Measurement of normal retinal vascular pulse wave attenuation using modified photoplethysmography

Pulse wave attenuation characteristics reflect compliance and resistance properties of the vessel wall as well as initial pulse generation factors. Recently, it has become possible to measure and map the retinal vessel wall pulse wave amplitudes. Predictable pulse wave amplitude distribution may allow inferences to be made concerning vascular compliance and resistance. Twenty-eight eyes from sixteen subjects (8 male and 8 female) were examined using modified retinal photoplethysmography with simultaneous ophthalmodynamometry. This allowed the assessment of vessel wall pulsation amplitudes under a dynamic range of intraocular pressures. Pulse amplitudes were calculated using harmonic regression analysis. The pulse wave attenuation was measured under different ranges of ophthalmodynamometric force (ODF) as a function of distance along the vessel (V-Dist), which in turn was calculated in disc diameters (DD) from the center of the optic disc. A linear mixed-effects model with randomized slopes and intercepts was used to estimate the correlations between the logarithmically transformed harmonic regression wave amplitude (HRWa) and the Fourier trigonometric coefficients with the predictors (V-Dist and ODF). The retinal venous harmonic regression wave attenuation (coefficient value +/- standard error) -0.40 +/- 0.065/DD, (p-value < 0.00001, 95% confidence interval (CI) -0.53 to -0.27), which was approximately twice that of the arterial -0.17 +/- 0.048/DD, (p-value < 0.0004, 95% CI = -0.27 to -0.08). There was a positive correlation between attenuation of the harmonic regression wave and ophthalmodynamometric force in both vascular systems. The attenuation of all but the sine coefficient of the second Fourier harmonic (b(n2)) achieved statistical significance in the correlation with V-Dist. The cosine coefficient of the first Fourier harmonic a(n1) was the only coefficient to achieve statistical significance in the correlation with the predictors V-Dist and ODF in both vascular systems. The a(n1) coefficient value in the correlation with V-Dist was -3.79 +/- 0.78 and -1.269 +/- 0.37 (p < 0.0006), while this coefficient value in the correlation with ODF was 0.026 +/- 0.0099 and 0.009 +/- 0.04 (p < 0.01) in both the retinal veins and arteries respectively. The predictable attenuation characteristics in normal subjects suggest that this technique may allow the non-invasive quantification of retinal vascular compliance and other hemodynamic parameters.