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Relationship between peripapillary vessel density and visual field in glaucoma: a broken-stick model
  1. Min Kyung Song1,
  2. Joong Won Shin1,
  3. Younhye Jo1,
  4. Hun Jae Won1,
  5. Michael S Kook1,2
  1. 1 Department of Ophthalmology, Asan Medical Center, Seoul, Korea (the Republic of)
  2. 2 University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Michael S Kook, Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-736, Korea; mskook{at}


Background/Aims To determine the tipping point at which peripapillary vessel density (pVD), measured using optical coherence tomography angiography (OCT-A), is associated with detectable visual field (VF) loss in cases of open-angle glaucoma (OAG).

Methods Peripapillary retinal nerve fibre layer (pRNFL) thickness and pVD were measured using OCT and OCT-A in 166 healthy participants, those with suspected glaucoma and patients with early-stage OAG. All participants were Koreans. A broken-stick model was used to determine the tipping points below which pRNFL thickness (pRNFLT) or pVD reduction was associated with significant VF loss. The slopes were computed above and below the tipping points for the relationship between pVD, pRNFLT and VF sensitivity (VFS).

Results Tipping points were detected for pRNFLT globally and in the inferior and superior quadrants, at which there were significant differences between the slopes above and below the tipping points. The slopes above the tipping points were approximately zero. However, no tipping point was found for pVD in the global area or regional sectors.

Conclusion The relationship between pVD and VFS does not show a tipping point. This suggests that the correlation between pVD-VFS may be linear and stronger than that of pRNFLT-VFS, even at the early stage of glaucoma.

  • Glaucoma
  • diagnostic tests/investigation
  • field of vision
  • imaging

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  • Contributors MKS and JWS designed the model and the computational framework and analysed the data. HJW and YJ contributed to the interpretation of the results and revising work critically. MKS wrote the manuscript with input from all authors. MSK conceived the study and was in charge of overall direction and planning.

  • Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Written informed consent was obtained from all subjects.

  • Ethics approval This study was approved by the Asan Medical Center Institutional Review Board and conformed to the principles of the Declaration of Helsinki.

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

  • Data availability statement Data are available upon reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. (

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