The retinal venous pulse : its relation to optic disc characteristics and choroidal pulse

The presence or absence of the spontaneous retinal venous pulse is an important clinical sign, especially when one is evaluating a patient who may have increased intracranial pressure. The purpose of this study is to evaluate a large group of healthy patients, correlating optic disc characteristics, choroidal pulse, and brachial pulse pressure with the presence and intensity of the spontaneous retinal venous pulse. Ninety-seven patients were studied correlating these parameters with their fundus photographs. Ocular pneumotonometry as a measure of the choroidal pulse and the brachial pulse pressure were correlated with the optic disc characteristics and the intensity of the retinal venous pulse statistically. The results showed a highly significant correlation with these parameters. The greater the pulse amplitude--especially the choroidal pulse the more likely the spontaneous retinal venous pulse would be present. More importantly, the anatomic variable of optic disc cup and vascular configuration had the greatest influence on whether the spontaneous retinal venous pulse is present or absent. The authors conclude that unless the clinician is aware of the importance of optic nerve characteristics and pulse amplitude in the choroid (indirectly measured in a normal clinical setting by the brachial pulse) the significance of the spontaneous retinal venous pulse cannot be properly determined.