[Neovascular age-related macular degeneration in Germany. Encroachment on the quality of life and the financial implications]. / Neovaskuläre altersabhängige Makuladegeneration in Deutschland. Beinträchtigung der Lebensqualität und ihre finanziellen Auswirkungen.

BACKGROUND: Approximately 35,000 cases of neovascular age-related macular degeneration (AMD) occur annually in Germany. The neovascular form of AMD (NV-AMD) is responsible for severe vision loss associated with the disease in 90% of the cases. This study was conducted to assess the humanistic and economic burden of NV-AMD in the German population. METHODS: A cross-sectional, observational study of subject self-reported functional health, well-being, and disease burden among elderly subjects with (n=83) and without (n=93) NV-AMD in Germany was conducted. Patients participated in telephone surveys involving the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), the EuroQol (EQ-5D), the Hospital Anxiety and Depression Scale (HADS), and also reported history of falls, fractures, and healthcare resource utilization. Furthermore, the healthcare utilization and unit costs for the NV-AMD patients were calculated. RESULTS: The mean age of NV-AMD patients was 77.2 years and 64% were female. NV-AMD patients reported significantly worse vision-related function and overall well-being than controls (adjusted mean scores: NEI-VFQ-25 overall scale: 51.3 vs 96.3; p<0.0001) and significantly more depression symptoms than controls (HADS depression: 6.2 vs. 2.7; p<0.0001). NV-AMD patients also reported that the need for assistance with daily activities was more than 10 times greater compared to controls (26.5% vs. 2.2%; p<0.0001) and the prevalence of falls was 3 times that of the control group (13.3% vs 4.3%; p=0.031). Annual NV-AMD costs per patient were 9871, 6 times that of elderly patients without NV-AMD ( 1559). Of the NV-AMD costs one-half were direct non-medical-related costs (assistance of ADL or social benefit) and one-third were direct medical costs. CONCLUSIONS: NV-AMD is associated with decreased functional abilities and quality of life, which result in an increase in healthcare resource utilization. Consequently, costs were higher for NV-AMD patients compared to controls. These findings emphasize the need for new NV-AMD treatments that will prevent vision loss and progression to blindness, and lessen the ensuing economic burden. Sponsored by Pfizer Inc. New York, US.

["White dot syndromes" in childhood]. / "White-dot-Syndrome" im Kindesalter.

BACKGROUND: The term "white dot syndromes" describes a group of heterogeneous inflammatory disorders of the choriocapillaris. They were first described a few decades ago and our knowledge about these variable diseases is very limited, especially in regard to their overall incidence and their differential diagnostic relevance in uveitis of childhood. MATERIAL AND METHODS: A retrospective analysis has been performed of all cases of white dot syndromes in 407 patients with paediatric uveitis who were examined between 1996 and 2006. The relevant literature was reviewed. RESULTS: The following incidence of white dot syndromes in childhood was found: acute posterior multifocal placoid pigmentepitheliopathy (APMPPE) (n = 4), multiple evanescent white dot syndrome (MEWDS) (n = 4), multifocal choroiditis and panuveitis (MCP) (n = 3) and 1 case of serpiginous choroiretinitis. The review of literature shows a different age predilection of the different white dot diseases. The relative frequency of white dot syndromes in paediatric uveitis patients is estimated to be between 1 - 5%. CONCLUSION: "White dot syndromes" are an important differential diagnosis in uveitis of childhood. ICG angiography is an important tool for the diagnosis and follow-up examinations of these inflammatory diseases of the choriocapillaris. The different entities of white dot syndromes show differences concerning incidence, prevalence, course of disease, rate of complications and therapeutic implications.

Vitreoretinal surgery: pre-emptive analgesia.

AIM: Vitrectomies are performed either under general anesthesia (GA), local anesthesia (LA), or a combination of both. Postoperative pain is expected to be less in patients with LA because of prolonged action of the local anaesthetic. Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards. The authors compared postoperative analgesia in patients with GA combined with preoperative or postoperative LA. METHODS: 90 patients scheduled for vitrectomy without buckling were enrolled in the study. 60 patients underwent GA, 30 without LA, 15 with preoperative LA, and 15 with postoperative LA. 30 patients received LA alone. Subjective postoperative pain was determined using the visual analogue scale. RESULTS: Postoperative pain was less under LA alone compared to GA alone (p < 0.0001). Additional preoperative application of LA resulted in less pain than additional postoperative application (p <0.05). Additional postoperative peribulbar aneasthesia did not differ from GA alone. CONCLUSION: The authors conclude that LA alone or preoperatively in addition to GA provides the best comfort for the patient in vitreoretinal surgery.

[Functional results after surgical extraction or photocoagulation of choroid neovascularization (CNV) in age-related macular degeneration]. / Funktionelle Ergebnisse nach CNV-Extraktion oder Photokoagulation bei alterskorrelierter Makuladegeneration.

BACKGROUND: SLO microperimetric examination after the extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD) shows absolute scotoma in the area of pigment epithelial loss. Laser treatment also causes complete functional loss. The functional results of these two methods should be compared before the surgical procedure is expanded. METHODS AND PATIENTS: Five eyes of five patients with large subfoveal well-defined CNV were treated by photocoagulation following the MPS criteria. Functional results were compared with similar phenotypes from a group of 78 patients operated upon. Before and after the treatment visual acuity was tested following the ETDRS criteria. The need for magnification for reading was tested using the ZEISS charts. Fundus-controlled microperimetry was performed using the scanning laser ophthalmoscope (Rodenstock) to detect deep and relative scotomata. RESULTS: The recurrence rate (OP 2/5; ALK 1/5) was normal regarding the small number of patients. Visual results are slightly better in patients operated on (mean: pre 0.08; 6 weeks 0.09; 3 month 0.13; last 0.13) than in laser-treated patients (mean: pre 0.06; 6 weeks 0.07; 3 months 0.08; last 0.12). Deep scotoma can be reduced with surgical extraction of the CNV (mean factor: 6 weeks 0.6; last control 0.8) while laser treatment of the margins enlarges the scotoma (mean factor: 6 weeks 2.3; last control 2.2). CONCLUSIONS: Because of the minimal functional advantages of the surgical procedure we do not think it is the method of first choice. For both methods the treatment of well-defined CNV increases the possibility of low-vision rehabilitation.

Removal of silicone oil with vision improvement after rhegmatogenous retinal detachment following CMV retinitis in patients with AIDS.

PURPOSE: To report that silicone oil may be safely removed from immuno-recovered patients with acquired immunodeficiency syndrome (AIDS) after instillation for cytomegalovirus (CMV)-related rhegmatogenous retinal detachment. METHOD: We report two patients with CMV-related retinal detachment who had previously been treated with vitrectomy and silicone oil. RESULTS: Six months after removal of silicone oil, the retina remained attached in both patients. Without specific anti-CMV therapy, there was no relapse of CMV retinitis while patients were undergoing highly active antiretroviral therapy. Best-corrected visual acuity improved in both patients. CONCLUSION: It appears to be possible to remove silicone oil safely from patients with AIDS who show immune recovery, thus avoiding side effects of long-standing silicone oil and increasing quality of life. After silicone oil removal, visual acuity was improved.

[Surgical removal of subfoveal choroid neovascularization in senile macular degeneration]. / Chirurgische Entfernung subfovealer chorioidaler Neovaskularisationen bei AMD. Prä- und postoperative fundusperimetrische Befunde mit dem SLO.

UNLABELLED: The follow-up of central scotomas and fixation--next to visual acuity--are important parameters for the evaluation of new therapies in AMD. PATIENTS AND METHODS: Twenty-three patients (age 67 to 91 years) with subfoveal CNV had SLO fundus-controlled perimetry before and 6-8 weeks after surgical removal of the CNV. The size and location of deep (0 dB) and relative (12 dB) scotomas were measured. Stability and location of fixation were analyzed. RESULTS: Fifty-six percent of patients gained (10% lost) more than 2 lines of VA; 52% of deep scotomas decreased in size (26% increased). No relative scotoma increased, but 63% decreased, some remarkably. Most scotomas had steeper borders postoperatively. Five of 7 patients were able to fixate again. Fixation moved slightly more peripheral in 4 patients and was otherwise unchanged. None of 7 patients whose fixation was close to their fovea preoperatively lost that fixation. CONCLUSION: Subfoveal surgery may stabilize the course of subfoveal CNV in AMD at 6 weeks follow-up. In some patients the major benefit can be a reduction of relative scotoma due to reattachment of the retina. As the location of fixation changes little with surgery and is typically located within the area of relative scotoma, visual function can improve.

Evaluation of microvascularization pattern visibility in human choroidal melanomas: comparison of confocal fluorescein with indocyanine green angiography.

BACKGROUND: The presence of specific microvascularization patterns (networks, parallel with and without crosslinking, silent) in histological sections of human choroidal melanomas has prognostic significance for survival. We showed previously in selected patients that the identification of these microvascularization patterns is possible in vivo by using confocal scanning laser indocyanine green angiography and that this technique is superior to fluorescein angiography using a conventional acquisition technique with a fundus camera. We now routinely use simultaneous confocal fluorescein/indocyanine green angiography to study microvascularization patterns in choroidal melanomas. The purpose of this study was to compare the visibility of tumor vessels and microvascularization patterns in fluorescein and indocyanine green angiography in simultaneous confocal series taken with the same instrument in a large prospective series of patients. PATIENTS AND METHODS: The simultaneously procured confocal fluorescein and indocyanine green angiograms of 50 patients with untreated choroidal melanomas (maximal apical height according to standardized A-scan between 2 and 8 mm) were studied for the visibility of tumor vessels and microvascularization patterns. At least one simultaneous confocal optical series (32 images in sequential depth order) during the early arterial venous phase was obtained per patient. RESULTS: Confocal forescein angiography disclosed signs of tumor vascularization in 12 (24%) of the 50 patients examined. However, in only 3 patients (6%) could microvascularization patterns be identified using confocal fluorescein angiography, and only in the very early arterial phase, which is often difficult to capture. In contrast, simultaneously obtained confocal indocyanine green angiograms disclosed tumor vessels in 47 (94%) of the examined 50 patients and microvascularization patterns could be identified in all of these cases. In 3 patients (6%) no tumor vessels could be detected within the tumor borders. CONCLUSION: This study demonstrates that confocal indocyanine green angiography images microvascularization patterns in choroidal melanomas better than fluorescein angiography, even when the images are acquired with the same technique. This can be explained with the different absorption, fluorescence and exudation characteristics of these dyes. In vivo imaging of these microvascularization patterns using confocal indocyanine green angiography offers the possibility of assessing the prognosis of choroidal melanomas without the removal of tissue.

[Cytomegalovirus (CMV) retinitis in AIDS. Gancilovir implantation in comparison with systemic therapy]. / Zytomegalievirus (CMV)-Retinitis bei AIDS. Ganciclovir-Implantat im Vergleich zur systemischen Therapie.

INTRODUCTION: Untreated CMV retinitis with AIDS leads to blindness; therefore, a life-long virostatic treatment is required. It can either be administered systemically or locally, as there are different advantages and disadvantages. When treating patients we aim at therapy that preserves vision without diminishing quality of life. It should induce as few drug-induced side effects as possible and not shorten the patient's life expectation. METHODS AND RESULTS: A total of 111 patients (150 eyes) with systemic maintenance treatment were compared retrospectively with 33 patients (62 eyes) that received a ganciclovir implant only as maintainance therapy and no additional systemic treatment. Patients with an implant showed a prolonged interval of nonprogression of retinitis than patients receiving systemic treatment. Patients with unilateral retinitis are at higher risk of developing bilateral disease in the implant group than in the systemically treated group. Manifestation of extraocular disease was equal in both groups. Local treatment with the implant does not shorten patient survival time. CONCLUSION: Local treatment with the ganciclovir implant means quality of life for patients and also safe protection of the affected eye. Extraocular disease and survival time are not influenced adversely by local treatment. However, primarily unilateral involved patients show higher risk for bilateral disease in the implant group than in the systemically treated group.

Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study.

BACKGROUND: The surgical extraction of subfoveal choroidal new vessels (CNV) is one of several possibilities to treat subfoveal CNV or haemorrhages in age-related macular degeneration (ARMD). METHODS: Prospective study, follow-up 3-6 months. Clinical and angiographic differentiation of three subgroups: (1) subfoveal well-defined CNV (24 eyes); (2) subfoveal ill-defined CNV with or without well-defined components (10 eyes); (3) submacular haemorrhages (20 eyes). RESULTS: The mean and median visual acuity and the proportion of eyes with > or = 20/200 vision increased slightly in group 1 and decreased slightly in group 2; the differences were not significant. Group 3 demonstrated mean improvement but was heterogeneous, depending on the site and type of underlying CNV. The proportion of eyes with 3 or more lines of improvement after 3 months was 35.3% (7/17), 10% (1/10) and 38.9% (7/18) respectively. The proportion of eyes with a loss of 3 or more lines after 3 months was 5.9% (1/17), 20% (2/10) and 5.6% (1/18) respectively. The recurrence rate was 29.2% (7/24), 8.3% (1/11) and 25% (5/20). Intraoperative complications were iatrogenic central tears in 7.3% (4/55), peripheral tears in 14.5% (8/55) and peripheral retinal detachment in 3.6% (2/55). A postoperative retinal detachment was observed in 2 of 55 eyes (3.6%). All these complications could be managed without ill effect. CONCLUSION: Subfoveal surgery might preserve remaining retinal function in eyes with well-defined CNV. However, subgroups of the MPS subfoveal laser trials with comparable initial visual acuity demonstrated postoperative functional stabilisation and similar recurrence rates in well-defined CNV. Though selected cases of submacular haemorrhage did profit from surgery, TPA-assisted gas injection will probably be a better alternative. Unfortunately, surgery for ill-defined CNV, found in the vast majority of eyes with exudative ARMD, seems to worsen the natural course. Surgery has to be combined with restoration of Bruch's membrane before it can become a possible therapeutic option in ARMD.

[Intra-vitreal rt-PA and gas introduction in submacular hemorrhage]. / Intravitreale rt-PA- und Gaseingabe bei submakulärer Blutung.

UNLABELLED: Efficacy and complications of intravitreally injected tissue plasminogen activator (rt-PA) and sulfahexafluoride gas (SF6) in submacular hemorrhage are demonstrated. PATIENTS AND METHODS: Fifty-three patients with submacular hemorrhage were treated (27 women, 26 men, mean age 79 +/- 1 years). Causes of hemorrhage were a choroidal neovascularization in 47 patients and macroaneurysm in 6 patients. After i.v. administration of 500 mg acetazolamide and disinfection of the conjunctiva, 50 micrograms rt-PA in 0.1 ml (BSS) and 0.5 ml SF6 were injected intravitreally. The patient was positioned prone for 24 h. RESULTS: In 23 patients with choroidal neovascularization visual acuity improved by 2 lines and more; in 12 patients vision remained unchanged. In 12 patients visual acuity deteriorated. In 5 of 6 patients with a macroaneurysm vision improved from less than 0.1 to 0.1-0.5. Postoperative complications were four cases of vitreous hemorrhage and one case of endophthalmitis. CONCLUSION: The intravitreal injection of rt-PA and SF6 is an alternative method for treatment of submacular hemorrhage.

[Choroid neovascularization in senile macular degeneration. 1 hear follow-up after radiotherapy]. / Choroidale Neovaskularisation bei altersbezogener Makuladegeneration. Einjahresergebnisse nach Strahlentherapie.

UNLABELLED: Choroidal neovascularization (CNV) associated with age-related macular degeneration is the major cause of legal blindness in Europe and the USA in patients aged more than 65 years, but Chakravarthy et al. has reported that radiotherapy has a beneficial effect on visual acuity. METHODS: Since March 1996 we have treated 56 patients in cooperation with the Department of Radiotherapy at the Technical University in Munich. The total dose with external beam radiotherapy was 16 Gy in 8 fractions, delivered through an anterior oblique axis to spare the lens. Before the treatment and 3, 6 and 12 months after therapy, we performed a standardized visual acuity and contrast-sensitivity test (ETDRS, Pelli Robson Chard) and fluorescin angiography 6 and 12 months after therapy. RESULTS: Twenty-five angiograms showed well-defined CNV and 31 not well-defined CNV. Six months after the treatment 15 patients had stable visual acuity within one line. Twenty-seven patients had lost more than one line of visual acuity. There was no difference between well and not well defined CNV's. One year after treatment the visual acuity remained stable within one line in 4 patients, no patient had an increase of two lines or more and 17 patients lost more then 2 lines of vision. We saw no side effects other than sicca symptoms in 3 patients. CONCLUSION: In our opinion, these results do not show that radiation treatment has a real beneficial effect on visual acuity. Further randomized studies are needed to demonstrate the efficiency of this treatment for choroidal neovascularization in AMD.

[Recurrent choroid neovascularization in age-related macular degeneration. Fluorescein angiographic morphology after surgical membranectomy]. / Rezidivierende choroidale Neovaskularisationen bei altersbezogener Makuladegeneration. Fluoreszenzangiographische Morphologie nach chirurgischer Membranektomie.

UNLABELLED: The surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) causes a retinal pigment epithelial defect (RPED) corresponding to the area of diffuse RPE damage. We describe angiographic features of recurrent CNV in AMD after surgical membranectomy in order to elucidate the nature of persistence and recurrence. METHODS: After digitalization of the pre- and postoperative fluorescein angiographic images of eight patients with recurrent CNV in AMD we determined the morphology (well or ill-defined) and the area of the CNV and of the subretinal hemorrhage preoperatively and of the recurrent CNV and of the RPE defect postoperatively. RESULTS: The nature of recurrences showed differences between preoperatively well- and ill-defined CNV. Four preoperatively well-defined CNV with surrounding subretinal hemorrhage showed recurrences in the entire area of the preoperative CNV excluding the retinotomy 8-9 weeks postoperatively. Four preoperatively ill-defined CNV with subretinal hemorrhage developed marginal recurrences at the rim of the RPED. There was no background fluorescence in the area of the RPED. CONCLUSION: The nature of recurrences extending over the entire area of the preoperatively well-defined CNV without loss of background fluorescence only a few weeks after surgical removal of well-defined CNV suggests partial persistence. The removal of the subretinal well-defined CNV could leave sub-RPE parts in locations that preoperatively cannot be visualized angiographically. The marginal recurrence of preoperatively ill-defined CNV weeks to months postoperatively shows angiographic similarities to recurrent CNV after laser coagulation.

[Choroid neovascularization in age-related macular degeneration. Correlation of histological and fluorescence angiography findings]. / Chorioidale Neovaskularisationen bei AMD. Korrelation histologischer und fluoreszenzangiographischer Befunde.

BACKGROUND: Recent studies have raised confusion about the fluorescein angiographical and histopathological correlation of CNV. MATERIAL AND METHODS: The preoperative fluorescein angiograms of four patients with subfoveal CNV due to ARMD extracted by pars plana vitrectomy were classified as wellor ill-defined CNV and were correlated to the histopathologically (in serial sections) verrified CNV-location (subneuroretinal (= type II according to Gass) versus sub-RPE (type I according to Gass)). RESULTS: The locations of all four CNV could be classified by histopathological landmarks as there were RPE, BLD/drusen, and inner Bruchs membrane. Angiographically welldefined membranes were type II membranes according to Gass, whereas the ill-defined membrane represented type I. The CNV with well- and ill-defined borders consisted of type II and type I parts according to Gass. CONCLUSION: We find subneuroretinal locations of the well-defined CNV examined (type II membranes according to Gass). Correspondingly, ill-defined CNV or ill-defined parts of a CNV seem to be beneath the RPE (type I). The correlation of fluorescein angiography and histopathology should be studied in greater numbers of well- and ill-defined CNV.

[Senile macular degeneration]. / Die altersbedingte Makuladegeneration.

The most frequent cause of severe visual deficiency in old age is degeneration-related neovascularization beneath the site of maximum visual discrimination. To date, the therapeutic possibilities are limited, but new methods of examination and treatment give reason for cautious optimism. In recent years, the condition has increased dramatically and, mild cases included, now affects some 20% of over-70-year-olds. A basic knowledge of this degeneration should therefore be required of every family doctor.

[Outer retinitis as an early symptom of subacute sclerosing panencephalitis]. / Aussere Retinitis als Frühsymptom bei subakut sklerosierender Panencephalitis (SSPE).

BACKGROUND: A primary ocular manifestation of subacute sclerosing panencephalitis is known and can progress to severe visual deterioration. The rare occurrence of the disease makes diagnosis often difficult. CASE REPORT: The lethal clinical course of a patient with subacute sclerosing panencephalitis (SSPE) is presented. The disease manifested itself with severe ophthalmic symptoms preceding clinical and neurological signs and leading to bilateral blindness. The dramatic drop of visual acuity was due to a unilateral and later in the course bilateral pigmentepitheliopathy of the posterior pole. Inflammatory signs of retinal vasculature or inner retinal layers were detected neither clinically nor by fluoresceine angiography. A typical blockage of background fluorescence was demonstrated in fluoresceine and indocyanine angiography. Within two weeks after initial symptoms optic atrophy developed in both eyes. CONCLUSION: The primary lesion of retinal pigment epithelium and outer retinal layer were the prominent findings in this case. The presence of an outer retinitis of the posterior pole should alert the physician to the possibility of subacute sclerosing panencephalitis.

[Central serous chorioretinopathy. Studies of the site of the lesion with indocyanine green]. / Chorioretinopathia centralis serosa. Untersuchungen zur Lage des Quellpunktes mit Indozyaningrün.

Indocyanine green angiographies of 33 patients with central serous chorioretinopathy (CSC) were examined in order to find out whether the location of ICG exudation was correlated with other findings. Areas of delayed choroidal filling at the site of the hot spot were found in 27 patients (82%). The hot spot was usually located at the margin of such areas. Furthermore, it seemed correlated to a larger ciliary artery in 19 patients (60.6%). A detachment of the pigment epithelium was detected in 18% and showed a characteristic early hypo- and late hyperfluorescence. There is evidence that the exudation of indocyanine green indicates a primary choroidal disorder as the cause of CSC. Many clinical features, for example pigment epithelial detachments, are easier to explain with this hypothesis. A correlation of the hot spot with variation of choroidal filling has to be interpreted with caution. Yet, it seems feasible that the border between areas of different speed of filling is especially vulnerable and might therefore decompensate in the case of diseased regulation of the choroidal vessels, as has been postulated for CSC.

[Exudation of indocyanine green from subretinal neovascularization and its significance]. / Exsudation von Indozyaningrün aus subretinalen Neovaskularisationen und ihre Bedeutung.

Owing to its tight binding to protein, exudation of indocyanine green from subretinal new vessels would not normally be expected, but it has been demonstrated. We investigated 102 subretinal new vessels to find out how often exudation develops and to understand the reason for it. Exudation was found in 29 (28.4%) of the cases examined; 37 (36.6%) were stained, which means that these membranes became hyperfluorescent but not lighter than other, definitively non-exuding, structures on the fundus. In 26 (25.5%) no hyperfluorescence was seen in the late phase, and in 10, or 9.8%, neovascularization remained occult. The correlation of indocyanine green exudation with retinal blood or lipid deposits was significant (r = 0.77, p = 0.0001). Histological examinations showed a correlation of lipid deposits with a severe disintegration of retinal vessels. This finding, in combination with others, indicates that the exudation of indocyanine green reflects severe destruction of vessel walls, which does not seem to occur consistently in all neovascular membranes. The exudation of indocyanine green might be of prognostic value.

[Perfusion time of the central retinal artery in normal pressure glaucoma. Initial results]. / Perfusionszeit der A. centralis retinae bei Normaldruckglaukom. Erste Ergebnisse.

UNLABELLED: A possible explanation for the progressive visual field defects in normal tension glaucoma is reduced ocular blood flow. We have tried to answer this question using fluorescence perfusion scintigraphy that measures the circulation times between the subclavian vein, carotid artery, central retinal artery and central retinal vein. PATIENTS: Eight normal subjects and eight age- and sex-matched normal tension glaucoma patients were compared. Inclusion criteria for NTG patients were an IOP below 23 mmHg, glaucomatous visual field defects, glaucomatous disk cupping, normal chamber angle and no neurologic deficits. The subclavian carotid time, the carotid retina time and the mean retinal perfusion time of the intravenously injected radioactive fluorescein bolus were measured using digitized scanning laser angiography and technetium scintigraphy. RESULTS: Subclavian carotid time and mean retinal perfusion time were not significantly different between groups, whereas the carotid retina time was 1.6 s (min = 0.8, max = 2.6) in normals and 3.3 (min = 2.6, max = 4.2) in normal tension glaucoma. This difference was highly significant (P < 0.001). CONCLUSIONS: The delay of the carotid retina circulation time in normal tension glaucoma patients may reflect a reduced blood flow velocity in the internal carotid artery, the ophthalmic artery and the central retinal artery. The subclavia carotid time and ultrasound investigation of the carotid artery were normal. This suggests that the delayed carotid retina time is an indicator of reduced blood flow velocity in ophthalmic and mainly central retinal artery. The good discrimination between normal subjects and NTG patients must be confirmed in a larger group of patients.