Validity of pulsatile ocular blood flow measurements

The determination of average net pulsatile ocular blood flow from measurements of the intraocular pressure (IOP) pulse is based upon 1) an accurate measurement of IOP and its time variation; 2) a knowledge of the relation between the volume of the living eye and its IOP; 3) a physical model for the flow of blood through the eye; and 4) a concept of steady venous outflow from the eye. Each of these premises needs to be examined. The present analysis assesses the validity of the pneumatic tonometer for measuring the pressure in a flowing column of gas that is directed toward a thin membrane that is in contact with the surface of the cornea. The pressure of this stream of gas exerts a force against the cornea that depresses the corneal surface against the opposing force of the IOP. The balance of these forces and the resultant effect on the tonometer pressure sensor is described by the theories of elasticity, thermodynamics and fluid mechanics. In this treatment, differential equations are solved for the elastic deflections of the cornea subject to the opposing intraocular and tonometer pressures. This permits the pressure in the chamber of the pneumatic tonometer to be related through first principles to the IOP. The response of the tonometer pressure sensor to a range of IOPs (5-60 mmHg) is obtained, as well as the dynamical response of the tonometer to IOP oscillations. The conclusion is that the pneumatic tonometer provides a high fidelity, noninvasive measure of the IOP and its time variation. The quantitative validation of this premise, provided by this work, is significant for providing a basis for calculating the average net pulsatile ocular blood flow from IOP measurements using a pneumatic tonometer.