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Adeleh Yarmohammadi, Linda M Zangwill, Luke J Saunders, Alberto Diniz-Filho, Min Hee Suh, Patricia Isabel C Manalastas, Akram Belghith, Tadamichi Akagi, Takuhei Shoji, Rafaella Cleto Penteado, Felipe Medeiros, Robert N Weinreb; Vessel Density is Associated with Visual Field Damage in Advanced Glaucoma Eyes. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5830. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Detection of glaucomatous change in advanced glaucoma is challenging as standard structural and functional measures are of diminished value due to the floor effect of structural measurements and increased variability of visual fields. The purpose of this study is to assess whether vascular measurements obtained by optical coherence tomography angiography (OCT-A) have a sufficient dynamic range to provide clinically relevant information across the full spectrum of glaucoma severity.
Fifty-five eyes of 38 advanced glaucoma participants [VF MD < -10 decibels (dB)] were included. All subjects underwent OCT-A imaging using the Angiovue (Optovue, Fremont, CA), SD-OCT imaging, and standard automated perimetry (SAP). Two vessel density measurements extracted from the retinal nerve fiber layer (RNFL) were analyzed: (1) circumpapillary vessel density (cpVD) measured in a 750-μm-wide elliptical annulus around the disc and (2) whole image vessel density (wiVD) measured over the entire scan field. Linear regressions and generalized estimating equation (GEE) models were used to assess the associations between VF indices with wiVD, cpVD, cpRNFL, rim area, and macular ganglion cell complex (mGCC) thickness while adjusting for within-patient inter-eye correlations.
In these advanced glaucoma eyes, cpVD and wiVD measured by OCT-A were associated with VF MD (R2= 0.32, and 0.25 respectively; P <0.001 for both). However, the associations between RNFL, rim area and mGCC thickness measurements with VF MD were not statistically significant (R2=0.02, 0.06 and 0.04 respectively; all P>0.05). The association between VF PSD with cpVD and wiVD were also statistically significant (R2= 0.20, and 0.21 respectively; P <0.001 for both), while RNFL, rim area and mGCC thickness measurements were not associated with VF PSD (R2=0.05, 0.06 and 0.01 respectively; all P>0.05).
In advanced glaucoma eyes, OCT-A vascular measurements demonstrate a closer relationship with function than structural measurements. OCT-A derived vascular measurements are correlated with the severity of visual field damage, while the standard structure-function relationship reaches a floor in advanced glaucoma eyes. OCT-A might provide additional information in the management of glaucoma specifically in advanced stages of the disease. Longitudinal studies are needed to determine its value for diagnosing, staging, and monitoring glaucoma.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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