Original article
Regional Comparisons of Optical Coherence Tomography Angiography Vessel Density in Primary Open-Angle Glaucoma

https://doi.org/10.1016/j.ajo.2016.08.030Get rights and content

Purpose

To compare the diagnostic abilities of the vessel densities in optic nerve head (ONH), peripapillary, and macular regions measured using optical coherence tomography angiography (OCTA) in eyes with primary open-angle glaucoma (POAG), and to evaluate the effect of glaucoma severity (based on the mean deviation, MD), optic disc size, and pretreatment intraocular pressure (IOP).

Design

Cross-sectional study.

Methods

Seventy-eight eyes of 53 control subjects and 64 eyes of 39 POAG patients underwent OCTA imaging. Area under receiver operating characteristic (ROC) curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary, and macular regions were analyzed. ROC regression was used to evaluate the effect of covariates on the diagnostic abilities.

Results

The AUCs of ONH vessel densities ranged between 0.59 (superonasal sector) and 0.73 (average inside disc), peripapillary between 0.70 (nasal, superonasal and temporal) and 0.89 (inferotemporal), and macular between 0.56 (nasal) and 0.64 (temporal). AUC of the average peripapillary vessel density was significantly better than the average inside disc (P = .05) and macular (P = .005) measurement. MD showed a negative association with the AUCs of the vessel densities of all regions. Pretreatment IOP (coefficient: 0.09) showed a significant (P < .05) effect on the AUC of ONH vessel density.

Conclusions

Diagnostic ability of the vessel density parameters of OCTA was only moderate. Macular and inside disc densities had significantly lower diagnostic abilities in POAG than the peripapillary density. Diagnostic abilities of vessel densities increased with increasing severity of glaucoma and that of ONH vessel density with higher pretreatment IOPs.

Section snippets

Methods

This was a cross-sectional study conducted at Narayana Nethralaya, a tertiary eye care center in Bengaluru, South India, between September 2015 and March 2016. The methodology adhered to the tenets of the Declaration of Helsinki for research involving human subjects. Written informed consent was obtained from all participants and the study was approved by the Institute's Ethics Committee.

Participants of the study included control subjects and POAG patients. Control subjects were either hospital

Results

One hundred and seventy-one eyes of 102 subjects (86 eyes of 56 subjects diagnosed as normal and 85 eyes of 46 subjects diagnosed as POAG on clinical examination) underwent OCTA imaging with SDOCT. Among these, 19 eyes of 13 patients, in which the optic disc classification on stereophotographs was not glaucomatous optic neuropathy, were excluded. In addition, 20 poor quality disc scans and 25 poor quality macular scans (10 eyes had poor quality of both disc and macular scans) were also

Discussion

In the current study, a 15% reduction was found in the median inside disc vessel density in POAG eyes compared with the normal eyes. Previous studies have reported an ONH vessel density reduction of 10%–34% in glaucomatous eyes.11, 12, 15 Jia and associates also reported that the reduction in ONH vessel density was greater in the temporal part of the ONH (57%), which is devoid of the major retinal vessels, compared with the entire ONH (34%).10 In contrast to that reported by Jia and associates,

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