Ocular Blood Flow in Glaucoma : 1st Edition (2009) by R.N. Weinreb PDF

Description

For the World Glaucoma Association Consensus VI, our topic was Blood Flow in Glaucoma. Global experts were assembled beginning in November 2008 to participate in the Project Forum E-Room, a unique aspect to facilitate discussion of each of the consensus meetings. With each of the prior meetings, arriving at the consensus was circuitous and filled with compromises, and this meeting had a similar path. Nevertheless, this was an excellent opportunity to critically assess the evidence relating to the relationship between glaucoma and ocular blood flow and develop consensus statements. The meeting, as with previous ones, was stimulating, educational, thought-provoking, and enjoyable for all participants and attendees. Preface Welcome ANATOMY AND PHYSIOLOGY Anatomy of blood from the heart to the eye Blood supply of the optic nerve Overview of blood flow regulation in general The mediators of autoregulation The anatomic underpinning of ocular blood flow control The ocular vasculature and its role in regulating blood flow to the optic nerve and retina CLINICAL MEASUREMENT OF OCULAR BLOOD FLOW Color Doppler Imaging Laser Doppler Flowmetry and Scanning Laser Flowmetry Retinal Vessel Analyzer Blue Field Entopic Stimulation Laser Interferometric Measurement of Fundus Pulsation Dynamic Contour Tonometry and Ocular Pulse Amplitude Pulsatile Ocular Blood Flow (POBF) Analyzer Laser Speckle Method (Laser Speckle Flowgraphy) Digital Scanning Laser Ophthalmoscope Angiography Bi-directional Laser Doppler Velocimetry and Simultaneous Vessel Densitometry Doppler Optical Coherence Tomography Retinal Oximetry CLINICAL RELEVANCE OF OCULAR BLOOD FLOW (OBF) MEASUREMENTS INCLUDING EFFECTS OF GENERAL MEDICATIONS OR SPECIFIC GLAUCOMA TREATMENT What is the evidence supporting a role for ocular blood flow in glaucoma patients? Clinical evidence derived from different measurement parameters Evidence from experimental animal studies What disease mechanisms lead to impaired blood flow in glaucoma? Ocular versus systemic causes Systemic factors Vascular dysregulation/perfusion instability What is the impact of medication and other modifiable factors on ocular blood flow? IOP-lowering topical medication Systemic drugs Ocular surgery, exercise Does modulation of blood flow alter glaucoma progression? Glaucoma and systemic vascular disease Systemic disease and glaucoma patients Diabetes Cardiovascular diseases SHOULD MEASUREMENTS OF OCULAR BLOOD FLOW BE IMPLEMENTED INTO CLINICAL PRACTICE? Interpreting clinical studies WHAT DO WE STILL NEED TO KNOW? Ocular blood flow and visual function in glaucoma patients Ocular perfusion pressure and prevalence and progression of glaucoma Ocular blood flow and optic nerve head structure The relationship between intraocular pressure and ocular blood flow The relationship between cerebrospinal fluid pressure and glaucoma Future research Summary of Consensus Points Index of authors

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