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Ocular blood flow biomarkers may predict long-term glaucoma progression
  1. Alice Chandra Verticchio Vercellin1,
  2. Alon Harris1,
  3. Francesco Oddone2,
  4. Brent Siesky1,
  5. George Eckert3,
  6. Aditya Belamkar4,
  7. Gal Antman1,5,
  8. Fani Segev6
  1. 1 Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Glaucoma Unit, IRCCS Fondazione G.B.Bietti, Rome, Italy
  3. 3 Department of Biostatistics abd Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
  4. 4 Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, USA
  5. 5 Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
  6. 6 Ophthalmology, Assuta Ashdod Medical Center, Goldman Medical School, Ben-Gurion University, Be'er Sheva, Israel
  1. Correspondence to Professor Alon Harris, Icahn School of Medicine at Mount Sinai, New York, USA; palonharris{at}


Background/aim To examine the relationship between baseline blood flow biomarkers and long-term open-angle glaucoma (OAG) progression.

Methods 112 patients with early to moderate OAG (mean age 64.9±11.0 years; 68 female) were evaluated at baseline and every 6 months from 2008 to 2013. Biomarkers of retinal capillary blood flow were assessed by Heidelberg retinal flowmetry. Functional disease progression was monitored via Humphrey visual field examinations, defined as two consecutive visits with a mean deviation decrease ≥2 decibels and/or Advanced Glaucoma Intervention Study score increase ≥2 compared with baseline. Structural progression was monitored with optical coherence tomography and Heidelberg retinal tomograph, defined as two consecutive visits with retinal nerve fibre layer thickness decrease ≥8% and/or horizontal or vertical cup/disk ratio increase ≥0.2 compared with baseline. Mixed-model analysis of covariance was used to test for significant change from baseline to 5-year follow-up. Times to functional and structural progression were analysed using Cox proportional hazards models.

Results Lower HRF retinal capillary blood flow in the superior retina was significantly associated with structural progression (p=0.0009).

Conclusion In our OAG sample, baseline lower retinal capillary perfusion in the superior retina was predictive of structural progression after 5 years.

Trial registration number NCT01145911.

  • Glaucoma
  • Imaging
  • Optic Nerve

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors AB, ACVV, AH, BS, GE, GA, FO, FS made substantial contributions to the conception of the work and the acquisition, analysis and interpretation of data for the work. AH is the guarantor of the study.

  • Funding Professor Alon Harris is supported by NIH grants (R01EY030851 and R01EY034718), NYEE Foundation grants, and in part by a Challenge Grant award from Research to Prevent Blindness, NY.

  • Competing interests There are no competing interests. Professor Alon Harris would like to disclose that he received remuneration from AdOM, Qlaris, Cipla for serving as a consultant, and he serves on the board of AdOM and Qlaris. Professor Alon Harris holds an ownership interest in AdOM, Oxymap, Qlaris and SlitLed. All relationships listed above are pursuant to Icahn School of Medicine’s policy on outside activities. The contribution of the author Francesco Oddone was supported by Fondazione Roma and by the Italian Ministry of Health. None of the other authors listed have any financial disclosures.

  • 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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