Abstract
PurposeTo evaluate optic nerve vascular density using swept source optical coherence tomography angiography (OCTA) in patients with early primary open angle glaucoma (POAG), pre-perimetric glaucoma and normal eyes.MethodsThis is a prospective, observational study including 56 eyes in total and divided into 3 groups; 20 eyes with mild POAG, 20 pre-perimetric glaucoma eyes, and 16 age-matched normal eyes as controls. The optic disc region was imaged by a 1050-nm-wavelength swept-source OCT system (DRI OCT Triton, TOPCON). Vessel density was assessed as the ratio of the area occupied by the vessels in 3 distinct regions: 1) within the optic nerve head; 2) in the 3 mm papillary region around the optic disc; and 3) in the peripapillary region, defined as a 700-μm-wide elliptical annulus around the disc. The potential associations between vessel density and structural, functional measures were analyzed.ResultsThere was a statistically significant difference for the peripapillary vessel density, optic nerve head vessel density, and papillary vessel density among all the groups (p<0.001). Control eyes showed a significant difference for all measured vessel densities compared to glaucomatous eyes (p values from 0.001 to 0.024). There was a statistically significant difference between control and pre-perimetric glaucoma eyes for peripapillary, optic nerve head and papillary vessel density values (p values from 0.001 to 0.007). The optic nerve head vessel density, superior and inferior papillary area vessel density (Pearson r = 0.512, 0.436, 0.523 respectively) were highly correlated with mean overall, superior and inferior RNFL thickness in POAG eyes (p = 0.04, p = 0.02 and p = 0.04 respectively). Multiple linear regression analysis of POAG group showed that optic nerve head vessel density in POAG group was more strongly linked to RNFL thickness than to any other variables.ConclusionsEyes with mild POAG could be differentiated from pre-perimetric glaucoma eyes, which also could be differentiated from normal eyes using OCTA-derived retinal vessel density measurements.
Highlights
Glaucoma is a group of eye diseases that result in damage to the optic nerve and potentially leads to irreversible blindness [1]
Eyes with mild primary open angle glaucoma (POAG) could be differentiated from pre-perimetric glaucoma eyes, which could be differentiated from normal eyes using optical coherence tomography angiography (OCTA)-derived retinal vessel density measurements
Pre-perimetric glaucoma patients represent a group of individuals with risk factors such as elevated intraocular pressure (IOP) or ocular findings such as optic disc cup enlargement that are suspicious for glaucoma, but often do not have the classic optic nerve neuroretinal rim loss or characteristic visual field defects to meet the formal definition of definite glaucoma
Summary
Glaucoma is a group of eye diseases that result in damage to the optic nerve and potentially leads to irreversible blindness [1]. The nerve damage involves loss of retinal ganglion cells in a characteristic pattern [2,3,4,5] with intraocular pressure (IOP) the only modifiable risk factor and IOP reduction the only treatment. Pre-perimetric glaucoma patients represent a group of individuals with risk factors such as elevated IOP or ocular findings such as optic disc cup enlargement that are suspicious for glaucoma, but often do not have the classic optic nerve neuroretinal rim loss or characteristic visual field defects to meet the formal definition of definite glaucoma. Optical coherence tomography (OCT) gives an objective measurement of retinal nerve fiber layer (RNFL) thickness and/or ganglion cell complex (GCC) which is important for glaucoma assessment but is limited utility in advanced disease and does not relate to cause of disease as opposed to the final presentation [9]
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