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Huiyuan Hou, Sasan Moghimi, Linda M Zangwill, James Alexander Proudfoot, Rafaella Penteado, Christopher Bowd, Eren Ekici, Robert N Weinreb; Progressive Optical Coherence Tomography Angiography Vessel Density Loss in Primary Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3533.
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© ARVO (1962-2015); The Authors (2016-present)
Studies using Optical coherence tomography angiography(OCT-A) have shown microvascular dropout, measured as a decrease of vessel density, within the optic nerve head (ONH), the peripapillary retina and the macula in primary open angle glaucoma (POAG) eyes. This study aimed to characterize the progressive vessel density loss across different stages of the POAG continuum.
Eyes from 90 glaucoma patients, who underwent more than 3 semiannual visits with both 4.5×4.5 mm ONH and 3×3 mm macula OCT-A imaging at each visit, were included from the Diagnostic Innovations in Glaucoma Study observational cohort study. Of the 111 glaucoma eyes, 37 had pre-perimetric glaucoma, 54 had mild glaucoma with visual field mean deviation (MD) better than -6 dB, and 20 had moderate/severe glaucoma. The rates of vessel density loss were calculated and compared using mixed effects models. The associations between the rates of vessel density loss and baseline visual field (VF) MD and baseline ONH retinal nerve fiber layer thickness (RNFLT) were evaluated.
The mean follow-up time and number of visits were 2.9 years and 3.9 visits for pre-perimetric glaucoma eyes, and 2.9 years and 4.0 visits for perimetric glaucoma eyes. Significant rates of vessel density loss in both ONH and macula were detectableinpre-perimetric, mild, and moderate/severe glaucoma eyes(all P<0.05 comparing with 0 slope). The rate of vessel density loss increased with increasing severity of glaucoma, especially the perifoveal region (-0.79%/year in pre-perimetric, -1.13%/year in mild, and -1.28%/year in moderate/severe). Faster rates of ONH and macula vessel density loss were significantly associated with worse baseline VF MDand thinner baseline RNFLT in perimetric glaucoma eyes (all P<0.05). The strongest association with baseline VF MD was found for the rate of ONH whole image vessel density loss (R2=10.6%, P=0.0007). The rates of macula and ONH vessel density loss were correlated (R2=8.8%, P=0.009).
In this cohort, progressive vessel density lossin ONH and macula was detectable across different stages of the glaucoma continuum. The vessel density loss rates were associated with glaucoma severity. Serial measurement of vessel density loss with OCT-A is a novel approach for monitoring glaucoma progression, especially for more severe disease.
This is a 2020 ARVO Annual Meeting abstract.
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