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No flow through the vitreous humor: How strong is the evidence?
Prog Retin Eye Res. 2020 Feb 06 [Online ahead of print]PR

Abstract

When analyzing vitreal drug delivery, or the pharmacological effects of drugs on intraocular pressure, or when interpreting outflow facility measurements, it is generally accepted that the fluid in the vitreous humor is stagnant. It is accepted that for all practical purposes, the aqueous fluid exits the eye via anterior pathways only, and so there is negligible if any posteriorly directed flow of aqueous through the vitreous humor. This assumption is largely based on the interpretation of experimental data from key sources including Maurice (1957), Moseley (1984), Gaul and Brubaker (1986), Maurice (1987) and Araie et al. (1991). However, there is strong independent evidence suggesting there is a substantial fluid flow across the retinal pigment epithelium from key sources including Cantrill and Pederson (1984), Chihara and Nao-i, Tsuboi (1985), Dahrouj et al. (2014), Smith and Gardiner (2017) and Smith et al. (2019). The conflicting evidence creates a conundrum-how can both interpretations be true? This leads us to re-evaluate the evidence. We demonstrate that the data believed to be supporting no aqueous flow through the vitreous are in fact compatible with a significant normal aqueous flow. We identify strong and independent lines of evidence supporting fluid flow across the RPE, including our new outflow model for the eye. On balance it appears the current evidence favors the view that there is normally a significant aqueous flow across the RPE in vivo. This finding suggests that past and future analyses of outflow facility, interpretations of some drug distributions and the interpretation of some drug effects on eye tissues, may need to be revised.

Authors+Show Affiliations

Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Australia. Electronic address: david.smith@uwa.edu.au.Faculty of Engineering and Mathematical Sciences, The University of Western Australia, Perth, Australia; College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia.College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32035123

Citation

Smith, David W., et al. "No Flow Through the Vitreous Humor: How Strong Is the Evidence?" Progress in Retinal and Eye Research, 2020, p. 100845.
Smith DW, Lee CJ, Gardiner BS. No flow through the vitreous humor: How strong is the evidence? Prog Retin Eye Res. 2020.
Smith, D. W., Lee, C. J., & Gardiner, B. S. (2020). No flow through the vitreous humor: How strong is the evidence? Progress in Retinal and Eye Research, 100845. https://doi.org/10.1016/j.preteyeres.2020.100845
Smith DW, Lee CJ, Gardiner BS. No Flow Through the Vitreous Humor: How Strong Is the Evidence. Prog Retin Eye Res. 2020 Feb 6;100845. PubMed PMID: 32035123.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - No flow through the vitreous humor: How strong is the evidence? AU - Smith,David W, AU - Lee,Chang-Joon, AU - Gardiner,Bruce S, Y1 - 2020/02/06/ PY - 2019/08/20/received PY - 2020/01/30/revised PY - 2020/02/03/accepted PY - 2020/2/9/pubmed PY - 2020/2/9/medline PY - 2020/2/9/entrez KW - Aqueous Outflow KW - Fluid physiology of the eye KW - Outflow facility KW - Vitreal flow KW - Vitreal transport SP - 100845 EP - 100845 JF - Progress in retinal and eye research JO - Prog Retin Eye Res N2 - When analyzing vitreal drug delivery, or the pharmacological effects of drugs on intraocular pressure, or when interpreting outflow facility measurements, it is generally accepted that the fluid in the vitreous humor is stagnant. It is accepted that for all practical purposes, the aqueous fluid exits the eye via anterior pathways only, and so there is negligible if any posteriorly directed flow of aqueous through the vitreous humor. This assumption is largely based on the interpretation of experimental data from key sources including Maurice (1957), Moseley (1984), Gaul and Brubaker (1986), Maurice (1987) and Araie et al. (1991). However, there is strong independent evidence suggesting there is a substantial fluid flow across the retinal pigment epithelium from key sources including Cantrill and Pederson (1984), Chihara and Nao-i, Tsuboi (1985), Dahrouj et al. (2014), Smith and Gardiner (2017) and Smith et al. (2019). The conflicting evidence creates a conundrum-how can both interpretations be true? This leads us to re-evaluate the evidence. We demonstrate that the data believed to be supporting no aqueous flow through the vitreous are in fact compatible with a significant normal aqueous flow. We identify strong and independent lines of evidence supporting fluid flow across the RPE, including our new outflow model for the eye. On balance it appears the current evidence favors the view that there is normally a significant aqueous flow across the RPE in vivo. This finding suggests that past and future analyses of outflow facility, interpretations of some drug distributions and the interpretation of some drug effects on eye tissues, may need to be revised. SN - 1873-1635 UR - https://www.unboundmedicine.com/medline/citation/32035123/No_flow_through_the_vitreous_humor:_How_strong_is_the_evidence L2 - https://linkinghub.elsevier.com/retrieve/pii/S1350-9462(20)30017-3 DB - PRIME DP - Unbound Medicine ER -
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