Acute increase in ocular microcirculation blood flow upon cholesterol removal. The eyes the window of the heart

Published:September 21, 2022DOI:


      • Laser speckle flowgraphy can quantify ocular microcirculation blood flow before and after lipoprotein apheresis in patients with hereditary hypercholesterolemia.
      • The optic disk microcirculation showed an acute increase in blood flow upon lipoprotein removal.
      • These results highlight the potential clinical importance of the eye as an easily accessible window to microcirculation.



      Lipoprotein apheresis acutely increases coronary microvascular blood flow. However, measurement techniques are time-consuming, costly, and invasive. The ocular vasculature may be an appropriate surrogate and an easily accessible window to investigate the microcirculation. Recent advances in ocular imaging techniques enable quick, non-invasive quantification of ocular microcirculation blood flow. The insights from these techniques represent a significant opportunity to study the short-term changes in optic disk blood flow after lipoprotein apheresis for inherited hypercholesterolemia.


      This study was performed at the Italian Reference Centre for Inherited Dyslipidemias in Tuscany. The study sample was comprised of 22 patients with inherited hypercholesterolemia who were previously studied for coronary microcirculation. Laser speckle flowgraphy (LSFG) was used to measure optic disk blood flow before and after lipoprotein apheresis. The main outcomes measures were average tissue blood flow (referred to as ‘Mean Tissue’, MT) and arteriolar/venular average blood flow (referred to as ‘Mean Vessel’, MV). Eyes were divided into two groups based on pre-lipoprotein apheresis optic disk blood flow values. P<0.05 was considered statistically signficant.


      After each lipoprotein apheresis treatment resulting in the reduction of plasma lipids, there was a concurrent increase in all optic disk microcirculatory parameters. The increase was statistically significant in eyes with lower pre-apheresis optic disk blood flow values (MT +7.0%, P<0.005; MV +7.2%, P<0.05).


      A single lipoprotein apheresis session resulted in a statistically significant short-term increase in optic disk blood flow. These findings together with previous coronary microcirculation data, suggest a similar ocular and coronary blood flow response to lipoprotein apheresis. Ocular microcirculation may represent a versatile biomarker for evaluating systemic microcirculatory health, including coronary microcirculation. Hence, it is plausible that plasma lipoprotein levels may influence optic disk blood flow.


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