July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Macular and Peripapillary Vascular Dropout Are Associated with Disease Severity in Advanced Glaucoma
Author Affiliations & Notes
  • Elham Ghahari
    Ophthalmology, UCSD, San Diego, California, United States
  • Linda M Zangwill
    Ophthalmology, UCSD, San Diego, California, United States
  • Christopher Bowd
    Ophthalmology, UCSD, San Diego, California, United States
  • Kyle Hasenstab
    Ophthalmology, UCSD, San Diego, California, United States
  • Huiyuan Hou
    Ophthalmology, UCSD, San Diego, California, United States
  • Rafaella Penteado
    Ophthalmology, UCSD, San Diego, California, United States
  • Patricia Isabel C Manalastas
    Ophthalmology, UCSD, San Diego, California, United States
  • Sasan Moghimi
    Ophthalmology, UCSD, San Diego, California, United States
  • Takuhei Shoji
    Ophthalmology, UCSD, San Diego, California, United States
    Ophthalmology, Saitama Medical University, Iruma, Saitama, Japan
  • Andrew J Li
    Ophthalmology, UCSD, San Diego, California, United States
    Dartmouth College, Hanover, New Hampshire, United States
  • Khoa Nguyen
    Ophthalmology, UCSD, San Diego, California, United States
    Northeast Ohio Medical University, Rootstown, Ohio, United States
  • George Villatoro
    Ophthalmology, UCSD, San Diego, California, United States
    5. UCSD School of Medicine, University of California, La Jolla, California, United States
  • Adeleh Yarmohammadi
    Ophthalmology, UCSD, San Diego, California, United States
  • Robert N Weinreb
    Ophthalmology, UCSD, San Diego, California, United States
  • Footnotes
    Commercial Relationships   Elham Ghahari, None; Linda Zangwill, Carl Zeiss Meditec Inc. (F), Heidelberg Engineering GmbH (F), Merck (C), National Eye Institute (F), Optovue (R), Optovue Inc. (F), Topcon Medical Systems (R), Topcon Medical Systems Inc. (F); Christopher Bowd, None; Kyle Hasenstab, None; Huiyuan Hou, None; Rafaella Penteado, None; Patricia Isabel Manalastas, None; Sasan Moghimi, None; Takuhei Shoji, Alcon (R), Kowa (R), Otsuka (R), Pfizer (R), Santen (R), Senju (R); Andrew Li, None; Khoa Nguyen, None; George Villatoro, None; Adeleh Yarmohammadi, None; Robert Weinreb, Aerie Pharmaceutical (C), Alcon (C), Allergan (C), Bausch & Lomb (C), Carl Zeiss Meditec (F), Eyenovia (C), Genentech (F), Heidelberg Engineering (F), Optovue (F), Quark (F), Sensimed (C), Topcon (F), Unity (C)
  • Footnotes
    Support  NEI R01EY022039, R21EY027945 (CB); NEI P30EY022589 (KH); UC San Diego Clinical and Translational Research Institute 1TL1TR001443 (GAV); NEI R01EY023704 (RNW); NEI R01EY011008, R01EY026590, R01EY027510, P30EY022589 (LMZ) and participant retention incentive grants in the form of glaucoma medication at no cost from Alcon Laboratories Inc, Allergan, Alcon, Pfizer Inc, and Santen Inc. Unrestricted grant from Research to Prevent Blindness, New York, New York.
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5075. doi:
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    • Get Citation

      Elham Ghahari, Linda M Zangwill, Christopher Bowd, Kyle Hasenstab, Huiyuan Hou, Rafaella Penteado, Patricia Isabel C Manalastas, Sasan Moghimi, Takuhei Shoji, Andrew J Li, Khoa Nguyen, George Villatoro, Adeleh Yarmohammadi, Robert N Weinreb; Macular and Peripapillary Vascular Dropout Are Associated with Disease Severity in Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5075.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the association between macular and peripapillary vessel density assessed by optical coherence tomography angiography (OCTA) and visual field (VF) mean deviation (MD) in advanced glaucoma eyes.

Methods : OCTA (Angiovue) vessel density and VF MD measurements from 39 eyes of 36 advanced glaucoma patients (VF MD < -10 dB) were included from the Diagnostic Innovations in Glaucoma Study. Superficial macular vessel density was measured in the whole image (mwiVD) and the parafoveal region (pfVD). Optic nerve head vessel density was measured in whole image (ONH wiVD) and the circumpapillary region (cpVD) with and without automated removal of large vessels (wiVD capillary and cpVD capillary). SDOCT global circumpapillary retinal nerve fiber layer (cpRNFL) thickness and macular ganglion cell complex (mGCC) thickness were obtained from the same scans as vessel density. Mixed effect models were used to assess the association between OCTA and SDOCT measures and VF MD while adjusting for image quality index (QI), age and within-patient inter-eye correlations.

Results : Macular and ONH vessel densities were significantly lower with worsening VF MD. For each 1 dB decrease in VF MD, a reduction in macular vessel densities of 0.44% and 0.46% for mwiVD and pfVD with R2 values of 0.20 for both was seen, respectively. The association between VF MD and ONH vessel density was strongest after removal of large vessels, wiVD capillary and cpVD capillary, followed by ONH wiVD and cpVD; For each 1 dB decrease in VF MD, a reduction of 0.43%, 0.49%, 0.35%, 0.38%, with R2 values 0.30, 0.24, 0.21, 0.16 was seen, respectively (all P<0.01). For each 1 dB decrease in VF MD, a reduction of 0.85 and 0.24 microns for parafoveal GCC (P=0.04) and cpRNFL (P=0.51) was seen, with R2 values of 0.10 (P=0.05) and 0.01 (P=0.51), respectively. The coefficient between MD and all ONH and macula vessel density parameters and mGCC thickness remained significant after controlling for QI and age (all P≤0.05).

Conclusions : OCTA vascular measurements, particularly vessel density calculated after large vessel removal, are associated with the severity of visual field damage in advanced glaucoma eyes. While OCT RNFL and GCC thickness measures likely reach a floor in advanced glaucoma, OCTA might provide additional information in the management of advanced stages of the disease.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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