Abstract
To compare the retinal vessel density and glaucomatous parameters in primary angle closure glaucoma (PACG), to evaluate the diagnostic and monitoring abilities of the peripapillary and macular vessel density in the progression of glaucoma. This was a observational, prospective and cross-sectional study. According to Glaucoma Staging System, 218 eyes (116 participants) were divided into 5 groups: no glaucoma, early glaucoma, moderate glaucoma, advance glaucoma, severe glaucoma. All participants underwent a comprehensive ocular examination, which included corrected distance visual acuity measurement, slit-lamp biomicroscopy, intra ocular pressure (IOP), gonioscopy, fundus examination, stereoscopic optic disc photography, Humphrey visual field test(VF), peripapillary and macular optical coherence tomography angiography(OCTA) scan. SPSS software was used to calculate and compare retinal vessel density (peripapillary vessel density, PVD and macular vessel density, MVD) and glaucomatous parameters (mean deviation (MD),pattern standard deviation(PSD), retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer(GCIPL),rim area, average cup/disc(C/D) ratio). The GCIPL thickness, RNFL thickness, PVD and MVD are significantly reduced in PACG. There were significant differences in all measurements among the groups (P<0.01).Reduced peripapillary and macular vessel density in glaucoma were detected and a statistically significant correlation with glaucoma stages (P<0.01). In addition, the results of retinal vessel density, reduced RNFL thickness and GCIPL thickness were also statistically related to the stage of glaucoma. As expected, the rim area was significantly smaller with higher C/D area ratios in glaucomatous eyes corresponding to the severity of disease. The changes of PVD and MVD had strongly positive correlation with GCIPL thickness and RNFL thickness, had negative correlation with the severity of glaucoma, which meant the more severe the glaucoma was, the lower PVD and MVD were. Compared to traditional glaucoma staging system judged by VF, the changes of PVD and MVD obtained by OCTA might be a new method to grade the stage of glaucoma. These findings theorize that the changes of PVD and MVD may be better facilitated for the observation and monitoring of glaucoma progression.
Highlights
Glaucoma is the leading cause of irreversible blindness in the world, around 65 million people suffer from this disease. [1] It is well documented that early diagnosis, early treatment and monitoring of the progression are the key determinants to reduce the risk of irreversible vision loss.Though, the pathogenesis of glaucoma is not fully understood, reducing intra ocular pressure (IOP) is still the only effective method to slow glaucoma damage [2].As we know, structural damage occurs prior to functional damage in glaucoma
Compared to traditional glaucoma staging system judged by visual field (VF), the changes of PVD and macular vessel density (MVD) obtained by optical coherence tomography angiography (OCTA) might be a new method to grade the stage of glaucoma
These findings theorize that the changes of PVD and MVD may be better facilitated for the observation and monitoring of glaucoma progression
Summary
The pathogenesis of glaucoma is not fully understood, reducing IOP is still the only effective method to slow glaucoma damage [2].As we know, structural damage occurs prior to functional damage in glaucoma. Functional, such as VF may be not appropriate to diagnose the earliest stages of glaucoma or judge the progression of glaucoma. Some studies have recently suggested that reduced ocular blood flow is a primarily independent metric of visual function outside of other structural parameters, supporting a vascular role in the development of glaucoma [4,5,6]. The main purpose of this study was to compare the retinal vascular density and glaucomatous parameters in PACG and to evaluate the diagnostic and administrative abilities of the peripapillary and macular vessel density in the progression of glaucoma
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