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. 2022 Nov;260(11):3587-3595.
doi: 10.1007/s00417-022-05722-6. Epub 2022 Jun 6.

Optic disc blood perfusion and oxygenation in glaucoma

Hosni Al Zoubi  1 , Thomas Riemer  2 , Rowena Simon  1 , Walthard Vilser  3 , Somar Hasan  1 , Daniel Meller  1 , Regine Augsten  1 , Martin Hammer  4   5
Affiliations

Optic disc blood perfusion and oxygenation in glaucoma

Hosni Al Zoubi et al. Graefes Arch Clin Exp Ophthalmol. 2022 Nov.

Abstract

Purpose: To investigate the haemoglobin concentration and oxygenation in the optic disc in glaucoma patients vs. controls.

Methods: Thirty-one eyes of primary open angle glaucoma patients (mean age: 64.9 ± 2.1 years) and 31 eyes of 31 healthy controls (65.5 ± 2.0 years) were included. Perimetry, optical coherence tomography (OCT), and OCT angiography were performed. Multispectral imaging was used to record the optic disc reflectance at wavelengths 522 nm, 548 nm, 555 nm, 586 nm, and 610 nm, and haemoglobin concentration and oxygenation (SO2) were calculated from these measures. This was done in the rest and under stimulation of neuronal activity by flicker light.

Results: The haemoglobin concentration was significantly lower (p < 0.001) in the rim (40.0 ± 6.3) and the excavation (35.7 ± 8.0) of the glaucoma patients' discs than in controls (45.7 ± 7.5). SO2 was not different in general, but lower in a subgroup of 18 glaucoma patients with ischaemic disc rims than in non-ischaemic ones (median 26.8%, interquartile range (IQR): 29.5% vs. 51.9%, IQR 32.0%, p = 0.02) as well as in controls (41.0%, IQR 30.6%, p = 0.01). Flicker light stimulation significantly increased the haemoglobin concentration in the controls (+ 1.3 ± 3.6, p = 0.048) as well as in the rim of glaucoma discs (+ 2.6 ± 5.0, p = 0.006) and SO2 in the controls only (+ 15.4 ± 23.6%, p = 0.001). The haemoglobin concentration was significantly correlated with the perimetric mean defect, retinal nerve fibre layer (RNFL) thickness and para-papillary perfusion density.

Conclusions: The optic disc haemoglobin concentration and oxygenation are quantifiable from multispectral imaging and reduced in glaucoma. The correlation of haemoglobin concentration with perfusion density, RNFL thickness and visual field loss indicates its implication in glaucoma pathology.

Keywords: Blood supply; Glaucoma; Optic disc; Oximetry.

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Conflict of interest statement

Thomas Riemer is an employee of Imedos Systems GmbH. Martin Hammer holds patents in retinal oximetry.

Figures

Fig. 1
Fig. 1
Boxplot of optic disc haemoglobin concentrations (**p < 0.001). Hb — haemoglobin
Fig. 2
Fig. 2
Increase in optic disc oxygen saturation upon flicker light stimulation. SO2 — Hb oxygenation
Fig. 3
Fig. 3
Optic disc oxygen saturation in controls and patients with ischaemic discs (Hb concentration in the first percentile of controls, *p = 0.01). SO2 — haemoglobin oxygenation
Fig. 4
Fig. 4
Correlation of the para-papillary perfusion density (top), the retinal nerve fibre layer (RNFL) thickness (middle) and the perimetric mean defect (bottom) with the haemoglobin concentration at the rim of the optic disc in glaucoma patients. Hb — haemoglobin, RNFL — retinal nerve fibre layer, OCTA — optical coherence tomography angiography
See this image and copyright information in PMC

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