Gardiner Stuart K, Reynaud Juan, Cull Grant, Yang Hongli, Mansberger Steven L, Fortune Brad
Devers Eye Institute, Legacy Health, Portland, Oregon, Unites States.
Invest Ophthalmol Vis Sci. 2025 Sep 2;66(12):34. doi: 10.1167/iovs.66.12.34.
Glaucomatous pathophysiology may impair retinal vasodilation, leading to increased upstream pulsatility. We sought to quantify pulsatility at multiple locations, concurrently, and identify changes that correlate with the rate of disease progression.
One hundred eighty-one eyes of 139 participants were tested twice annually for six or more visits. Vessels within the optic nerve head (ONH) and peripapillary region were identified and classified as arteries versus veins using deep learning models applied to optical coherence tomography angiography scans. Vessels were then colocalized to high temporal resolution scans from laser speckle flowgraphy to quantify pulsatility and average flow at each location. These were compared against the rates of functional loss (mean deviation from automated perimetry) and structural loss (retinal nerve fiber layer thickness from optical coherence tomography) over time, using linear generalized estimating equation models.
More severe functional and structural loss were correlated with lower blood flow within ONH major vessels (Pearson correlation r = 0.406, P < 0.001 and r = 0.466, P < 0.001, respectively) and tissue (r = 0.432, P < 0.001 and r = 0.466, P < 0.001), and with lower pulsatility in ONH tissue only (r = 0.293, P = 0.001 and r = 0.279, P < 0.001). Higher pulsatility in the peripapillary arteries was correlated with more rapid functional loss (r = -0.220, P = 0.004) and structural loss (r = -0.220, P = 0.006), and remained a significant predictor when adjusting for current severity, age, or IOP.
Faster glaucomatous progression was associated with increased pulsatility in peripapillary arteries, suggesting impaired downstream retinal vasodilation beyond the ONH and neuroretinal rim.
青光眼的病理生理学可能会损害视网膜血管舒张功能，导致上游搏动性增加。我们试图同时对多个位置的搏动性进行量化，并确定与疾病进展速度相关的变化。
139名参与者的181只眼睛每年接受两次测试，共进行六次或更多次检查。使用应用于光学相干断层扫描血管造影扫描的深度学习模型，识别视神经乳头（ONH）和视乳头周围区域内的血管，并将其分类为动脉和静脉。然后将这些血管与激光散斑血流图的高时间分辨率扫描进行共定位，以量化每个位置的搏动性和平均血流。使用线性广义估计方程模型，将这些结果与随时间的功能丧失率（自动视野检查的平均偏差）和结构丧失率（光学相干断层扫描的视网膜神经纤维层厚度）进行比较。
更严重的功能和结构丧失与ONH主要血管内较低的血流相关（Pearson相关系数r分别为0.406，P<0.001和r = 0.466，P<0.001）以及组织内较低的血流相关（r = 0.432，P<0.001和r = 0.466，P<0.001），并且仅与ONH组织内较低的搏动性相关（r = 0.293，P = 0.001和r = 0.279，P<0.001）。视乳头周围动脉较高的搏动性与更快的功能丧失（r = -0.220，P = 0.004）和结构丧失（r = -0.220，P = 0.006）相关，并且在调整当前严重程度、年龄或眼压后仍然是一个显著的预测因素。
更快的青光眼进展与视乳头周围动脉搏动性增加相关，提示ONH和神经视网膜边缘以外的下游视网膜血管舒张功能受损。
