Background/aims To investigate the association of macular optical coherence tomography (OCT)/OCT angiography (OCTA) parameters with visual acuity (VA) in glaucoma.

Methods 144 pseudophakic primary open-angle glaucoma eyes were included. Foveal (fVD), parafoveal (pf), perifoveal (perifVD) and whole-image vessel densities (wiVD) of superficial and deep layers, and their corresponding ganglion cell complex (GCC) thicknesses were obtained from OCTA 6×6 mm² macula scans. Foveal avascular zone (FAZ) area, FAZ circumference and foveal density-300 (FD300) were measured. Correlation between OCT/OCTA parameters and Logarithm of the Minimum Angle of Resolution VA (logMAR VA) in early and moderate-advanced glaucoma was evaluated with age and Signal Strength Index-adjusted mixed models. Area under receiver operating characteristic (AUC) was used to evaluate discriminative power of OCT/OCTA for decreased VA (<20/25).

Results In early glaucoma (80 eyes), no parameter correlated with VA. In moderate-advanced glaucoma (64 eyes), greater FAZ area (β=0.228) and circumference (β=0.063) correlated with worse VA (p<0.05), but not FD300. fThinner sectoral and global GCC was associated with worse VA (β=0.002–0.003, p<0.05), except for inferior hemifield perifGCC and wiGCC. For VD, lower superior hemifield superficial perifVD and wiVD (β=0.007–0.008) and deep fVD (β=0.004) correlated with worse VA (p<0.05). OCT/OCTA parameters showed modest ability to discriminate decreased VA, with the superior hemifield performing better than the inferior hemifield. In early glaucoma, GCC and VD showed similar discrimination (AUC=0.67–0.77). In moderate-advanced glaucoma, fGCC and pfGCC yielded higher AUC (0.75–0.81) than VD (AUC=0.63–0.72).

Conclusions Some macular OCT/OCTA parameters were associated with VA in moderate-advanced, but not early glaucoma. These structural parameters may help identify glaucoma patients with impaired vision and reduced quality of life.

Trial registration number NCT00221897.