Patient outcomes using revised guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008).

AIM: To determine the efficacy of selection of patients for NHS (Scotland) continuing care using revised guidance eligibility criteria, CEL (2008). METHODS: On September 2009, a census was conducted of 632 patients, distributed over 10 hospital sites in NHS Lanarkshire Older People's Directorate, to identify those patients who had future care needs assessed using revised NHSS CEL (2008) eligibility criteria during the previous 3 months. These patients were then assigned to one of four categories: (1) eligible for NHS continuing care; (2) likely destination care home; (3) likely discharge home with complex care package; and (4) outcome uncertain. 'Frailty' was recorded in a sub-group of patients using Rockwood's frailty index. The index records frailty on a scale 0-1, a higher score indicating greater frailty. Outcomes were recorded at 2-monthly intervals for 1 year. Patients undergoing acute assessment and/or specialist rehabilitation, those admitted before 1 April 2009 and already accepted for NHS continuing care and those with a planned discharge date were excluded. RESULTS: Two hundred and eleven patients were identified as meeting the criteria for allocation to one of the four categories. Mortality at 1 year was as follows: NHS continuing care 40/45 (89%), likely Care Home destination 39/81 (48%), likely home discharge 22/61 (35%), outcome uncertain 13/24 (54%). Mean frailty scores were: NHS continuing care 0.4, likely care home 0.34, likely discharge home 0.29; p=0.0002 (ANOVA). Re-admission rates were high, 60% once and 40% twice or more, in patients discharged from hospital. CONCLUSION: The revised guidance on Eligibility for NHS Continuing Care in Scotland, CEL (2008), is useful in identifying the frailest patients with complex needs and limited survival. However, hospital re-admission rates and mortality are high in all patients considered for eligibility to NHS continuing care in whom the guidance is applied.

Sex differences in musculoskeletal injury epidemiology and subsequent loss of tactical readiness during Marine Corps Officer Candidates School.

INTRODUCTION: The US Marine Corps (USMC) Officer Candidates School (OCS) is a 10-week training course for Marine Officer Candidates (MOCs). OCS training is rigorous and demanding, which results in a high risk of musculoskeletal injuries (MSIs). The objective of this analysis was to describe MSIs among women and men during the USMC OCS at Quantico, Virginia, from September 2020 to November 2021. METHODS: This prospective cohort study assessed MSIs that occurred among 736 MOCs (women: 17.8% of sample, men: 82.2%). Data for the study were derived from routinely collected injury data by athletic trainers and physical therapists embedded within the training units. Injury incidence, event at the time of injury occurrence, anatomic location, injury type and disposition following injury were described. Fisher's exact tests were used to compare proportions of injured women and men. RESULTS: The cumulative injury incidence was higher among women (39.7%) compared with men (23.1%, p<0.001). When specific events associated with injuries were reported, most frequent events were the obstacle course (women: 20.9% of injuries, men: 12.9%) and the conditioning hike (women: 11.6%, men: 6.9%). Most injures affected the lower body (women: 67.4%, men: 70.8%). The most frequent body part injured was the lower leg (18.6%) in women and the knee (23.3%) in men. The most frequent injury type was strain (women: 39.5%, men: 24.3%), followed by sprain (women: 16.3%, men: 14.9%). A greater percentage of female (92.3%) compared with male MOCs (69.3%; p<0.001) were assigned light duty status following MSIs. CONCLUSIONS: Mitigation of injuries during OCS events such as the obstacle course and the conditioning hike needs further investigation. The high risk of overuse lower leg injuries among women and the higher incidence of injuries among women compared with men underscore the need for further investigation of modifiable sex-specific injury risk factors.

Use-dependent corticospinal excitability is associated with resilience and physical performance during simulated military operational stress.

Simulated military operational stress (SMOS) provides a useful model to better understand resilience in humans as the stress associated with caloric restriction, sleep deficits, and fatiguing exertion degrades physical and cognitive performance. Habitual physical activity may confer resilience against these stressors by promoting favorable use-dependent neuroplasticity, but it is unclear how physical activity, resilience, and corticospinal excitability (CSE) relate during SMOS. To examine associations between corticospinal excitability, physical activity, and physical performance during SMOS. Fifty-three service members (age: 26 ± 5 yr, 13 women) completed a 5-day and -night intervention composed of familiarization, baseline, SMOS (2 nights/days), and recovery days. During SMOS, participants performed rigorous physical and cognitive activities while receiving half of normal sleep (two 2-h blocks) and caloric requirements. Lower and upper limb CSE were determined with transcranial magnetic stimulation (TMS) stimulus-response curves. Self-reported resilience, physical activity, military-specific physical performance (TMT), and endocrine factors were compared in individuals with high (HIGH) and low CSE based on a median split of lower limb CSE at baseline. HIGH had greater physical activity and better TMT performance throughout SMOS. Both groups maintained physical performance despite substantial psychophysiological stress. Physical activity, resilience, and TMT performance were directly associated with lower limb CSE. Individual differences in physical activity coincide with lower (but not upper) limb CSE. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during SMOS. Future studies may use noninvasive neuromodulation to clarify the interplay among CSE, physical activity, and resilience and improve physical and cognitive performance.NEW & NOTEWORTHY We demonstrate that individual differences in physical activity levels coincide with lower limb corticospinal excitability. Such use-dependent corticospinal excitability directly relates to resilience and physical performance during a 5-day simulation of military operational stress with caloric restriction, sleep restriction and disruption, and heavy physical and cognitive exertion.

Effect of acute caffeine ingestion on EPOC after intense resistance training.

AIM: This study investigated the effect of acute caffeine (CAF) intake on postexercise oxygen consumption (EPOC) after intense resistance training. METHODS: Fourteen strength-trained men (mean ± SD age and mass =23.1 ± 4.2 yr and 83.4 ± 13.2 kg, respectively) who were caffeine users initially completed one-repetition maximum testing (1-RM) of four exercises: bench press, leg press, lat row, and shoulder press. On each of two days separated by one week, they completed four sets of each exercise to fatigue at 70-80% 1-RM, which was preceded by ingestion of CAF (6 mg/kg) or placebo. Pre-exercise, indirect calorimetry was used to assess energy expenditure for 35 min; this was repeated for 75 min postexercise while subjects remained seated in a quiet lab. Two-way analysis of variance with repeated measures was used to examine differences in gas exchange variables across time and treatment. RESULTS: Results revealed that EPOC was significantly higher (P<0.05) with CAF (26.7 ± 4.1 L) compared to placebo (22.8 ± 3.8 L). With CAF ingestion, oxygen uptake was significantly higher (P<0.05) from 10 min pre-exercise to 70 min postexercise. Respiratory exchange ratio was significantly different (P<0.05) with CAF versus placebo. Caffeine intake increased total energy expenditure by 15% (P<0.05), but the additional calories burned was minimal (+27 kcal). CONCLUSION: Caffeine ingestion in individuals regularly completing rigorous resistance training significantly increases EPOC and energy expenditure pre-and post-exercise, yet the magnitude of this effect is relatively small.

Low mean level sustained and intermittent grip exertions: influence of age on fatigue and recovery.

The goal of this study was to quantify localised muscle fatigue resulting from low mean levels of exertion in younger (< 40 years) and older (> 50 years) adults. Fatigue, elicited in the finger flexor muscles by intermittent (10% mean maximum voluntary contraction (MVC)) and sustained (8% MVC) handgrip exercises, was quantified by a muscle twitch force response before, immediately after and during 3 h following exercise. Despite greater mean loads, recovery time was shorter following intermittent than sustained contractions, which suggests that recovery from fatigue is more sensitive to rest within the work cycle than mean work. The more pronounced effects for younger than older individuals following the sustained exertion indicate that changes in muscle fibre type composition might predispose older individuals to be more resistant to fatigue resulting from sustained contractions of low level. Performing hand exertion tasks requiring low mean force levels contributes to similar long-lasting fatigue effects regardless of gender and age. Intermittent periods of complete rest reduce muscle fatigue. Since fatigue was not perceived during recovery from the tested sustained and intermittent contractions, subjective evaluations may not be a reliable indicator of localised muscle fatigue.

Ankylosing spondylitis: an Australian experience.

BACKGROUND: The purpose of this study was to characterize an Australian cohort of ankylosing spondylitis (AS) patients and examine predictors of important disease outcomes. METHODS: Cross-sectional study of first visit data among patients referred to the Austin Spondylitis Clinic from rheumatology or general practices. We obtained clinical and laboratory data and validated composite indices through self-reported questionnaire. RESULTS: Delay in AS diagnosis averaged 8.1 years and was higher among women and younger-onset disease. Cervicothoracic mobility was better in women although they showed more entheseal tender points and greater impairment of quality of life. Those with long-standing AS had similar disease activity to recent onset disease but had greater functional disability. Current smoking was associated with worse outcomes although there was no association between cumulative exposure and AS outcomes. CONCLUSION: The clinical expression of AS in this first-described Australian cohort is similar to previously described cohorts. We observed greater cervicothoracic mobility and a higher enthesitis index among women perhaps contributing to longer delay to diagnosis.

Diuretic-associated hypomagnesemia in the elderly.

Serum magnesium concentration was measured in 320 consecutive elderly patients (mean age, 81 years) receiving diuretic therapy at the time of hospital admission. When compared with serum concentrations of 250 elderly patients who were not taking diuretics at the time of hospital admission, only the group taking thiazide diuretics had a significantly reduced mean serum level. The 24-hour urine sampling from representative subgroups demonstrated impaired magnesium-conserving ability in hypomagnesemic subjects receiving loop and thiazide diuretic therapy. Patients taking therapy that included a potassium-sparing diuretic had no significant evidence of reduced magnesium-conserving ability. Dietary assessments of the study population revealed suboptimal magnesium intake in the diet.

Relative selective action of propranolol on cardiovascular and respiratory responses to isoproterenol.

Organ selectivity of beta sympathetic blockade with propranolol was studied in 6 normal men by comparing the cardiovascular and respiration responses during isoproterenol infusions before and after propranolol. Beta sympathetic blockade was achieved with propranolol and was considered present when there was no heart rate (HR) response to isoproterenol during an infusion tenfold greater than that which raised HR 25% during a control period. During blockade there was no change in HR or systolic or diastolic blood pressure during isoproterenol infusions. There was a consistent (p less than 0.05) rise in resting ventilation (+17%), oxygen consumption (+9%), and carbon dioxide production (+15%) with low-dose (raised HR 10% before blockade) isoproterenol infusion during blockade. These respiratory effects of low-dose isoproterenol during cardiovascular blockade were quantitatively similar to that before blockade. With infusion that raised HR 25%, there was a further increase in VE, VO2, and VCO2 before blockade but no further increase during beta blockade. Changes in acid-base status did not explain the increase in VE during blockade. We conclude that there are differences between effectiveness of propranolol blockade of the cardiovascular system and of the respiratory system.

Isocapnia blocks exercise-induced reductions in ocular tension.

Previous reports suggest that isometric exercise (2-min handgrip at 50% maximal voluntary contraction [MVC]) substantially lowers intraocular pressure (IOP). The authors questioned whether the mechanism for lowered IOP in exercise is secondary to hyperventilation. Accordingly, in this study 11 subjects, with elevated IOP (greater than or equal to 18 mm Hg) and otherwise healthy, did 2 min of handgrip exercise at 50% MVC with and without carbon dioxide supplementation to maintain isocapnic conditions. Compared with a control experiment that involved neither exercise nor CO2 addition, exercise induced a fall in IOP from 18.3 to 15.6 mm Hg (P less than 0.001). This statistically significant decline in IOP persisted for 15 min after the exercise session. At the point of minimum IOP (1 min after the end of exercise), the minute ventilation was elevated from 6.5-8.1 l/min (P less than 0.05), and the end-tidal partial pressure of CO2 (PCO2) was reduced from 37.0 to 33.7 mm Hg (P less than 0.05) with respect to control values. By contrast, adding CO2 sufficient to maintain isocapnic conditions (experimental end-tidal PCO2 = 38.9 versus 38.5 mm Hg in the control study; P = not significant) abolished the exercise-induced ocular hypotension (experimental IOP = 17.8 versus 18.1 mm Hg in the control study; P = not significant). It was concluded that prevention of hypocapnia during isometric handgrip exercise blocks the subsequent fall in IOP, suggesting both that isometric exercise per se has no direct influence on IOP and that therapy for ocular hypertension could involve manipulation of blood gases.

Regional differences in retinal vascular reactivity.

PURPOSE: Although glaucomatous visual field defects are more common in the superior field than in the inferior field, microaneurysms are more frequent in the superior than in the inferior retina in diabetic retinopathy. The authors hypothesized that differences in vascular hemodynamics in the two areas might contribute to these phenomena. METHODS: The blood flow response to hyperoxia and hypercapnia was evaluated in peripapillary retinal tissue superior and inferior to the optic nerve head using confocal scanning laser Doppler flowmetry. In 14 young, healthy persons, blood flow was measured while breathing room air and during isocapnic hyperoxia (100% O2 breathing) and isoxic hypercapnia (PCO2 increased 15% above baseline). Histograms were generated from pixel-by-pixel analysis of retinal portions of superior and inferior temporal quadrants of the entire image. RESULTS: Baseline blood flow in the inferior temporal quadrant was significantly greater than in the superior temporal quadrant (P < 0.05). However, the inferior region failed to increase in perfusion during hypercapnia and experienced significant mean blood flow reduction; flow reduction in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and an increased percentage of pixels without measurable flow, during hyperoxia (each P < 0.05). In contrast, in the superior temporal region, hyperoxia failed to reduce blood volume, velocity, or flow, whereas hypercapnia significantly increased mean flow; increased flow in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and reduced the percentage of pixels without measurable flow (each P < 0.05). CONCLUSIONS: The inferior temporal quadrant of the peripapillary retina is, in comparison with the superior temporas region, less responsive to vasodilation and more responsive to vasoconstriction. These differences could contribute to different susceptibility to visual field defect or vascular dysfunction in the superior and inferior retina.

Chronic physical activity: hepatic hypertrophy and increased total biotransformation enzyme activity.

Does chronic voluntary physical activity alter hepatic or intestinal capacities for xenobiotic biotransformation? This question was investigated by comparing biotransformation enzyme activities in liver and small intestine of active and sedentary rats. Male rats allowed unlimited access to a running wheel and fed ad lib. for 6 weeks were weight-matched to sedentary controls; the active rats ate 22% more food than the sedentary rats (P less than 0.05). Active rats ran 2.8 +/- 0.6 miles/day. Liver weights were higher in the active rats (11.2 +/- 0.2 vs 9.8 +/- 0.2 g; P less than 0.05), as were total liver protein, and liver microsomal and cytosolic protein (P less than 0.05). As a result of liver hypertrophy, the active rats showed higher total liver activity of several biotransformation enzymes, including 2-naphthol sulfotransferase, styrene oxide hydrolase, benzphetamine N-demethylase, ethacrynic acid glutathione S-transferase and morphine UDP-glucuronosyltransferase (P less than 0.05). In contrast, there was no detectable difference in total liver N-acetyltransferase activity toward p-aminobenzoic acid, 2-naphthylamine, and 2-amino-fluorene as well as, relative hepatic enzyme activity (expressed per g liver or per mg protein) and total and relative intestinal enzyme activity. We conclude that chronic voluntary physical activity, accompanied by an increased food intake, results in liver hypertrophy and potentially increases total hepatic capacity to biotransform certain xenobiotic chemicals.

Scanning laser ophthalmoscopy-based evaluation of epipapillary velocities: method and physiologic variability.

PURPOSE: Scanning laser ophthalmoscopy is capable of producing high-resolution fluorescein angiograms. Measurements of capillary blood velocities in the fovea are well established. In this study, we used an identical technique to measure particle velocities in the superficial layers of the optic nerve head. We compared these data with simultaneous velocity measurements in the retinal and macular vasculature. METHODS: Fluorescein angiograms were performed in 30 subjects (12 men, 18 women; mean age, 26 years; standard deviation [SD], 3 years). Off-line, the velocities of hypofluorescent particles through the microvasculature of epipapillary and macular vessels were measured by image-processing techniques. We also assessed the arteriovenous passage (AVP) time of the fluorescein dye front. RESULTS: Epipapillary blood velocities ranged from 2.7 to 6.5 mm/sec (mean, 4.0 mm/sec; SD, 0.99 mm/sec) and differed significantly from macular capillary blood velocities (MCBVs), which ranged from 1.67 to 3.31 mm/sec (mean, 2.53 mm/sec; SD, 0.34 mm/sec). The AVP time in all subjects was 1.74 +/- 0.5 sec (mean +/- SD) and correlated with the MCBV (P < 0.05, r = -0.46). Epipapillary blood velocities showed no correlation with either AVP time or MCBV. CONCLUSIONS: The scanning laser methodology, adapted to objectively assess velocities in the epipapillary vasculature, shows that these measurements are neither correlated with velocities in the perifoveal network, nor inversely correlated with overall retinal transit time. Epipapillary blood velocities were found to be substantially higher than those measured in macular capillaries. This result might be explained by the different anatomy of epipapillary vessels compared with macular capillaries.

Gastrointestinal transit during mild exercise.

Although exercise is often recommended as therapy for constipation, almost nothing is known of the effects of exercise on rates of movement of material in the gastrointestinal tract. In this study we investigated the influence of mild exercise on transit of a liquid meal from the mouth to the large intestine. Orocecal transit time was determined by a consistent elevation of H2 concentration in a rebreathing apparatus after ingestion of 30 g lactulose; the lactulose was part of a 360-kcal, 350-ml liquid meal. Comparison of transit time was made, in 12 young healthy subjects, between seated rest and a treadmill walk at 5.6 km/h up a 2% grade. The walk elevated heart rate from 64 +/- 4 to 109 +/- 5 beats/min, O2 uptake (VO2) from 0.29 +/- 0.02 to 1.20 +/- 0.07 l/min STPD, and final rectal temperature from 37.0 +/- 0.1 to 38.3 +/- 0.1 degrees C (all P less than 0.01). Exercise speeded transit of the liquid meal, with mean rises in H2 concentration taking place 66 +/- 10 min after ingestion at rest, compared with 44 +/- 6 min after food intake during exercise (P less than 0.02). H2 concentrations in the rebreathing apparatus showed similar base lines in the two experiments, and quantitative increases in H2 concentration, although shifted in time by exercise, were otherwise identical. Subjects with the slowest resting transit rates showed the largest exercise effects (r = 0.79, P less than 0.05). These results indicate that mouth-to-cecum transit of at least the first portion of a liquid meal-based nonabsorbable carbohydrate marker is significantly accelerated during mild exercise.

Ventilatory and treadmill endurance during acute semistarvation.

Little is known about respiratory muscle function in acute undernutrition, although an inadequate caloric intake is common in numerous disease states. Twelve young-adult, healthy female volunteers performed two familiarization experiments and were then studied after 7 days of consuming 40% of normal daily caloric intake as well as after 1 wk of normal caloric intake. In each experiment subjects performed tests of resting pulmonary function, inspiratory muscle strength, and ventilatory endurance, the last of which involved two 60-s and two 6-min isocapnic maximum voluntary ventilation maneuvers. Subjects then walked to exhaustion in 8-20 min on a treadmill. The caloric restriction did not affect performance of any breathing test but did lower endurance time in severe treadmill exercise (P less than 0.05). Basal metabolic rate was lowered, resting blood levels of free fatty acids and beta-hydroxybutyrate elevated, and glucose lowered following the caloric restriction (P less than 0.05). Blood lactate levels were lower during and after exercise following caloric restriction (P less than 0.05). We conclude that ventilatory muscle strength and endurance are fully preserved in caloric restriction severe enough to cause mild ketoacidosis and hypoglycemia, lowered basal metabolic rate, and decreased endurance in severe treadmill exercise.

Rapid orocecal transit in chronically active persons with high energy intake.

Although chronic physical activity by humans can raise energy requirements and energy intake severalfold above sedentary levels, whether these increases alter digestive strategy remains unknown. To investigate this possibility, food passage rate (mouth-to-large intestinal lactulose transit) and absorption (xylose) were compared in a cross section of young men chosen to represent a wide range of daily physical activity and food intake. In 20 men (energy intake 1,272-5,342 kcal/day), resting mouth-to-cecum transit was faster in high caloric consumers (r = -0.69, P less than 0.01). In contrast, xylose absorption (n = 26; measured either as urinary xylose excretion or integrated breath H2 production from the sugar) was unrelated to food intake. Dietary fiber intake was uncorrelated with energy intake. This apparent human digestive strategy of rapid transit across the gut absorptive surface, without a sacrifice in absorption, parallels the adaptations made by several animal species similarly faced with increased energy demand at constant fiber intake. We therefore conclude that the hyperphagia of chronic exercise in humans may be linked with significant gastrointestinal adaptations.

Orocecal transit during mild exercise in women.

Little is known of the influence of exercise on movement of ingested food through the alimentary tract or of the association of several gastrointestinal hormones with transit rate in exercise. In this study, orocecal transit during mild exercise was measured in 21 women by detecting a rise in expired H2 after ingestion of 20 g lactulose in a 350-ml (360 kcal) liquid meal. Motilin, gastrin, and cortisol were measured in peripheral venous blood when, as evidenced by a breath H2 rise, the first portion of the meal arrived at the cecum. Comparison was made between seated rest and a treadmill walk at 5.6 km/h up a 2% grade. The walk predictably elevated heart rate, O2 uptake, and rectal temperature and also reduced transit time from 98 min at rest to 75 min during exercise (P less than 0.001). Faster transit in exercise was associated with a significant rise in cortisol, while gastrin and motilin levels were both unchanged. In conclusion, in women mild concurrent exercise accelerates orocecal transit rate of at least the first portion of nonabsorbable carbohydrate in a liquid meal. Although the mechanism for the effect remains unknown, it may be secondary to some aspect of the stress response to physical activity.

Coordination between respiration and swallowing: respiratory phase relationships and temporal integration.

The coordination of breathing and swallowing was studied in 13 young healthy adult subjects during the administration of graduated volumes of water (3, 10, and 20 ml). Simultaneous submental electromyography, respiratory plethysmography, and fiber-optic endoscopy revealed a well-timed pattern between physiological respiratory events and related swallowing events. Expiration was the phase of respiration that was most closely associated with deglutition. Respiration was usually maintained at the onset of deglutition and halted before the onset of laryngeal elevation. The apneic interval was approximately 1 s for the 3-, 10-, and 20-ml boluses. A large-volume (100-ml) straw swallow resulted in variable respiration-swallowing patterns and in statistically significant differences (P < 0.01) in the duration of apneic pause and laryngeal excursion. The expiratory phase of respiration resumed nearly 0.50 s before the completion of swallowing. Clinical implications of the findings are addressed and related to aspiration and pulmonary complications in dysphagic patients.

Estrogen-replacement therapy: effects on retrobulbar hemodynamics.

PURPOSE: Estrogen-replacement therapy causes vasodilation and increased blood flow in major peripheral arteries. We examined the role that estrogen may play in enhancing perfusion within the watersheds of several major and minor retrobulbar arteries. METHODS: Postmenopausal women receiving estrogen-replacement therapy (n = 16) were compared with both age-matched women not receiving estrogen (n = 16) and with young women (n = 20). Studies involved color Doppler imaging analysis of flow velocities measured in the ophthalmic, central retinal, and nasal and temporal posterior ciliary arteries. RESULTS: In the ophthalmic artery, young women and postmenopausal women receiving estrogen exhibited reduced resistance indexes as compared with postmenopausal women not receiving estrogen (each P <. 001). In contrast, flow velocities in the central retinal artery were similar among the three groups of women. In the posterior ciliary arteries, a different pattern emerged: young women, as compared with either group of postmenopausal women, showed greater peak systolic and end-diastolic velocities at similar resistance index (each P <.05). CONCLUSIONS: Estrogen-replacement therapy in postmenopausal women apparently helps reduce vascular resistance distal to the ophthalmic artery to levels matching those of young women. However, estrogen replacement has little impact on flow velocities in the posterior ciliary arteries. In those vessels, aging per se may reduce perfusion, potentially contributing to the age-dependent risk of major eye diseases, such as glaucoma and age-related macular degeneration.

Color Doppler analysis of ocular vessel blood velocity in normal-tension glaucoma.

The pathogenesis of normal-tension glaucoma remains unknown. Because ocular vasospasm has been proposed as a possible mechanism, we investigated ocular vessel flow velocity in normal-tension glaucoma patients at rest and under treatment with a cerebral vasodilator. Ten normal-tension glaucoma patients and nine age- and gender-matched controls had flow velocity measured in three vessels (ophthalmic artery, central retinal artery, and temporal short posterior ciliary artery) by using color Doppler imaging, under baseline conditions and during carbon dioxide supplementation sufficient to increase end-tidal PCO2 by 15%. Peak systolic and end-diastolic velocities were measured, and the resistance index (peak systolic velocity minus end-diastolic velocity, divided by peak systolic velocity) was calculated. Compared with controls, these normal-tension glaucoma patients had significantly lower end-diastolic velocities (P = .002) and higher resistance indices (P = .007) in the ophthalmic artery at baseline. When PCO2 was increased, control subjects remained unchanged, whereas it increased end-diastolic velocity in patients (P = .003) and abolished the difference in resistance index between the two groups. Patients and control subjects differed little in their baseline or carbon dioxide response velocities or in resistance in the other two vessels. These results indicate that at baseline these normal-tension glaucoma patients may have increased vascular resistance distal to the ophthalmic artery, although this increased resistance cannot be specifically ascribed to the central retinal arterial or to temporal short posterior ciliary arterial vascular beds. The responsiveness of these patients to a cerebral vasodilator (increased PCO2) indicates further that the increased resistance distal to the ophthalmic artery may be the reversible result of vasospasm.