Deep-layer Microvasculature Dropout in Preperimetric Glaucoma Patients

Suh, Min Hee; Na, Jeong Ho; Zangwill, Linda M.; Weinreb, Robert N.

doi:10.1097/ijg.0000000000001489

Cited by 20 publications

(28 citation statements)

References 28 publications

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“…Alternatively, more advanced glaucoma with less perfusion to the SCP may allow more vessels to be visible in the DCP, which creates a paradoxical trend showing higher perfusion in the deeper layers as the disease progresses. We also know that DCP microvasculature dropout detected qualitatively was associated with the disease severity in glaucoma suspects,66 and the presence of gamma zone peripapillary atrophy67,68 and higher VF progression rates in glaucoma patients 69…”

Section: Discussionmentioning

confidence: 99%

Superficial and Deep Macula Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

El-Nimri

Manalastas

Zangwill

et al. 2021

Journal of Glaucoma

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Precis: Macular superficial capillary plexus (SCP) vessel density is more informative than deep capillary plexus (DCP) vessel density for the detection of glaucoma. Purpose:The purpose of this study was to characterize optical coherence tomography angiography macular SCP and projectionresolved DCP vessel densities and compare their diagnostic accuracies with ganglion cell complex (GCC) thickness in healthy, glaucoma suspect, and glaucoma eyes.Materials and Methods: Sixty-eight eyes of 44 healthy subjects, 26 eyes of 16 preperimetric glaucoma suspects, and 161 eyes of 124 glaucoma patients from the Diagnostics Innovations in Glaucoma Study with good quality high-density 6×6 mm 2 macula optical coherence tomography angiography images were included. The diagnostic accuracy of SCP vessel density, projection-resolved DCP vessel density and GCC thickness were compared among groups.Results: Mean whole image vessel density (wiVD; % of area occupied by vessels containing flowing blood) in the SCP layer was highest in healthy eyes (49.7%), followed by glaucoma suspect eyes (46.0%), and glaucoma eyes (40.9%) (P < 0.001). Mean wiVD in the DCP layer was similar in healthy (50.6%), glaucoma suspect (47.3%), and glaucoma eyes (45.7%) (P = 0.925). Diagnostic accuracy of both GCC thickness and SCP wiVD was significantly higher than DCP wiVD for classifying healthy and glaucoma eyes [adjusted area under the receiver operating characteristic curve (95% confidence interval): GCC = 0.86 (0.72, 0.94), SCP = 0.80 (0.66, 0.91) and DCP = 0.44 (0.30, 0.57)] (P < 0.001).Conclusions: SCP vessel densities have better diagnostic accuracy for detecting glaucoma than DCP vessel densities. Although the diagnostic accuracy of the macula SCP is relatively modest, it is more informative than the DCP.

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Section: Discussionmentioning

confidence: 99%

Superficial and Deep Macula Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

El-Nimri

Manalastas

Zangwill

et al. 2021

Journal of Glaucoma

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“…Similarly, Wang et al 33 found that POAG eyes showed significantly reduced CVI values in the large vessel layer, and these changes were related to glaucomatous structural and functional changes. Moreover, recent studies reported that enlargement of the choroidal microvasculature dropout was related to disease severity in POAG, such as progressive RNFL thinning and visual field MD damage 34,35 . In particular, in a recent longitudinal study, Cheng et al 29 found that the rate of decline in choriocapillaris vessel density was positively related to thinning of the RNFL.…”

Section: Discussionmentioning

confidence: 98%

“…Moreover, recent studies reported that enlargement of the choroidal microvasculature dropout was related to disease severity in POAG, such as progressive RNFL thinning and visual field MD damage. 34,35 In particular, in a recent longitudinal study, Cheng et al 29 found that the rate of decline in choriocapillaris vessel density was positively related to thinning of the RNFL. A potential reason for the observed association between reduced CVI or LA and glaucomatous damage might be related to the role of choroidal vessels in providing blood supply to the papillary sieve plate, which includes retinal ganglion cells.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Choroid in Primary Open Angle and Angle Closure Glaucoma Using Optical Coherence Tomography

Wang,

Xiao,

Lin

et al. 2023

Journal of Glaucoma

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Précis: The current study highlights distinct choroidal alterations in primary open-angle and angle-closure glaucoma, underscoring the potential of choroidal vascularity index as a valuable indicator for understanding glaucoma pathogenesis. Purpose: To evaluate choroidal structural changes in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) and healthy controls utilizing the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) by enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: This study was cross-sectional. A total of 171 eyes of 171 subjects, comprising 69 eyes with untreated POAG, 58 eyes with untreated PACG and 44 healthy eyes, were enrolled in this study. SFCT, luminal area (LA), stromal area (SA) and total choroidal area (TCA) were measured on EDI-OCT scans. The CVI parameter is calculated as the proportion of LA to TCA. Results: This study included 69 POAG patients with a mean age of 51.4±13.3 years, 58 PACG patients with a mean age of 57.0±7.3 years, and 44 healthy subjects with a mean age of 51.11±10.7 years. The CVI in the POAG and PACG groups was significantly lower than that in the control group (P = 0.001 and P = 0.005, respectively), however not significantly different between the two glaucoma groups (P = 1.000). POAG eyes had significantly lower LA than PACG and controls (P = 0.014 and P = 0.049, respectively), while PACG eyes had significantly greater SA than controls (P = 0.041). Conclusions: The CVI of POAG and PACG eyes was significantly lower than that of normal eyes. A reduced LA was observed mainly in eyes with POAG, and an increased SA was observed mainly in eyes with PACG. The role of the choroid may differ between POAG and PACG eyes.

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“…In particular, lower parapapillary choroidal VD has been reported to be associated with the progression of glaucoma 22 – 24 . Investigations are ongoing to discover systemic risk factors that may influence impairment or loss of VD in glaucoma 25 , 26 . Dips in nocturnal BP have been reported to be associated with localized choroidal VD loss in glaucoma patients 27 .…”

Section: Introductionmentioning

confidence: 99%

Association of choroidal blood flow with autonomic dysfunction in patients with normal tension glaucoma

Shin

Hong

Lee

et al. 2022

Sci Rep

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There is increasing evidence that autonomic dysfunction is an important factor in the progression of glaucoma. Mechanism of the association between autonomic dysfunction and progression of glaucoma is poorly understood. Since blood circulation is basically regulated by the autonomic nervous system, autonomic dysfunction may contribute to unstable or fluctuating blood pressure. Therefore, It is hypothesized that autonomic dysfunction may contribute to impaired ocular blood flow and lead to glaucoma progression. However, no clinical study yet has evaluated the relationship between ocular blood flow and autonomic nervous function. We enrolled 152 open angle glaucoma patient. Ocular blood flow was assessed by measuring vessel density (VD) using optical coherence tomography angiography, and autonomic nervous function was evaluated with heart-rate variability (HRV) parameters. The low frequency/high frequency (LF/HF) ratio, which is one of the HRV parameters, quantified the degree of sympathovagal balance. This indicator could represent autonomic dysfunction. Higher LF/HF ratio was associated with reduction of the deep parapapillary VD (R = − 0.243, P = 0.003). Linear regression analysis showed a significant negative association between parapapillary choroidal VD and LF/HF ratio (β = − 0.249; 95% confidential interval = − 1.193 to − 0.249; P = 0.002) in multivariate analysis. We demonstarted the association between impaired ocular blood flow (parapapillary choroidal vessel density) and autonomic dysfunction (LF/HF ratio). This study could help understand the role of the autonomic dysfunction in pathophysiology of glaucoma progression.

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Deep-layer Microvasculature Dropout in Preperimetric Glaucoma Patients

Cited by 20 publications

References 28 publications

Superficial and Deep Macula Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

Superficial and Deep Macula Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes

Comparison of the Choroid in Primary Open Angle and Angle Closure Glaucoma Using Optical Coherence Tomography

Association of choroidal blood flow with autonomic dysfunction in patients with normal tension glaucoma

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