Theoretically, there are 3 constituents lending to optic blood flow decrease in glaucoma patients increased local opposition to flux, ( 2 ) decreased optic perfusion force per unit area ( OPP ) , and ( 3 ) increased blood viscousness. ( Shaarawy et. Al, 2009 ) . All these constituent shows that optic blood flow is of import for us to understand the pathology & A ; procedure of defect in glaucomatous oculus.
The consequence indicate that nimodipine additions ocular nervus caput ( ONH ) and choroidal blood flow in normal tenseness glaucoma ( NTG ) patients and inproves color contrast sensitiveness ( CCS ) . The latter consequence does non, nevertheless, seems to be direct effect of the blood flow betterment. ( Lukschet et. Al, 2004 ) . Dorzolamide/timolol fixed combination increased blood flow significantly at the neuroretinal rim demoing a combination of hypotensive and heamodynamic effects. ( Rolle et. Al, 2008 ) . These findings shows drug consequence could bring on alterations on optic blood flow and it proves that blood flow measuring is a worthy findings towards glaucomatous patterned advance in the oculus.
The neuroretinal rim is the tissue between the outer border of the cup and the phonograph record border. The normal healthy rim has an orange or tap coloring material and shows a features constellation. The inferior rim is the broadest followed by the superior, rhinal, and temporal, ISNT. ( Kanski, 2007 ) . Eyess with and without cilioretinal did non differ significantly in the countries of neuroretinal rim and alpha ( I± ) and beta ( I? ) zones of parapapillary wasting, when measured in the whole ocular phonograph record and in the 4 sectors individually ; in ratios of the temporal horizontal country to entire country of rim and parapapillary wasting ; and in the ratio of temporal rim country to nasal rim country, neither in an interindividual comparing nor in an intraindividual intereye comparing. In contrast to the place of the cardinal retinal vas bole, presence and place of cilioretinal arterias do non markedly act upon the form of neuroretinal rim loss and patterned advance of parapapillary wasting in glaucoma. ( Wido et. Al, 2003 ) . In some other findings, an of import morphologic prognostic factors for patterned advance of the glaucomatous visual aspect of the ocular nervus caput in white individuals are little size of neuroretinal rim and big country of I? zone of parapapillary wasting. Progression of glaucomatous ocular nervus caput alterations is independent of size and form of the ocular phonograph record, size of I± zone of parapapillary wasting, retinal vas diameter, and ocular cup deepness. ( Jonas et. Al, 2002 ) .
Findingss in early 2000, glaucoma patients exhibit reduced optic blood flow at the neuroretinal rim, which seems to impact high speed flow more deeply than low speed flow. ( Hosking et. Al, 2001 ) . The glaucoma topics had significantly lower the retinal haemodynamics than the control subjects. There were no important differences in HRF parametric quantities between the NTG and POAG topics. The phonograph record had been identified as holding unnatural sections had lower HRF values than those with a corresponding normal section. Logan et. Al, 2004 survey show the relation between structural harm of the ocular nervus caput and the degree of retinal blood flow and this may bespeak an early marker of the pathological procedure. On the other research findings, specific location is identified that inferior sector of retinal nervus fiber bed and the ocular nervus caput may hold lower blood flow per unit nervus tissue volume compared to the superior sector. This consequences suggest that the inferior sector is more vulnerable to promote intraocular force per unit area ( IOP ) and ischemic abuses in glaucomatous ocular neuropathy. ( Harris A. et. Al, 2003 ) . Hafez et. Al, 2003 stated that average neuroretinal rim blood flow was significantly higher in OHT patients with C/D ratios less than 0.4 when compared to OHT patients with larger C/D ratios. This suggests that cut down neuroretinal rim blood flow in higher hazard optic high blood pressure may be an early event in the development of glaucomatous ocular neuropathy, looking prior to the manifestation of ocular field defects. Changes in neuroretinal rim & A ; alterations in blood flow works along as an early mark to attest ocular field defect.
Association between blood flow measuring in cup & A ; pulsing amplitude in cup, and association between average defect from ocular field proving and optic hemodynamic parametric quantity were besides important. Reduced ocular phonograph record perfusion in patients with open-angle glaucoma is evidenced from two independent methods in the present survey. Furthermore, the informations indicate that reduced optic blood flow in these patients is linked to ocular field alterations. It remains to be established whether compromised ocular phonograph record and choroidal blood flow contributes to ocular phonograph record harm in glaucomatous oculus or is a secondary functional phenomenon. ( Findl O. et. Al, 2000 ) . Ocular blood flow change in glaucoma patient seems, at least partially, to be related to a systemic vascular dysregulation. ( Emre et. Al, 2004 ) . There is another follow up findings, provinces that, for topics with asymmetric glaucoma harm between eyes, flow and speed were significantly lower in the eyes with worse glaucoma harm. When comparing ocular phonograph record exposing within-eye dissymmetry, the hemidisc with greater harm showed significantly lower blood speed than the hemidisc with less harm, but nevertheless, no difference in blood flow or volume was detected. This provide grounds that impaired ocular nervus circulation is associated with the extent of glaucomatous pathology. ( Lam A. et. Al, 2005 ) .
Inferior rim blood flow is less than superior rim blood flow in patients with superior hemifield defect, and superior rim blood flow is reduced compared to the inferior in patients with inferior hemifield defect. The blood flow in the neuroretinal rim was found to match to the regional ocular field defect in eyes with NTG. Decrease in flow were associated with decrease in map. ( Sato et. Al, 2006 ) .
The measuring taken with Heidelberg Retinal Flowmetry ( HRF ) was used to carry on the survey of blood flow through retinal vass which the flow of the ocular nervus caput. Harmonizing to Boehm et. Al ( 2005 ) , the blood capillary speed, flow and volume were found to be reduced significantly with the age. The research conducted by Boehm et. Al ( 2005 ) includes 103 healthy topic runing age 22 to 76 old ages old. They besides accounted patterned advance of IOP, blood force per unit area, bosom rate and gender, and found that the blood flow decrease addition with age affecting lessening overall blood flow. This may propose that the opposition involve lessening figure of the blood capillary or the diameter of the capillary. Kerr J. et. Al ( 1998 ) examined 14 hypertensive and 10 primary unfastened angle glaucoma patients with equal IOP position, the pulsatile optic blood flow reading were performed in sitting, standing, and supine places. No intervention were given during the trial and the consequence shows that a important decrease in volume, flow, and speed were found at lamina cribosa and the temporal neuroretinal rim in glaucoma ( POAG ) compared to optic high blood pressure topic. Somehow, consequence does n’t demo any alterations at rhinal neuroretinal rim and juxtapapillary retina. Their rating suggest that short posterior ciliary arteria and choroidal were besides cut down in flow but the mechanism is yet still unknown on glaucomatous ocular wasting. The other findings by done by Michelson G. et. Al ( 1996 ) , by utilizing scanning optical maser Doppler flowmetry ( SLDF ) to measure 43 patients with POAG and 43 healthy persons. POAG capable were found significantly reduced both juxtapapillary retinene blood flow and neuroretinal rim country blood flow compared with normal topic. The difference was up to 71 % and 49 % for both neuroretinal rim country flow and juxtapapillary retinal blood flow. Furthermore, decrease of neuroretinal rim country blood flow were found to be important with cup/disc ratio and juxtapapillary blood flow were found to be important with glaucomatous with/out instillment of any glaucomatous therapy compared to command capable. Research conducted by Embleton S.J. et. Al ( 2002 ) , by utilizing SLDF on 15 healthy topic ( immature ) , 15 healthy topic ( grownup ) . The survey found a cut down in optic blood flow at neuroretinal rim on matured capable compared to immature topic ( flow and speed ) and a diminution in lamina cribosa and retinal volume but non with the flow and speed.
Michelson et. Al ( 1996 ) prove that there is relation between age and retinal blood flow but no relationship between lamina cribosa and neuroretinal rim. Comparison between all research conducted by Boehm et. Al ( 2005 ) , Kerr J. et. Al ( 1998 ) , Michelson G. ( 1996 ) and Embleton et. Al ( 2002 ) show a assortment figure of participant involved ( 103, 24, 86, 30 ) severally with different age degree. In short, we tend to set more weight on Boehm et. Al survey because it is the most recent survey that have the largest participant involved although the consequence may non strong plenty due to HRF is rather new to ophthalmic appraisal. Recent survey on 24-hour blood flow in ocular nervus caput and sunspot of healthy human eyes shows that important diurnal-to-nocturnal lessenings at those location for older topic compared to younger topics. In add-on, the alterations were found to be independent of the alteration in optic perfusion force per unit area. ( Kida et. Al, 2008 ) .
2.2 Autoregulation of the blood flow of the ocular nervus caput
Autoregulation is the ability of a vascular bed to keep blood flow despite alterations in perfusion force per unit area. In other words, autoregulation may besides mention to the intrinsic ability of tissue to keep comparatively changeless blood flow in the face alterations in perfusion force per unit area or its ability to modify blood flow response to changing metabolic demand. Ocular nervus caput ( ONH ) partially portions blood flow physiologic of the encephalon and act as a continuance of the cardinal nervous system. ( Flammer J. and Orgul S. , 1998 ) . Cardinal retinal arteria ( CRA ) is the lone beginning of the blood supply and feeds the retinal arterias. These distal vas nourish the retinal ganglion cells and the meeting of unmyelinated nervus fibers anterior to the lamina cribosa. ( Onda E. Et. Al, 1995 ) . Previous literature have once and for all shown that glaucoma is a disease that cause the decease of the retinal ganglion cells and eroding of the ocular nervus caput.
Regulation of the blood flow is of import during position alteration to keep proper circulation position in many variety meats. In a status of unsloped position, the gravitation pulls the blood off from variety meats above the bosom and towards variety meats below the bosom. Appropriate blood flow is ensured by compressing the vas to barricade hyperemia and hydrops when altering from supine to unsloped position while the vass above the bosom dilate to countervail falling perfusion. Evans D.W. et. Al ( 1999 ) , proved that glaucoma patients demonstrate defective autoregulation of optic blood flow during posture alteration. Another extended research, the anatomy of the microvascular and the blood flow ordinance of the ONH remains hard to determine harmonizing to Harris A. et.al ( 2003 ) . Recent survey to measure the autoregulation retinal blood flow in healthy immature topic, along with the systemic blood force per unit area and IOP suggest no important alteration in retinal blood flow was found. This prove that a normal topic has the ability to counterbalance the addition of blood force per unit area and keep a stable retinal blood flow after exercising. ( Lester M. Et. Al, 2007 ) .
Cerebral circulation was proved to be dependent on local blood gas disturbances. ( Haggendal et. Al, 1969 ) . These determination may besides applied at autoregulation of ONH as the blood flow lessenings, whereby the local metabolic vascular response is chiefly oxygen-dependent. ( Kontos et. Al, 1978 ) . Harmonizing to Flammer et. Al ( 1998 ) , acapnia and hyperoxia mediate arteriolar bottleneck and a subsequent lessening in ONH blood flow, while hypercarbia and hypoxia does non demo any important. ( Flammer and Orgul 1998 ) . Research on inspiration of different mixture of O and C dioxide may consequence retinal blood flow. Retinal blood speed, retinal vas diameter and retinal blood flow were found to be decreased during all take a breathing periods as the mixture of gases had small consequence on systemic haemodynamics. ( Luksch A. et. Al, 2002 ) . Breathing with wholly oxygenated environment can do addition in O saturated degree ( SaO2 ) and a lessening in end-tidal C dioxide ( EtCO2 ) . The trial was done with 20 immature grownup in pure oxygenated room to understand the alterations in retinal vas diameter during physiological emphasis or diseased conditions. Although the survey were based on single fundus exposure, the chief aim was to detail the clip class and amplitude alterations in the diameter of arterias and venas across all retinal quarter-circles, during and after hypertoxic vascular emphasis. The findings shows that during systemic hypertoxic emphasis, the retinal vass change in quality uniformly across retinal quarter-circles in healthy immature grownups. ( Jean-Louis et. Al, 2005 ) .
Research of The Singapore Malay Eye Study done by Koh et. Al ( 2010 ) , cross-sectional survey was conducted in Malay individuals aged 40-80 old ages shacking in Singapore, by utilizing confocal scanning optical maser ophthalmoscope, ocular phonograph record measurings including disc country, rim country, and rim-to-disc country ( RDA ) ratio were taken. A important findings of planetary RDA ratio suggest retinal venular tortuousness demonstrated a stronger association with RDA ratio compared to the arteriols. Cutting of neuroretinal rim were significantly associated with consecutive retinal vas. Geometric retinal vascular alterations noticeable in early glaucomatous ocular neuropathy, this findings may supply an extra fact about blood vas architecture and its function in physiology. ( Koh V. Et. Al, 2010 ) . Additionally, concentration of K+ , H+ , adenosine, and intercellular osmolarity are known to consequence local vascular tone. ( Orgul et. Al, 1995a ) .
The mechanism of autoregulation depends on 2 type of stimulations, metabolic and myogenic whereby can bring on an autoregulatory responce from local vasculature. ( Johnson P.C. , 1986 ) . Metabolic stimulations can change vascular tone include the osmolarity of extracellular fluid and its concentration of CO2, K+ , H+ , O2 and adenosine, and were known to modifies the O and alimentary demand by local tissue. ( Orgul S. Et. Al, 1999 ) . In the retina there is general understanding that blood flow adapts in response to different conditions of visible radiation and darkness including diffuse luminosity spark. The measuring were taken earlier, during and after stimulation with diffuse luminosity spark. Flicker visible radiation is a flashes of visible radiation at wavelength below 550nm and retinal irradiance of 140 AµW/cm. The survey clearly demonstrates that diffuse luminosity spark increases ocular nervus blood flow but shows no consequence on choroidal blood flow, therefore choriodal blood flow appears to be work independently of the change in retinal metamorphosis. ( GarhC?fer G. et. Al, 2002 ) . Myogenic appear to actively lend to the autoregulation of retinal blood flow. ( Rosa R.H. , 2004 ) . In optic tissue, autonomic nervous system contributes extensively to the retrobulbar and choroidal circulatory system, but the retinal and ONH vasculature still lack direct excitations. ( Funk 1997 ) . As for sympathetic stimulation, it merely provides indirect influence on ONH perfusion neurogenic part to the vascular responce is minimum. ( Harris et. Al, 2003 ) .
Harmonizing to Mchedlishvili 1981, vasospasm can do a decrease in luminal diameter and respective the blood flow. ( Mchedlishvili 1981 ) . Attendant ischaemia environing tissue may arise from vasoconstriction or deficient distension of the microcirculation. Dysregulation of the blood flow can take to an over- or underperfusion. As for long term harm can come from a steady overperfusion of the blood flow. While under perfusion can take to weave wasting and cell infarction. Systemic ordinance can be primary or secondary of nature.
Autoimmune disease such arthritic arthritis, gaint cell arteritis, systemic lupus erythematodes, multiple induration, inflammatory bowel disease ulcerosa or Chrohns disease are categorize as a secondary dysregulation. Harmonizing to Gasser P. ( 1991 ) , vasospasm are non merely occur in Raynaud ‘s disease, megrim, Prinzmetal ‘s variant angina, ocular filed defects and partly in low-tension glaucoma, but may besides be involved in pathogenesis of Crohn ‘s disease. In other words, vasospasm does happen in the oculus. Increase of endothelin-1 circulation leads to a decrease of blood flow in both choroid and ocular nervus caput in secondary vascular dysregulation. The primary vascular dysregulation has a small influence on optic blood flow but still interferes with autoregulation. This seems to be a relevant constituent in pathogenesis of glaucomatous ocular neuropathy. ( Greishaber M.C. et. Al, 2007 ; Emre M. Et. Al, 2004 ) . Normal tenseness glaucoma ( NTG ) reported twice female than male and considered to be an independent hazard factor for ocular field loss patterned advance in NTG. ( Orgul S. Et. Al, 1994 ; Drance S. Et. Al, 2001 ) . Estrogen is known to hold vasodilatory effects in systemic circulation. Decrease in estrogen degrees during climacteric may therefore complicate or contribute to optic pathologies as estrogen receptors are found in both retinal and choroidal tissue. Therefore, the susceptibleness in females may due to falling to estrogen degree under post-maturity. ( Seisky et. Al, 2008 ) .
Vasospasm has been associated with glaucoma, but the mechanism have non been clearly elaborated. A powerful endogenous vasoconstrictive, endothelin ( ET ) -1 were increase in patient with glaucoma compared to normal topic. They besides found that glaucoma patient with acral vasospasm, more likely to demo impairment in ocular Fieldss after chilling than patient without acral vasospasm. In other words, glaucoma patient with grounds of vasospasm have the hazard of declining ocular Fieldss under chilling induced than nonvasospastic patients. ( Nicolela et al 2003 ) . Vasospasm were besides identified in megrim, which normally found in females and associated with NTG. ( Cursiefen et al 2000 ) . McKendrick A.M. et. Al ( 2000 ) , suggest that migrainous form portions some characteristics in early phases of glaucoma and this raises to the possibility that vascular engagement occur in these instances. Disability to stay changeless of optic blood flow during physiological status, may categorise as holding optic vasospasm or dyregulation. NTG patient had significantly lower ophthalmic arteria blood flow speeds and higher vascular opposition than normal capable. Reversible vasospasm in NTG is noticeable with elevated CO2 external respiration compared to normal topic. ( Harris et. Al, 1994 ) .
A reverse response form were found in ONH and choroidal with female that has vasospasm sing blood gas disturbance compared to without vasospasm. ( Gugleta et. Al, 2005 ) . A distinction during blood gas disturbances and Ca channel blockers may show which individuals are at greatest hazard for vasospasm, impaired optic blood flow and perchance OAG. Although, vasospasm is associated with multiple disease provinces including OAG with NTG patients and adult females looking to be the most at hazard for vasopastic parts to disease procedures. Fluctuations in optic perfusion, ischaemia, and/or reperfusion hurt to the optic tissues are possible vasospasm consequence. Vasospasm besides likely classified to be reversible ( treatable ) . Blood gas disturbances test on OAG should be farther explored, particularly in patients that demonstrate a vasospastic standard. Vascular endothelium secretes vasodilator azotic oxide ( NO ) and vasoconstrictor endothelin-1 ( ET-1 ) that consequence the microcirculation of the blood flow. ( Adams J.A. , 2006 ) . Prostacyclins, acetylcholine, bradykinin, and histamine were activated by endothelium derivation. ( Flammer and Orgul 1998 ; Adams 2006 ) . Vasodilation were promoted on smooth musculus when secernment of NO from endothelial cells. ( Toda and Nakanishi-Toda 2007 ) . Speed of lower diastolic and systolic ophthalmic arteria blood flow of NTG has a lessening of cyclic GMP ( index of NO ) in plasma and aqueous wit of glaucoma patients. ( Laude et al 2004 ) . Blood flow decrease at anterior ocular nervus were demonstrated when ET-1 applied on peculiar part of the anterior ocular nervus. ( Orgul et al 1996 ) .
2.3 Ocular Blood Flow & A ; Visual Field
Plange et. Al found that asymmetric glaucomatous ocular field loss was associated with asymmetric flow speed in cetral retinal and ophthalmic arterias in POAG patients. ( Plange et al, 2006 ) . In add-on, Zeitz et Al found glaucoma patterned advance to be associated with reduced blood flow speeds in the short buttocks ciliary arterias. ( Zeitz et. Al, 2006 ) . Zink et Al Found an association between lower ocular nervus optical maser Doppler blood volume measuring and glaucomatous ocular field patterned advance. ( Zink et Al, 2003 ) . Galassi F. Et. Al ( 2003 ) , reported that patient with a stable ocular field had a higher diastolic speed and a lower electric resistance index in the ophthalmic arteria ( OA ) compared to those with a deteriorating ocular field during the survey. Patient with a vascular opposition greater than 0.78 in the OA had 6-times the hazard of ocular field impairment.
Following research by Martinez et. Al ( 2005 ) , proposing a correlativity between RI greater than 0.72 in the OA and increased VF patterned advance over a period of 3 old ages. Mugwump of the patterned advance rate of glaucomatous ocular field harm statistically correlates with retrobulbar hemodynamic variables as the faster rate in patterned advance of glaucomatous harm, a lower baseline terminal diastolic blood flow speed in the cardinal retinal arteria. ( Satilmis M. et. Al, 2003 ) . The rating of glaucoma harm were besides conducted between the extent of glaucoma harm and ocular nervus blood flow, found that when both of the eyes have glaucoma, the hemidisk with greater harm showed significantly lower blood speed than the hemidisk with less harm. ( Lam A. et. Al, 2005 ) . This survey provides extra grounds that impaired ocular nervus circulation is associated with the extent of glaucomatous pathology. Sato and associates reported that decrease of capillary blood flow at neuroretinal rim in normal tenseness glaucoma patients was associated with regional ocular field loss.
Sclera buckling for a rhegmatogenous retinal withdrawal ( RPD ) were besides found to do a decrease in blood flow at neuroretinal rim. Upon taking the buckle, the blood flow were improved to normal degrees and a farther deterioration of the ocular field was non detected. These consequence suggest that an encircling of sclerotic coat buckle may impair choroidal circulation and lead to ocular field defects similar to eyes with normal tenseness glaucoma. ( Sato E.A. et. Al, 2008 ) . Research done by Vassilos and associates with 13 male & A ; 3 female with bilateral carotid stricture, found that postoperatively peak systolic speed had significantly improved in all vass examined in the carotid that was operated on, but merely in the OA and short buttocks cilary arteria in the fellow side.
Ocular blood flow shortages may therefore represent either a primary abuse or are secondary to vascular regulative disfunction during diurnal fluctuations in vascular hazard factors in certain OAG patients ( Grieshaber and Flammer 2005 ) .
2.4 Clinical curative drug consequence on ocular disc blood flow with glaucomatous oculus.
Some grounds of blood flow shortage in glaucoma derived from flourescein angiography since flourescein is a safe consistent drug to be usage for staining and should be considered in bad patients. ( Kwan A.S. et. Al, 2006 ) . Previous findings conducted by Harris A. et. Al on NTG patients found that dorzolamide besides accelerated retinal arteriovenous transition clip ( AVP ) of flourescein dye, at changeless retinal arterial and venous diameter, but failed to alter flow speeds in any retrobulbar vas. ( Harris A. et Al, 1999 ) . Similar findings were found on healthy voluntaries by utilizing brinzolamide which decrease IOP degree but showed no important alteration in retrobulbar haemodynamics, but shortening of AVP. Since in glaucoma AVP is prolonged bespeaking vascular disfunction this consequence might be good in glaucoma therapy. ( Kaup M. et. Al, 2004 ) . Dorzolamide is a carbonaceous anhydrase inhibitor, an anti-glaucoma agent and locally applied in the signifier of oculus bead was treated as placebo drug. Following survey with dorzolamide found that there is no measureable vascular effects from topical dorzolamide intervention in antecedently untreated glaucoma eyes. ( Bergstrand I.C. et. Al, 2002 ) . Harmonizing to Ali S.H. et. Al, decrease of IOP in OAG after curative IOP decrease had a statistically important betterment of blood flow in neuroretinal rim of the ONH, where as OHT patients does non show any alterations. ( Ali S.H. et. Al, 2003 ) .
Another topical drug can be use to cut down IOP lift is latanoprost. A survey has been conducted to measure the consequence of a individual instillment of latanoprost on human ONH and retinal circulation within certain clip. Yasuhiro T. et. Al found that tissue blood speed in the ONH increased at least temporarily following a individual instillment of topical latanoprost even the mechanism of the additions remain ill-defined. This may bespeak that the consequence of latanoprost on ONH tissue circulation in homo may hold clinical deduction. ( Yasuhiro et. Al, 2004 ) . The use of topical nipradilol caused a transient, but important addition in the ipsilateral ONH blood speed after twice instillment in a hebdomad which indicate that the addition in ONH blood speed in homo was non a secondary consequence accompanied by a lessening in IOP in the ipsilateral oculus. ( Ken M. et. Al, 2002 ) . This may be nipradilol property on vasodilative action. ( Okamura T. et. Al, 1996 ) . It had been reported that topical nipradilol increases the ONH blood speed in coneies and suggest is partially attributable to local incursion of the drug. ( Kanno K. , 1998 ) . Similar scenario besides had been reported with topical betaxolol. ( Araie M. et. Al, 1997 ) . Nipradilol besides has been use in Canis familiariss, whereby decrease of IOP by nipradilol was similar to that by an bing I?-adrenergic adversary, timolol maleate, but nipradilol was associated with fewer systemic side effects in Canis familiariss. Nipradilol lowered IOP to an tantamount grade to timolol maleate but its difficult plenty to measure blood flow relationship between homo and animate being optic haemodynamics. ( Maehara S. , 2004 ) .
Findingss through topical unoprostone besides consequence the tissue blood speed in the ONH, the writer recorded and increase temporarily following instillment of unoprostone twice daily for 7 yearss. The increment deduction is ill-defined but the consequence of topical unoprostone on human ONH circulation deserve farther consideration. ( Yasuhiro T. et. Al, 2004 ) .
Ocular blood flow appears to be related to any disease that involve blood circulation. As for epilepsy patients exhibit reduced neuroretinal capillary blood flow, volume, and speed compared with normal topics. A decrease in optic perfusion may hold deduction for ocular map in people with epilepsy. ( Emma J.R.H. , 2002 ) .
Study besides shows that the use of dormolamide addition the blood flow in temporal neuroretinal rim and the cup of the ocular nervus caput, and fundus pulsing amplitude. ( Fuchsjager-Mayrl G. Et. Al, 2005 ) . Recent survey done by Andrzej S. et.al, linear consequence of dorzolamide hydrochloride ( Trusoft ) and a forenoon dosage of bimatoprost ( Lumigan ) on IOP and retrobulbar blood flow in patients with POAG reduces IOP significantly with these combined intervention whereby the vascular opposition in ophthalmic arteria lessenings. ( Andrzej S. et. Al, 2010 ) . Vascular retinal arteria in untreated or progressive POAG after treated with topical 2 % of dorzolamide for 2 hebdomads show addition in diameter, speed, and flow in response to normoxic hypercarbia. Similar tendencies were noted for ONH vascular reactivty excessively. ( Subha T.V. et. Al, 2010 ) . Most of the survey shows that the optic blood flow is a good index for pathogenesis of glaucoma and it proves that blood flow measuring is a worthy findings to be exposed.
The end for drug therapy originally to cut down IOP lift or decelerate down the ocular field loss patterned advance. The ocular field and ocular nervus appraisal can be evaluated through fundus exposure to corroborate the mark of alteration sing IOP lift. There are several categorization on IOP curative drug such as beta blockers, prostaglandin, carbonaceous anhydrase inhibitors, sympathomimetic agonists, cholinergic barricading agents and a combination of merchandises. For a drug to be to the full effected, therapies must perforate the anterior surface of the oculus, range at the tissue of involvement, and put to death the physiologic consequence. The most common topical therapies being usage is timolol whereby it blocks the I?-adrenergic receptors on the ciliary epithelial tissue to cut down the aqueous temper production. I?-adrenergic receptors mediate relaxation of vascular smooth musculus. ( Tsujimoto G. Et. Al, 1985 ; Virginia P.A. et. Al, 2006 ) ) . If I?-adrenergic were blocked, this may do vasoconstriction in the tissue and the receptor were found on retina and the ocular nervus caput. ( Nies A.S. et. Al, 1973 ; Elena P.P. et. Al, 1987 ; Dawidek G.M.B. , 1993 ) . Timolol consequence on optic blood flow in glaucoma is still controversial and non consistent, so suggested to be limited in footings of optic vasculature consequence.
Topical carbonaceous anhydrase inhibitors ( CAIs ) like brinzolamide and dorzolamide were found to be helpful to cut down IOP lift in the oculus. By footings of pharmacological medicine procedure, carbonaceous anhydrase is an enzyme that helps unstable balance in organic structure and transform C dioxide along with H2O into carbonaceous acid. Finally dissociates into protons and bicarbonate whereby hydrogen carbonates ions regulate the formation of aqueous wit via osmosis. CAI will adhere to active site of the enzyme and prevent formation of C dioxide, H2O, hydrogen carbonate and a proton. CA-II were inhibited by CAI which the concentration found at ciliary organic structure. The suppression procedure found to cut down IOP lift. ( Virginia P.A. et. Al, 2006 ) . Harmonizing to assorted research, CAI were the found to be the most effectual curative drug to change the optic blood flow. ( Fuchsjager-Mayrl G. et. Al, 2005 ; Andrzej S. et. Al, 2010 ; Subha T.V. et. Al, 2010 ) .