Highway workers, such as policemen, automotive service companies, and toll collectors, are placed at risk of the accelerated atherosclerotic process, since recent studies have suggested that exposure to exhaust particles and ambient air pollution increases carotid intima-media thickness and reduces ocular blood flow velocity. Therefore, we assessed the relationship between serum homocysteine, a potential parameter for atherosclerosis, and the ocular blood flow velocity and the resistivity index in highway toll collectors. The peak systolic and end diastolic flow velocities and the resistivity index were measured in 22 toll collectors and 24 control subjects by color Doppler ultrasonography. The resistivity index, which is an indirect measure of the atherosclerotic process, was calculated: resistivity index = (peak systolic velocity - end diastolic velocity)/peak systolic velocity. Serum homocysteine levels were determined by fluorometric high-performance liquid chromatography. In the highway toll collectors, the serum homocysteine level (14.4 +/- 4.8 mu mol/l; p < 0.005) and the resistivity index of the ophthalmic artery (0.741 +/- 0.015; p < 0.05) were higher and the ophthalmic blood flow velocity (33.0 < 3.0 cm/s; p < 0.001) was lower than those in the controls (10.6 +/- 3.1,mu mol/l; 0.728 +/- 0.023; 36.8 +/- 2.2 cm/s; respectively). There were significant correlations between the serum homocysteine level and ophthalmic artery resistivity index in both highway toll collectors (p < 0.001) and controls (p < 0.005). Exposure to exhaust particles might increase the serum homocysteine level, which in turn could lead to the decreased ocular blood flow and the increased resistivity index.