Purpose To characterize the rate of macula vessel density loss in primary open angle glaucoma (POAG), glaucoma suspect, and healthy eyes. Design Longitudinal, observational cohort from the Diagnostic Innovations in Glaucoma Study. Methods One hundred eyes (32 POAG, 30 glaucoma suspect and 38 healthy) followed for at least one year with optical coherence tomography angiography (OCT-A) imaging on at least two visits were included. Vessel density was calculated in the macula superficial layer. The rate of change was compared across diagnostic groups using multivariate linear mixed-effects model. Results Baseline macula vessel density was highest in healthy eyes, followed by glaucoma-suspect and POAG eyes (P < 0.01). The rate of vessel density loss was significantly different from zero in the POAG, but not in the glaucoma suspect or healthy eyes. The mean rate of change in macula whole en-face vessel density was significantly faster in glaucoma eyes (−2.23 %/yr) than in glaucoma suspect (0.87%/yr, P = 0.001) or healthy eyes (0.29 %/yr, P = 0.004). Conversely, the rate of change in ganglion cell complex (GCC) thickness was not significantly different from zero in any diagnostic group, and no significant differences in the rate of GCC change among diagnostic groups were found. Conclusions With a mean follow-up of less than 14 months, eyes with POAG had significantly faster loss of macula vessel density than either glaucoma suspect or healthy eyes. Serial OCT-A measurements also detected glaucomatous change in macula vessel density in eyes without evidence of change in GCC thickness.

Purpose: To determine if optical coherence tomography angiography (OCTA)-derived vessel density measurements can extend the available dynamic range for detecting glaucoma compared to spectral-domain optical coherence tomography (SDOCT)-derived thickness measurements.Design: Observational, cross-sectional study. Participants: A total of 509 eyes from 38 healthy participants, 63 glaucoma suspects and 193 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. Methods: Relative vessel density and tissue thickness measurement floors of perifoveal superficial vessel density (pfVD), circumpapillary capillary density (cpCD), circumpapillary retinal nerve fiber (cpRNFL) thickness, ganglion cell complex (GCC) thickness and visual field mean deviation were investigated and compared with a previously reported linear change point model (CPM) and locally weighted scatterplot smoothing (LOWESS) curves. Main Outcome Measures: Estimated vessel density and tissue thickness measurement floors and corresponding dynamic ranges. Results: Visual field MD ranged from −30.1 dB to 2.8 dB. No measurement floor was found for pfVD which continued to decrease constantly until very advanced disease. A true floor (i.e. slope ~ 0 after observed CPM change point) was detected for cpRNFL thickness only. Post-CPM estimated floors were 49.5±2.6 μm for cpRNFL thickness, 70.7±1.0 μm for GCC thickness and 31.2± 1.1% for cpCD. pfVD reached the post-CPM estimated floor later in the disease (VF MD: −25.8±3.8 dB) than cpCD (VF MD: −19.3±2.4 dB), cpRNFL thickness (VF MD: −17±3.3 dB) and GCC thickness (VF MD: −13.9±1.8 dB) (p<0.

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