Optical Coherence Tomography Angiography and Humphrey Visual Field in Patients with Obstructive Sleep Apnea

Abstract

Purpose : To determine if obstructive sleep apnea (OSAS) predisposes patients to glaucoma and macular disease due to vascular compromise by evaluating retinal and optic nerve vasculature and function using optical coherence tomography angiography (OCT-A) and Humphrey visual field testing.

Methods : Forty-five patients undergoing polysomnography ordered per standard of care were enrolled and grouped into three categories based on apnea-hypopnea index (AHI) with control patients having AHI <5 episodes/hr. Medical history, visual acuity testing, 24-2 Humphrey visual field (HVF), intra-ocular pressure measurement, OCT-A studies of the macular and peripapillary retina were obtained. Correlations between polysomnography parameters and imaging data were evaluated.

Results : OCT-A radial peripapillary capillary (RPC) vascular density (VD) demonstrated no relationship to AHI (95% CI (-0.026,0.038)) or severity of OSAS (95% CI: (-0.772, 3.648) for moderate OSAS compared to mild/normal and (-1.295, 3.1421) for severe comparing to mild/normal). OCT-A superficial parafoveal VD (95% CI: (-0.068,0.011), deep parafoveal VD (95% CI: (-0.080,0.009)), and FAZ (95% CI: (-0.001, 0.001)) showed no statistically significant relationship to AHI or OSAS severity after controlling for confounders. OCT retinal nerve fiber layer (RNFL) thickness increased with AHI (p=0.014), but there was no statistically significant correlation with OSAS severity with RNFL thickness (95% CI: (-12.543, 6.792) for moderate comparing to normal and (-2.883, 16.551) for severe comparing to normal). 24-2 HVF parameters were unaffected by OSAS (95% CI: Mean deviation (-0.21,0.29), Pattern standard deviation: (-0.351,0.121), Visual field index: (-0.166, 0.329)). OCT choroidal thickness showed a statistically significant decrease when OSAS was grouped by severity (p=0.0092), but did not correlate with AHI (p=0.129, 95% CI: (-1.210, 0.095))

Conclusions : The severity of OSAS did not show a statistically significant effect on parameters associated with glaucoma or macular vascular disease. Larger cohorts may be required to determine the physiologic consequences of OSAS on the macular and optic nerve vasculature, structure, and function.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.