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Purpose of Review <p>The goal of this review is to examine the relationship between pulsatile flow disturbances and region-specific microvascular biomarkers in the disease pathology of glaucoma. We seek to explore the evolution of research on the association between pulsatile flow, vascular resistance, and their effects on the microcirculation at the optic nerve head, leading to mechanical stress.</p> Recent Findings <p>We conducted a review using the PICO framework to identify studies on microvasculature, pulsatile blood flow, and hemodynamic parameters in glaucoma. From 437 initial records, 81 articles were selected for full-text analysis. These studies convey the growing evidence supporting the vascular theory that reducing ocular blood flow, particularly to the optic nerve head, results in ischemic damage. Several methodological approaches have been employed to assess ocular blood flow, including Doppler ultrasound, optical coherence tomography angiography (OCTA), laser Doppler flowmetry, laser speckle flowgraphy, and Doppler optical coherence tomography. OCTA has emerged as particularly valuable, enabling non-invasive visualisation and quantification of retinal and optic nerve head microvasculature and revealing region-specific reductions in vessel density that correlate with visual field loss. Challenges remain in accurately measuring and modelling pulsatile flow in the microcirculation, but future directions involving artificial intelligence and multi-scale modelling approaches show promise.</p> Summary <p>The vascular perspective significantly enhances understanding of glaucoma as a multifactorial disease, with vascular assessment potentially complementing traditional evaluations for earlier detection and more accurate risk stratification, opening new therapeutic possibilities beyond intraocular pressure reduction. Pulsatile flow acts as a vital factor in the disease genesis and progression. OCTA enables non-invasive visualisation and quantification of the microvasculature, which could be further investigated in its role in region-specific examination, leading to targeted treatment options.</p>

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Pulsatile Flow Disturbances and Region-Specific Microvascular Biomarkers in Glaucoma

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Avinash V. Prabhu,
  • Pradeep R,
  • Ananth Bhandary,
  • Ksheeraja Y,
  • J. Tejas

摘要

Purpose of Review

The goal of this review is to examine the relationship between pulsatile flow disturbances and region-specific microvascular biomarkers in the disease pathology of glaucoma. We seek to explore the evolution of research on the association between pulsatile flow, vascular resistance, and their effects on the microcirculation at the optic nerve head, leading to mechanical stress.

Recent Findings

We conducted a review using the PICO framework to identify studies on microvasculature, pulsatile blood flow, and hemodynamic parameters in glaucoma. From 437 initial records, 81 articles were selected for full-text analysis. These studies convey the growing evidence supporting the vascular theory that reducing ocular blood flow, particularly to the optic nerve head, results in ischemic damage. Several methodological approaches have been employed to assess ocular blood flow, including Doppler ultrasound, optical coherence tomography angiography (OCTA), laser Doppler flowmetry, laser speckle flowgraphy, and Doppler optical coherence tomography. OCTA has emerged as particularly valuable, enabling non-invasive visualisation and quantification of retinal and optic nerve head microvasculature and revealing region-specific reductions in vessel density that correlate with visual field loss. Challenges remain in accurately measuring and modelling pulsatile flow in the microcirculation, but future directions involving artificial intelligence and multi-scale modelling approaches show promise.

Summary

The vascular perspective significantly enhances understanding of glaucoma as a multifactorial disease, with vascular assessment potentially complementing traditional evaluations for earlier detection and more accurate risk stratification, opening new therapeutic possibilities beyond intraocular pressure reduction. Pulsatile flow acts as a vital factor in the disease genesis and progression. OCTA enables non-invasive visualisation and quantification of the microvasculature, which could be further investigated in its role in region-specific examination, leading to targeted treatment options.