10.14639/0392-100X-N1708
text/xml
1827-675X
1708
en
Francesco Parmeggiani
http://creativecommons.org/licenses/by-nc-nd/4.0
ACTA Otorhinolaryngologica Italica
OCTA
Methodological insight for assessment of haemodynamic perfusion in neural retina and optic nerve
Text.Serial.Journal
https://www.actaitalica.it/
41
Letters to the Editor-in-Chief
2021-11-05
2021-05-19
2021-11-02
2021-11-02
487-488
1
Francesco Parmeggiani
2021/11/05
10.14639/0392-100X-N1708
487
Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
1827-675X
OCTA
488
Methodological insight for assessment of haemodynamic perfusion in neural retina and optic nerve
https://www.actaitalica.it/article/download/1708/686
41
ACTA OTORHINOLARYNGOLOGICA ITALICA 2021;41:487-488; doi: 10.14639/0392-100X-N1708




Letter to the Editor


Methodological insight for assessment
of haemodynamic perfusion in neural retina
and optic nerve
Indicazioni metodologiche per la valutazione della perfusione emodinamica della retina
neurale e del nervo ottico
Alessandro Martini1, Flavia Sorrentino2, Francesco Parmeggiani3
1
 Padova University Research Center “I-APPROVE - International Auditory Processing Project in Venice “Santi Giovanni e Paolo”
Hospital, Venice, Italy; 2 Otorhinolaryngology, Department of Neuroscience, University of Padova, Padova, Italy; 3 Department of
Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy


KEY WORDS: BPPV, retinal haemodynamics, OCTA
PAROLE CHIAVE: BPPV, emodinamica retinica, OCTA


Dear Editor,
We read with great interest the article by Neri and co-workers focusing on the           Received: May 19, 2021
evaluation of vascular factors in patients with recurrent benign paroxysmal po-          Accepted: June 14, 2021
sitional vertigo (BPPV) 1. By study design, the vascular factor was specifically
                                                                                         Correspondence
assessed using both extracranial colour-coded duplex sonography of vertebral             Alessandro Martini
arteries (ECCSVA) to examine vertebral flow, and retinal fluorangiography                Padova University Research Center “I-APPROVE -
(FAG) to indirectly study the cerebral microcirculation. In the above-described          International Auditory Processing Project in Venice
                                                                                         “Santi Giovanni e Paolo” Hospital, Venice, Italy
diagnostic methodological context, the authors affirm that “The FAG excluded             via N. Giustiniani 2 (sede amministrativa), 35128
qualitative alterations of the cerebral microcirculation” 1, but this conclusive         Padova, Italy
statement appears to be supported only by an outdated speculative presupposi-            Tel. +39 049 821 6369/8997. Fax +39 049 821 1300
                                                                                         E-mail: alessandromartini@unipd.it
tion of FAG-based correlation between retinal and cerebral haemodynamics 2,
which has lost its investigative value soon after the introduction of diagnostic         Funding
tools specifically aimed at the measurement of retinal microvascular blood flow,         None.
such as scanning laser Doppler flowmetry 3 and, above all, optical coherence
                                                                                         Conflict of interest
tomography angiography (OCTA) 4,5. During the last years, OCTA has been                  The Authors declare no conflict of interest.
repeatedly applied for quantitative assessment of retinal haemodynamics, de-
tailing that microvascular changes in the retina can reflect small vessel cerebral         How to cite this article: Martini A, Sorren-
changes in patients with Alzheimer’s disease or cognitive decline 4,6-9. In this           tino F, Parmeggiani F. Methodological insight
current scenario, OCTA definitely represents the first-choice method to verify             for assessment of haemodynamic perfusion
                                                                                           in neural retina and optic nerve. Acta Otorhi-
the contribution of vascular factors in a clinical manifestation such as BPPV,             nolaryngol Ital 2021;41:487-488. https://doi.
and its unexpected non-utilisation is probably as result of a lack of updated              org/10.14639/0392-100X-N1708
scientific literature search in absence of an ophthalmologist within the authors’
                                                                                         © Società Italiana di Otorinolaringoiatria
research group. In fact, during the indirect evaluation of cerebral microcircula-        e Chirurgia Cervico-Facciale
tion, OCTA allows very higher levels of specificity and sensitivity compared
with FAG, also avoiding the risks related to the intravenous injection of fluores-                      OPEN ACCESS
cein, the vital colourant used to carry out FAG. In view of that, among BPPV             This is an open access article distributed in accordance with
patients reported by Neri and co-workers it is not possible to exclude alterations       the CC-BY-NC-ND (Creative Commons Attribution-Non-
                                                                                         Commercial-NoDerivatives 4.0 International) license. The
of cerebral microcirculation which could be indirectly highlighted by a safe             article can be used by giving appropriate credit and mentio-
                                                                                         ning the license, but only for non-commercial purposes and
and modern methodological approach using several important OCTA-based                    only in the original version. For further information: https://
outcome measures, such as peripapillary and parafoveal perfusion densities of            creativecommons.org/licenses/by-nc-nd/4.0/deed.en




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A. Martini et al.




both retinal vascular networks, choriocapillaris and choroid.                  4
                                                                                    Lee JY, Kim JP, Jang H, et al. Optical coherence tomography angi-
Moreover, the paper does not include a complete audiologi-                          ography as a potential screening tool for cerebral small vessel dis-
                                                                                    eases. Alzheimers Res Ther 2020;12:73. https://doi.org/10.1186/
cal evaluation of patients: history of hearing loss and tinni-
                                                                                    s13195-020-00638-x
tus should be investigated for a more complete assessment                      5
                                                                                    Sardone R, Sborgia G, Niro A, et al. Retinal vascular density on
of the patients examined. Episodes of sudden or rapidly                             optical coherence tomography angiography and age-related central
progressive hearing loss may be suggestive of vertebrobasi-                         and peripheral hearing loss in a Southern Italian older population.
lar insufficiency and many audiological disorders such as                           J Gerontol A Biol Sci Med Sci 2020 Oct 17;glaa269. https://doi.
presbycusis, noise-induced hearing loss and tinnitus are                            org/10.1093/gerona/glaa269
suspected of being related to alterations in blood flow 10.                    6
                                                                                    Bulut M, Kurtuluş F, Gözkaya O, et al. Evaluation of optical coher-
Detecting these symptoms could corroborate the hypoth-                              ence tomography angiographic findings in Alzheimer’s type demen-
                                                                                    tia. Br J Ophthalmol 2018;102:233-237. https://doi.org/10.1136/
esis proposed by Neri at al. that ischaemic events contrib-
                                                                                    bjophthalmol-2017-310476
ute to aetiopathogenesis of BPPV. To this end, we suggest                      7
                                                                                    Querques G, Borrelli E, Sacconi R, et al. Functional and morpho-
that pure tone audiometry results, THI (Tinnitus Handicap                           logical changes of the retinal vessels in Alzheimer’s disease and mild
Inventory) and relevant episodes of audiological history                            cognitive impairment. Sci Rep 2019;9:63. https://doi.org/10.1038/
should be collected and included in the data analysis.                              s41598-018-37271-6
                                                                               8
                                                                                    Criscuolo C, Cennamo G, Montorio D, et al. Assessment of retinal
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