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Rajesh S. Kumar, Neha Anegondi, Rachana S. Chandapura, Suria Sudhakaran, Sujatha V. Kadambi, Harsha L. Rao, Tin Aung, Abhijit Sinha Roy; Discriminant Function of Optical Coherence Tomography Angiography to Determine Disease Severity in Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(14):6079-6088. doi: 10.1167/iovs.16-19984.
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© 2017 Association for Research in Vision and Ophthalmology.
To determine the discriminant function of optical coherence tomography angiography (OCTA) by disease severity in glaucoma.
In this prospective, observational cross-sectional study, all subjects underwent visual fields, retinal nerve fiber layer (RNFL) measurements, and OCTA imaging. Local fractal analysis was applied to OCTA images (radial peripapillary capillaries [RPC] layer). Vessel density en face and inside the disc and spacing between large and small vessels were quantified. Stepwise logistic regression was performed and a glaucoma severity score (range, 0–1: 0, normal; 1, severe glaucoma) was developed by using global and regional (superotemporal [ST], inferotemporal [IT], temporal, superonasal [SN], inferonasal, and nasal) vascular parameters. Glaucoma severity score was compared with visual field and RNFL indices.
One hundred ninety-nine eyes (112 subjects) with glaucoma (28 eyes preperimetric; 83 early, 43 moderate, and 45 severe glaucoma) and 74 normal (54 subjects) eyes were enrolled. Preperimetric and glaucomatous eyes had significantly altered (P < 0.001) global vascular parameters as compared to normal; regionally, ST, then SN and IT sectors (in that order) showed more change in glaucomatous eyes. Vascular parameters showed better discriminant ability (area under the curve [AUC], sensitivity, and specificity of 0.70, 69.2%, and 72.9%, respectively) than structural parameters between normal and preperimetric glaucomatous eyes. Vascular parameters had comparable AUC (P > 0.05) to visual fields for perimetric glaucoma. Glaucoma severity score identified preperimetric glaucoma and early glaucoma better than did visual fields.
Vascular parameters could be a useful adjunct tool to evaluate/diagnose glaucoma. Longitudinal studies are needed to determine their use in early detection and prognostication.
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