Abstract
Intraocular pressure (IOP) and pulsatile ocular bloodflow (POBF) have been recorded in 15 patients with unilateral non-arteritic anterior ischaemic optic neuropathy (na-AION) and in 28 healthy subjects of comparable age. Measurements were obtained in both the upright and lying postures with a pneumotonometer linked to a Langham ocular bloodflow system.
By comparison with the healthy subjects, patients with na-AION were found to have a significantly greater postural pressure change in IOP (3.9 ± 0.4 mmHg in the affected eye and 3.6 ± 0.6 mmHg in the unaffected eye of the patients with na-AION compared to 2.2 ± 0.4 mmHg in the right eye of the healthy subjects P<0.01 and <0.05 respectively). There was no significant difference between the IOP in the affected and unaffected eyes of patients with na-AION nor between this group and the healthy subjects in either posture. Pulsatile ocular bloodflow measurements were similar in both groups and in both eyes of the patients with na-AION. In both groups POBF fell significantly on lying down (healthy right eyes −84 ± 16 ul/min p<0.01, na-AION affected eye −84 ± 24 ul/min p<0.01, unaffected eye −83 ± 26 ul/min p<0.001). These figures represent decrements of 19% in all groups.
These findings suggest that assumption of the supine posture may be associated with a reduction in the pulsatile component of ocular perfusion. The importance of this in the pathogenesis of na-AION is discussed.
Similar content being viewed by others
Article PDF
References
Hayreh SS : Anterior ischaemic optic neuropathy I. Terminology and pathogenesis. Br J Ophthalmol 1974, 58: 955–63.
Hayreh SS and Baines JAB : Occlusion of the posterior ciliary artery III. Effects on the optic nerve head. Br J Ophthalmol 1972, 56: 754–64.
Knox DL and Duke JR : Slowly progressive ischaemic optic neuropathy. Tr Am Acad Ophth and Otol 1971, 75: 1065–8.
Katz B, Weinreb RN, Wheeler DT, Klauber MR : Anterior ischaemic optic neuropathy and intraocular pressure. Br J Ophthalmol 1990, 74: 99–102.
Tomask RL and Remler BF : Anterior ishaemic optic neuropathy and increased intraocular pressure. J Clin Neuro-ophthalmol 1989, 9: 116–18.
Foulds WS : Visual disturbances in systemic disorders: Optic neuropathy and systemic disease. Trans Ophthalmol Soc UK 1969, 89: 125–46.
Bosley TM, Savino PJ, Sergott RC, Eagle RC, Sandy R, Gee W : Ocular pneumoplethysmography can help in the diagnosis of giant cell arteritis. Arch Ophthalmol 1989, 107: 379–81.
Horven I : Dynamic tonometry IV: The corneal indentation pulse in giant cell arteritis. Acta Ophthalmol 1970, 48: 710–18.
Bienfang DC : Loss of the ocular pulse in the acute phase of temporal arteritis: Acta Ophthalmol 1989, 67: (Suppl 191): 35–37.
Henkind P, Charles NC, Pearson J : Histopathology of ischemic optic neuropathy. Am J Ophthalmol 1970, 69: 78–90.
Silver DM, Farrell RA, Langham ME, O'Brien V, Schilder P : Estimation of pulsatile ocular blood flow from intraocular pressure. Acta Ophthalmol 1989, 67 (Suppl 191): 25–9.
Langham ME, Farrell RA, O'Brien V, Silver DM, Schilder P : Blood flow in the human eye. Acta Opthalmol 1989, 67 (Suppl 191): 9–13.
Eisenlohr J, Langham ME, Maumenee AE : Manometric studies of the pressure/volume relationships in living and enucleated eyes of individual subjects. Br J Ophthalmol 1962, 46: 536–48.
Beck RW, Savino PJ, Repka MX, Schatz NJ, Sergott RC : Optic disc structure in anterior ischemic optic neuropathy. Ophthalmol 1984, 91: 1334–7.
Beck RW, Servais GE, Hayreh SS : Anterior ischemic optic neuropathy IX Cup-to-disc ratio and its role in pathogenesis. Ophthalmology 1987, 94: 1503–8.
Feit RH, Tomsak RL, Ellenberger C : Structural factors in the pathogenesis of ischemic optic neuropathy. Am J Ophthalmol 1984, 98: 105–8.
Hayreh SS : Anterior Ischaemic Optic Neuropathy. VIII. Clinical Features and Pathogenesis of psthaemorrhagic amaurosis. Ophthalmology 1987, 94: 1488–502.
McDonald WI and Sanders MD : Migraine complicated by ischaemic papillopathy. Lancet 1971, ii: 521–3.
Tomsak RL : Ischaemic optic neuropathy associated with retinal embolism. Am J Ophthalmol 1985, 99: 590–2.
Portnoy SL, Beer PM, Packer AJ, Van Dyk HJL : Embolic anterior optic neuropathy. J Clin Neuro-ophthalmol 1989, 9: 21–5.
Lieberman MF, Shahi A, Green R : Embolic Ischaemic optic neuropathy. Am J Ophthalmol 1978, 86: 206–10.
Hayreh SS : Anterior ischaemic optic neuropathy IV. Occurence after cataract extraction. Arch Ophthalmol 1980, 98: 1410–16.
Repka MD, Savino PJ, Schatz NJ, Sergott RC : Clinical profile and long-term implications of anterior ischemic optic neuropathy. Am J Ophthalmol 1983, 96: 478–83.
Guyer DR, Miller NR, Auer CL, Fine SL : The risk of cerebrovascular disease in patients with anterior ischemic optic neuropathy. Arch Ophthalmol 1985, 103: 1136–42.
Olver JM, Spalton DJ, McCartney ACE : Microvascular structure of the retrolamina optic nerve in man: the possible significance in anterior ischaemic optic neuropathy. Eye 1990, 4: 7–24.
Hayreh SS : Blood supply of the anterior optic nerve. In Ritch R, Shields, MB, Krupin T eds. The Glaucomas, St Louis: CV Mosby 1989, 133–161.
Williams BI, Peart WS, Letley E : Abnormal intraocular pressure control in systemic hypertension and diabetes mellitus. Br J Ophthalmol 1980, 64: 845–51.
Quigley HA and Langham ME : Comparative intraocular pressure measurements with the pneumatonograph and Goldmann tonometer. Am J Ophthalmol 1975, 80: 266–73.
To'mey KF, Faris BM, Jalkh AE, Nasr AM : Ocular pulse in high myopia: a study of 40 eyes. Ann Ophthalmol 1981, 13: 569–71.
Perkins ES : The ocular pulse. Curr Eye Res 1981, 1: 19–23.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
James, C., Smith, S. The effect of posture on the intraocular pressure and pulsatile ocular blood flow in patients with non-arteritic anterior ischaemic optic neuropathy. Eye 5, 309–314 (1991). https://doi.org/10.1038/eye.1991.49
Issue Date:
DOI: https://doi.org/10.1038/eye.1991.49