Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method

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Cheng" }, { "@type": "Person", "name": "Sandeep Samudre" }, { "@type": "Person", "name": "John T LiVecchi" }, { "@type": "Person", "name": "Shailesh K. Gupta" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Advanced clinical diagnostic tools enable ophthalmologists to diagnose not only ocular pathologies but also identify disorders that extend beyond ocular diseases. Ophthalmodynamometry (ODM), a screening tool that most ophthalmologists do not commonly use, measured reduced mean central retinal artery pressure (MCRAP) in the clinical setting. We describe a 70-year-old female with a reduced MCRAP in the right eye who identified 50% stenosis in her right internal carotid artery (ICA). Early diagnosis facilitated prompt management and potentially prevented future ischemic events." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-508/v1", "name": "Case Report: Early Detection of Carotid Artery Stenosis with Falck..." } } ] } Home Browse Case Report: Early Detection of Carotid Artery Stenosis with Falck... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Murillo B, Cheng AMS, Samudre S et al. Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.12688/f1000research.164433.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] Brian Murillo 1 , Anny M.S. Cheng https://orcid.org/0000-0001-7035-8567 2,3 , Sandeep Samudre 4 , John T LiVecchi 3 , Shailesh K. Gupta 2,4 Brian Murillo 1 , Anny M.S. Cheng https://orcid.org/0000-0001-7035-8567 2,3 , [...] Sandeep Samudre 4 , John T LiVecchi 3 , Shailesh K. Gupta 2,4 PUBLISHED 21 May 2025 Author details Author details 1 New York Medical College School of Medicine, Valhalla, New York, USA 2 Ophthalmology, Broward Health North, Deerfield Beach, Florida, 33064, USA 3 Ophthalmology, University of Florida, Gainesville, FL, 32605, USA 4 Ophthalmology, Advanced Research Center, Deerfield Beach, FL, 33064, USA Brian Murillo Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Anny M.S. Cheng Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Sandeep Samudre Roles: Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing John T LiVecchi Roles: Project Administration, Software, Writing – Original Draft Preparation Shailesh K. Gupta Roles: Conceptualization, Formal Analysis, Methodology, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. Abstract Advanced clinical diagnostic tools enable ophthalmologists to diagnose not only ocular pathologies but also identify disorders that extend beyond ocular diseases. Ophthalmodynamometry (ODM), a screening tool that most ophthalmologists do not commonly use, measured reduced mean central retinal artery pressure (MCRAP) in the clinical setting. We describe a 70-year-old female with a reduced MCRAP in the right eye who identified 50% stenosis in her right internal carotid artery (ICA). Early diagnosis facilitated prompt management and potentially prevented future ischemic events. READ ALL READ LESS Keywords carotid artery stenosis, internal carotid artery, mean central retinal artery pressure, ocular perfusion pressure, Ophthalmodynamometry Corresponding Author(s) Shailesh K. Gupta ( [email protected] ) Close Corresponding author: Shailesh K. Gupta Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Murillo B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Murillo B, Cheng AMS, Samudre S et al. Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.12688/f1000research.164433.1 ) First published: 21 May 2025, 14 :508 ( https://doi.org/10.12688/f1000research.164433.1 ) Latest published: 09 Oct 2025, 14 :508 ( https://doi.org/10.12688/f1000research.164433.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Ophthalmodynamometry (ODM) is a non-invasive method to evaluate ophthalmic vascular pressure dynamics in the central retinal artery (CRA). This technique involves increasing the intraocular pressure (IOP) by applying a standardized pressure to the globe. CRA pressure is measured at the point where the lowest standardized pressure induces pulsations. 1 , 2 ODM assessment of CRA perfusion provides insight into other arteries due to their direct anatomical communication. When ODM measures mean central retinal artery pressure (MCRAP), the ocular perfusion pressure (OPP) can be derived by calculating the difference between MCRAP and IOP. 3 Because of the anatomical relationship between the CRA, the ophthalmic artery (OA) and internal carotid artery (ICA), narrowing in the OA or the ICA will decrease MCRAP and/or OPP. Therefore, identifying compromised MCRAP or reduced OPP through ODM may suggest systemic cerebrovascular occlusive disease, 4 prompting further vascular assessments. ODM has traditionally been measured using various techniques of raising the IOP, including compression or negative suction pressure. Many of these methods often require a second operator to visualize central artery changes. Recently, the Falck Multifunctional Device (FMD, Falck Medical, CT, USA) has modernized the classic ODM approach by incorporating a digitalized pressure sensor into the holding grip of a slit lamp. This improvement allows a calibrated pressure application to induce fine vascular pulsations in the CRA, eliminating the need for visualizing vessel changes during traditional ODM techniques. In this report, we present one of the first cases of FMD utility in an asymptomatic individual with minimal vascular risk factors. The patient presented with diminished MCRAP and was identified as having focal carotid vascular occlusive disease on further carotid doppler testing. Written informed consent was obtained from the patient to publish this report. Case history A 70-year-old female in good general health, except with a history of well-controlled hypertension presented for a routine eye exam. She reported no negative effect of taking amlodipine and losartan. Her family history was significant for coronary artery disease, but she was non-diabetic and non-smoking. Her past medical history and surgical history was otherwise unremarkable. Her best corrected visual acuity was 20/20 OU. Slit lamp examination of the anterior segment was unremarkable. Bilateral dilated indirect fundoscopic examination showed arterio-venous nicking, but the retinal nerve fiber layer could be seen clearly. The optic disc margin was sharp and there was no retinal hemorrhage or exudate. Methods ODM using the FMD was performed because of the presence of vascular risk factors. FMD ODM directly measured the following: IOP of 15 mmHg OD and 14 mmHg OS; and MCRAP of 51.6 mmHg OD and 55.4 mmHg OS. Brachial mean arterial pressure (MAP) measured with automated blood pressure cuff was 102.7 mmHg on right and 93.3 mmHg on left. The right MCRAP (51.6 mmHg), representing 50% of the right MAP, was significantly lower (variability 3%) than the left MCRAP (55.4 mmHg), representing 59% of the left MAP. Similarly, the OPP revealed significantly lower pressure (variability 2%) in the right eye of 36.7 mmHg than in the left eye of 41.2 mmHg. The reduced MCRAP and OPP OD prompted further evaluation with carotid artery duplex scan. Outcome and follow-up On doppler imaging study, all vessel velocities measured by carotid duplex were significantly higher on the right side than the left. The measured peak velocity of the right internal carotid artery (ICA) was 122.02 cm/s, the external carotid artery (ECA) 118.45 cm/s, and the common carotid artery (CCA) 98.81 cm/s. The left sided measured peak velocities were the ICA of 47.33 cm/s, the ECA of 75.59 cm/s, and the CCA of 68.88 cm/s. In addition, the vessel velocity difference was greater in the ICA at 74.69 cm/s, than in the ECA (42.86 cm/s) or the CCA (29.93 cm/s). The carotid duplex interpretation concluded 50% stenosis in the right ICA ( Figure 1 ) with heterogenous calcified plaquing and minimal stenosis on the left. The patient was therefore referred for further vascular evaluation. Figure 1. Carotid doppler imaging. Carotid doppler showed 50% stenosis in right carotid bulb and proximal cervical internal carotid artery (ICA). Discussion In this report, ODM using the FMD demonstrated reduced MCRAP and OPP in an otherwise asymptomatic patient. The patient had carotid artery stenosis as determined by carotid duplex ultrasound. Both the right MCRAP and OPP were not only measured low, but also considerably lower than the left MCRAP and OPP readings, suggesting that these parameters can be significantly and linearly linked with the existence and severity of carotid artery stenosis. 5 Compared to classic ODM, FMD averages multiple measurements over the cardiac cycle, making it more reproducible. The repeated measurement for each eye in our patient was consistent, with a low variation of 2 to 3%. The FMD can also be performed by a single operator as it is mounted to a slit-lamp thereby reducing variability. FMD has the potential to be used in a variety of applications. For example, it can detect patients at risk of having a drop in OPP after anti-VEGF injections, improving safety. 6 The FMD can also measure accurate and repeatable applanation forces that compensate for the effect of corneal thickness and curvature. 7 FMD can be a promising diagnostic tool for glaucoma screening and glaucoma severity assessment. 8 Our case showed that the FMD may also be superior to relying on historical vascular risk factors alone in determining the need for further vascular testing. Collectively, these findings render ODM using the FMD as a relatively fast, inexpensive, and reproducible office-based diagnostic test that can help determine a patient’s risk profile for systemic cerebrovascular disease. The association between reduced MCRAP and OPP and carotid artery stenosis suggests that FMD assisted ODM should be further explored as an indicator of compromised cerebrovascular hemodynamic status. Thus, the FMD provides ophthalmologists with an inexpensive non-invasive screening tool for cardiovascular disease. Institutional review board statement Institutional approval was waived as our single case report involves retrospective medical record review of one patient and the only interaction with the patient has been for purposes of treating the patient and does not meet the Common Rule definition of research (45 CFR 164.501). Informed consent statement Written informed consent for publication of her clinical details and/or clinical images was obtained from the patient. Reporting guidelines Mendeley Data: Murillo, Brian; Cheng, Anny; Samudre, Sandeep; LiVecchi, John; Gupta, Shailesh (2025), “Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method”, DOI: 10.17632/893knw22df.1 9 The project contains the following reporting guidelines: 1. CARE_checklist.pdf Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Data availability statement All data underlying the results are available as part of the article and no additional source data are required. Acknowledgments None. References 1. Best M, Blumenthal M, Futterman HA, et al. : Critical closure of intraocular blood vessels. Arch. Ophthalmol. 1969; 82 (3): 385–392. PubMed Abstract | Publisher Full Text 2. Krieglstein GK, da Silva FA : Comparative measurements of the ophthalmic arterial pressure using the mikuni dynamometer and the stepanik-arteriotonograph®. Albrecht Von Graefes Arch. Klin. Exp. Ophthalmol. 1979; 212 : 77–91. PubMed Abstract | Publisher Full Text 3. Jonas JB: Reproducibility of ophthalmodynamometric measurements of central retinal artery and vein collapse pressure. Br. J. Ophthalmol. 2003; 87 : 577–579. PubMed Abstract | Publisher Full Text | Free Full Text 4. Paulson OB: Ophthalmodynamometry in internal carotid artery occlusion. Stroke. 1976; 7 (6): 564–566. Publisher Full Text 5. Murillo BA, Cheng AM, Tsai J, et al. : Decreased Ocular Perfusion Pressure Associated With Reverse Ophthalmic Artery Flow on Transcranial Doppler Ultrasonography. Cureus. 2024; 16 (5): e60706. PubMed Abstract | Publisher Full Text 6. Reichel E, Shah H: The Effects of Intravitreal Anti-VEGF Injections on Ocular Perfusion Pressure. Invest. Ophthalmol. Vis. Sci. 2010; 51 : 5032. 7. Falck FY, Falck R: Clinical and Manometric Comparison of The Falck Autotonometer and The Goldmann Tonometer. Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO). Fort Lauderdale, Florida: 2008 Apr 27. 8. Falck FY, Falck R: Clinical Comparison of FAT1 to Calibrated Weight Indentation Tonography. Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO). Fort Lauderdale, Florida: 2011 Jan 10. 9. Murillo B, Cheng A, Samudre S, et al. : Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method. Mendeley Data. 2025; V1 . Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 21 May 2025 ADD YOUR COMMENT Comment Author details Author details 1 New York Medical College School of Medicine, Valhalla, New York, USA 2 Ophthalmology, Broward Health North, Deerfield Beach, Florida, 33064, USA 3 Ophthalmology, University of Florida, Gainesville, FL, 32605, USA 4 Ophthalmology, Advanced Research Center, Deerfield Beach, FL, 33064, USA Brian Murillo Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Anny M.S. Cheng Roles: Conceptualization, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Sandeep Samudre Roles: Formal Analysis, Software, Writing – Original Draft Preparation, Writing – Review & Editing John T LiVecchi Roles: Project Administration, Software, Writing – Original Draft Preparation Shailesh K. Gupta Roles: Conceptualization, Formal Analysis, Methodology, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 09 Oct 2025, 14:508 https://doi.org/10.12688/f1000research.164433.2 version 1 Published: 21 May 2025, 14:508 https://doi.org/10.12688/f1000research.164433.1 Copyright © 2025 Murillo B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Murillo B, Cheng AMS, Samudre S et al. Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.12688/f1000research.164433.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 21 May 2025 Views 0 Cite How to cite this report: Kanter E. Reviewer Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r414795 ) The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-414795 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 30 Sep 2025 Efe Kanter , Izmir Katip Çelebi University, Izmir, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180947.r414795 This case report presents the early detection of internal carotid artery stenosis in an asymptomatic patient through ophthalmodynamometry (ODM) using the Falck Multifunctional Device (FMD). The manuscript is original and clinically relevant, as it demonstrates the potential of a relatively ... Continue reading READ ALL This case report presents the early detection of internal carotid artery stenosis in an asymptomatic patient through ophthalmodynamometry (ODM) using the Falck Multifunctional Device (FMD). The manuscript is original and clinically relevant, as it demonstrates the potential of a relatively underutilized ophthalmic tool in identifying systemic cerebrovascular risk. The description of the case is sufficiently detailed, with well-documented examination findings and comparative measurements that convincingly support the diagnosis. The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Emergency medicine, ultrasonography, novel methodology in stroke, non-invasive ophthalmic monitoring. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Kanter E. Reviewer Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r414795 ) The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-414795 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 14 Oct 2025 Anny Cheng , Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA 14 Oct 2025 Author Response We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be ... Continue reading We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment : Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Comment : Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Reply: We linking our findings to recent literature “Kanter et al 2025” in Discussion Section paragraph 3. “Our findings align with a recent Turkish prospective study that investigated 65 stroke patients (42 ischemic, 23 hemorrhagic) and 27 stroke-free controls, utilizing Doppler ultrasound (OAD-US) to measure peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery. The receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy in PSV ratio of 0.913 and the EDV ratio of 0.724 in differentiating stroke patients from controls. The congruence between their utilization of ophthalmic artery diagnostics and our revised FMD ODM method, underscores the ophthalmic artery's role and potential as a non-invasive access point to the systemic vascular system. This offers a promising pathway for the early detection of conditions such as carotid artery stenosis.” We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment : Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Comment : Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Reply: We linking our findings to recent literature “Kanter et al 2025” in Discussion Section paragraph 3. “Our findings align with a recent Turkish prospective study that investigated 65 stroke patients (42 ischemic, 23 hemorrhagic) and 27 stroke-free controls, utilizing Doppler ultrasound (OAD-US) to measure peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery. The receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy in PSV ratio of 0.913 and the EDV ratio of 0.724 in differentiating stroke patients from controls. The congruence between their utilization of ophthalmic artery diagnostics and our revised FMD ODM method, underscores the ophthalmic artery's role and potential as a non-invasive access point to the systemic vascular system. This offers a promising pathway for the early detection of conditions such as carotid artery stenosis.” Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 14 Oct 2025 Anny Cheng , Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA 14 Oct 2025 Author Response We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be ... Continue reading We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment : Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Comment : Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Reply: We linking our findings to recent literature “Kanter et al 2025” in Discussion Section paragraph 3. “Our findings align with a recent Turkish prospective study that investigated 65 stroke patients (42 ischemic, 23 hemorrhagic) and 27 stroke-free controls, utilizing Doppler ultrasound (OAD-US) to measure peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery. The receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy in PSV ratio of 0.913 and the EDV ratio of 0.724 in differentiating stroke patients from controls. The congruence between their utilization of ophthalmic artery diagnostics and our revised FMD ODM method, underscores the ophthalmic artery's role and potential as a non-invasive access point to the systemic vascular system. This offers a promising pathway for the early detection of conditions such as carotid artery stenosis.” We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment : Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Comment : Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Reply: We linking our findings to recent literature “Kanter et al 2025” in Discussion Section paragraph 3. “Our findings align with a recent Turkish prospective study that investigated 65 stroke patients (42 ischemic, 23 hemorrhagic) and 27 stroke-free controls, utilizing Doppler ultrasound (OAD-US) to measure peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery. The receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy in PSV ratio of 0.913 and the EDV ratio of 0.724 in differentiating stroke patients from controls. The congruence between their utilization of ophthalmic artery diagnostics and our revised FMD ODM method, underscores the ophthalmic artery's role and potential as a non-invasive access point to the systemic vascular system. This offers a promising pathway for the early detection of conditions such as carotid artery stenosis.” Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Tirsi A. Reviewer Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r408440 ) The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-408440 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Sep 2025 Andrew Tirsi , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.180947.r408440 This is a very interesting report describing the use of a new Falck FMD and its use in screening "normal" patients with no overt signs of vascular abnormalities but at high risk for future ischemic events. This patient was ... Continue reading READ ALL This is a very interesting report describing the use of a new Falck FMD and its use in screening "normal" patients with no overt signs of vascular abnormalities but at high risk for future ischemic events. This patient was considered healthy, until MCRAP and OPP were measured using this non-invasive device. What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Normal tension glaucoma, OPP, electrophysiology in glaucoma, retinal ganglion cell dysfunction in glaucoma, mitochondrial dysfunction in glaucoma and other retinal diseases I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tirsi A. Reviewer Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r408440 ) The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-408440 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 16 Oct 2025 Anny Cheng , Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA 16 Oct 2025 Author Response We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing ... Continue reading We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7.Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment #2: I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7.Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment #2: I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 16 Oct 2025 Anny Cheng , Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA 16 Oct 2025 Author Response We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing ... Continue reading We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7.Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment #2: I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7.Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment #2: I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 21 May 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 09 Oct 25 read read Version 1 21 May 25 read read Andrew Tirsi , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA Efe Kanter , Izmir Katip Çelebi University, Izmir, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tirsi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Nov 2025 | for Version 2 Andrew Tirsi , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 0 Views copyright © 2025 Tirsi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions No further comments to make Competing Interests No competing interests were disclosed. Reviewer Expertise Normal tension glaucoma, OPP, electrophysiology in glaucoma, retinal ganglion cell dysfunction in glaucoma, mitochondrial dysfunction in glaucoma and other retinal diseases I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Tirsi A. Peer Review Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.189354.r421992) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-508/v2#referee-response-421992 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kanter E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Oct 2025 | for Version 2 Efe Kanter , Izmir Katip Çelebi University, Izmir, Turkey 0 Views copyright © 2025 Kanter E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Article is ready for indexing. Competing Interests No competing interests were disclosed. Reviewer Expertise Emergency medicine, ultrasonography, novel methodology in stroke, non-invasive ophthalmic monitoring. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Kanter E. Peer Review Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.189354.r421993) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-508/v2#referee-response-421993 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Kanter E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 30 Sep 2025 | for Version 1 Efe Kanter , Izmir Katip Çelebi University, Izmir, Turkey 0 Views copyright © 2025 Kanter E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report presents the early detection of internal carotid artery stenosis in an asymptomatic patient through ophthalmodynamometry (ODM) using the Falck Multifunctional Device (FMD). The manuscript is original and clinically relevant, as it demonstrates the potential of a relatively underutilized ophthalmic tool in identifying systemic cerebrovascular risk. The description of the case is sufficiently detailed, with well-documented examination findings and comparative measurements that convincingly support the diagnosis. The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Emergency medicine, ultrasonography, novel methodology in stroke, non-invasive ophthalmic monitoring. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 14 Oct 2025 Anny Cheng, Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer Comments: Comment : The report could be further strengthened by addressing a few minor issues. The possible impact of antihypertensive therapy, particularly amlodipine, on ocular perfusion pressure should be briefly discussed, as well as whether the patient had risk factors such as obstructive sleep apnea that might influence ODM measurements. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7. Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment : Including a figure or schematic showing the device display and measurement process would add clarity for readers unfamiliar with the FMD. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. Comment : Furthermore, the discussion would benefit from linking the findings to recent literature on ocular hemodynamic parameters as predictors of cerebrovascular events. In this context, the study by Kanter E. et al. [Reference 1] provides supportive evidence for the prognostic value of ophthalmic artery Doppler ultrasound in ischemic and hemorrhagic stroke and would enrich the discussion. 1. Kanter E, Payza U, Karakaya Z, Acar H, et al.: A new diagnostic method in ischemic and hemorrhagic stroke: Doppler ultrasound of ophthalmic artery. Clinical Neurology and Neurosurgery . 2025; 254 . Reply: We linking our findings to recent literature “Kanter et al 2025” in Discussion Section paragraph 3. “Our findings align with a recent Turkish prospective study that investigated 65 stroke patients (42 ischemic, 23 hemorrhagic) and 27 stroke-free controls, utilizing Doppler ultrasound (OAD-US) to measure peak systolic velocity (PSV) and end-diastolic velocity (EDV) in the ophthalmic artery. The receiver operating characteristic (ROC) analysis revealed high diagnostic accuracy in PSV ratio of 0.913 and the EDV ratio of 0.724 in differentiating stroke patients from controls. The congruence between their utilization of ophthalmic artery diagnostics and our revised FMD ODM method, underscores the ophthalmic artery's role and potential as a non-invasive access point to the systemic vascular system. This offers a promising pathway for the early detection of conditions such as carotid artery stenosis.” View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Kanter E. Peer Review Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r414795) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-414795 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tirsi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Sep 2025 | for Version 1 Andrew Tirsi , Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 0 Views copyright © 2025 Tirsi A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a very interesting report describing the use of a new Falck FMD and its use in screening "normal" patients with no overt signs of vascular abnormalities but at high risk for future ischemic events. This patient was considered healthy, until MCRAP and OPP were measured using this non-invasive device. What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Normal tension glaucoma, OPP, electrophysiology in glaucoma, retinal ganglion cell dysfunction in glaucoma, mitochondrial dysfunction in glaucoma and other retinal diseases I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 16 Oct 2025 Anny Cheng, Ophthalmology, Broward Health North, Deerfield Beach, 33064, USA We thank you and the reviewers for your valuable comments. We have revised the manuscript accordingly and provided the following point-to-point responses: Reviewer 1 Comments: Comment #1: What is missing is obstructive sleep apnea status which could also show some changes in OPP but in this case, these changes could manifest differently and most likely binocularly. The effects of amlodipine on OPP could also be discussed here. Reply: We discussed the effect of Obstructive sleep apnea and amlodipine on OPP in Discussion Section, 2 nd paragraph “Notably, systemic blood pressure may significantly influence OPP.​ A study reported that a nocturnal dip in blood pressure, characterized by a systolic reduction of 10-12% and a diastolic reduction of 14-17%, has been linked to compromised OPP. 6 Patients receiving aggressive antihypertensive medication that leads to excessive blood pressure lowering are also at risk of low OPP. If our patient's systemic blood pressure was not appropriately controlled with amlodipine, it could paradoxically lead to an increase in OPP, potentially masking cardiovascular disease diagnoses. The relationship between OPP and ocular blood flow is complex, largely due to the eye's autoregulation mechanisms. However, vascular endothelial dysfunction, such as that seen in obstructive sleep apnea (OSA), can impair these autoregulatory capabilities, leading to unstable OPP and significantly impacting ocular perfusion. 7 “ 6. Schmidl D, Garhofer G, Schmetterer L. The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma. Exp Eye Res. 2011;93(2):141-155. doi:10.1016/j.exer.2010.09.002 7.Faridi O, Park SC, Liebmann JM, Ritch R. Glaucoma and obstructive sleep apnoea syndrome. Clin Exp Ophthalmol. 2012;40(4):408-419. doi:10.1111/j.1442-9071.2012.02768.x Comment #2: I would like to recommend adding a figure showing the screen of the device with all the measurements, and maybe a short explanation of how the measurement is done, since no literature is available about this device. Reply: we added a figure and explanation showing the screen of the device with all the measurements per request. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Tirsi A. Peer Review Report For: Case Report: Early Detection of Carotid Artery Stenosis with Falck Multifunctional Device (FMD), A Revised Ophthalmodynamometry Method [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2025, 14 :508 ( https://doi.org/10.5256/f1000research.180947.r408440) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-508/v1#referee-response-408440 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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