Background/aims To investigate the relationship between ganglion cell complex (GCC) thinning and baseline deep and superficial macular vessel density (VD) in glaucoma.
Methods 97 eyes of 69 primary open-angle glaucoma (POAG) and glaucoma suspect patients from the Diagnostics Innovations in Glaucoma Study with a minimum of 4 visits and 2 years of follow-up after baseline optical coherence tomography angiography (OCTA) examination were included. OCTA 3×3 mm2 macular scans were acquired at each visit and used to calculate superficial and deep parafoveal VD (pfVD) and OCT-based parafoveal GCC (pfGCC) thickness. Association of baseline superficial and deep pfVD with pfGCC thinning rate was evaluated using linear mixed model.
Results The included subjects had a baseline mean visual field mean deviation (95% CI) of −2.9 (–3.7 to –2.1) dB and a mean follow-up period of 3.6 years. In the univariable model, lower baseline superficial pfVD and higher mean intraocular pressure (IOP) during follow-up were significantly associated with a faster pfGCC thinning rate (p<0.05 for all), while deep pfVD was not (p=0.177). In the multivariable model, faster pfGCC thinning was correlated with higher mean IOP during follow-up (β=−0.05, p=0.002) and lower baseline superficial pfVD (β=−0.04, p=0.011). Eyes with a baseline superficial pfVD in the lowest tertile (≤46%) had significantly faster pfGCC loss compared with eyes with baseline superficial pfVD greater than 46% (p=0.015).
Conclusion Lower baseline superficial pfVD, but not deep pfVD, was associated with faster pfGCC thinning in glaucoma. Moreover, superficial macular VD may help predict central macula thinning in patients with glaucoma.
Data availability statement
Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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J-HW and SM are joint first authors.
J-HW and SM contributed equally.
Contributors Concept and design: J-HW, SM and RNW; Acquisition and reviewing of data: J-HW, SM, TN, JAP, AK and LMZ; Analysis or interpretation of data: J-HW, SM, TN, JAP, AK, LMZ and RNW; Drafting of the manuscript: J-HW, SM and TN; Critical revision of the manuscript: all authors; Obtained funding: SM, LMZ and RNW; Supervision: SM and RNW. RNW had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This work is supported by National Institutes of Health/National Eye Institute Grants (R01EY029058, R01EY011008, R01EY026574, R01EY027510), and Core Grant P30EY022589; University of California Tobacco-Related Disease Research Programme (T31IP1511), and an unrestricted grant from Research to Prevent Blindness (New York, NY).
Disclaimer The sponsor or funding organisation had no role in the design or conduct of this research.
Competing interests LMZ reported grants from the National Eye Institute; grants and nonfinancial support from Heidelberg Engineering, non-financial support from Carl Zeiss Meditec, Optovue, and Topcon. RNW reported nonfinancial support from Heidelberg Engineering, Carl Zeiss Meditec, Konan Medical, Optovue, Centervue and Topcon; grants from the National Eye Institute; personal fees from Allergan, Equinox, Nicox and Topcon; all outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.