Greater Severity of Glaucomatous Damage in Eyes With Than Without Choroidal Microvasculature Dropout in Open-Angle Glaucoma

Abstract

Citation: Jo YH, Kwon J, Shon K, Jeong D, Kook MS. Greater severity of glaucomatous damage in eyes with than without choroidal microvasculature dropout in open-angle glaucoma. Invest Ophthalmol Vis Sci. 2019;60:901-912. https://doi.org/ 10.1167/iovs.18-26298 PURPOSE.To assess whether open-angle glaucoma (OAG) eyes with choroidal microvasculature dropout (CMvD) have greater severity of glaucomatous damage compared to those eyes without CMvD. METHODS.In this retrospective case-control study, 80 eyes of 80 OAG patients with visual field (VF) defects confined to a superior hemifield (40 eyes with CMvD and 40 eyes without CMvD matched for age [ 10 years], axial length [ 1 mm], and VF loss [ 1 dB (decibel)]) and 43 healthy eyes were consecutively included. The circumpapillary retinal nerve fiber layer thickness (cpRNFLT), macular ganglion cell-inner plexiform layer thickness (mGCIPLT), circumpapillary vessel density (cpVD), parafoveal VD (pfVD), and VF mean sensitivity (VFMS) were measured. The relationships between CMvD angular extent and structural/VD/ functional measures were assessed at both hemiretinae in OAG eyes with CMvD. Logistic regression analyses were performed to evaluate the associations between significant cpRNFLT reduction at perimetrically intact hemiretinae and relevant clinical variables. RESULTS. Sectoral cpRNFLT and mGCIPLT in the perimetrically intact hemiretinae of eyes withCMvD were significantly lower than those of eyes without CMvD (P < 0.05). There were significant correlations between CMvD angular extent and sectoral measures of structural/ VD/functional parameters at perimetrically intact hemiretinae as well as perimetrically affected hemiretinae in OAG eyes with CMvD. The presence and extent of CMvD had a significant influence on cpRNFLT reduction at perimetrically intact hemiretinae (P < 0.05).CONCLUSIONS. OAG eyes with CMvD showed significantly lower cpRNFLT and mGCIPLT than those without CMvD at the hemiretinae corresponding to intact hemifields, thus requiring more vigilant attention for greater disease severity.

Choroidal microvasculature dropout is spatially associated with optic nerve head microvasculature loss in open-angle glaucoma

“…inferior hemiretinae) of CMvD(+) eyes than in those of CMvD(−) eyes, notwithstanding a similar average RNFLT and VF severity in both groups ( P < 0.05, Table 1 ). These findings are consistent with those of Jo et al, which demonstrated that OAG eyes with a localized CMvD exhibit more severe RNFLT and cpVD loss in the same location compared to those without CMvD despite having similar glaucoma severity 13 . Furthermore, the global pCVD in the β-PPA was significantly lower in CMvD(+) eyes than CMvD(-) eyes in the current series of OAG eyes (Table 2 ).…”

“…Although it is unclear why CMvD is frequently found at the inferotemporal parapapillary region, this location is consistent with the macular vulnerability zone in the retina, which corresponds to the zone that is particularly susceptible to glaucomatous damage 12 . In line with this possibility, previous studies have shown that a localized CMvD at the inferior hemiretinae in OAG eyes is associated with glaucomatous RNFL damage in the same hemiretinae, and VF damage in the superior hemifield of eyes 8 , 13 . These earlier findings suggested that the presence of CMvD may play an important role in the pathogenesis of glaucoma, the mechanism of which remains to be further explored.…”

“…Sixth, there was no healthy control group to determine whether CMvD or ONH-VD occurs in this group and compare pCVD and ONH-VD values between the control and OAG groups in the present study. However, to this date, CMvD has not been reported to occur in the healthy control eyes in the literature 8 , 13 . Finally, because of the cross-sectional design of our present study, the longitudinal relationship between the detection of CMvD and the emergence of ONH-MvD or a reduced ONH-VD in the neighboring ONH location could not be explored in our analysis.…”

“…2 , right, yellow line). This method of measuring the angular extent of the CMvD has been previously reported in various studies 13 , 35 .…”

Comparative Topographical Analysis of Choroidal Microvascular Dropout Between Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy

“…The structural association between RNFL defect and MvD as shown in Figure 4 may plainly explain (1) why the topography is related to the RNFL defect 9 , 13 , 14 and preconditioned by the presence of βPPA, 1 , 9 , 27 (2) why MvD and glaucomatous damage have a proportional relationship both cross-sectionally 1 – 6 and longitudinally, 3 , 5 , 7 and (3) why our study group showed such a high prevalence of MvD compared to other studies. The NAION eyes had 100% MvD and 100% PPA, while the eyes with compressive optic neuropathy had MvD in only 34.1% of eyes and PPA in only 68.2% of eyes.…”