Br J OphthalmolJanuary 202129 citations

OCT-angiography detects longitudinal microvascular changes in glaucoma: a systematic review.

Miguel Ana, Silva André, Barbosa-Breda Joao, Azevedo Luis, Abdulrahman Abdulkarim, Hereth Esther, Abegão Pinto Luis, Lachkar Yves, Stalmans Ingeborg

View on PubMed DOI: 10.1136/bjophthalmol-2020-318166

AI Summary

OCTA detects progressive microvascular loss in glaucoma patients, with rates varying. This non-invasive tool shows promise for monitoring glaucoma, but standardization is crucial for future clinical use.

Abstract

Background/aims: Optical coherence tomography angiography (OCTA) allows the study of vessel density (VD). We intended to perform a systematic review of studies focusing on longitudinal changes in peripapillary and macular VD measurements in glaucoma.

Methods

A search was performed across MEDLINE, Scopus, ISI Web of Science and Google Scholar, using the following query from inception until 20 September 2019: (("optical coherence tomography angiography"[tiab]) OR (optical coherence tomography angiography[MeSH]) OR ("OCTA"[tiab]) OR ("OCT-A"[tiab]) OR ("angio-OCT"[tiab]) OR ("OCT- angiography"[tiab]) OR ("OCT-angio"[tiab]) OR ("OCT-angiographie"[tiab])) AND (glaucom*[tiab] OR glaucoma[MeSH]). Prospective studies that quantitatively assessed the longitudinal changes in VD in glaucoma with at least 3 months of follow-up were included.

Results

Ten out of 4516 studies were included. The rate of VD change in glaucoma varied from 0.036/year to 1.08/year and 1.3% to 3.2% per year, with significantly different rates between glaucoma and healthy controls. Five studies assessed VD change after glaucoma surgery, obtaining variable results, ranging from a temporary VD decrease to increase after 3 months. Meta-analysis was not possible due to a wide variation in methods, measurements and region of VD.

Conclusion

OCTA is a non-invasive technology, which shows promise in glaucoma. Measures should be taken to increase the quality and standardise the methodology of VD measures in OCTA longitudinal studies, for future meta-analyses.

MeSH Terms

Fluorescein AngiographyGlaucomaGlaucoma, Open-AngleHumansIntraocular PressureOptic DiskProspective StudiesRetinal VesselsTomography, Optical Coherence

Shields Classification

Ch. 4Optic Nerve, Retina, and Choroid

Ch. 27Management of the Glaucoma Patient

Key Concepts5

The rate of vessel density (VD) change in glaucoma, as measured by OCT-angiography, varied from 0.036/year to 1.08/year and 1.3% to 3.2% per year, showing significantly different rates compared to healthy controls.

PrognosisReviewSystematic Reviewn=10 studiesCh5Ch12

Five studies included in a systematic review assessed vessel density (VD) change after glaucoma surgery using OCT-angiography, obtaining variable results ranging from a temporary VD decrease to an increase after 3 months.

TreatmentReviewSystematic Reviewn=5 studiesCh5Ch40

Optical coherence tomography angiography (OCTA) is a non-invasive technology that shows promise in glaucoma for studying vessel density (VD).

DiagnosisReviewSystematic Reviewn=10 studiesCh5

Meta-analysis of longitudinal changes in peripapillary and macular vessel density measurements in glaucoma using OCT-angiography was not possible due to wide variation in methods, measurements, and region of VD across the included studies.

MethodologyReviewSystematic Reviewn=10 studiesCh5

Measures should be taken to increase the quality and standardize the methodology of vessel density (VD) measures in OCT-angiography longitudinal studies for future meta-analyses in glaucoma research.