Association of superficial and deep macula vessel density with past visual field progression in glaucoma

Abstract

Purpose : To investigate the relationship between deep and superficial macular vessel density measured by optical coherence tomography angiography (OCTA) and visual field (VF) progression in a cohort of patients with open-angle glaucoma (OAG)

Methods : A total of 194 eyes of 143 patients with OAG (follow-up 7.3±2.3 years) from the Diagnostics Innovations in Glaucoma Study (DIGS) and with at least five VFs prior to OCTA imaging were included in this retrospective, cohort study. Association of deep, superficial macula vessel density parameters, or ganglion cell complex (GCC) thickness, with VF progression (defined by Guided Progression Analysis based “likely progression” event) were evaluated using logistic regression while adjusting for potential confounders. Univariate and multivariable linear mixed models with random slope and intercept were also constructed to explore if the rate of MD worsening in the past was associated with macula vessel density.

Results : 50 eyes (25%) demonstrated VF progression. After adjustment for age and scan quality, eyes with VF progression had significantly lower superficial parafoveal vessel density (pfVD) but not deep layer vessel density measures than non-progressing eyes (44%[95% CI 42.7%, 45.2%] vs 46.5%[45.7%, 47.3%], p=0.005; and 50.1%[49.5%, 50.7%] vs 50.1%[49.5%, 50.7%], p=0.513, respectively). In multivariable logistic regression analysis, older age (OR per 1 year:1.05[1.01, 1.10],p=0.022), lower mean ocular perfusion pressure(OR per 1 mmHg:1.04 [1.00, 1.09],p=0.045), lower superficial pfVD (OR per 1%: 1.13 [1.04, 1.22], p=0.005) and thinner GCC (OR per 1m: 1.04 (1.01, 1.07), p=0.016) were significantly associated with VF progression. Although superficial pfVD( area under receiver operator curve [AUROC]:0.63 (95% CI:0.54, 0.72) and GCC thickness (AUROC: 0.63[0.52, 0.74] could differentiate VF progressive eyes from non-progressive eyes (sensitivity at 80% specificity of 52% and 34%, respectively), deep pfVD (AUROC:0.42[0.33,0.51]) lacked the ability to differentiate the two groups. For each 1% lower vessel density, the rate of MD change was -0.015 (95% CI:-0.023,-0.008) dB/year faster (p<0.001).

Conclusions : Lower superficial, but not deep layer, macula vessel density parameters were associated with past VF progression in OAG suggesting that glaucoma preferentially affects perfusion in the superficial macular capillary plexus more than in the deeper plexuses.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.