Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma.
Yarmohammadi Adeleh, Zangwill Linda M, Diniz-Filho Alberto, Suh Min Hee, Yousefi Siamak, Saunders Luke J, Belghith Akram, Manalastas Patricia Isabel C, Medeiros Felipe A, Weinreb Robert N
AI Summary
OCT-A vessel density strongly correlated with glaucoma visual field loss, even independent of nerve structure. This suggests OCT-A is promising for glaucoma management, emphasizing vascular factors in the disease.
Abstract
Purpose
To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma.
Design
Observational, cross-sectional study.
Participants
A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study.
Methods
All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field).
Main outcome measures
Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density.
Results
Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R 2 = 0.54 and R 2 = 0.51, respectively) than the association between SAP MD with RNFL (R 2 = 0.36) and rim area (R 2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss.
Conclusions
Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.
MeSH Terms
Shields Classification
Key Concepts5
In a cross-sectional study of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients, normal eyes demonstrated a denser microvascular network within the retinal nerve fiber layer (RNFL) compared with glaucoma eyes.
In a cross-sectional study of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients, vessel density was higher in normal eyes (55.5% for whole-image vessel density (wiVD) and 62.8% for circumpapillary vessel density (cpVD)) followed by glaucoma suspects (51.3% for wiVD and 61.0% for cpVD), mild glaucoma (48.3% for wiVD and 57.5% for cpVD), and moderate to severe glaucoma eyes (41.7% for wiVD and 49.6% for cpVD) (P < 0.001 for both wiVD and cpVD).
In a cross-sectional study of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients, the association between standard automated perimetry (SAP) mean deviation (MD) with circumpapillary vessel density (cpVD) (R^2 = 0.54) and whole-image vessel density (wiVD) (R^2 = 0.51) was stronger than the association between SAP MD with RNFL (R^2 = 0.36) and rim area (R^2 = 0.19) (P < 0.05 for all).
In a cross-sectional study of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients, multivariate regression analysis showed that each 1% decrease in whole-image vessel density (wiVD) was associated with 0.66 decibel (dB) loss in mean deviation (MD), and each 1% decrease in circumpapillary vessel density (cpVD) was associated with 0.64 dB loss in MD.
In a cross-sectional study of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients, decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss.
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