A new novel method for assessing intracranial pressure using non-invasive fundus images: a pilot study

Arteriole and venule diameter ratio (A/V-ratio) can be measured using fundus photography. In this pilot study, we correlated changes in the intracranial pressure with the diameter of vessels of the retina. We investigated whether increased intracranial pressure (ICP) was reflected in a measurable and quantifiable distention of the venule diameter, leading to a decreased A/V-ratio. This was demonstrated by assessment of the A/V-ratio in patients already undergoing conventional ICP monitoring with a cerebral intraparenchymal pressure monitor. Our method shows a correlation between A/V ratio and ICP and suggests an easily obtainable and usable point-of-care (POC), non-invasive method to estimate the intracranial pressure without the necessity of mydriatic drugs. Furthermore, the sensitivity/specificity analysis with a cut-off of < 0.8015 A/V-ratio, showed a sensitivity of 94% [85–98%] and a specificity of 50% [34–66%] with a positive likelihood ratio of 9.0. This means that in a clinical setting there is a 94% chance of correctly identifying individuals with ICP ≥ 20 mmHg.