Ischemia and loss of vascular autoregulation in ocular and cerebral diseases : a new perspective

__Ischemia and Loss of Vascular Autoregulation in Ocular and Cerebral Diseases: A New Perspective__ presents evidence that ischemia and loss of autoregulation of blood flow are associated with the onset of the major ocular and cerebral diseases including macular degeneration, diabetic retinopathy, low and normal tension open angle glaucoma, stroke and Alzheimer’s disease. Recognition of these vascular changes underline the critical need for clinicians to monitor blood flow and autoregulation to improve early diagnosis and to optimize therapies of ocular and cerebral vascular diseases. The text brings to clinicians in Ophthalmology, Neurology, Medicine, Optometry and Geriatrics decisive guidance on the practical aspects for early diagnosis and treatment of ocular and cerebral diseases. The author brings together in a concise form the progress made over the span of his career and provides new perspectives and understanding of the fluid circulations of the eye and the brain. In addition, he explains the new analytical technologies that made the new concepts possible. The physiological and functional importance of blood flow autoregulation in the eye and in the brain in minimizing the progression of pathology, including the ischemia resulting from stenosis of the internal carotid artery and stroke, are also presented . ABOUT THE AUTHOR: Dr. Langham was born in London, England. In 1947, he joined the Ophthalmological Research Unit, newly formed by the Medical Research Council of the United Kingdom under the direction of Sir Stewart Duke-Elder. In 1956, the author enjoyed a research fellowship at Harvard University. After returning to England for a time, he accepted a position of Associate Professor of Ophthalmology and Director of Research at the Wilmer Ophthalmological Institute of the Johns Hopkins Hospital and Medical school in 1959. There he initiated a program in which all residents spent time engaged in research. This productive interaction between the disciplines led to many important clinical diagnostic and therapeutic advances. Front Matter....Pages i-xix Front Matter....Pages 1-1 “In Vivo” Manometric Studies of the Steady State Intraocular Pressure and the Intraocular Pressure Pulse in Animals and Man....Pages 1-9 The Rate of Formation of the Aqueous Humor....Pages 11-14 The Steady State Intraocular Pressure/Flow Relations in Dead and Living Animal and Human Eyes....Pages 15-18 Homeostasis, Autoregulation, and Relative Ischemia....Pages 19-26 The Pressure/Volume Relation in Eyes of Dead and Living Animal and Human Eyes....Pages 27-30 The Ocular Perfusion Pressure and Its Influence on the Intraocular Pressure Pulse....Pages 31-34 Direct and Indirect Measurements of Ocular Blood Flow in Anesthetized and Conscious Animals and Humans....Pages 35-40 The Morphology and Hydrodynamics of the Chamber Angle Draining the Aqueous Humor....Pages 41-43 The Sympathetic Nerve Innervation of the Eye and the Actions of the Adrenergic Neuron Transmitter Norepinephrine on Intraocular Pressure and Ocular Blood Flow....Pages 45-53 Manometric Studies on the Intraocular Pressure and Vascular Circulation in Ophthalmic Disease....Pages 55-57 Back Matter....Pages 1-5 Front Matter....Pages 1-1 Indirect Measurements of the Intraocular Pressure and the Intraocular Pressure Pulse....Pages 67-69 The Effect of Posture and Corneal Thickness on the Measurement of the Intraocular Pressure....Pages 71-75 The Langham Pneumatic Analogue and Digitized Tonometers....Pages 77-83 The Calibration of the Intraocular Pressure and the Intraocular Pressure Pulse using the Langham Pneumatic Tonometer....Pages 85-88 The Theory of the Langham Tonometer....Pages 89-90 The Intraocular Pressure/Pulse Amplitude Relation in Healthy Animal and Human Eyes....Pages 91-97 The Intraocular Pressure/Pulse Amplitude Relation and Loss of Autoregulation in Ocular Diseases....Pages 99-115 Autoregulation of the Intraocular Pressure and the Ocular Blood Flow....Pages 117-120 The Evaluation of Ocular Ischemia and the Loss of Autoregulation for the Early Detection of Ocular Vascular Diseases....Pages 121-123 The Action of Drugs on Ocular Blood Flow and on the Intraocular Pressure/Pulse Amplitude Relation....Pages 125-130 Back Matter....Pages 1-6 Front Matter....Pages 1-1 The Confluence and Integration of Therapies Based on Modulation of the Intraocular Pressure and Ocular Blood Flow....Pages 131-135 Longitudinal Therapeutic Studies....Pages 137-140 Back Matter....Pages 1-6 Front Matter....Pages 1-1 The Ophthalmic Arterial Pressure, the Intraocular Pressure/Pulse Amplitude Curve, and Their Relations to the Ocular and Cerebral Circulations....Pages 149-151 Ophthalmodynamometry....Pages 153-155 Autoregulation of the Intraocular Pressure and Blood Flow in the Human Eye....Pages 157-158 Objective Measurement of the Diastolic and Systolic Ophthalmic Arterial Pressures....Pages 159-161 The Ophthalmic Arterial Pressure in Healthy Subjects....Pages 163-164 The Relation Between the Ophthalmic Arterial Pressure and the Intraocular Pressure/Pulse Amplitude Relation....Pages 165-168 Modulation of the Intraocular Pressure/Pulse Amplitude Relation in Subjects with Stenosis of the Internal Carotid Artery....Pages 169-178 Alzheimer's Disease and the Eye....Pages 179-181 The Ocular Perfusion Pressure and the Visual Threshold....Pages 183-184 Concepts and New Perspectives....Pages 185-186 Back Matter....Pages 1-2 Back Matter....Pages 189-192

From the introduction: “The purpose of the present book is to bring together in a coherent manner new knowledge gained from research over the past 50 years on the physiology of intraocular pressure, ocular blood flow and the relation of these fundamental parameters to early diagnosis and therapy of vascular diseases of the eye and brain. It will be evident to the reader that the presentation is influenced significantly by the author’s own research. My justification is that by good fortune I have spent many years with superb collaboration helping solve outstanding problems of ocular physiology. This knowledge has increased understanding of the parameters underlying the onset of ischemia and the loss of autoregulation associated with common ocular disease and thereby led to new methods of diagnosis and therapy.”

From the introduction of this book: 'The purpose of the present book is to bring together in a coherent manner new knowledge gained from research over the past 50 years on the physiology of intraocular pressure, ocular blood flow and the relation of these fundamental parameters to early diagnosis and therapy of vascular diseases of the eye and brain. It will be evident to the reader that the presentation is influenced significantly by the author's own research. My justification is that by good fortune I have spent many years with superb collaboration helping solve outstanding problems of ocular physiology. This knowledge has increased understanding of the parameters underlying the onset of ischemia and the loss of autoregulation associated with common ocular disease and thereby led to new methods of diagnosis and therapy'