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Objective-To investigate systematically the various associated systemic and ophthalmic abnormalities in different types of retinal artery occlusion (RAO). Design-Cohort study.Participants-439 consecutive untreated patients (499 eyes) with RAO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Initially they also had carotid Doppler/angiography and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.Main Outcome Measures-Demographic features, associated systemic and ophthalmic abnormalities and sources of emboli in various types of RAO.Results-RAO was classified into various types of central (CRAO) and branch (BRAO) artery occlusion. In both nonarteritic CRAO and BRAO the prevalence of diabetes mellitus, arterial hypertension, ischemic heart disease, and cerebrovascular accidents were significantly higher compared to the prevalence of these conditions in the matched US population (all p<0.0001). Smoking prevalence, compared to the US population, was significantly higher for males (p=0.001) with nonarteritic CRAO and for females with BRAO (p=0.02). Ipsilateral internal carotid artery had ≥50% stenosis in 31% of nonarteritic CRAO patients and 30% of BRAO, and plaques in 71% of nonarteritic CRAO and 66% of BRAO. Abnormal echocardiogram with embolic source was seen in 52% of nonarteritic CRAO and 42% of BRAO. Neovascular glaucoma developed in only 2.5% of nonarteritic CRAO eyes.Conclusion-This study showed that in CRAO as well as BRAO the prevalence of various cardiovascular diseases and smoking was significantly higher compared to the prevalence of these conditions in the matched US population. Embolism is the most common cause of CRAO and BRAO;Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. The authors have no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 October 1. Published in final edited form as:Ophthalmology . 2009 October ; 116(10): 1928-1936. doi:10.1016/j.ophtha.2009.006. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript plaque in the carotid artery is usually the source o...

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Objective-To investigate systematically the natural history of visual outcome in central retinal vein occlusion (CRVO). Design-Cohort study.Participants-667 consecutive CRVO patients (697 eyes) with CRVO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. The same ophthalmic evaluation was performed at each follow-up visit. CRVO was classified into nonischemic (588 eyes) and ischemic (109 eyes) at initial visit, based on functional and morphological criteria. Main Outcome Measures-Visual acuity and visual fields.Results-Of the eyes first seen within 3 months of onset, visual acuity was 20/100 or better in 78% in non-ischemic CRVO and only 1% in ischemic CRVO (p<0.0001), and visual field defects were minimal or mild in 91% and 8% respectively (p<0.0001). Final visual acuity, on resolution of macular edema, was 20/100 or better in 83% in non-ischemic CRVO and only 12% in ischemic CRVO (p<0.0001), and visual field defects minimal or mild in 95% and 18% respectively (p<0.0001). On resolution of macular edema, in eyes with initial visual acuity 20/70 or worse, visual acuity improved in 59% of the non-ischemic CRVO, with no significant (p=0.55) improvement in ischemic CRVO. Similarly, on resolution of macular edema, in eyes with moderate to severe initial visual field defect, improvement was seen in 86% of non-ischemic CRVO eyes but no significant (p=0.83) improvement in ischemic CRVO. In non-ischemic CRVO, development of foveal pigmentary degeneration and/or epiretinal membrane was the main cause of poor final visual acuity. This shows that initial presentation and the final visual outcome in the two types of CRVO are totally different.Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2012 January 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusion-A clear differentiation of CRVO into non-ischemic and ischemic types, based primarily on functional criteria, is crucial and fundamental in determining visual outcome. Visual outcome is good in non-ischemic CRVO and poor in ischemic CRVO Unders...

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Objective: To investigate the role of nocturnal arterial hypotension, intraocular pressure (IOP) and heart rate in optic nerve head (ONH) ischemic disorders, and the effects of systemic factors and topical β-blocker eye-drops on nocturnal arterial hypotension and heart rate. Methods: We investigated prospectively, by 24-hour ambulatory blood pressure (BP) monitoring and diurnal curve of the IOP, 275 white patients with anterior ischemic optic neuropathy (AION – 114), normal tension glaucoma (NTG – 131) and primary open angle glaucoma (POAG – 30). Results: Hourly average BP data analyses showed a significantly greater drop in mean diastolic BP (p < 0.009) at night in NTG than AION. Cases with visual field deterioration had significantly (p = 0.05) lower minimum nighttime diastolic BP. Arterial hypertensives on oral hypotensive therapy showed a significantly lower mean nighttime systolic BP (p = 0.006) and larger mean percentage drop in systolic (p < 0.0001), diastolic (p = 0.0009) and mean (p < 0.0001) BPs. Normotensives and hypertensives without therapy had no such difference. IOP showed no significant correlation with visual field deterioration in any of these conditions. Patients using β-blocker eyedrops, compared with those not using them, had greater percentage drop in diastolic BP (p = 0.028), lower minimum nighttime diastolic BP (p = 0.072) and lower minimum nighttime heart rate (p = 0.002). Conclusions: Findings of our study suggest that nocturnal hypotension, by reducing the ONH blood flow below a crucial level during sleep in a vulnerable ONH, may play a role in the pathogenesis of AION and glaucomatous optic neuropathy (GON) and progression of visual loss in them. Thus, nocturnal hypotension may be the final insult in a multifactorial situation.