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Peripapillary perfused capillary density in primary open-angle glaucoma across disease stage: an optical coherence tomography angiography study
  1. Lawrence S Geyman1,2,
  2. Reena A Garg1,
  3. Yanin Suwan1,3,
  4. Vivek Trivedi4,
  5. Brian D Krawitz1,2,
  6. Shelley Mo1,2,
  7. Alexander Pinhas5,
  8. Apichat Tantraworasin2,6,
  9. Toco Y P Chui1,
  10. Robert Ritch1,
  11. Richard B Rosen1
  1. 1 Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
  2. 2 Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3 Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  4. 4 New York University, New York, New York, USA
  5. 5 Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
  6. 6 Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  1. Correspondence to Dr Richard B Rosen, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, 310 East 14th Street, 5th Floor, South Building, New York, NY 10003, USA; rrosen{at}


Aims To assess peripapillary perfused capillary density (PCD) in primary open-angle glaucoma (POAG) across stage of disease.

Methods In this observational, cross-sectional study, 60 eyes with varying stages of POAG and 24 control eyes were imaged on a spectral domain optical coherence tomography angiography system (AngioVue, Optovue, Fremont, California, USA) generating images centred on the optic nerve head. Major blood vessels were removed using custom automated software. PCD was calculated as a percentage as the ratio of pixels associated with perfused capillaries to the total number of pixels in the corresponding region-of-interest (ROI). Analysis of covariance was used to compare PCD among the subject groups and control for possible covariates. Area under the receiver operating characteristic curve (AROC) and sensitivity at 95% specificity were calculated to assess the capability of PCD to distinguish mild glaucoma from control. The Pearson's product-moment correlation coefficient was used to assess correlations between PCD and circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and visual field mean deviation (MD).

Results PCD demonstrated a progressive stepwise decrease from control eyes throughout worsening POAG stage at all ROIs. PCD demonstrated AROC and sensitivity values comparable to cpRNFLT and visual field parameters and exhibited significant correlations with cpRNFLT and MD at all corresponding ROIs.

Conclusions PCD displayed significant correlations with morphological and functional indices and exhibited diagnostic capabilities comparable to currently employed clinical variables. Our preliminary results suggest that PCD analysis may prove to be a useful tool in monitoring POAG across stage and identifying early POAG.

  • Glaucoma
  • Imaging
  • Optic Nerve

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  • Meeting presentation: This study was presented in part at the Association for Research in Vision and Ophthalmology Imaging in the Eye Conference (Geyman L, Krawitz B, Garg R, Trivedi V, Mo S, Suwan Y, Pinhas A, Chui TY, Ritch R, Rosen RB. Radial peripapillary capillary density within the four peripapillary quadrants in primary open-angle glaucoma. ARVO Imaging in the Eye Conference. April 2016. Seattle, Washington, USA).

  • Contributors LSG: planning, conduct, reporting. RG: planning, conduct, reporting. YS: planning, conduct, reporting. VT: conduct. BDK: conduct. SMo: conduct. AP: planning, reporting. AT: conduct, reporting. TYPC: conduct, reporting. RR: planning, reporting. RBR: planning, reporting.

  • Funding This work was supported by the New York Eye and Ear Infirmary Chairman's Research Fund, New York, NY; the Marrus Family Foundation, New York, NY and the Jane Banks Research Fund of the New York Glaucoma Research Institute, New York, NY.

  • Competing interests RR: reports personal fees from iSonic Medical, personal fees from Sensimed AG, personal fees from Aeon Astron, non-financial support from GLIA, LLC, other support from Xoma (USA), LLC, other support from Guardion Health Sciences, other support from Mobius Therapeutics, other support from Intelon Optics, personal fees from Ocular Instruments, ownership interest from Diopsys and ownership interest from International Eye Wellness Institute, outside the submitted work; RBR: reports personal fees from Clarity Medical Systems, personal fees from Nano Retina, personal fees from Ocata Therapeutics and personal fees from Optovue, outside the submitted work.

  • Ethics approval Institutional Review Board of the New York Eye and Ear Infirmary of Mount Sinai.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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