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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.

Types of Strokes

Transient Ischemic attack - (Mini Stroke)

Anything that blocks blood flow to the brain. This lasts a short period of time.

Ischemic Stroke ( Blockages)-An ischemic stroke occurs when a blood clot keeps blood from flowing to your brain. The blood clot is often due to atherosclerosis, which is a buildup of fatty deposits on the inner lining of a blood vessel. 87% of strokes are Ischemic.

Hemorrhagic Stroke ( Bleeding)-When a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues.

Types of Strokes

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

Positive

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

Hypertension

Smoking / HX

Diabetes

Atherosclerosis is hardening and narrowing of arteries (stenosis).

Stenosis leads to stroke, heart attacks and many vascular issues.

Connecting

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.

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

Recent findings suggest that patients with glaucomatous damage may have a higher risk of other cerebrovascular abnormalities. Doppler imaging has found that patients with certain types of glaucoma have increased resistance and decreased blood flow in the ophthalmic arteries and posterior communicating arteries, suggesting that changes in blood supply can correlate with optic nerve pathology.

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.

Reversal of the flow in the OA can often be related to high grade proximal ICA stenosis and can be very important to treat, prior to a patient having a CVA.

Decreased OA velocity measurement can often be associated chronic open angle or normal low tension glaucoma.

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.

*Strokes are the second highest cost for treatments.*

Prescreening

PRESCREEN

Identifying those patients who will benefit best from a TCD.

PRESCREEN

SPREADSHEET

Superbill

How much space do we need?

TCD in a Clinical Setting

Ramsoft

There are two places in Ramsoft you can obtain your patients reports.

Report Portal

Power Reader

Application Based- Detailed, Advanced Report Portal

Power Reader

Rapid Results

Web Based - Simple Report Portal

Rapid Results

Thank You For your Time......

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