The influence of contour line size and location on the reproducibility of topographic measurement with the Heidelberg Retina Tomograph.

BACKGROUND: The recommended contour line (CL) location with the Heidelberg Retina Tomograph (HRT) is on the inner edge of Elschnig's scleral ring. This study investigated HRT parameter reproducibility when: (i) the CL size is altered relative to Elschnig's ring; (ii) the CL is either redrawn or imported between images. METHODS: Using the HRT, seven 10 degrees images were acquired for 10 normal volunteers and 10 primary open angle glaucoma (POAG) subjects. A CL was drawn on one image for each subject using Elschnig's scleral ring for reference and imported into subsequent images. The CL diameter was then (a) increased by 50 microns; (b) increased by 100 microns; and (c) decreased by 50 microns. To investigate the effect of the method of contour line transfer between images a CL was: (1) defined for one image and imported to 6 subsequent images; (2) drawn separately for each image. RESULTS: Parameter variability improved as the size of the CL increased for the normal group relative to Elschnig's ring but was unchanged in the POAG group. The export/import function (method 1) resulted in better parameter reproducibility than the redrawing method for both groups. CONCLUSIONS: The exporting and importing function resulted in better parameter variability for both subject groups and should be used for transferring CLs across images for the same subject. Increasing the overall CL size relative to Elschnig's scleral ring improved the reproducibility of the measured parameters in the normal group. No significant difference in parameter variability was observed for the POAG group. This suggests that the reproducibility of HRT images are affected more by the variation in topography between images than change in CL definition.

Regional differences in retinal vascular reactivity.

PURPOSE: Although glaucomatous visual field defects are more common in the superior field than in the inferior field, microaneurysms are more frequent in the superior than in the inferior retina in diabetic retinopathy. The authors hypothesized that differences in vascular hemodynamics in the two areas might contribute to these phenomena. METHODS: The blood flow response to hyperoxia and hypercapnia was evaluated in peripapillary retinal tissue superior and inferior to the optic nerve head using confocal scanning laser Doppler flowmetry. In 14 young, healthy persons, blood flow was measured while breathing room air and during isocapnic hyperoxia (100% O2 breathing) and isoxic hypercapnia (PCO2 increased 15% above baseline). Histograms were generated from pixel-by-pixel analysis of retinal portions of superior and inferior temporal quadrants of the entire image. RESULTS: Baseline blood flow in the inferior temporal quadrant was significantly greater than in the superior temporal quadrant (P < 0.05). However, the inferior region failed to increase in perfusion during hypercapnia and experienced significant mean blood flow reduction; flow reduction in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and an increased percentage of pixels without measurable flow, during hyperoxia (each P < 0.05). In contrast, in the superior temporal region, hyperoxia failed to reduce blood volume, velocity, or flow, whereas hypercapnia significantly increased mean flow; increased flow in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and reduced the percentage of pixels without measurable flow (each P < 0.05). CONCLUSIONS: The inferior temporal quadrant of the peripapillary retina is, in comparison with the superior temporas region, less responsive to vasodilation and more responsive to vasoconstriction. These differences could contribute to different susceptibility to visual field defect or vascular dysfunction in the superior and inferior retina.

Comprehensive assessment of retinal, choroidal and retrobulbar haemodynamics during blood gas perturbation.

BACKGROUND: A study was performed to evaluate the effect of isoxic hypercapnia on ocular haemodynamics using colour Doppler imaging (CDI), scanning laser Doppler flowmetry (SLDF) and ocular blood flow (OBF) tonography. METHODS: Measurements were taken for one eye of each of 14 healthy subjects (mean age 27 +/- 6 years) during breathing of room air and then during isoxic hypercapnia (breathing CO2 and room air). Using CDI, blood flow velocities and resistance indices were determined for the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs). Using SLDF a 10 x 10 pixel frame was used to measure blood flow, volume and velocity in each quadrant of the peripapillary retina. Pulsatile ocular blood flow (POBF) was measured using the OBF tonograph. RESULTS: Using CDI, peak systolic and end diastolic velocities increased and resistance index decreased significantly in the SPCAs during hypercapnia. Using SLDF, blood flow, volume and velocity increased significantly during hypercapnia in the superior temporal quadrant of the peripapillary retina. No significant difference was observed between baseline and hypercapnia for POBF. CONCLUSIONS: Isoxic hypercapnia resulted in an increase in peripapillary retinal and SPCA blood flow parameters as determined by SLDF and CDI respectively. This implies the presence of autoregulatory activity in these vasculatures. These findings may be of significance in the pathogenesis of ocular disease such as glaucoma where autoregulation is thought to be compromised.