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Published on: November 12, 2020
No Evidence for Retinal Damage Evolving from Reduced Retinal Blood Flow in Carotid Artery Disease
Henning Heßler1, Hanna Zimmermann1, Timm Oberwahrenbrock1
1NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany.
Insights
Chronic carotid artery disease (CAD) with severe stenosis or occlusion significantly reduces retinal artery blood flow. However, this does not cause measurable changes in retinal structure or visual function.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Carotid artery disease (CAD), including high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO), can impair cerebral blood flow and reduce retinal blood supply.
- Understanding the impact of CAD on the eye is crucial for comprehensive patient management.
Purpose of the Study:
- To investigate the effects of chronic CAD on retinal blood flow, morphology, and visual function.
- To correlate the severity of carotid stenosis/occlusion with changes in ocular hemodynamics and structure.
Main Methods:
- Patients with unilateral CAS (≥50%) or CAO were assessed.
- Retinal perfusion was measured using transorbital duplex ultrasound to evaluate central retinal artery (CRA) blood flow velocities.
- Optical coherence tomography (OCT) and visual function tests were employed to assess retinal morphology and visual performance.
Main Results:
- A significant reduction in CRA peak systolic velocity was observed in eyes with severe CAS (≥80%)/CAO and retrograde ophthalmic artery flow compared to the non-affected side.
- Despite hemodynamic changes, OCT measurements of optic nerve thickness and visual functional parameters showed no significant differences between affected and unaffected eyes.
Conclusions:
- Chronic high-grade carotid artery disease demonstrates measurable hemodynamic effects on retinal blood flow.
- However, these hemodynamic changes do not appear to translate into significant, detectable morphological or functional alterations in the retina.
Introduction:
Carotid artery disease (CAD) comprising high-grade internal carotid artery stenosis (CAS) or carotid artery occlusion (CAO) may lead to ipsilateral impaired cerebral blood flow and reduced retinal blood supply.
Objective:
To examine the influence of chronic CAD on retinal blood flow, retinal morphology, and visual function.
Methods:
Patients with unilateral CAS ≥ 50% (ECST criteria) or CAO were grouped according to the grade of the stenosis and to the flow direction of the ophthalmic artery (OA). Retinal perfusion was measured by transorbital duplex ultrasound, assessing central retinal artery (CRA) blood flow velocities. In addition, optic nerve and optic nerve sheath diameter were measured. Optical coherence tomography (OCT) was performed to study retinal morphology. Visual function was assessed using high- and low-contrast visual paradigms.
Results:
Twenty-seven patients were enrolled. Eyes with CAS ≥ 80%/CAO and retrograde OA blood flow showed a significant reduction in CRA peak systolic velocity (no-CAD side: 0.130 ± 0.035 m/s, CAS/CAO side: 0.098 ± 0.028; p = 0.005; n = 12). OCT, optic nerve thicknesses, and visual functional parameters did not show a significant difference.
Conclusion:
Despite assessable hemodynamic effects, chronic high-grade CAD does not lead to gaugeable morphological or functional changes of the retina.
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