title: Anterior optic nerve capillary blood flow response to diurnal variation of mean ocular perfusion pressure in early untreated primary open-angle glaucoma.
abstract: OBJECTIVE
  To examine the impact of diurnal variation in intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) on the variation in anterior optic nerve capillary blood flow (BF) in patients with untreated early primary open-angle glaucoma (uPOAG) and healthy volunteers.
  
  
  METHODS
  Fourteen patients with uPOAG (age, 56.3 +/- 12 years [SD]; seven men) and 14 normal subjects (age, 57.6 +/- 9.9 years; five men) were examined. Diurnal IOP, systolic (SBP) and diastolic (DBP) blood pressures, and optic nerve head (ONH) topography were measured every hour; and diurnal BF was measured by flowmeter every 2 hours between 0700 and 2200 hours. A perfusion image analyzer was used to calculate the mean BF within the rim (mean rim flow, MRF). The local flow (LF) was calculated using the median and mean flow rates within a 10 x 10-pixel window placed on the rim in the area of maximum topography fluctuation (MTF). The MOPP was then calculated. Mixed-effect linear models were used to analyze the repeated measures data in which both fixed and random effects were included.
  
  
  RESULTS
  IOP, BP, and MOPP had significant diurnal variation (P < 0.040). LF measured at the sector of MTF significantly changed in patients with uPOAG (P = 0.006) but not in normal subjects (P = 0.660). MRF did not show significant diurnal change in either group (P = 0.130, P = 0.770). LF increased significantly after lunch in the uPOAG group (P = 0.001). SBP had a significant effect on LF over the course of the day in the uPOAG group (P = 0.043). The diurnal change in IOP, BP, and MOPP did not have a significant effect on MTF in either group. In uPOAG, the local flow, in areas of greatest topographical change, correlated inversely with IOP at 0700 hours (P < or = 0.002).
  
  
  CONCLUSIONS
  The mean rim flow did not change during the day, implying that the anterior optic nerve capillary blood flow was autoregulated in both normal subjects and in patients with uPOAG, despite significant changes in IOP and MOPP. However, the regions of greatest diurnal change in rim topography (MTF) had significant diurnal change in capillary blood flow in patients with uPOAG but not in normal subjects.
authors.affiliation: School of Optometry, University of Waterloo, Waterloo, Canada. msehi@med.miami.edu
authors.forename: Mitra
authors.initials: M
authors.lastname: Sehi
authors.forename: John G
authors.initials: JG
authors.lastname: Flanagan
authors.forename: Leilei
authors.initials: L
authors.lastname: Zeng
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Graham E
authors.initials: GE
authors.lastname: Trope
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002196:Capillaries; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology*; D006706:Homeostasis; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000098:blood supply*; D009900:Optic Nerve / Q000098:blood supply; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology