Decreased Ocular Perfusion Pressure Associated With Reverse Ophthalmic Artery Flow on Transcranial Doppler Ultrasonography

Abstract

Innovative applications of clinical ocular diagnostic tools are emerging to help identify systemic disorders that extend beyond ocular diseases. Ophthalmodynamometry (ODM) is a screening tool that non-invasively determines mean central retinal artery pressure (MCRAP) and ocular perfusion pressure (OPP). Decreased OPP and MCRAP on Falck Medical Multifunctional Device (FMD, Falck Medical, Inc., Mystic, CT), along with reverse ophthalmic artery flow (ROAF) on transcranial Doppler ultrasonography (TCD), indicate increased collateral brain perfusion and possible stenosis of the ophthalmic artery or internal carotid artery (ICA). In this case report, we describe the case of a 78-year-old female with ROAF, reduced MCRAP, and OPP in the right eye, confirmed by carotid duplex of 50-79% right ICA stenosis. Early application of ODM and TCD allowed for prompt diagnosis and management with a vascular specialist.

Keywords: cerebrovascular occlusive disease; mean central retinal artery pressure; ocular perfusion pressure; ophthalmodynamometry; reverse ophthalmic artery flow; transcranial doppler ultrasonography.

Figure 1. Transcranial Doppler ultrasonography (TCD) and carotid duplex scan.

(A) Right ophthalmic artery (OA) waveforms by TCD below the baseline indicate blood flow away from the probe. (B) Increased right internal carotid artery (ICA) peak systolic velocity by carotid duplex indicative of right ICA stenosis.