Macular microvasculature alterations in patients with primary open-angle glaucoma

Abstract

To evaluate and compare macular microvasculature changes in eyes with primary open-angle glaucoma (POAG) to normal eyes, and to assess associations among the retinal microvasculature, neural structural damage, and visual field loss.Ninety-nine eyes (68 patients with POAG and 31 normal subjects) were enrolled in this study. Thirty-five eyes with early-stage glaucoma (EG), 33 eyes with advanced-stage glaucoma (AG), and 31 normal eyes were included. An optical coherence tomography system with a split-spectrum amplitude-decorrelation angiography algorithm was used to measure the macular capillary vessel area density and retinal thickness. Visual field testing (30-2 and 10-2 programs) was performed using a Humphrey field analyzer. Correlations between the capillary vessel area density, retinal thickness, and visual field parameters were analyzed.Compared to normal eyes, those with EG and AG had a lower macular capillary vessel area density and lesser retinal thickness (P < 0.001, all). Results of multivariate linear regression analyses showed that each standard deviation (SD) decrease in the vessel area density was associated with a 1.5% and 4.2% thinning of the full retinal thickness and inner retinal layer thickness, respectively. Each SD decrease in the vessel area density was also associated with a 12.9% decrease in the mean sensitivity and a 33.6% increase in the pattern standard deviation (P < 0.001, both). The Pearson partial regression analysis model showed that the vessel area density was most strongly associated with the inner retinal layer thickness and inferior hemimacular thickness. Furthermore, a lower vessel area density was strongly associated with a more severe hemimacular visual field defect and the corresponding hemimacular retinal thickness.The macular capillary vessel area density and retinal thickness were significantly lower in eyes with POAG than in normal eyes. A diminished macular microvasculature network is closely associated with visual field defects, which are dependent on structural damage due to POAG.

Optical Coherence Tomography Angiography in Glaucoma: A Review

“…This can explain why some studies that measured only the fovea or parafovea found no difference [32, 37]. The finding that the greatest differences between normal and glaucoma eyes were found in the inferotemporal sector further corroborates this theory [36, 47, 62, 70]. …”

“…A significant correlation was found between the OCTA parameters and visual field MD, between OCTA parameters and glaucoma stage, and, as previously described, between the OCTA and OCT parameters in the peripapillary area [6, 17-20, 22-24, 26, 28-30, 33, 35, 36, 38, 39, 41, 45, 48, 50, 71-75], the optic disc [19, 23, 29, 36, 51-53, 57, 58], and the macular area [21, 36, 38, 61, 62, 64, 69, 75, 76]. As mentioned above, the results for the parafoveal area were not significant in some of the studies [38, 70].…”

“…Most studies investigated the OCTA parameters in the superficial layers (above the inner plexiform layer) [3, 16, 18, 20-22, 25-29, 32-38, 41, 45, 47, 48, 50, 61-63, 69-71, 75-77, 85-88] or in the full-thickness scan [6, 17, 19, 21, 23, 30, 36, 39, 46, 51-54, 56-58, 62, 72, 83]. …”

Diagnostic Ability and Discriminant Values of OCT-Angiography Parameters in Early Glaucoma Diagnosis

“…However, macula vessel densities did not differ between the control and the early glaucoma group (mean MD = -2.42). Another study [22] found a higher decrease of the superficial vessel density in the macula in both early and advanced glaucoma (8 and 20%). An explanation of this discrepancy could lie in the small macular scan area considered in our and Rao studies (3 × 3 mm) compared to the 6 × 6 mm in the study of Xu et al [22].…”

Optical Coherence Tomography Angiography Macular and Peripapillary Vessel Perfusion Density in Healthy Subjects, Glaucoma Suspects, and Glaucoma Patients

“…[4][5][6][7][8][9] Further, even though the macular involvement in glaucoma has been demonstrated, few papers have focused on the macular microvasculature in patients affected by this disease. [10][11][12][13][14][15] The purposes of the present study were (1) to evaluate both macular and peripapillary vessel perfusion density (VD) in glaucoma suspects (GS) and glaucoma (G) patients, (2) to correlate macular RGC and RNFL defects with macular and peripapillary VD, and (3) to evaluate the diagnostic accuracy of RGC and RNFL thicknesses and vascular parameters in detecting glaucoma.…”