A theoretical model to allow prediction of the CSF pressure from observations of the retinal venous pulse

Abstract

Purpose: There is no easy way to estimate the intracranial pressure (ICP) noninvasively. The retinal vein can exhibit large amplitude oscillations at the level of the lamina cribrosa under certain circumstances. The aims of this study were to develop a theoretical understanding of the conditions required to establish this vigorous oscillatory behavior and to determine whether observations of it could lead to a noninvasive estimate of the ICP.

Methods: A mathematical model was constructed in which the central retinal vein was modeled as 2 Starling resistors in series, 1 located in the eye and the other in the cerebrospinal fluid (CSF) space, separated by a region where it was not collapsible, corresponding to its course within the optic nerve itself. Intraocular pressure (IOP) and ICP were modeled as sinusoidal wave forms.

Results: The model predicted an approximately linear relationship between the IOP and the ICP at the point of onset of oscillatory behavior. The predicted onset IOP also depended weakly on the retinal blood flow rate and on vein diameter and was only mildly sensitive to the phase difference between the two pressure waveforms. The predicted onset curve showed encouraging agreement with measurements in canines.

Conclusions: The model suggested that it may be possible to estimate the ICP from observations of the retinal venous pulse by using a modified form of ophthalmodynamometry.

Keywords: cerebrospinal fluid pressure; glaucoma; retinal venous pulse.