Optical Coherence Tomography Angiography Compared With Optical Coherence Tomography Macular Measurements for Detection of Glaucoma

Abstract

IMPORTANCE Whether optical coherence tomography angiography (OCT-A) outperforms OCT to detect glaucoma remains inconclusive. OBJECTIVE To compare (1) the diagnostic performance for detection of glaucoma and (2) the structure-function association between inner macular vessel density and inner macular thickness. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study included 115 patients with glaucoma and 35 healthy individuals for measurements of retinal thickness and retinal vessel density, segmented between the anterior boundary of internal limiting membrane and the posterior boundary of the inner plexiform layer, over the 3 × 3-mm 2 macula using swept-source OCT. All participants were Chinese. Visual sensitivity corresponding to the 3 × 3-mm 2 macular region was expressed in unlogged 1/lambert for investigation of the structure-function associations. Diagnostic performance was evaluated with area under the receiver operating characteristic curves (AUCs). The study was conducted between January 12, 2016, and December 12, 2016. MAIN OUTCOMES AND MEASURESArea under the receiver operating characteristic curve and R 2 analysis. RESULTSOf the 115 patients with glaucoma, 42 (36.5%) were women (mean [SD] age, 53.5 [13.4] years); of the 35 individuals with healthy eyes, 25 (71.4%) were women (age, 60.6 [5.9] years). Inner macular vessel density and thickness were 4.3% (95% CI, 2.4%-6.1%) and 21.1 μm (95% CI, 17.4-24.9 μm) smaller, respectively, in eyes with glaucoma compared with healthy eyes. The AUC of mean inner macular thickness for glaucoma detection was greater than that of mean inner macular vessel density (difference, 0.17; 95% CI, 0.01-0.31; P = .03). At 90% specificity, the sensitivity of mean inner macular thicknesses for detection of glaucoma was greater than that of mean inner macular vessel densities (difference, 29.2%; 95% CI, 11.5%-64.6%; P = .02). The strength of the structure-function association was stronger for mean inner macular thickness than mean inner macular vessel density in the linear (difference in R 2 = 0.38; 95% CI, 0.22-0.54; P < .001) and nonlinear (difference in R 2 = 0.36; 95% CI, 0.21-0.51; P < .001) regression models.CONCLUSIONS AND RELEVANCE In this study, OCT measurement of inner macular thickness shows a higher diagnostic performance to detect glaucoma and a stronger structure-function association than the currently used OCT-A measurement of inner macular vessel density. These findings may suggest that OCT-A of the macula has a limited role in the diagnostic evaluation of glaucoma.

Macular vessel density versus ganglion cell complex thickness for detection of early primary open-angle glaucoma

“…The AUROCs of wiVD and GCC thickness were comparable in our study, which is consistent with Hou et al's results [30]. However, other studies have reported that macular VD performed worse than GCC thickness in differentiating between glaucoma from healthy eyes [9,13,15,36]. The inconsistency may be attributed to the fact that the glaucoma severities differed from our study or the fact that the regions of interest for macular VD measurement and GCC thickness were not the same.…”

Optical Coherence Tomography Angiography in Mice: Quantitative Analysis After Experimental Models of Retinal Damage

“…[29][30][31] Nonetheless, our results from three models of RGC loss (i.e., optic nerve transection, optic nerve crush, and NMDA injection) sharply contrast those in glaucoma patients where there is a dropout of capillaries in the SVP that corresponds to areas of both structural and functional damage 6,32,33 ; however, whether changes in retinal perfusion precede or follow clinically measured neuroretinal rim or nerve fiber layer loss remains to be determined. 34 The implementation of OCT-A quantification and reproducibility in healthy rodents has been described previously by other groups, but most studies have either analyzed the superficial plexus to include the ICP or incompletely determined inter-and intrasession variability. [35][36][37][38] We analyzed OCT-A images based on the recognized vascular plexuses in mice, 14 an approach that should be more suited for assessing changes in the individual vascular plexuses.…”

Diagnostic ability of vessel density measured by spectral-domain optical coherence tomography angiography for glaucoma in patients with high myopia

“…The retinal nerve fibre layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) can also be mistaken for glaucoma as they increase in thinness as the axial length increases 4,5 .Spectral-domain optical coherence tomography (SD-OCT) has grown in importance in diagnosing glaucoma, allowing clinicians to assess structural changes in the optic disc and macula 6-10 . Further, recent studies have shown that peripapillary vessel density (VD) and macular VD, as measured by OCT angiography (OCTA), in glaucoma eyes are reduced 11,12 . Interestingly, a recent study reported that peripapillary VD well correlated with VF defects in both non-highly and highly myopic eyes 13 .…”