Peripapillary and Macular Vascular Density in Patients With Preperimetric and Early Primary Open Angle Glaucoma

Abstract

Précis: Decreased circumpapillary vascular density (cpVD) and average retinal nerve fiber layer (RNFL) thickness were detected at different locations in eyes with preperimetric glaucoma (PPG). Although RNFL loss was more prominent in preperimetric eyes, in early glaucoma, both cpVD and RNFL thickness showed comparable diagnostic ability.Purpose: To evaluate changes in circumpapillary and macular vascular density and investigate correlations between vascular and structural parameters in PPG and early glaucoma.Method: This cross-sectional study included a total of 27 patients with PPG in 1 eye and early primary open angle glaucoma in the fellow eye, as well as a control group consisting of 27 eyes of 27 healthy volunteers. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RNFL and macular ganglion cell complex measurements were obtained simultaneously with vascular parameters by AngioVue OCTA using the single-scan protocol. cpVD was examined in 8 sectors. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve.Results: In preperimetric eyes, average RNFL thickness and wholeimage vessel density had comparable diagnostic performance (area under the receiver operating characteristic curve = 0.853 and 0.753, respectively). Compared with the control group, PPG eyes had significantly lower RNFL thickness in all quadrants (P < 0.001-0.003) except for the temporal quadrant, whereas cpVD differed only in the nasal inferior and nasal superior sectors (P = 0.001 and 0.041, respectively). In early glaucoma eyes, cpVD differed significantly from controls in all sectors except for the inferotemporal, temporal inferior, and temporal superior sectors, whereas perifoveal macular vascular parameters differed in all quadrants (all P < 0.05). cpVD was strongly correlated with RNFL thickness in the superior, nasal, and temporal quadrants (r = 0.664, 0.698, and 0.649, respectively, P < 0.001) and moderately correlated in the inferior quadrant (r = 0.450, P < 0.001). Conclusion:Although RNFL involvement is valuable in the diagnosis and follow-up of PPG, the change in nasal cpVD has an important place in these patients. The role of macular vascular parameters and macular ganglion cell complex in glaucoma follow-up becomes important in early glaucoma. Longitudinal studies are needed to determine the place of OCTA in the diagnosis and follow-up of glaucoma.

Quantitative Analysis of Ganglion Cell-Inner Plexiform Layer Thickness, Inner Plexiform Layer Integrity, and Macular Vascular Density in High Myopia Using Optical Coherence Tomography Angiography

“…[8] Changes in macular vascular density have been observed in several retinal diseases and are considered an essential parameter in understanding retinal vascular health. [9,10] Given the crucial roles of GC-IPL, IPL thickness, and macular vascular density in assessing retinal health, investigating their relationship in the context of high myopia could provide valuable insights into the underlying mechanisms and potential early indicators of disease progression. Understanding the association between these two parameters may help in the early detection and monitoring of retinal changes associated with high myopia, potentially enabling targeted interventions to preserve visual function and prevent complications.…”

Retinal microvasculature features in patients with migraine: a systematic review and meta-analysis

“…The traditional FFA cannot see this layer of the vascular network, but OCTA can show ( 26 ). In addition, PVD can assess ischemia and its potential role in glaucoma, and precise details of these capillaries can be seen on OCTA but not on conventional FFA, which is a clear advantage of OCTA over conventional imaging modalities ( 27 ). The FAZ refers to the area surrounded by the continuous capillary plexus of the retina without any capillary structure itself, and its morphology and changes in peripheral capillary density reflect the degree of macular ischemia and are commonly used indicators for OCTA to evaluate the severity and progression of angioretinopathy ( 28 ).…”

Factors Associated with Vascular Changes at the Level of Retinal Ganglion Cell Axon versus Soma/Dendrite in Glaucoma Patients

“…Additionally, deep macular VD is related to visual field (VF) progression and paracentral scotoma, independent of structural parameters [ 12 , 13 ]. However, various terms have been used to describe the layers of macular VD, which are not uniform, as different OCTA devices have been used (AngioVue OCTA -Optovue Inc. Fremont, CA, USA; AngioPlex–Zeiss Meditec, Inc., Dublin, CA, USA; DRI OCT Triton, Topcon, Tokyo, Japan) to evaluate macular VD changes in many studies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Automated layer segmentation applied to OCT instrument software has shown the superficial macular VD comprising mainly of RNFL, GCL, and IPL from the internal limiting membrane (ILM) to the inner border of the inner nuclear layer (INL).…”