Original Articles
Color Doppler imaging discloses reduced ocular blood flow velocities in nonexudative age-related macular degeneration

https://doi.org/10.1016/S0002-9394(99)00061-6Get rights and content

Abstract

PURPOSE: To study ocular perfusion defects in age-related macular degeneration.

METHODS: Twenty-five subjects with nonexudative age-related macular degeneration were compared with 25 age-matched control subjects in studies of flow velocities in several retrobulbar vessels. Color Doppler imaging, which was performed by an examiner who was masked to the subjects’ assignment to the control or age-related macular degeneration group, measured peak systolic and end diastolic velocity in the ophthalmic, central retinal, and nasal and temporal posterior ciliary arteries of one eye. A resistive index was calculated from the peak systolic and end diastolic velocity.

RESULTS: Subjects with nonexudative age-related macular degeneration showed a consistent trend toward lower peak systolic and end-diastolic velocities in the posterior ciliary arteries. For example, in the nasal posterior ciliary artery, the mean end diastolic velocity measured 1.45 ± 0.34 cm per sec in the age-related macular degeneration group compared with 1.96 ± 0.66 cm per sec in the control group, yielding a 26% decrease in the age-related macular degeneration group, which represented the largest difference and was highly statistically significant (P = .0012). The resistive index was not significantly altered in the nasal or temporal posterior ciliary artery. Subjects with nonexudative age-related macular degeneration did not differ from control subjects in peak systolic velocity, end diastolic velocity, or resistive index in the ophthalmic artery. In the central retinal artery, the end diastolic velocity was lower (1.37 ± 1.95 cm per sec vs 1.95 ± 0.66 cm per sec), whereas the resistive index was higher (0.83 ± 0.05 vs 0.76 ± 0.06 cm per sec), in the age-related macular degeneration group; these results were highly statistically significant (P = .0007 and P < .0001, respectively).

CONCLUSIONS: Retrobulbar vascular changes in nonexudative age-related macular degeneration subjects include reduced flow velocities in the nasal and temporal posterior ciliary arteries. The reduced peak systolic velocity, combined with the reduced end diastolic velocity at a constant resistive index, seen in nonexudative age-related macular degeneration, is consistent with reduced bulk flow in these vessels, suggesting that choroidal perfusion is abnormal in this form of age-related macular degeneration. The changes in the central retinal artery suggest there may be a more generalized perfusion abnormality beyond the choroid in patients with age-related macular degeneration or that the central retinal artery exhibits a secondary autoregulatory response to a primary change elsewhere.

Section snippets

Methods

Study subjects were eligible for inclusion if they had nonexudative macular degeneration, which is defined according to the International Classification System as a degenerative disorder in patients older than 50 years who have “soft drusen greater than 63 μm, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium, … or geographic atrophy of the retinal pigment epithelium.”5 Exclusion criteria included exudative macular degeneration in the study eye, which is defined by the

Results

Twenty-five age-related macular degeneration and 25 control subjects were evaluated. As summarized in Table 1, the mean age of the age-related macular degeneration subjects was 73.0 ± 10.9 years, whereas the mean age of the control subjects was 70.2 ± 8.5 years; there was no statistically significant difference in age. The age-related macular generation population comprised 15 men and 10 women and the control population comprised four men and 21 women, which represented a significant difference

Discussion

Investigators have traditionally believed that senescent retinal pigment epithelium accumulates metabolic debris from incomplete degradation of phagocytosed rod and cone membranes, which causes progressive engorgement of these retinal pigment epithelium cells, leading to drusen formation with subsequent progressive dysfunction of the remaining retinal pigment epithelium.1, 2 Healthy retinal pigment epithelium is necessary for maintenance of the choroid and choriocapillaris.9, 10, 11, 12, 13, 14

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    This study was supported in part by a grant from the Fight for Sight research division of Prevent Blindness America, Schaumberg, Illinois (Dr Ciulla) by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York; and by National Institutes of Health, Bethesda, Maryland, grant EY10801 (Dr Harris). Dr Ciulla is the recipient of a Career Development Award from Research to Prevent Blindness, Inc.

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