Association of macular structure, function, and vessel density with foveal threshold in advanced glaucoma

Abstract

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.

Factors Associated with Visual Acuity in Advanced Glaucoma

“…Although the role of the choroid in the pathogenesis of glaucoma remains unclear, we suggest that a thin subfoveal choroid may be associated with decreased blood flow in the fovea region, which can lead to photoreceptor dysfunction that subsequently affects the functional status of the overlying outer retina. Recently, associations between macular microvasculature and central visual function or BCVA have been reported by several studies using OCT angiography [12][13][14], which found that macular microvascular density, especially from the deep layer, was an important independent predictor of BCVA [12][13][14]. Additionally, Song et al [14] demonstrated that the severity of central VF impairment can vary significantly according to the status of deep macular microvasculature, despite similar VF MD and macular structural damage.…”

“…Recently, associations between macular microvasculature and central visual function or BCVA have been reported by several studies using OCT angiography [12][13][14], which found that macular microvascular density, especially from the deep layer, was an important independent predictor of BCVA [12][13][14]. Additionally, Song et al [14] demonstrated that the severity of central VF impairment can vary significantly according to the status of deep macular microvasculature, despite similar VF MD and macular structural damage. Since the parafoveal region can support central visual function, impairment of the blood flow at the parafoveal retina can affect central visual function.…”

“…Takahashi et al [9] showed that damage to the papillomacular bundle, a specific area of the retina, was strongly associated with BCVA in glaucoma. It has recently been demonstrated that macular vascular density of the deep layer is independently associated with central visual function in glaucoma patients [12][13][14]. However, information regarding the potential factors influencing visual acuity in advanced glaucoma patients is still limited.…”

Comparison of the Circumpapillary Structure-Function and Vasculature-Function Relationships at Different Glaucoma Stages Using Longitudinal Data

“… 13 , 19 In addition, since there are no universally accepted criteria for the classification of advanced glaucoma, an MD ≤ −15 dB criterion was selected for this study based on previously published studies. 9 , 20 , 21 …”

“… 4 , 5 Several prior studies, including our own reports, have demonstrated the presence of significant correlations between the reduction in OCT/OCTA parameters and the loss of VF sensitivity (VFS) in glaucoma based on a cross-sectional study design. 6 – 9 …”