To investigate retinal venous pressure (RVP) as a function of airway pressure (AirP) during the Valsalva maneuver (VM) in human subjects.
Forty-three healthy volunteers (age, 22.0 (2.3) years) (median and interquartile range) were investigated using the following instruments: dynamic contour tonometer, contact lens dynamometer (CLD), and aneroid manometer. The following measurements were performed in their left eyes: tonometry and dynamometry during VM at different levels of airway pressure (AirP = 0, 10, 20, 30, and 40 mmHg).
The median RVP during spontaneous breathing (AirP = 0) was 19.7 (6.4) (median in mmHg (interquartile range)) and the intraocular pressure (IOP) in mydriasis was 16.3 (3.1) mmHg. Spontaneous pulsation occurred in 58.1% of the subjects. RVP increased nonlinearly. The coefficient of variation of four individual measurements of RVP at each pressure level averaged 8.1 (7.6) %. At different AirP levels of 10, 20, 30, and 40 mmHg, the following RVPs were measured: 29.6 (12.6); 34.2 (12.8); 38.0 (10.5); and 40.3 (11.0), respectively. The rise of RVP (Δ RVP) during VM was significantly higher than that of Δ IOP (p < 0.0001, Wilcoxon test). Δ RVP between 0 and 40 mmHg AirP was 20.6 mmHg and Δ IOP 1.5 mmHg. The steepest slope of the RVP/AirP curve was observed at the first step from 0 to 10 mmHg of AirP (∆ RVP = 9.9 mmHg).
A nonlinear relationship between RVP and AirP was found during VM. Small rises in AirP increase the RVP and affect retinal circulation.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Aykan U, Erdurmus M, Yilmaz B, Bilge AH (2010) Intraocular pressure and ocular pulse amplitude variations during the Valsalva maneuver. Graefes Arch Clin Exp Ophthalmol 248:1183–1186
Brody S, Erb C, Veit R, Rau H (1999) Intraocular pressure changes: the influence of psychological stress and the Valsalva maneuver. Biol Psychol 51:43–57
Oggel K, Sommer G, Neuhann T, Hinz J (1982) Veränderungen des Augeninnendruckes be intrathorakaler Druckerhöhung in Abhängigkeit von der Körperposition und der Achsenlänge des Auges. Graefes Arch Clin Exp Ophthalmol 218:51–54
Pott F, van Lieshout JJ, Ide K, Madsen P, Secher NH (2000) Middle cerebral artery blood velocity during a Valsalva maneuver in the standing position. J Appl Physiol 88(5):1545–1550
Kappmeyer K, Lanzl IM (2010) Augeninnendruck während und nach dem Spielen von Hoch- und Niedrigwiderstandblasinstrumenten. Ophthalmologe 107(1):41–46
Schmidtmann G, Jahnke S, Seidel EJ, Sickenberger W, Grein HJ (2011) Intraocular pressure fluctuations in professional brass and woodwind musicians during common playing conditions. Graefes Arch Clin Exp Ophthalmol 249(6):895–901
Stodtmeister R, Heyde M, Georgii S, Matthè E, Spoerl E, Pillunat LE (2018) Retinal venous pressure is higher than the airway pressure and the intraocular pressure during the Valsalva manoeuvre. Acta Ophthalmol 96:e68–e73
Hayreh SS (1978) Structure and blood supply of the optic nerve. In: Heilmann K, Richardson KT (eds) Glaucoma: conceptions of a disease: pathogenesis, diagnosis, therapy. Thieme, Stuttgart, pp 78–96
Kanngiesser HE, Kniestedt C, Robert YCA (2005) Dynamic contour tonometry: presentation of a new tonometer. J Glaucoma 14:344–350
Gelman S (2008) Venous function and central venous pressure: a physiologic story. Anesthesiology 108:735–748
Hainsworth R (1990) The importance of vascular capacitance in cardiovascular control. News Physiol Sci 5:250–254
Berger D, Takala J (2018) Determinants of systemic venous return and the impact of positive pressure ventilation. Ann Transl Med 6:350
Krogh A (1912) The regulation of the supply of blood to the right heart. Skand Arch Physiol 27:227–248
Magder S (2016) Volume and its relationship to cardiac output and venous return. Crit Care 20:271
Lovasik JV, Kergoat H, Riva CE et al (2002) Correlation between the intra-thoracic pressure and choroidal blood flow. Invest Ophthalmol Vis Sci 49:E-Abstract 3315
Lovasik JV, Kergoat H (2012) Systemic determinants. In: Schmetterer L, Kiel JW (eds) Ocular blood flow, 1st edn. Springer, Heidelberg, pp 173–210
Morgan WH, Hazelton ML, Azar SL, House PH, Yu DY, Cringle SJ, Balaratnasingam C (2004) Retinal venous pulsation in glaucoma and glaucoma suspects. Ophthalmology 111:1489–1494
Legler U, Jonas JB (2009) Frequency of spontaneous pulsations of the central retinal vein in glaucoma. J Glaucoma 18:210–212
Lorentzen SE (1970) Incidence of spontaneous venous pulsation in the retina. Acta Ophthalmol 48:765–770
Morgan WH, Balaratnasingam C, Hazelton ML, House PH, Cringle SJ, Yu DY (2005) The force required to induce hemivein pulsation is associated with the site of maximum field loss in glaucoma. Invest Ophthalmol Vis Sci 46:1307–1312
Nomura H, Shimokata H, Ando F, Miyake Y, Kuzuya F (1999) Age-related changes in intraocular pressure in a large japanese population: a cross-sectional and longitudinal study. Ophtalmology 106:2016–2022
Köpke B (2016) Zusammenhang zwischen dem am Oberarm und am Auge gemessenen Blutdruck und Messung des Venenpulsationsdruckes mittels Kontaktglas-Dynamometer. (Correlation between the blood pressure measured at the upper arm and the eye and measurement of the retinal venous pressure using a contact lens dynamometer) Dissertation. Kiel University, Faculty of Medicine
Stodtmeister R, Oppitz T, Spoerl E, Haustein M, Boehm AG (2010) Contact lens dynamometry: the influence of age. Invest Ophthalmol Vis Sci 51:6620–6624
Schmetterer L, Dallinger S, Findl O, Strenn K, Graselli U, Eichler HG, Wolzt M (1998) Noninvasive investigations of the normal ocular circulation in humans. Invest Ophthalmol Vis Sci 39:1210–1220
Reiner A, Fitzgerald MEC, Li C (2012) Neural control of ocular blood flow. In: Schmetterer L, Kiel JW (eds) Ocular blood flow, 1st edn. Springer, Heidelberg, p 244
Schuman JS, Massicotte EC, Connolly S, Hertzmark E, Mukherji B, Kunen MZ (2000) Increased intraocular pressure and visual field defects in high resistance wind instrument players. Ophthalmology 107:127–133
Alm A (1992) Ocular circulation. In: Hart WM Jr (ed) Adler’s physiology of the eye, 9th edn. Mosby Year Book, St. Louis, pp 198–227
Bron AJ, Tripathi RC, Tripathi BJ (1997) The choroid and uveal vessels. In: Wolff’s anatomy of the eye and orbit. Chapman & Hall, London, p 405
Bill A (1984) Circulation in the eye. In: Renkin EM, Michel CC (eds) Handbook of physiology: the cardiovascular system. Waverly Press, Baltimore, pp 1001–1034
Kirsch KA, von Ameln H (1982) Physiologie des Niederdrucksystems. In: Busse R (ed) Kreislaufphysiologie. Georg Thieme Verlag, Stuttgart, pp 104–135
Stodtmeister R, Ventzke S, Spoerl E, Boehm AG, Terai N, Haustein M, Pillunat LE (2013) Enhanced pressure in the central retinal vein decreases the perfusion pressure in the prelaminar region of the optic nerve head. Invest Ophthalmol Vis Sci 54:4698–4704
Schwab B, Schultze-Florey A (2004) Intraorale Druckentwicklung bei Holz- und Blechbläsern. Musikphysiologie und Musikermedizin 11(4):183–194
We thank Dr. A. Klimova for assistance with statistical analysis.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The methodology for this study was approved by the ethics committee of Univ. Hospital Carl Gustav Carus, TU Dresden (Ethics approval number: EK 171042017). This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Heimann, S., Stodtmeister, R., Pillunat, L.E. et al. The retinal venous pressure at different levels of airway pressure. Graefes Arch Clin Exp Ophthalmol (2020). https://doi.org/10.1007/s00417-020-04796-4
- Airway pressure
- Retinal venous pressure
- Intraocular pressure
- Valsalva maneuver