See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/19550483

Effect of body position on intraocular pressure and aqueous flow

Article  in  Investigative Ophthalmology & Visual Science · September 1987

Source: PubMed

CITATIONS READS

96 94

4 authors, including:

Jay McLaren
Mayo Foundation for Medical Education and Research
142 PUBLICATIONS   5,234 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Jay McLaren on 24 December 2013.

The user has requested enhancement of the downloaded file.

 Effect of Body Position on Introoculor Pressure
and Aqueous Flow
Keirh H. Carlson, Jay W. McLaren, Jane E. Topper, and Richard F. Brubaker

The relationship between intraocular pressure and the rate of aqueous humor formation was studied in
human subjects. Intraocular pressure was altered by changing the subject's gravity-dependent body
position. Aqueous humor flow was measured fluorophotometrically. An average change of intraocular
pressure of 2.4 ± 1.2 mmHg and 11.2 ± 2.7 mmHg was recorded in subjects whose body position was
alternated ±15° from horizontal and ±50° from horizontal. No change of the rate of fluorescein
clearance was observed for the milder change of position. A small change of fluorescein clearance was
noted in response to the steeper change of position. Changing intraocular pressure seems not to induce
compensatory changes in aqueous flow. Therefore we conclude that aqueous formation is relatively
pressure-insensitive, a conclusion one would draw from clinical instances of angle-closure glaucoma or
as in other systems of secretion, such as the toad bladder or the cerebrospinal fluid, where alterations
in pressure do not necessarily influence flow. If there is a regulator of aqueous flow it is not responsive
to the changes in intraocular pressure brought about in this study. If aqueous flow regulates intraocu-
lar pressure or compensates for changes in intraocular pressure, the signal is not small changes in
pressure. Invest Ophthalmol Vis Sci 28:1346-1352,1987

Goldmann's important work1 established that the
major determinants of intraocular pressure were flow
of aqueous humor, resistance to outflow, and epis-
cleral venous pressure. An additional factor, uveo-
scleral flow, was established by the more recent work
of Bill.2 These four factors maintain the steady-state
intraocular pressure of the normal eye within fairly
narrow limits over the span of a lifetime.
This paper is concerned with one of the determi-
nants of intraocular pressure, namely the rate of flow
of aqueous humor through the anterior chamber. The
research reported in this paper is an attempt to find if
the rate of aqueous humor flow through the anterior
chamber changes in response to disturbances of intra-
ocular pressure, and if the direction and magnitude of
such change is sufficient to suggest that intraocular
pressure is regulated by feedback onto the rate of
aqueous flow.
Before describing the experiment, it is necessary to
define exactly what is meant in this paper by the term
"regulator." We define a regulator as a control pro-
cessor which imparts a biologically advantageous
From the Department of Ophthalmology, Mayo Clinic, Roches-
ter, Minnesota.
Supported in part by NIH grant EY-00634, Research to Prevent
Blindness, Inc., New York, New York and the Mayo Foundation,
Rochester, Minnesota.
Submitted for publication: April 21, 1986.
Reprint requests: Richard F. Brubaker, MD, Mayo Clinic, De-
partment of Ophthalmology, Rochester, MN 55905.
property to the organism primarily by compensating
for uncontrolled inputs (disturbances).3 Thus a regu-
lator creates a forcing function which can maintain
the regulated variable within narrow limits around a
set point.
In the experiment described below, the intraocular
pressure of normal conscious humans was disturbed
by changing the position of the body with respect to
gravity. The disturbance of intraocular pressure was
measured by tonometry and the response of the rate
of aqueous humor flow was measured by fluoropho-
tometry.
Materials and Methods
Healthy volunteers ranging in age from 14 to 47
were studied. Each volunteer was interviewed and
underwent an ophthalmic examination to confirm
that both eyes were normal. Informed consent was
obtained in accordance with federal guidelines. The
experiment consisted of independent measurements
of the intraocular pressure and the rate of flow of
aqueous humor of each eye while the intraocular
pressure was modulated. Modulation of intraocular
pressure was achieved by alternating the supine vol-
unteer between two gravity-dependent body positions
on a tilt table.
The experiment was divided into three parts. In
Part 1, 11 volunteers remained for 6 hr in the 15°
head-up position one day and in the 15° head-down
position another day. In Part 2, 20 volunteers alter-

1346
No. 8 EFFECT OF DODY POSITION ON IOP AND AQUEOUS FLOW / Corlson er ol. 1347

nated every hour between 15° head-up and 15°

head-down for three complete cycles. In Part 3, 10
volunteers alternated every 30 min between 50°
head-up and 50° head-down for two complete
cycles.4
Intraocular pressure was measured without mov-
ing the subject. The Bigliano-Webb tonometer was
employed (Pneumatonograph, Alcon Laboratories,
Inc., Fort Worth, TX). The axis of the tonometer was
held at approximately 45° from vertical for all mea-
surements because of the gravity dependency of this
instrument5 (Fig. 1 and 2).
Intraocular pressure was measured after instillation
of 1/2% proparacaine hydrochloride. Each eye was
measured twice, alternating between the two eyes.
The pressure was recorded on a strip chart recorder.
The tonometer was allowed to rest against the cornea
for approximately 3 sec. This procedure permitted Fig. 1. Subject in 50° head-up position. Pressure recorded with
the examiner to be sure that the tonometer was prop- Bigliano-Webb tonometer (Pneumatonometer) held at 45° from
erly coupled to the eye. Intraocular pressure was vertical.
measured from the tracing. The average of the two
readings for each eye was used to calculate the pres- total fluorescence. The mass of fluorescein in the cor-
sure for that eye. neal stroma (mc) was calculated as the product of the
The procedure for measuring the intraocular pres- mean concentration of fluorescein in the stroma (cc)
sure of both eyes could be accomplished in approxi- and the geometric volume of the stroma (vc) (as-
mately 1 min. Intraocular pressure was measured at sumed to be 70 /A for all eyes). The mass of fluores-
the end of each half-cycle of modulation and 7 min cein in the anterior chamber (ma) was calculated as
after the beginning of each half-cycle. (A 7-min delay the product of the mean concentration of fluorescein
is sufficient to permit the unregulated eye to return in the anterior chamber (ca) and the geometric vol-
almost completely to a steady-state pressure after a ume of the anterior chamber (va), measured for each
change of body position, as calculated by Gold- eye photogrammetrically.10
mann's1 and Friedenwald's models of the eye6; regu- The rate of clearance of fluorescein from the ante-
lation would hasten the return to a steady-state pres- rior chamber by diffusion and flow was calculated for
sure.) each temporally-spaced pair of measurements of flu-
The rate of flow of aqueous humor through the orescence in the eye employing equation 14, page 211
anterior chamber was measured by observing the rate of Jones and Maurice7:
of clearance of topically applied fluorescein according
to the method described by Jones and Maurice.7 Flu-
orescein was applied to the conjunctival cul-de-sac by
the subject 6 hr prior to the beginning of testing ac-
cording to the method of Yablonski et al.8 The con-
centration of fluorescein in the cornea and in the
anterior chamber was measured at the beginning and
end of each half-cycle of modulation of intraocular
pressure. In all three experiments measurements of
fluorescence were made half-hourly or hourly. This
procedure made it necessary that the subject step
down from the tilt table and sit in front of a fluoro-
photometer for approximately 4 min before return-
ing to the position required by the protocol (Fig. 3).
The concentration of fluorescein in the mid-hori-
zontal plane of the anterior segment was measured
with a two-dimensional scanning fluorophotometer.9 Fig. 2. Subject in 50° head-down position. Pressure recorded
The autofluorescence of the stroma, measured before with Bigliano-Webb tonometer (Pneumatonometer) held at 45°
application of fluorescein, was subtracted from the from vertical.
1348 INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / August 1987
Fluorophotometer
Fig. 3. Concentration of fluorescein in anterior chamber and
cornea measured with fluorophotometer in sitting position.
rate of clearance = (Amc + Ama)/(ca X At)
Ten percent of the clearance of fluorescein was as-
sumed to be due to diffusional losses and 90% due to
the flow of aqueous humor through the anterior
chamber:
rate of flow of aqueous humor
= (rate of clearance) X 0.9
CONSTANT POSITION 15
Fig. 4. Aqueous flow is same in both body positions. Intraocular
pressure is significantly higher in head down position (P < .05).
Vol. 28
A detailed explanation of this method is given else-
where."
In one volunteer, measurements of the axial depth
of the anterior chamber were made ultrasonometri-
cally before, during, and after prolonged exposure to
the 50° head-down position.
The reproducibility of the technique for measuring
hourly flows was determined by comparing the rate
of clearance of fluorescein during adjacent hourly pe-
riods in subjects who were studied in Part 1. We also
calculated the reproducibility of hourly flow mea-
surements by comparing the flow measured at the
same time of day on two different days. In addition,
we compared hourly and half-hourly measurements
of flows made simultaneously in fellow-eyes. These
measurements permitted us to determine the statisti-
cal power of the experimental procedures. Signifi-
cance was determined by the single-sided t test for
paired samples, a <. 0.5. The same procedure was
carried out to determine the reproducibility of to-
nometry.
Results
In Part 1 of the experiment the subjects lay in the
supine position (± 15°) for 6 hr. On one day the head
was elevated and on another day the head was low-
ered. At the beginning of the experiment, the mean
intraocular pressure was 14.5 ± 1.24 (mean ± SD) in
the head-up position and 16.8 ± 1.44 in the head-
down position. The intraocular pressure difference
remained approximately 2 mmHg (higher in the
head-down position) during the early part of the ex-
periment and gradually diminished to approximately
1 mmHg. The difference was statistically significant
(P < .05) for all 6 hr.
The mean flow of the eleven subjects in the 15°
head-up position for 6 hr was 3.00 ± 0.78 jil/min. On
a separate day when the head was down 15° for 6 hr
the mean flow was almost identical, 2.99 ± 0.57 MV
min (P > .05). In both positions there was a gradual
and significant decrease in the rate of flow, which
began at 3.1 /tl/min and diminished over the 6 hr to
2.9 /xl/min (see Fig. 4). The gravity-dependent posi-
tion had no effect on this gradual decline.
The reproducibilities of the measurements of pres-
sure and flow were determined by comparing paired
hourly measurements (Table 1). The coefficient of
variation of the measurement of either the mean
pressure of two eyes or the mean flow of two eyes of a
single subject over 1 hr was found to be 9%. When the
comparison of flow was made on two different days
the coefficient of variation was 20% for hourly mea-
surements and 18% for 6-hr measurements. The sta-
tistical power of the flow measurement of Part 1 of
No. 8 EFFECT OF BODY POSITION ON D P AND AQUEOUS FLOW / Corlson er ol. 1349

Table 1. Reproducibility of measurements

Standard deviation
Number of of differences Coefficient
paired between paired of
Parameter measurements measurements variation

Intraocular pressure
Mean pressure of two fellow eyes measured at two times 1 hr apart 132 1.4 mmHg 9.0%
Pressure of right eye versus left eye measured at same time 153 1.3 mmHg 8.3%
Aqueous humor flow
Mean flow during 1 hr of two fellow eyes measured at two times 1
hr apart 110 0.27 Ml/min 9.0%
Mean flow during 1 hr of two fellow eyes measured at two times
at same time of day on different days 66 0.60 Ml/min 20%
Mean flow during 6 hr of two fellow eyes measured at two times
on different days 11 0.53 M'/min 18%
Flow of right eye versus left eye measured during the same hour 131 0.54 Ml/min 18%
*Flow of right eye versus left eye measured during the same 4 hr 71 0.41 M'/min 16%
*Flow of right eye versus left eye measured during the same 8 hr 71 0.34 Ml/min 13%
1
Different group of 71 subjects.

our experiment can be calculated from this last fig-
ure.12 The experiment has a 90% chance of detecting
a 26% reduction in the rate of flow in the head down
position (a = 0.05, single-sided test). A smaller
change might have gone undetected, but a larger
change probably would not. We conclude that the
gravity-induced change of intraocular pressure did
not induce a biologically significant compensatory
change of flow (Fig. 4).
In Part 2 the 15° head-up and the 15° head-down
positions were alternated hourly. This procedure per-
mitted observation of the response of flow to a change
of pressure without concern for drifts in the rate of
flow over the 6 hr and without the need to compare
the pressures and flows on different days.
Figure 5 summarizes the results of a single subject.
In this subject, the higher intraocular pressure in the
head-down position is obvious. However, no changes
of flow were observed.
Half of the subjects of Part 2 (n = 10) began the
experiment in the head-up position. Figure 6 is a
graphical representation of the results of these 10
subjects. Figure 7 is a graphical representation of the
results of the other 10 subjects of Part 2 who began
the experiment in the head-down position. Neither
group showed any significant changes except for the
gravity dependency of intraocular pressure. The
ments in sequence on the same day is better than
comparable measurements on different days (see
Table 1). Second, twice as many subjects were stud-
ied. Third, several comparisons of the two positions
were possible in each subject. A power calculation
based on the number of subjects and the coefficient of
variation of this method suggests that experiment 2
has a 90% chance of detecting a change of 10% or
greater in flow. Since no change was detected, we
conclude that a modest increase in intraocular pres-
sure due to a change in the gravity-dependent posi-
tion for 1 hr causes no significant change in the rate of
aqueous humor formation.
In Part 3, 10 subjects underwent a procedure simi-
lar to the procedure in Part 2. In Part 3 the angle of
tilt was 50° in order to produce a larger disturbance
of intraocular pressure. The duration of a half cycle
SINGLE SUBJECT, ALTERNATING POSITION 15°
i s (sit)
55 Up
,?o Down
• Right eye
o Left eye
. 21
18
5J
; 15
Q.

12
change of pressure induced by the change of position
was 2.4 ± 1.2 mmHg (mean ± SD), which was statis-
tically significant. The mean change of the rate of
flow associated with the change of body position was
-0.05 ± 0.5 Ail/min (mean ± SD) which was neither
3
physiologically nor statistically significant. Hours
The statistical power of Part 2 to detect changes in Fig. 5. One subject changing body positions every hour. Intraoc-
flow is considerably greater than Part 1 for three rea- ular pressure is higher while head-down and lower while head-up.
sons. First, the reproducibility of hourly measure- Flow remains stable.
1350 INVESTIGATIVE OPHTHALMOLOGY 6 VISUAL SCIENCE / Augusr 1987
ALTERNATING POSITION 15
I f I f
Fig. 6. Ten subjects beginning Part 2 in head-up position.
was shortened to 30 min. Longer exposures to the
head-down position caused numbness of the feet of
the subjects, due in part to tightness of a restraining
ring clamped around the ankles (Gravity Inversion
Boots®, Gravity Guidance, Inc., Duarte, CA).
In this group, the gravity-dependent change of in-
traocular pressure was 11.2 ± 2.7 mmHg (mean
± SD), statistically significant. The gravity-depen-
dent change of flow was -0.4 ± 0 . 5 (mean ± SD)
Ml/min. This change was also statistically significant
(P < .05). The negative sign indicates that the rate of
ALTERNATING POSITION 15°
Fig. 7. Ten subjects beginning Part 2 in head-down position.
Vol. 28
flow was slower when the intraocular pressure was
higher. Thus, larger changes of intraocular pressure
were accompanied by small but consistent changes of
the rate of flow in the opposite direction (Fig. 8).
In one subject the depth of the central portion of
the anterior chamber was measured by ultrasonogra-
phy in each gravity-dependent position. The depth of
the anterior chamber during inversion to 50° was
stable and was the same as in the sitting position both
before and after inversion.
Discussion
Measurement of intraocular pressure was made in
such a way that the change in body position could
have had no direct effect on the tonometer; the to-
nometer was held at the same angle for all measure-
ments in order that its gravity-dependency not be a
factor. Intraocular pressure was measured near the
beginning and at the end of each period. The results
suggest that intraocular pressure rises in a few min-
utes, remains elevated in the inverted position, and
returns in a few minutes to normal when the head is
elevated. The rate of rise or fall during the first 7 min
was not measured.
When the pressure changes, the volume of the con-
tents of the globe also change. The relation between
pressure and volume of the human eye has been
carefully worked out by Friedenwald6 and serve as
the basis for Schiotz tonometry. The largest pressure
change observed in our experiment would have been
associated with a 12 ^1 change in volume of the globe.
This volume is 7% of the volume of the average ante-
rior chamber of our subjects and approximately 0.2%
the volume of the posterior segment of the eye.
Twelve microliters is also 15% of the measured clear-
ance of fluorescein in 30 min. In longer experiments
with smaller changes of intraocular pressure, the
change of volume is trivial compared to the volume
of aqueous humor passing through the anterior
chamber, and no allowance need be made for it.
It is likely that most of the change of volume occur-
ring with changes in pressure took place behind the
plane of the iris, away from the compartments con-
taining fluorescein. This point of view is supported by
the observation that the depth of the anterior
chamber of the subject who was measured by ultraso-
nography at 50° head-down did not change. The vol-
ume of expansion in the 50° experiment could have
come from either a 12 /A expansion of blood volume,
from 12 A*l of newly formed aqueous humor, or some
combination of the two. If the expansion had come
from any source other than newly formed aqueous
humor, the fluorophotometric measurement would
accurately measure any change in the rate of aqueous
No. 8 EFFECT OF BODY POSITION ON IOP AND AQUEOUS FLOW / Carlson er ol.
humor formation; if the expansion were produced
entirely from newly formed aqueous humor, a correc-
tion based on Friedenwald's formula of ocular rigid-
ity must be applied. If we apply a full correction to
the results, we can conclude that aqueous flow was
not suppressed at all in the head-down position; if we
apply no correction, the suppression was only 16%
when intraocular pressure was almost doubled.
In an eye with normal outflow resistance, a change
of aqueous flow of 16% would result in a change of
pressure of less than 1 mmHg, hardly sufficient to
overcome a disturbance of nearly 12 mmHg. If one
assumes that intraocular pressure is regulated by neg-
ative feedback, onto the rate of flow,3 the loop gain of
such a regulator can be calculated from the results of
this experiment. The calculated gain with or without
the Friedenwald correction is too low to be of any
biological significance.
The change of body position cannot be regarded as
an isolated perturbation of intraocular pressure.
Venous pressure around the eye will certainly have
changed and arterial pressure can have changed as
well. Undoubtedly other autonomic changes occur in
order to regulate the vascular system; we have made
no attempt to block these changes with exogenously
applied pharmacologic agents. Is it possible that these
complex changes, some of which could have tended
to increased aqueous flow and some of which could
have tended to decrease it can have overpowered the
function of any putative regulator? If the answer to
this question is "yes," then the biological advantage
of the eye's being equipped with such a regulator is
drawn into question, and the regulator does not meet
its functional expectations.
Aside from loop gain, feedback regulators differ in
their response time. The possibility exists that a regu-
lator exists which cannot respond to a disturbance as
brief as 30 min to 6 hr. This experiment does not
exclude the possibility of the existence of a regulator
with a slow response time. However, as cited in the
next paragraph, data from other sources make it seem
unlikely that chronic disturbances of intraocular
pressure due to increased outflow resistance induce
important compensatory changes of the rate of
aqueous flow.
Anselmi, Bron, and Maurice13 have compared the
rate of flow in steroid responders whose intraocular
pressure was raised an average of 18.8 mmHg in one
eye by the topical application of 0.1% dexamethasone
for 1 month. The rate of flow was the same in the eye
with the higher pressure as in the fellow eye. Brubaker
et al14 have studied several patients with pigment dis-
persion syndrome and have not found that such per-
sons have a chronically depressed rate of aqueous
humor flow. Steroid-induced glaucoma and pigmen-
1351
ALTERNATING POSITION 50
Fig. 8. Ten subjects alternated 50° every half-hour. Larger
changes of intraocular pressure are observed as compared to Part 2.
Small, gravity-dependent changes in flow are observed.
tary glaucoma share the common feature that the
resistance to aqueous humor outflow is abnormally
high. In neither disease does it seem likely that the
ciliary body would be unable to respond to the com-
mands of a pressure regulator. Also, it has been
shown that improvement of outflow facility by laser
trabeculoplasty with subsequent lowering of intraoc-
ular pressure is not accompanied by a change in the
rate of aqueous humor flow through the anterior
chamber.1516 We conclude from these measurements
and from commonplace clinical observations of pa-
tients affected with glaucoma of many causes that
chronically elevated intraocular pressure does not
alter the rate of aqueous humor flow.
In 1963 Barany wrote a theoretical paper in which
he formulated the relation between intraocular pres-
sure and aqueous formation, taking into account
Starling's law of fluid exchange 17 and the anatomical
arrangement of vessels inside the pressurized eye. He
predicted, in the absence of vasoregulatory influ-
ences, aqueous formation would be suppressed by
elevation of intraocular pressure, an effect he called
pseudofacility. Subsequently, several investigators
measured pseudofacility in anesthetized primates
18 20
~ and in unanesthetized humans.21 The results of
these studies indicate that the rate of aqueous humor
flow slows as intraocular pressure rises.
How do the results of this study compare to pre-
viously reported studies of pseudofacility? The results
are similar. The experiment of Kupfer and Ross 21
demonstrates that an elevation of intraocular pres-
1352 INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / Augusr 1987
sure of 10 mmHg should suppress aqueous flow by
0.6 Ail/min, close to our uncorrected figure of 0.4 ix\/
min for an 11 mmHg change. Earlier work was con-
ducted in anesthetized monkeys by Bill and Barany 18
and by Brubaker and Kupfer.19 The results of this
work would suggest that elevation of intraocular
pressure by 10 mmHg would suppress aqueous for-
mation by 1.3-1.4 Atl/min, several times greater than
later results would suggest. The pressure disturbances
in the earlier work were short, 4-10 min.
More recently, Bill conducted experiments in anes-
thetized monkeys where pressure elevations were
maintained for several hours.22 His results suggest a
long-standing rise in pressure has less effect on the
rate of aqueous flow. The results of the present ex-
periment are in very good agreement with Bill's more
recent study, despite differences in species and
methods. Both experiments demonstrate that
aqueous flow is rather insensitive to changes of intra-
ocular pressure.
Key words: bioregulation, intraocular pressure, aqueous
flow, human eye, body position
References
1. Goldmann H: Abflussdruck, Minutenvolumen und Wider-
stand der Kammerwasserstromung des Menschen. Doc
Ophthalmol 5-6:278, 1951.
2. Bill A: The aqueous humor drainage mechanism in the cyno-
molgus monkey (Macaca irus) with evidence for unconven-
tional routes. Invest Ophthalmol 4:911, 1965.
3. Houk JC: Homeostasis and control principles. In Medical
Physiology, 14th ed., Mountcastle VB, editor. St. Louis, CV
Mosby, 1980, pp. 246-267.
4. Weinreb RN, Cook J, and Friberg TR: Effect of inverted body
position on intraocular pressure. Am J Ophthalmol 98:784,
1984.
5. Moses RA and Grodzki WJ: The pneumatonograph—a labo-
ratory study. Arch Ophthalmol 97:547, 1979.
6. Friedenwald JS: Contributions to the theory and practice of
tonometry. Am J Ophthalmol 20:985, 1937.
7. Jones RF and Maurice DM: New methods of measuring the
Vol. 28
rate of aqueous flow in man with fluorescein. Exp Eye Res
5:208, 1966.
8. Yablonski ME, Zimmerman TJ, Waltman SR, and Becker B:
A fluorophotometric study of the effect of topical timolol on
aqueous humor dynamics. Exp Eye Res 27:135, 1978.
9. McLaren J and Brubaker R: A two-dimensional scanning ocu-
lar fluorophotometer. Invest Ophthalmol Vis Sci 26:144,1985.
10. Johnson S, Coakes RL, and Brubaker RF: A simple photo-
grammetric method of measuring anterior chamber volume.
Am J Ophthalmol 85:469, 1978.
11. Brubaker RF: Clinical evaluation of the circulation of aqueous
humor. In Clinical Ophthalmology, vol 3, Duane TD and
Jaeger EA, editors. Philadelphia, JB Lippincott Co, 1986, pp.
1-11.
12. Beyer WH: Handbook of Tables for Probability and Statistics
(2nd ed.). Cleveland, Chemical Rubber Company, 1968, p.
287.
13. Anselmi P, Bron A, and Maurice D: Action of drugs on the
aqueous flow in man measured by fluorophotometry. Exp Eye
Res 7:487, 1968.
14. Brubaker RF, Bourne WM, and Nagataki S: Effect of chroni-
cally administered timolol on aqueous humor flow in patients
with glaucoma. Ophthalmology 89:280, 1982.
15. Brubaker RF and Liesegang TJ: Effect of trabecular photoco-
agulation on the aqueous humor dynamics of the human eye.
Am J Ophthalmol 96:139, 1983.
16. Yablonski ME, Cook DJ, and Gray J: A fluorophotometric
study of the effect of argon laser trabeculoplasty on aqueous
humor dynamics. Am J Ophthalmology 99:579, 1985.
17. Barany EH: A mathematical formulation of intraocular pres-
sure as dependent on secretion, ultrafiltration, bulk outflow,
and osmotic reabsorption of fluid. Invest Ophthalmol 2:584,
1963.
18. Bill A and Barany H: Gross facility, facility of conventional
routes, and pseudofacility of aqueous humor outflow in the
cynomolgus monkey. Arch Ophthalmol 75:665, 1966.
19. Brubaker RF and Kupfer C: Determination of pseudofacility
in the eye of the rhesus monkey. Arch Ophthalmol 75:693,
1966.
20. Brubaker RF: The measurement of pseudofacility and true
facility by constant pressure perfusion in the normal rhesus
monkey eye. Invest Ophthalmol 9:42, 1970.
21. Kupfer C and Ross K: Studies of aqueous humor dynamics in
man. I. Measurements in young normal subjects. Invest
Ophthalmol 10:518, 1971.
22. Bill A: Effects of longstanding stepwise increments in eye pres-
sure on the rate of aqueous humor formation in a primate
{Cercopithecus ethiops). Exp Eye Res 12:184, 1971.