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Clinical science
Association of foveal avascular zone area withstructural and functional progression in glaucoma patients
  1. Fei Li1,
  2. Fengbin Lin1,
  3. Kai Gao1,
  4. Weijing Cheng1,
  5. Yunhe Song1,
  6. Yuhong Liu1,
  7. Yu Meng Wang2,
  8. Alexander Lam2,
  9. Clement C Tham2,
  10. Carol Cheung2,
  11. Xiulan Zhang1,
  12. Linda M. Zangwill3
  1. 1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  2. 2 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
  3. 3 Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA
  1. Correspondence to Professor Xiulan Zhang, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; zhangxl2{at}mail.sysu.edu.cn; Dr Carol Cheung, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; carolcheung{at}cuhk.edu.hk

Abstract

Background To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina and optic disc are associated with glaucoma progression risk.

Methods A total of 238 eyes from 119 patients with open angle glaucoma or ocular hypertension, and no history of systemic hypertension or diabetes mellitus were included. All participants underwent OCTA imaging with a swept-source OCT (DRI-OCT 1, Topcon, Japan). OCTA metrics of superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macular region, and radial peripapillary capillary network of the optic disc were measured by a customised MATLAB program to obtain foveal avascular zone (FAZ) area, FAZ circularity and capillary density of SCP/DCP, and capillary density of the peripapillary region. Relationships between baseline OCTA metrics, visual field (VF) metrics, intraocular pressure fluctuation and risk of glaucoma progression were analysed with the Cox proportional hazards model. A frailty model was used to adjust for intereye correlation.

Results During a mean follow-up duration of 29.39 months (range 12–56 months), 50, 48 and 16 eyes were determined to have retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL) and VF progression respectively. FAZ area per SD increase at baseline were significantly associated with both RNFL thinning (HR 1.73 95% CI 1.04 to 2.90); p=0.036) and GC-IPL thinning (HR 2.62, 95% CI 1.59 to 4.31; p<0.001), after adjusting for age, axial length and other potential confounding factors. VF progression was associated with age (HR 1.05, 95% CI 1.02 to 1.08; p<0.001) and mean deviation value (HR 0.91, 95% CI 0.84 to 0.98; p=0.010), but not with any OCTA metrics.

Conclusion Enlarged FAZ area measured by OCTA was associated with a higher risk of RNFL and GC-IPL thinning associated with glaucoma, but not with functional deterioration in glaucoma.

  • glaucoma
  • imaging

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/bjophthalmol-2020-318065

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors Study design: XZ, CC, LMZ, FLi; Data collection: FLi, FLin, KG, YS, YL; Data analysis and interpretation: XZ, CC, LMZ, FLi, FLin, YMW, AL; Manuscript drafting and revision: XZ, LMZ, CC, CCT, FLi, YMW.

    • Funding This study was supported by the Science and Technology Program of Guangzhou (201803010066).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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