Retinal Vein Pulsation Is in Phase with Intracranial Pressure and Not Intraocular Pressure

Morgan, William H.; Lind, Christopher R. P.; Kain, Samuel; Fatehee, Naeem; Bala, Arul; Yu, Dao‐Yi

doi:10.1167/iovs.12-9837

Cited by 58 publications

(77 citation statements)

References 30 publications

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“…The remaining 12 studies enrolling 546 participants identified in our literature search were included in our meta-analysis (Table 1). 2,4,5,11,15,16,19,24,25,31,32,35,36 Although all of these 12 studies contributed to the calculation of a pooled estimated correlation coefficient, only 4 presented outcomes required for the calculation of summary diagnostic accuracy estimates (Table 2). 16,19,25,36 …”

Section: Resultsmentioning

confidence: 99%

“…36 In half of the included studies, invasive ICP measurement was obtained through lumbar puncture (LP) 11,15,19,25,31,32 while the remainder measured ICP through intracranial monitors. 2,4,5,16,24,35,36 The interval between IOP and ICP measurement ranged from simultaneous measurements 4,5,16,24,35,36 to up to 5 hours. 11 Among studies reporting diagnostic accuracy estimates, the thresholds for assigning elevated IOP and intracranial hypertension were defined as a measurement greater than 20 cm H 2 0.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…2,4,5,11,15,16,19,24,25,31,32,35,36 As these often small, disparate reports have produced conflicting results, IOP measurement in the evaluation of patients suspected of intracranial hypertension has yet to be adopted into clinical practice. We therefore conducted a systematic review and meta-analysis to determine the correlation between IOP and ICP and the diagnostic accuracy of IOP measurement for detecting raised ICP among patients with suspected intracranial hypertension.…”

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confidence: 99%

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Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis

Yavin¹,

Luu²,

James

et al. 2014

JNS

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Object Because clinical examination and imaging may be unreliable indicators of intracranial hypertension, intraocular pressure (IOP) measurement has been proposed as a noninvasive method of diagnosis. The authors conducted a systematic review and meta-analysis to determine the correlation between IOP and intracranial pressure (ICP) and the diagnostic accuracy of IOP measurement for detection of intracranial hypertension. Methods The authors searched bibliographic databases (Ovid MEDLINE, Ovid EMBASE, and the Cochrane Central Register of Controlled Trials) from 1950 to March 2013, references of included studies, and conference abstracts for studies comparing IOP and invasive ICP measurement. Two independent reviewers screened abstracts, reviewed full-text articles, and extracted data. Correlation coefficients, sensitivity, specificity, and positive and negative likelihood ratios were calculated using DerSimonian and Laird methods and bivariate random effects models. The I2 statistic was used as a measure of heterogeneity. Results Among 355 identified citations, 12 studies that enrolled 546 patients were included in the meta-analysis. The pooled correlation coefficient between IOP and ICP was 0.44 (95% CI 0.26–0.63, I2 = 97.7%, p < 0.001). The summary sensitivity and specificity for IOP for diagnosing intracranial hypertension were 81% (95% CI 26%–98%, I2 = 95.2%, p < 0.01) and 95% (95% CI 43%–100%, I2 = 97.7%, p < 0.01), respectively. The summary positive and negative likelihood ratios were 14.8 (95% CI 0.5–417.7) and 0.2 (95% CI 0.02–1.7), respectively. When ICP and IOP measurements were taken within 1 hour of another, correlation between the measures improved. Conclusions Although a modest aggregate correlation was found between IOP and ICP, the pooled diagnostic accuracy suggests that IOP measurement may be of clinical utility in the detection of intracranial hypertension. Given the significant heterogeneity between included studies, further investigation is required prior to the adoption of IOP in the evaluation of intracranial hypertension into routine practice.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis

Yavin¹,

Luu²,

James

et al. 2014

JNS

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“…This suggests a posture-dependent change in TLCPD. However, simultaneous assessment of the IOP and ICP is sparse [17][18][19][20] . Changes in TLCPD as a function of posture has not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

The pressure difference between eye and brain changes with posture

Eklund

Jóhannesson

Johansson

et al. 2016

Annals of Neurology

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Objective: The discovery of a posture-dependent effect on the difference between intraocular pressure (IOP) and intracranial pressure (ICP) at the level of lamina cribrosa could have important implications for understanding glaucoma and idiopathic intracranial hypertension and could help explain visual impairments in astronauts exposed to microgravity. The aim of this study was to determine the postural influence on the difference between simultaneously measured ICP and IOP.Methods: Eleven healthy adult volunteers (age 46±10 years) were investigated with simultaneous ICP, assessed through lumbar puncture, and IOP measurements when supine, sitting, and in 9° head down tilt (HDT). The trans-lamina cribrosa pressure difference (TLCPD) was calculated as the difference between the IOP and ICP. To estimate the pressures at the lamina cribrosa, geometrical distances were estimated from MRI and were used to adjust for hydrostatic effects. Results:The TLCPD (mm Hg) between IOP and ICP was 12.3±2.2 for supine, 19.8±4.6 for sitting and 6.6±2.5 for HDT. The expected 24-hour average TLCPD on earthassuming 8 h supine and 16 h upright-was estimated to be 17.3 mm Hg. By removing the hydrostatic effects on pressure, a corresponding 24 h-average TLCPD in microgravity environment was simulated to be 6.7 mmHg. Interpretation:We provide a possible physiological explanation for how microgravity can cause symptoms similar to those seen in patients with elevated ICP. The observed posture dependency of TLCPD also implies that assessment of the difference between IOP and ICP in upright may offer new understanding of the pathophysiology of idiopathic intracranial hypertension and glaucoma.

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“…Morgan and colleagues demonstrated in a previous study a difference in the phasing of the IOP curve and the phasing of the CSFP curve with respect to the cardiac cycle, with the ICP curve reaching its height earlier than the CSFP curve (Morgan et al 2012). It was then wondered whether these physiological short-term changes in the TLCPD, potentially even resulting in short-term reversals of the TLCPD and thus in a swinging TLCPD, may physiologically be needed to allow the retrograde axoplasmic flow entering the eye (Jonas et al 2012).…”

Section: Referencesmentioning

confidence: 96%

Intracranial pressure fluctuations: a potential risk factor for glaucoma?

Zheng

Wang

Jonas

et al. 2013

Acta Ophthalmologica

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Retinal Vein Pulsation Is in Phase with Intracranial Pressure and Not Intraocular Pressure

Abstract: During pulsation, central retinal vein collapse occurs in time with IOP and ICP diastole. Venous collapse is not induced by intraocular systole. These results suggest that ICP pulse pressure dominates the timing of venous pulsation.

Cited by 58 publications

References 30 publications

Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis

Diagnostic accuracy of intraocular pressure measurement for the detection of raised intracranial pressure: meta-analysis

The pressure difference between eye and brain changes with posture

Intracranial pressure fluctuations: a potential risk factor for glaucoma?

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