Colour Doppler analysis of ophthalmic vessels in the diagnosis of carotic artery and retinal vein occlusion, diabetic retinopathy and glaucoma: systematic review of test accuracy studies

Abstract

BackgroundColour Doppler analysis of ophthalmic vessels has been proposed as a promising tool in the diagnosis of various eye diseases, but the available diagnostic evidence has not yet been assessed systematically. We performed a comprehensive systematic review of the literature on the diagnostic properties of Colour Doppler imaging (CDI) assessing ophthalmic vessels and provide an inventory of the available evidence.MethodsEligible papers were searched electronically in (Pre) Medline, Embase and Scopus, and via cross-checking of reference lists. The minimum requirement to be included was the availability of original data and the possibility to construct a two-by-two table. Study selection, critical appraisal using the QUADAS II instrument and extraction of salient study characteristics was made in duplicate. Sensitivity and specificity was computed for each study.ResultsWe included 11 studies (15 two-by-two tables) of moderate methodological quality enrolling 820 participants (range 30 to 118). In 44.4% participants were female (range 37–59% in specific subgroups). CDI was assessed for internal carotid stenosis, diabetic retinopathy, glaucoma, and branch or central retinal vein occlusion diagnosis. There was insufficient data to pool the results for specific illnesses. For the assessments of ophthalmic arteries, mean sensitivity was 0.69 (range 0.27–0.96) with a corresponding mean specificity of 0.83 (range 0.70–0.96). Mean sensitivity of the central retinal artery assessments was 0.58 (range 0.31–0.84) and the corresponding mean specificity was 0.82 (range 0.63–0.94).ConclusionsRobust assessments of the diagnostic value of colour Doppler analysis remain uncommon, limiting the possibilities to extrapolate its true potential for clinical practice.PROSPERO 2014:CRD42014014027.

Non-invasive measurement techniques for quantitative assessment of optic nerve head blood flow

“…It is interesting that vascular abnormalities could be present before development of disease. 30 For example, in normal tension glaucoma, the most common type of glaucoma in Asia, 18 blood flow measurements could help identifying eyes at risk.…”

“…27,29 A systematic review from 2016 concluded however that CDI could not yet be recommended in a daily clinical setting due to the lack of standardized methods and solid studies of the method. 30 The lack of standardization makes it difficult to compare the different studies and evaluate the reproducibility of the method. The evaluated parameter in CDI measurements also vary in the different studies.…”

“…Some use the restrictive index, some diastolic velocity and others peak flow velocity. 30 Most studies are limited in sample size and Bittner et al 30 had trouble finding large studies that met their criteria for inclusion. Also, there could be issues with inter-observer and inter-subject variability.…”

Waveform parameters of retrobulbar vessels in glaucoma patients with different demographics and disease severity

“…Doppler ultrasonography is a noninvasive technique that measures blood flow velocities in retrobulbar vessels (ophthalmic artery, OA; central retinal artery, CRA; short posterior ciliary arteries, PCAs). Several studies showed significant blood velocity derangements in the OA, CRA, and PCAs in glaucomatous patients, [15][16][17][18][19][20] and retrobulbar blood flow impairment has been associated to glaucoma progression. [17][18][19][20][21][22][23][24] Peak systolic and end-diastolic velocities (PSV, EDV) and Pourcelot's resistivity index (RI) have been traditionally considered in the hemodynamic evaluations of the retrobulbar vessels.…”

“…Several studies showed significant blood velocity derangements in the OA, CRA, and PCAs in glaucomatous patients, [15][16][17][18][19][20] and retrobulbar blood flow impairment has been associated to glaucoma progression. [17][18][19][20][21][22][23][24] Peak systolic and end-diastolic velocities (PSV, EDV) and Pourcelot's resistivity index (RI) have been traditionally considered in the hemodynamic evaluations of the retrobulbar vessels. Recently, more attention has been given to additional arterial waveform parameters (WPs) commonly used in other medical specialties, such as WPs used in renal and hepatic arteries to predict transplantation failure, which might provide new insights in the characterization of retrobulbar hemodynamics in glaucoma patients.…”