nnnMETHODSnThe oximeter consists of a fundus camera, a beam splitter, a digital camera and software, which calculates hemoglobin oxygen saturation in the retinal vessels. In the first experiment, 18 healthy individuals underwent oximetry measurements after 30 minutes in the dark, followed by alternating 5-minute periods of white light (80 cd/m(2)) and dark. In the second experiment, 23 volunteers underwent oximetry measurements after 30 minutes in the dark, followed by light at 1, 10, and 100 cd/m(2). Three subjects were excluded from analysis in the first experiment and four in the second experiment because of poor image quality.nnnRESULTSnIn the first experiment, the arteriolar saturation decreased from 92% +/- 4% (n = 15; mean +/- SD) after 30 minutes in the dark to 89% +/- 5% after 5 minutes in the light (P = 0.008). Corresponding numbers for venules are 60% +/- 5% in the dark and 55% +/- 10% (P = 0.020) in the light. In the second experiment, the arteriolar saturation was 92% +/- 4% in the dark and 88% +/- 7% in 100 cd/m(2) light (n = 19, P = 0.012). The corresponding values for venules were 59% +/- 9% in the dark and 55% +/- 10% in 100 cd/m(2) light (P = 0.065).nnnCONCLUSIONSnOxygen saturation in retinal blood vessels is higher in dark than in 80 or 100 cd/m(2) light in human retinal arterioles and venules. The authors propose that this is a consequence of increased oxygen demand in the outer retina in the dark.

Glaucoma Filtration Surgery and Retinal Oxygen Saturation

PURPOSEnGlaucoma may involve disturbances in retinal oxygenation and blood flow. The purpose of this study was to measure the effect of glaucoma filtration surgery on retinal vessel oxygen saturation.nnnMETHODSnA noninvasive spectrophotometric retinal oximeter was used to measure hemoglobin oxygen saturation in retinal arterioles and venules before and after glaucoma filtration surgery. Twenty-five consecutive patients were recruited, and 19 had adequate image quality. Fourteen underwent trabeculectomy and five glaucoma tube surgery. Twelve had primary open-angle glaucoma and seven had exfoliative glaucoma. IOP decreased from 23 +/- 7 to 10 +/- 4 mm Hg (mean +/- SD, P = 0.0001).nnnRESULTSnOxygen saturation increased in retinal arterioles from 97% +/- 4% to 99% +/- 6% (n = 19; P = 0.046) after surgery and was unchanged in venules (63% +/- 5% before surgery and 64% +/- 6% after, P = 0.76). There were no significant changes in saturation in the fellow eyes (P > 0.60). The arteriovenous difference was 34% before and 36% after surgery (P = 0.35).nnnCONCLUSIONSnGlaucoma filtration surgery had almost no effect on retinal vessel oxygen saturation.

Dorzolamide-Timolol Combination and Retinal Vessel Oxygen Saturation in Patients with Glaucoma or Ocular Hypertension

Aims: To examine whether the addition of dorzolamide to timolol monotherapy influences oxygen saturation in the human retina. Methods: Non-invasive spectrophotometric retinal oximetry was used to measure oxygen saturation in retinal vessels. Twenty patients with open-angle glaucoma (11) and ocular hypertension (9) were recruited. The patients were randomised into receiving timolol monotherapy or dorzolamide–timolol combination for an 8-month test period, followed by a second test period, before which the patients switched treatments. Oximetry measurements were performed at 2-month intervals during each period. Of the 20 patients, 13 followed the study protocol into the second test period, and 10 managed all study visits. Results: The oxygen saturation in retinal vessels was stable within the test periods. The mean arteriolar saturation was 96 (2)% (mean (SD)) during timolol monotherapy and 97 (2)% during dorzolamide–timolol combination therapy (pu200a=u200a0.17, all patients pooled, nu200a=u200a13). Corresponding values in venules were 66 (5)% during timolol monotherapy and 65 (6)% during dorzolamide–timolol therapy (pu200a=u200a0.13). Patients who started on dorzolamide–timolol combination showed a significant reduction in arteriolar (98 (2)% to 95 (2)%, p<0.01) and venular saturation (69 (5)% to 66 (6)%, p<0.05) when changing to timolol monotherapy. Conclusion: Adding dorzolamide to timolol monotherapy has a minimal effect, but going from dorzolamide–timolol combination to timolol alone lowered arteriolar and venular oxygen saturation. The retinal oxygen saturation measurements show a high degree of stability over an extended period of time. Previous studies have suggested increased retinal and optic nerve blood flow with dorzolamide. Unchanged oxygen saturation and increased blood flow would indicate increased oxygen delivery to the retina.

Retinal Oximetry With a Scanning Laser Ophthalmoscope

PURPOSEnThe purpose of the study was to assess if a scanning laser ophthalmoscope (SLO), Optomap 200Tx, could be used for measurements of hemoglobin oxygen saturation in retinal blood vessels.nnnMETHODSnOptomap 200Tx uses two lasers for image acquisition, 532 and 633 nm. Retinal images of healthy individuals and patients with retinal vein occlusion were analyzed with modified Oxymap Analyzer software, which tracks retinal vessels and calculates relative hemoglobin oxygen saturation.nnnRESULTSnOxygen saturation in healthy individuals was measured as 92% ± 13% for arterioles and 57% ± 12% for venules (mean ± SD, n = 11, P = 0.0001). Standard deviation for repeated measurements of the same eye was 3.5% for arterioles and 4.4% for venules. In patients with confirmed venular hypoxia, central retinal vein occlusion (CRVO) or hemivein occlusion, the average venular oxygen saturation was measured as 23% ± 3% in the affected eyes and 59% ± 3% in the fellow eyes (n = 4, P = 0.0009).nnnCONCLUSIONSnTechnically, it is possible to derive information on retinal oxygen saturation from an SLO with a 2-wavelength oximetry algorithm. The system produced both sensitive and repeatable results. The remaining challenges include decreasing variability between vessels of the same eye and variability between individuals. Given the advantages that SLO imaging has over conventional fundus camera optics in retinal oximetry, further development of SLO oximetry may provide the optimal approach to retinal oximetry.

Spectrophotometric retinal oximetry in pigs.

PURPOSEnTo assess the validity of spectrophotometric retinal oximetry by comparison to blood gas analysis and intravitreal measurements of partial pressure of oxygen (pO(2)).nnnMETHODSnFemale domestic pigs were used for all experiments (n = 8). Oxygen fraction in inspired air was changed using a mixture of room air, pure oxygen, and pure nitrogen, ranging from 5% to 100% oxygen. Femoral arterial blood gas analysis and retinal oximetry were performed at each level of inspiratory oxygen fraction. Retinal oximetry was performed using a commercial instrument, the Oxymap Retinal Oximeter T1. The device simultaneously acquires images at two wavelengths (570 nm and 600 nm), and specialized software automatically detects retinal blood vessels. In three pigs, invasive pO(2) measurements were performed after the initial noninvasive measurements.nnnRESULTSnComparison of femoral arterial oxygen saturation and the optical density ratio over retinal arteries revealed an approximately linear relationship (R(2) = 0.74, P = 3.4 × 10(-9)). In order to test the validity of applying the arterial calibration to veins, we compared noninvasive oximetry measurements to invasive pO2 measurements in three pigs. This relationship was approximately linear (R(2) = 0.45, P = 0.04).nnnCONCLUSIONSnNoninvasive spectrophotometric oximetry is sensitive to changes in oxygen saturation in pigs and correlated with intravitreal pO(2) measurements and with femoral artery pO(2). Pigs present a higher intraindividual variability in retinal oxygen saturation and a lower overall saturation than do humans. The difference between porcine and human eyes makes direct comparisons of measurements difficult.

Retinal oxygen metabolism in patients with mild cognitive impairment

We have previously reported that retinal vessel oxygen saturation is increased in mild‐to‐moderate dementia of Alzheimers type when compared with healthy individuals. Mild cognitive impairment (MCI) is the predementia stage of the disease. The main purpose was to investigate if these changes are seen in MCI.