title: Application of a local search strategy improves the detection of blood flow deficits in the neuroretinal rim of glaucoma patients using scanning laser Doppler flowmetry.
abstract: OBJECTIVE
  Blood flow measures acquired using the scanning laser Doppler flowmeter (SLDF) are known to be highly susceptible to spatial and temporal variations of physiological origin. The purpose of this study was to evaluate a local search strategy intended to overcome these intrinsic variations, thereby improving the detection of blood flow defects resulting from glaucoma.
  
  
  METHODS
  The sample consisted of one eye of each of 15 glaucoma patients (aged 69.1 (SD 6.6) years) and 15 normal subjects (aged 65.2 (13.7) years). Three 10 degree images of the superior temporal retina and three images of the superior temporal rim were acquired using the Heidelberg retina flowmeter (HRF). Standard analysis was performed using a 10 x 10 pixel frame. For the search strategy the same frame was located within a 15 x 15 pixel window and manually repositioned in order to identify the highest and lowest local values of blood flow. Student's paired t test was used to identify differences between groups for the two methods (p<0.05).
  
  
  RESULTS
  The standard strategy revealed no significant differences in blood flow measures between the subjects at either the retina or neuroretinal rim. With the search strategy there was also no difference in blood flow measures at the retina. At the neuroretinal rim, the search strategy demonstrated that the highest measured blood flow, volume, and velocity values were significantly lower for the glaucoma patients (p = 0.002, 0.02, and 0.002 respectively) while comparison of the lowest flow values showed that glaucoma patients had lower blood flow and velocity only (p = 0.023 and 0.021 respectively).
  
  
  CONCLUSIONS
  Glaucoma patients exhibit reduced ocular blood flow at the neuroretinal rim, which seems to affect high velocity flow more profoundly than low velocity flow. When analysing perfusion images a local search strategy is recommend to identify the highest local blood flow values in order to optimise the ability to differentiate between subject groups.
authors.affiliation: Neurosciences Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK. s.l.hosking@aston.ac.uk
authors.forename: S L
authors.initials: SL
authors.lastname: Hosking
authors.forename: S J
authors.initials: SJ
authors.lastname: Embleton
authors.forename: I A
authors.initials: IA
authors.lastname: Cunliffe
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D001810:Blood Volume; D016022:Case-Control Studies; D005260:Female; D005583:Fourier Analysis; D005901:Glaucoma / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008297:Male; D012039:Regional Blood Flow; D012171:Retinal Vessels / Q000502:physiology*