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Transcranial Dopplers
For Ophthalmology
What is a TCD?
TCD
Ultrasound Doppler testing that is non invasive exam that looks at all of the major
arteries and vessels of the Circle of Willis, this allows assessment of the patients risk for stroke & ocular stroke by measuring the blood flow in ophthalmic and cerebral arteries.
75 % percent of all strokes occur in the Circle of Willis
Circle Of Willis
Stroke Symptoms
Symptoms of Stroke
Sudden weakness or numbness in the face, arm, or leg on one side of the body.
Abrupt loss of vision, strength, coordination, sensation, speech, or the ability to understand speech. These symptoms may become worse over time.
Sudden dimness of vision, especially in one eye.
Sudden loss of balance, possibly accompanied by vomiting, nausea, fever, hiccups, or trouble with swallowing.
Sudden and severe headache with no other cause followed rapidly by loss of consciousness -- indications of a stroke due to bleeding.
Brief loss of consciousness.
Unexplained dizziness or sudden falls.
VMR- VASO-MOTOR REACTIVITY
Patients whose VMR reserve is exhausted may be at risk for stroke.
VMR
EMBOLI DETECTION
High-Intensity Transient Signals
HITS
Positive HITS
Postive
Criteria For TCD
Retinal Ischemic
AMD Patients
Signs and Symptoms
- Diplopia
- Amaurosis Fugax
- Heart Disease/AFIB/Pacemaker
- Loss of vision
- Sudden Blurry vision
- Visual Field defect in both hemispheres
- Diabetes Type 1 or 2 with or w/out
- Must have HTN or High Cholesterol if no other ocular issues
- Diabetic Retinopathy
- Hypertensive Retinopathy
- Glaucoma (circle one below) circle if: OS / OD / OU
- POAG/Low tension/Chronic open angle/Glaucoma suspect
- Previous HX of CVA or TIA
- Known blockages/stenosis/carotid stenting
- BRVO/BRAO
- CRVO/CRAO
- Retinal Ischemia
- Retinal Neovasculization
- WET AMD WITH CNV
Some of the many connecting clinical reasons
Atherosclerosis
Connecting
Hypertension
Smoking / HX
Diabetes
Atherosclerosis is hardening and narrowing of arteries (stenosis).
Stenosis leads to stroke, heart attackS and many vascular issues.
High Cholesterol/High Lipids
Diabetic Retinopathy
Ocular HTN
Glaucoma
Neo-
vascularization
Retinal Ischemic AMD Patients
PI and RI in patients with AMD were significantly
higher and increased monotonically with the severity
of AMD.
Reduced Systemic Arterial Circulation affects retinal
ischemia and is associated with the increasing severity
of AMD.
Doppler Imaging demonstrates reduced or reversed
blood flow in the ophthalmic artery which directly
affects the blood supply to the choroid, retina, and
posterior ciliary arteries, thus causing chronic
ischemia to the Bruch’s membrane.
Retinal Specialist TCD Indications
Retinal OCT Diagnosis Corresponding
ICD 10 Codes
- AMD
- Retinal Ischemia
- Diabetic Retinopathy
- Hypertensive Retinopathy
- Macular Edema
- Retinal Ischemia H35.82
- Venous Engorgement H34.823
- CRVO H34.813
- CRAO H34.13
- Tributary Vein Occlusion H34.83
- Partial Arterial Occlusion H34.213
- Transient Arterial Occlusion H34.03
- Arterial Branch Occlusion H34.23
Diabetic Retinopathy
Diabetic Retinopathy
PDR patients have a significantly higher PI (pulsatility
index) and lower cerebrovascular reactivity than
NPDR patients, suggestive of a silent cerebral
microangiopathy
Patients with Proliferative Diabetic Retinopathy
demonstrate abnormal hemodynamic responses of
the cerebral and ophthalmic circulation .
Glaucoma
Glaucoma
Reversal flow in the OA can often be related to high grade proximal ICA Stenosis .
Decreased OA velocity measurement can often be associated chronic open angle or normal low tension glaucoma.
The ophthalmic artery peak systolic velocity will be elevated in untreated patients with POAG.
Altered ocular circulation (with different patterns of presentation) appears to be
common to patients with POAG.
STATISTICS
About 795,00 Americans each year suffer a new or recurrent stroke, that means on average a stroke occurs every 40 seconds
STATISTICS
On Average someone dies of a stroke every four minutes.
About 40 % of stroke deaths occur in males and 60 % in females.
Prescreening
PRESCREEN
Identifying those patients who will benefit best from a TCD