Identifying new biomarkers associated with central visual function impairment is important in advanced glaucoma patients. This retrospective cross-sectional study enrolled 154 eyes from 154 subjects, consisting of 86 patients with advanced open-angle glaucoma (mean deviation of 24-2 visual field [VF] tests < − 15 dB) and 68 healthy controls. Structure, function, and vessel density (VD) parameters were obtained using optical coherence tomography (OCT), 24-2 standard automated perimetry, and OCT angiography, respectively. The relationships of macular thickness, central 5° and 10° VF mean sensitivity (MS), and macular VD parameters with foveal threshold (FT), representing central visual function, were investigated using partial correlation analyses and linear regression analyses, with age adjustment. Superficial and deep layer macular VD, central 5° and 10° VF MS, and best corrected visual acuity (BCVA) correlated significantly with FT after age adjustment (P < 0.05). In multivariate linear regression analyses, FT associated significantly with BCVA (β = − 8.80, P < 0.001), central 5° MS (β = 0.30, P = 0.037), and deep-layer global parafoveal VD (β = 0.37, P = 0.037). Thus, deep-layer parafoveal VD is an independent predictor of FT and may be a potential biomarker for central visual function in advanced glaucoma.

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