Diagnostic Ability of Macular Vessel Density in the Ganglion Cell–Inner Plexiform Layer on Optical Coherence Tomographic Angiography for Glaucoma

Abstract

Purpose The purpose of this study was to analyze the macular vessel density layer-by-layer and compare the diagnostic value of each in diagnosing glaucoma. Methods This was a prospective comparative cross-sectional study, and the setting was glaucoma referral practice. The study participants were patients with primary open-angle glaucoma undergoing treatment with drugs, and age-matched normal controls who visited our clinic for regular eye examinations for refractive errors. All participants were investigated using macular optical coherence tomographic angiography, fundus photography, and 24-2 visual field (VF) testing. Average vessel densities in the retinal nerve fiber–ganglion cell–inner plexiform layer (IPL), retinal nerve fiber–ganglion cell layer (GCL), retinal nerve fiber layer (RNFL), ganglion cell–IPL, GCL, and IPL segments on optical coherence tomographic angiography. Results Fifty-eight glaucomatous eyes of 58 participants and 52 healthy eyes of 52 normal subjects were included in the study. The average vessel densities of all segments, except the RNFL in the glaucoma group, were significantly lower than that in normal subjects. The average vessel density in the ganglion cell–IPL showed the highest correlation with the mean deviation and VF index of the VF ( r = 0.515 and 0.538, respectively) and the best area under receiver operating characteristic curve to discriminate between patients with glaucoma and patients with normal eyes (0.750). Conclusions The present study demonstrated that macular vessel density in the ganglion cell–IPL has a higher diagnostic ability and better correlation with functional damage in glaucoma than that in the superficial vascular plexus. Translational Relevance These findings suggest that the macular vessel density in the ganglion cell–inner plexiform layer is better than that in the conventional superficial vascular plexus for detecting glaucoma.

Evaluation of Retinal Neurodegeneration and Choroidal Thickness in Patients with Inactive Gravesʼ Ophthalmopathy

“…It has been stated that abnormal changes in the RGCs soma and dendrites might be observed earlier than the axonal loss in the early stage of glaucoma [18]. This increases the role of GCL combined with RNFL for the assessment of retinal neurodegeneration, which might be the result of retinal blood flow changes causing ischemia and RGC loss seen in Gravesʼ disease [19,20].…”

Unveiling Novel Structural Biomarkers for the Diagnosis of Glaucoma

“…A study using macular whole image vessel density found that a 0.11 μm/year faster decreasing rate of RNFL was associated with every 1% loss of macular vessel density [ 59 ]. Several studies also found a significant decrease of vessel density and flow density in deep retinal vascular plexus and the whole retina, and the diagnostic ability of glaucoma of the vessel density in the GCIPL might be better than in the superficial vascular plexus [ 49 , 60 , 61 , 62 , 63 , 64 , 65 ]. However, still some studies found that macular vessel density performed no better than OCT GCC thickness in distinguishing early glaucoma from healthy eyes [ 66 , 67 , 68 , 69 ].…”