ARVO 2026: Perfusion pressure outperforms BP and IOP as cardiac predictor

Ocular perfusion pressure (OPP) was more strongly associated with myocardial strain and systolic pulmonary arterial pressure (sPAP) than systemic blood pressure (BP) or intraocular pressure (IOP) alone, according to findings presented at the Association for Research in Vision and Ophthalmology (ARVO) 2026 annual meeting in Denver, Colorado, May 3–7.¹ Brent A. Siesky, PhD, first study author from the Icahn School of Medicine at Mount Sinai, New York, presented the results. Siesky and colleagues investigated the relationships between systemic cardiovascular parameters and IOP, BP and OPP.

Study methodology

The study included 48 eyes (24 right and 24 left eyes) of 24 healthy adults; paired ocular and systemic measurements underwent targeted correlation analysis. The ocular variables included IOP in the right and left eyes, total OPP in the right and left eyes, and the systolic OPP (SPP) and diastolic OPP (DPP). The cardiac outcomes were the global longitudinal strain (GLS) endocardial peak A3C (GLS Endo A3C), left ventricle GLS (GLS avg), left ventricular ejection fraction (LVEF) and sPAP. The systemic variables studied were the systolic and diastolic BP and the mean arterial pressure (MAP).

What did the systemic BP and IOP show?

Siesky and colleagues reported that systemic BP was moderately negatively correlated with sPAP (systolic r = –0.56, P = .076 and diastolic r = –0.61, P = .047); MAP (r = –0.60, P = .049); and LVEF (systolic r = –0.29, P = 0.164 and diastolic r = –0.40, P = .055; MAP r = –0.36, P = .082). BP was positively correlated with GLS A3C (systolic r = 0.47, P = .104; diastolic r = 0.69, P = .009; MAP r = 0.60, P = .030).

The investigators also reported that IOP had minimal associations in both eyes and weak, non-significant correlations with sPAP, GLS A3C, GLS avg and LVEF.

The OPP results

“However, the OPP showed markedly stronger and more coherent associations,” the investigators stated.

Total OPP was correlated with sPAP (right eye, r = –0.64, P = .034; left eye, r = –0.68, P = .021), GLS A3C (right eye, r = 0.64, P = .018; left eye, r = 0.65, P = .016), GLS avg (right eye, r = 0.56, P = .046; left eye, r = 0.53, P = .060) and LVEF (right eye, r = –0.44, P = .033; left eye, r = –0.42, P = .040).

“The DPP produced the strongest and most consistent correlations across both eyes, including the sPAP (right eye, r = –0.60, P = .050; left eye, r = –0.66, P = .027), the GLS A3C (right eye, r = 0.74, P = .004; left eye, r = 0.74, P = .004), the GLS avg (right eye, r = 0.64, P = .018; left eye, r = 0.61, P = .026) and LVEF (right eye, r = –0.47, P = .019; left eye, r = –0.45, P = .028),” Siesky and colleagues reported.

Siesky and colleagues concluded: “The OPP showed stronger and more coherent correlations with myocardial strain and sPAP than the systemic BP or IOP did alone, indicating that perfusion-based metrics better capture cardiac functional status. The DPP emerged as the most robust predictor, indicating that diastolic-phase ocular perfusion may provide particularly sensitive insight into myocardial and pulmonary vascular loading.”

Reference

1. Siesky BA, Harris A, Potash S, et al. Ocular perfusion metrics demonstrate strong coupling with myocardial strain and pulmonary pressure. ARVO 2026 Annual Meeting; May 3–7, 2026; Denver, Colorado. Poster 0787.