Color Decoded Doppler Imaging in Glaucoma Diagnostics
Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf
Glaucoma is a multifactorial disease. Although its precise etiology is unknown, glaucoma is thought to be caused by alteration of the aqueous humor dynamics as well as disturbance of microcirculation in the peripapillary region.
The classical model of glaucoma pathogenesis according to Goldman assumes an elevated intraocular pressure (IOP) as the causative factor. Most glaucoma patients show chronic or intermittent IOP elevation, but in numerous patients with proven functional and morphologic glaucoma symptoms no IOP elevation is detectable. Although in these normal tension glaucoma patients a disturbed ocular perfusion of the optic disc presumably plays a key pathogenetic role, all current therapies aim only at lowering the intraocular pressure. However, considering the latest state of knowledge IOP-lowering eye drops should have at least a hemodynamically neutral, if not stimulating effect.
Color decoded Doppler imaging (CDI) enables to measure the blood flow velocity of retrobulbar vessels thus allowing an indirect assessment of microcirculation at the posterior pole. Compared to other methods CDI shows a good reproducibility of measurements and good correlations. In a clinical study it proved clearly superior to OBF.
Even if CDI offers multiple new approaches to glaucoma diagnostics, its therapeutic relevance is limited as long as glaucoma therapy is confined to IOP reduction.
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