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.
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 and SM; Acquisition and reviewing of data: J-HW, SM, TN, VM, AK and LMZ; Analysis or interpretation of data: J-HW, SM, TN, LMZ and RNW; Drafting of the manuscript: J-HW and SM; Critical revision of the manuscript: all authors; Obtained funding: SM, LMZ and RNW; Supervision: SM and RNW; Guarantor of the study: RNW.
Funding This work is supported by National Institutes of Health/National Eye Institute Grants R01EY029058, R01EY011008, R01EY019869, R01EY027510, R01EY026574, R01EY018926, 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 Abbvie, Aerie Pharmaceuticals, Allergan, Equinox, Nicox, and Topcon; all outside the submitted work. No other disclosures were reported.
Provenance and peer review Not commissioned; externally peer reviewed.
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