Additive Role of Optical Coherence Tomography Angiography Vessel Density Measurements in Glaucoma Diagnoses

Abstract

Purpose This study compared the glaucoma diagnostic abilities of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In addition, the possibility of enhancing diagnostic capability by combining the two modalities was investigated. Methods A total of 131 healthy eyes and 113 glaucomatous eyes were imaged by both OCT and OCTA. In OCT, glaucoma was defined as when the color of the superior or inferior quadrant of the peripapillary retinal nerve fiber layer thickness map was yellow (borderline, <5%) or red (outside normal limits, <1%). In OCTA, glaucoma was determined using the cut-off value of the superior or inferior peripapillary vessel density, calculated after receiver operating characteristic curve analysis. Sensitivity and specificity were determined by OCT alone, by OCTA alone, or by OCT and OCTA combined. Results The sensitivity of OCT (86.7%) was better than that of OCTA (74.3%), whereas the specificity of OCTA (87.0%) was better than that of OCT (67.9%). When these two modalities were combined, both sensitivity and specificity were enhanced (90.3% and 92.4%, respectively). Among the 131 eyes, 32 were misdiagnosed as glaucomatous by OCT but accurately diagnosed as normal by OCTA. These eyes were myopic, with a longer axial length and a thinner and temporally displaced peak of peripapillary retinal nerve fiber layer thickness, causing the false positive result in OCT. Conclusions When OCTA was combined with OCT, the specificity of glaucoma diagnoses were enhanced. OCTA may compensate for the shortcomings of OCT in the diagnosis of glaucoma.

Comparison of the Effect on Vessel Density and RNFL between Carteolol and Latanoprost

“…This is also why VD testing in glaucoma is of such importance. This is confirmed by recent work [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Signal Strength as an Important Factor in the Analysis of Peripapillary Microvascular Density Using Optical Coherence Tomography Angiography

“…Some investigators also reported that deep retinal layer and parapapillary choroidal microvasculature dropout is associated with RNFL thinning in primary open-angle glaucoma 13,19 . Other studies have reported a reduction in optic disc perfusion in glaucoma 10,12,14–18,30–32 . In addition, Wang et al .…”

Wedge Defects on Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma: Prevalence and Associated Clinical Factors

“…Optical coherence tomography angiography (OCTA) yields reproducible2,3 images of retinal microvasculature and may be useful in early glaucoma detection and monitoring of disease progression. Recent studies report a diagnostic accuracy comparable to that of retinal nerve fiber layer (RNFL) thickness as measured by OCT,4–6 which is routinely used in glaucoma care.…”