Effects of Head-down Tilt on Optic Nerve Sheath Diameter in Healthy Subjects

Overview

Journal Ophthalmic Physiol Opt

Date 2023 Jul 4

PMID 37401194

Authors

Jessica J Ustick

Laura P Pardon

Pratik Chettry

Nimesh B Patel

Han Cheng

Affiliations

Soon will be listed here.

Abstract

Purpose: Intracranial pressure increases in head-down tilt (HDT) body posture. This study evaluated the effect of HDT on the optic nerve sheath diameter (ONSD) in normal subjects.

Methods: Twenty six healthy adults (age 28 [4.7] years) participated in seated and 6° HDT visits. For each visit, subjects presented at 11:00 h for baseline seated scans and then maintained a seated or 6° HDT posture from 12:00 to 15:00 h. Three horizontal axial and three vertical axial scans were obtained at 11:00, 12:00 and 15:00 h with a 10 MHz ultrasonography probe on the same eye, randomly chosen per subject. At each time point, horizontal and vertical ONSD (mm) were quantified by averaging three measures taken 3 mm behind the globe.

Results: In the seated visit, ONSDs were similar across time (p > 0.05), with an overall mean (standard deviation) of 4.71 (0.48) horizontally and 5.08 (0.44) vertically. ONSD was larger vertically than horizontally at each time point (p < 0.001). In the HDT visit, ONSD was significantly enlarged from baseline at 12:00 and 15:00 h (p < 0.001 horizontal and p < 0.05 vertical). Mean (standard error) horizontal ONSD change from baseline was 0.37 (0.07) HDT versus 0.10 (0.05) seated at 12:00 h (p = 0.002) and 0.41 (0.09) HDT versus 0.12 (0.06) seated at 15:00 h (p = 0.002); mean vertical ONSD change was 0.14 (0.07) HDT versus -0.07 (0.04) seated at 12:00 h (p = 0.02) and 0.19 (0.06) HDT versus -0.03 (0.04) seated at 15:00 h (p = 0.01). ONSD change in HDT was similar between 12:00 and 15:00 h (p ≥ 0.30). Changes at 12:00 h correlated with those at 15:00 h for horizontal (r = 0.78, p < 0.001) and vertical ONSD (r = 0.73, p < 0.001).

Conclusion: The ONSD increased when body posture transitioned from seated to HDT position without any further change at the end of the 3 h in HDT.

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References

Quigley H, Brown A, Morrison J, Drance S . The size and shape of the optic disc in normal human eyes. Arch Ophthalmol. 1990; 108(1):51-7. DOI: 10.1001/archopht.1990.01070030057028. View

Ohle R, McIsaac S, Woo M, Perry J . Sonography of the Optic Nerve Sheath Diameter for Detection of Raised Intracranial Pressure Compared to Computed Tomography: A Systematic Review and Meta-analysis. J Ultrasound Med. 2015; 34(7):1285-94. DOI: 10.7863/ultra.34.7.1285. View

Stevens R, Huberts W, Gommer E, Ertl M, Aries M, Mess W . An Automated Algorithm for Optic Nerve Sheath Diameter Assessment from B-mode Ultrasound Images. J Neuroimaging. 2021; 31(4):724-732. DOI: 10.1111/jon.12851. View

Laurie S, Vizzeri G, Taibbi G, Ferguson C, Hu X, Lee S . Effects of short-term mild hypercapnia during head-down tilt on intracranial pressure and ocular structures in healthy human subjects. Physiol Rep. 2017; 5(11. PMC: 5471441. DOI: 10.14814/phy2.13302. View

Stevens R, Gommer E, Aries M, Ertl M, Mess W, Huberts W . Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies. J Neuroimaging. 2021; 31(5):814-825. DOI: 10.1111/jon.12906. View

Meiburger K, Naldi A, Michielli N, Coppo L, Fassbender K, Molinari F . Automatic Optic Nerve Measurement: A New Tool to Standardize Optic Nerve Assessment in Ultrasound B-Mode Images. Ultrasound Med Biol. 2020; 46(6):1533-1544. DOI: 10.1016/j.ultrasmedbio.2020.01.034. View

Raspanti M, Marchini M, Della Pasqua V, Strocchi R, Ruggeri A . Ultrastructure of the extracellular matrix of bovine dura mater, optic nerve sheath and sclera. J Anat. 1992; 181 ( Pt 2):181-7. PMC: 1259714. View

Sirek A, Garcia K, Foy M, Ebert D, Sargsyan A, Wu J . Doppler ultrasound of the central retinal artery in microgravity. Aviat Space Environ Med. 2014; 85(1):3-8. DOI: 10.3357/asem.3750.2014. View

Pircher A, Montali M, Berberat J, Remonda L, Killer H . Relationship between the optic nerve sheath diameter and lumbar cerebrospinal fluid pressure in patients with normal tension glaucoma. Eye (Lond). 2017; 31(9):1365-1372. PMC: 5601451. DOI: 10.1038/eye.2017.70. View

10.

Greenfield D, Wanichwecharungruang B, Liebmann J, Ritch R . Pseudotumor cerebri appearing with unilateral papilledema after trabeculectomy. Arch Ophthalmol. 1997; 115(3):423-6. DOI: 10.1001/archopht.1997.01100150425022. View

11.

Liu D, Li Z, Zhang X, Zhao L, Jia J, Sun F . Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement. BMC Neurol. 2017; 17(1):188. PMC: 5622417. DOI: 10.1186/s12883-017-0964-5. View

12.

Jasien J, Samuels B, Johnston J, Crawford Downs J . Effect of Body Position on Intraocular Pressure (IOP), Intracranial Pressure (ICP), and Translaminar Pressure (TLP) Via Continuous Wireless Telemetry in Nonhuman Primates (NHPs). Invest Ophthalmol Vis Sci. 2020; 61(12):18. PMC: 7585393. DOI: 10.1167/iovs.61.12.18. View

13.

Blehar D, Gaspari R, Montoya A, Calderon R . Correlation of visual axis and coronal axis measurements of the optic nerve sheath diameter. J Ultrasound Med. 2008; 27(3):407-11. DOI: 10.7863/jum.2008.27.3.407. View

14.

Liu K, Fleischman D, Lee A, Killer H, Chen J, Bhatti M . Current concepts of cerebrospinal fluid dynamics and the translaminar cribrosa pressure gradient: a paradigm of optic disk disease. Surv Ophthalmol. 2019; 65(1):48-66. DOI: 10.1016/j.survophthal.2019.08.005. View

15.

Hirzallah M, Lochner P, Hafeez M, Lee A, Krogias C, Dongarwar D . Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol. J Neuroimaging. 2022; 32(5):808-824. DOI: 10.1111/jon.13018. View

16.

Nguyen B, Cleary J, Glarin R, Kolbe S, Moffat B, Ordidge R . Ultra-High Field Magnetic Resonance Imaging of the Retrobulbar Optic Nerve, Subarachnoid Space, and Optic Nerve Sheath in Emmetropic and Myopic Eyes. Transl Vis Sci Technol. 2021; 10(2):8. PMC: 7873495. DOI: 10.1167/tvst.10.2.8. View

17.

Helmke K, Hansen H . Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol. 1996; 26(10):701-5. DOI: 10.1007/BF01383383. View

18.

Ren R, Jonas J, Tian G, Zhen Y, Ma K, Li S . Cerebrospinal fluid pressure in glaucoma: a prospective study. Ophthalmology. 2009; 117(2):259-66. DOI: 10.1016/j.ophtha.2009.06.058. View

19.

Killer H, Laeng H, Flammer J, Groscurth P . Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol. 2003; 87(6):777-81. PMC: 1771732. DOI: 10.1136/bjo.87.6.777. View

20.

Liu D, Kahn M . Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993; 116(5):548-56. DOI: 10.1016/s0002-9394(14)73195-2. View