Microvascular Density in Glaucomatous Eyes With Hemifield Visual Field Defects: An Optical Coherence Tomography Angiography Study

Akagi, Tadamichi; Iida, Yuto; Nakanishi, Hideo; Terada, Noriko; Morooka, Shigenori; Yamada, Hiroshi; Hasegawa, Tomoko; Yokota, Satoshi; Yoshikawa, Munemitsu; Yoshimura, Nagahisa

doi:10.1016/j.ajo.2016.06.009

Cited by 214 publications

(195 citation statements)

References 49 publications

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“…This finding is in line with Liu et al 21 and Akagi et al, 24 reporting that focal retinal vessel defects had a hemifield concordance with the location of functional deterioration: eyes with superior VF loss had a decreased inferior parapapillary vessel density. However, hemifield concordance between the retinal vessel defect and the VF defect does not necessarily indicate that the location and extent of the two changes coincide each other.…”

Section: Discussionsupporting

confidence: 89%

“…Similarly, Yarmohammadi et al 22 and Chen et al 23 reported that the vessel density within the RNFL was lower in eyes with primary open-angle glaucoma (POAG) than in glaucoma suspects and healthy eyes. Akagi et al 24 showed that the parapapillary retinal vessel density was reduced in the corresponding hemi-field in POAG eyes with hemi-field VF defect. These findings from the OCTA studies again shed light on the potential role of vascular factors in glaucoma.…”

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confidence: 99%

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OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

Lee

et al. 2016

Invest. Ophthalmol. Vis. Sci.

146

107

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PURPOSE. The purpose of this study was to investigate the topographic relationship between the decreased parapapillary retinal microvasculature as assessed by optical coherence tomography angiography (OCTA) and retinal nerve fiber layer (RNFL) defect in eyes with primary open-angle glaucoma (POAG) and a localized RNFL defect.METHODS. The peripapillary retinal circulation was evaluated using the OCTA centered on the optic nerve head in 98 POAG eyes having a localized RNFL defect and 45 healthy control eyes. A vascular impairment (VI) was identified in OCTA by the presence of a sign indicating decreased microvasculature. The frequencies of VI were compared between the POAG and control groups, and the topographic correlation between the VI and the RNFL defect identified in red-free fundus photographs was determined in the POAG group.RESULTS. The VI was observed as an area of decreased density of the microvascular network of the retina in 100% of the POAG eyes. The VI exactly coincided with the RNFL defect evident in red-free fundus photographs in terms of both the location and extent (Pearson's correlation coefficient ¼ 0.997 and 0.988, respectively, all P < 0.001). None of the control eyes exhibited VI in OCTA.CONCLUSIONS. Decreased parapapillary microvasculature of the retina determined by OCTA was found at the location of RNFL defect in POAG patients. This finding suggests that the decreased retinal microvasculature is likely secondary loss or closure of capillaries at the area of glaucomatous RNFL atrophy.Keywords: primary open-angle glaucoma, optical coherence tomography angiography, retinal microvasculature S tudies have shown that peripapillary retinal blood flow 1,2 and retinal vessel caliber 3,4 are reduced in glaucoma patients compared with healthy subjects, using laser Doppler flowmetry, 1 Doppler optical coherence tomography (OCT), 2 and measurements of retinal vessel caliber. [3][4][5][6] Decreased retinal perfusion has also been demonstrated angiographically in glaucoma patients using fluorescein angiography.7-10 These findings has raised the interest in the potential role of decreased ocular perfusion as an etiopathogenic factor for the glaucomatous optic neuropathy (GON), together with epidemiologic or clinical data that demonstrated the association of low blood pressure [11][12][13] or nocturnal blood pressure dips 14-16 with glaucoma. In contrast, Quigley et al. 17 demonstrated that the density of capillaries remained constant across a wide range of neural tissue losses within the optic nerve head (ONH) in both experimental and human glaucoma eyes. In addition, Cull et al. 18 showed that the ONH blood flow measured by laser speckle flowgraphy increased during the earliest stage of glaucoma followed by a linear decline that was strongly correlated with thickness reduction of the retinal nerve fiber layer (RNFL) thickness. These findings suggest that the reduced retinal perfusion could simply result from ONH degeneration and a consequently diminished metabolic demand.1,2,4-6 It therefore remains unc...

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Section: Discussionsupporting

confidence: 89%

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confidence: 99%

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

Lee

et al. 2016

Invest. Ophthalmol. Vis. Sci.

146

107

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“…[2][3][4][5] Recent reports indicate that there is decreased optic disc perfusion and peripapillary capillary density on OCT angiography in patients with chronic glaucoma. 4,[6][7][8][9] This has led to speculation that reduced capillary density from OCT angiography in glaucoma eyes provides evidence for a primary role in the pathogenesis of glaucoma. However, as Schuman pointed out in his commentary on OCT angiography, "recently acquired OCT angiography images still do not answer the question of which comes first: changes in ocular blood flow or optic nerve injury?"…”

Section: Introductionmentioning

confidence: 99%

Optical Coherence Angiographic Demonstration of Retinal Changes From Chronic Optic Neuropathies

Chen

AbouChehade

Iezzi

et al. 2017

Neuro-Ophthalmology

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Glaucoma causes a decrease in peripapillary perfused capillary density on optical coherence tomography (OCT) angiography. However, other chronic optic neuropathies have not been explored with OCT angiography to see if these changes were specific to glaucoma. The authors evaluated OCT angiography in 10 patients who suffered various kinds of chronic optic neuropathies, including optic neuritis and ischaemic optic neuropathy, and found that all optic neuropathies showed a decrease in peripapillary vessel density on OCT angiography, regardless of the aetiology of the optic neuropathy. The peripapillary vessel loss on OCT angiography correlated well with the areas of retinal nerve fibre layer thinning seen on OCT.ARTICLE HISTORY

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“…5 Prelaminar blood perfusion also was reduced in glaucomatous eyes. 6 However, the statistical significance of the OCTA parameters has not been compared to structural parameters, such as the ganglion cell complex or circumpapillary retinal nerve fiber layer thickness (cpNFLT).…”

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confidence: 99%

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

Chihara¹,

Dimitrova

Amano³

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. We evaluate the ability of optical coherence tomography angiography parameters, such as the peripapillary vessel density of the superficial retina and prelaminar flow index of the optic disc (PLFI), to differentiate primary open-angle glaucoma (POAG) and ocular hypertension (OH) from normal eyes. METHODS.The vessel density, PLFI, mean deviation of the visual field, circumpapillary retinal nerve fiber layer thickness (cpNFLT), and global loss volume of the ganglion cell complex were evaluated in one eye of 105 subjects with POAG and OH and normal eyes. The discriminatory powers of these parameters were evaluated based on the area under the curve (AUC) of the receiver operation characteristic curve and multiple comparisons.RESULTS. The vessel density (P < 0.001) and PLFI/unit area (PLFI/UA; P ¼ 0.020) in eyes with POAG were significantly less than in normal eyes. The vessel density in eyes with OH was significantly (P ¼ 0.018) reduced, whereas the PLFI/UA, global loss volume and cpNFLT were unaffected. The AUCs of the vessel density to discriminate glaucoma and OH from normal eyes were 0.832 and 0.724, respectively, and were significantly better than the PLFI/UA, in which the AUCs were 0.662 (P ¼ 0.002) and 0.569 (P ¼ 0.038), respectively. The powers of the vessel density and PLFI/UA to discriminate POAG from normal eyes were inferior to the global loss volume (P ¼ 0.006 and <0.0001) and cpNFLT (P ¼ 0.055 and P < 0.0001, respectively). CONCLUSIONS.The vessel density and PLFI/UA decreased significantly in glaucomatous eyes. The vessel density was more efficient than the PLFI/UA for differentiating glaucoma and OH from normal eyes.

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Microvascular Density in Glaucomatous Eyes With Hemifield Visual Field Defects: An Optical Coherence Tomography Angiography Study

Cited by 214 publications

References 49 publications

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

OCT Angiography of the Peripapillary Retina in Primary Open-Angle Glaucoma

Optical Coherence Angiographic Demonstration of Retinal Changes From Chronic Optic Neuropathies

Discriminatory Power of Superficial Vessel Density and Prelaminar Vascular Flow Index in Eyes With Glaucoma and Ocular Hypertension and Normal Eyes

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