To the Editor.
—The article by Dr Sauvé and colleagues1 on assessing clinical significance of carotid bruits failed to mention the value of ophthalmodynamometry to grossly estimate the severity of carotid stenosis.The optic nerve is observed with an ophthalmoscope. Pressure with the index finger is exerted against the sclera through the lid, and the central retinal artery is monitored for pulsation. If pulsation of the artery occurs (collapse at diastole, expansion at systole) with minimal pressure against the globe, the blood supply to the ophthalmic artery from the carotid system may be compromised. An ophthalmodynamometer provides more precise determination; however, with severe compromise of blood flow, it is inaccurate because the pressure may be too low to measure. Indeed, some patients with a pending central retinal artery occlusion on the basis of stenosis can exhibit spontaneous artery pulsations when moved from a supine to an upright position.To
Coyle TJ. Detection of Carotid Stenosis by Physicial Examination. JAMA. 1994;271(24):1908. doi:10.1001/jama.1994.03510480032026