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Longitudinal OCTA vessel density loss in macula and optic nerve head in healthy, glaucoma suspect and established glaucoma eyes
  1. Jo-Hsuan Wu1,
  2. Sasan Moghimi1,
  3. Takashi Nishida1,
  4. Mohsen Adelpour1,
  5. Alireza Kamalipour1,
  6. Gopikasree Gunasegaran1,
  7. Linda M Zangwill2,
  8. Robert N Weinreb1
  1. 1Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  2. 2Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Robert N Weinreb; rweinreb{at}ucsd.edu

Abstract

Background/aims To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes.

Methods Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes.

Results There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:−0.72 to −0.92 %/year) and wiCD (range:−0.28 to −0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R2=0.27 vs 0.16).

Conclusions In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.

  • Glaucoma
  • Macula

Data availability statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Data are available on reasonable request.

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Data availability statement

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Data are available on reasonable request.

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Footnotes

  • J-HW and SM contributed equally.

  • Contributors Study concept and design: J-HW, TN and LMZ. Data collection and analysis: J-HW, SM and TN. Data interpretation: J-HW, SM, TN, MA, LMZ and RNW. Manuscript drafting: J-HW and TN. Critical revision of the manuscript: J-HW, SM, TN, MA, LMZ and RNW. Guarantors: SM and RNW.

  • Funding This work is supported by National Institutes of Health/National Eye Institute Grants R01EY029058, R01EY011008, R01EY019869, R01EY027510, R01EY026574, R01EY018926, R01EY034148, Core grant P30EY022589; University of California Tobacco Related Disease Research Program grant #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 SM reported grants from the National Eye Institute. TN is a consultant for Topcon. LMZ reported grants from the National Institutes of Health, National Eye Institute; grants from Heidelberg Engineering and nonfinancial support from Carl Zeiss Meditec, Optovue, Heidelberg Engineering and Topcon; and patents from Carl Zeiss Meditec and AiSight Health; cofounder and board member AiSight Health. LMZ is a consultant for Abbvie and Topcon Medical Systems. RNW is a consultant for Abbvie, Alcon, Allergan, Amydis, Editas, Equinox, Eyenovia, Iantrek, IOPtic, Implandata, iSTAR Medical, Nicox, Santen, Ten Point and Topcon. He receives grants from the National Eye Institute and National Institute of Minority Health Disparities and Research to Prevent Blindness (New York, NY). He reports patents licensed by UCSD to Toromedes and Carl Zeiss Meditec from UCSD; founder of Toromedes; all outside the submitted work. No other disclosures were reported.

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

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