Effect of isosorbide mononitrate on the human optic nerve and choroidal circulations

Aims-To assess the effects of the nitric oxide donor 5-isosorbide mononitra te (ISMO) on blood flow in the optic nerve head (ON flow) and choroid (Ch f low). Methods-Laser Doppler flowmetry was used to measure ON flow and Ch flow in 12 normal subjects by aiming the laser beam at the fovea and at the tempora l rim, respectively. In a double masked, randomised, crossover design, each subject received orally on separate days either 20 mg of 5-isosorbide mono nitrate (ISMO) or placebo. Ch flow and ON flow were determined monocularly at baseline and 1 hour after dosing. In the last six subjects, additional m easurements were obtained at 3 hours. Mean arterial blood pressure (BPm), h eart rate, and intraocular pressure (IOP) were monitored, and ocular perfus ion pressure (PP) was estimated. Results-No significant changes in ON flow, PP, IOP, or BPm were observed fo llowing placebo. Following ISMO, ON flow increased from baseline by 19.8% ( SEM 9.3%) at 1 hour (paired t test, p = 0.058) and by 33.1% (7.5%) at 3 hou rs (p = 0.007). Compared with the changes following placebo, statistically significant increases in ON flow were observed both at 1 (p=0.050) and 3 ho urs (p=0.041) after ISMO treatment. Compared with placebo, PF decreased sig nificantly 1 hour after ISMO dosing (p=0.039), mainly as a function of redu ced BPm. A significant inverse correlation (R=-0.618; p=0.032) was observed between the percentage changes in PP and ON flow 1 hour following ISMO adm inistration, but not after placebo. No significant change in foveal Ch flow was documented. Conclusions-These results suggest that, in normal subjects, ISMO increases significantly ON flow but not Ch flow. The inverse correlation observed bet ween PP and ON flow suggests that the same mechanism(s) responsible for sys temic vasodilatation and blood pressure decrease may also cause the ON flow increase.