Article Text

Download PDFPDF
Optic nerve head vessel density in different stages of pseudoexfoliation disease
  1. Mona Safizadeh1,
  2. Amirreza Shaabani1,
  3. Alireza Kamalipour2,
  4. Masoud Aghsaei Fard1,
  5. Kaileen Yeh2,
  6. Mehdi Yaseri1,
  7. Nikoo Hamzeh1,
  8. Nassim Khatibi1,
  9. Harsha Laxmana Rao3,
  10. Robert Weinreb2,
  11. Sasan Moghimi2
  1. 1 Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  2. 2 Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
  3. 3 Glaucoma, Narayana Nethralaya, Bangalore, India
  1. Correspondence to Sasan Moghimi, Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, CA 92037; Sasanimii{at}


Purpose To evaluate the superficial vascular density of the optic nerve head in different stages of pseudoexfoliation disease using optical coherence tomography angiography (OCTA).

Methods In this cross-sectional study, 57 normal eyes, 41 eyes with pseudoexfoliation syndrome (PXS), 82 eyes with pseudoexfoliation glaucoma (PXG) and 27 non-glaucomatous fellow eyes of PXG (NL-PXG) that had OCTA were included. Circumpapillary RNFL (cpRNFL) thickness and circumpapillary capillary density (cpCD) were compared among the groups after adjusting for confounders using linear-mixed model.

Results PXG eyes had thinner global RNFL and lower cpCD (74.2±14.3 µm and 36.7±10.0%) than control (103.3±8.6 µm and 52.5±2.3%), PXS (96.8±8.8 µm and 51.5±2.3%), and NL-PXG eyes (96.3±11.1 µm and 50.1±3.9%) (p<0.001). After adjustment for age, gender and signal strength index, global cpRNFL thickness was comparable among control, PXS and NL-PXG. NL-PXG had the lowest cpCD (p=0.045) and sectoral cpCD compared to PXS and control eyes. Although cpCD was comparable between control and PXS (p=0.425) eyes, sectoral differences (p=0.009 and 0.004, for inferonasal and temporal-inferior cpCD, respectively) were detectable between the two groups. AUROC for differentiating NL-PXG eyes from normal were better for cpCD (0.78) compared to cpRNLF (0.69).

Conclusions OCTA can detect reduced capillary density before significant changes in cpRNFL in fellow eyes of PXG patients. This can enable earlier detection of glaucomatous loss in pseudoexfoliation disease and enhance management of the disease.

  • Glaucoma
  • Optic Nerve

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors SM, MS and RNW conceived and designed the trial. SM and MS were the chief investigators and oversaw the trial throughout. Data were provided by SM, MS, MF, SM, and MS, MF monitored the data, and SM, HLR, and MY performed analyses.

  • Funding National Institutes of Health/National Eye Institute Grants R01EY029058; Tobacco Related Disease Research Program Grant T31IP1511.

  • Competing interests Weinreb: Aerie Pharmaceuticals (C), Alcon (C), Allergan (C), Bausch & Lomb (C), Eyenovia (C), Unity (C), Heidelberg Engineering (F), Carl Zeiss Meditec (F), Genentech (F), Konan (F), OptoVue (F), Topcon (F), Optos (F), Centervue (F). Rao HL: Santen (C), Carl Zeiss Meditec (C), Allergan (C). Others: none.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

Linked Articles

  • At a glance
    Frank Larkin