RESUMEN
PURPOSE: To explore the association between progressive peripapillary capillary vessel density (pcVD) reduction and the progression of visual field (VF) impairment in individuals with normal tension glaucoma (NTG). DESIGN: Prospective cohort study. METHODS: The study enrolled 110 participants with one eye each, totalling 110 NTG eyes. VF defects were evaluated using standard automated perimetry mean deviation (MD), while pcVD measurements were obtained using optical coherence tomography angiography throughout the follow-up period. Estimates of VF progression were determined by event-based and trend-based analyses. Fast VF progression was defined as an MD slope steeper than -0.5 dB/year, while the slow progression or stable VF was defined as an MD slope better or equal to -0.25 dB/year. Linear mixed-effects models were employed to analyse the rates of change in pcVD reduction and VF MD decline over time. Additionally, univariable and multivariable linear models were used to examine the relationship between pcVD changes and VF loss rates in NTG. RESULTS: Slow VF progression or stable VF was observed in 45% of subjects, while 25% had moderate progression and 30% showed fast progression. Patients with VF progression exhibited faster rate of pcVD reduction in peripapillary global region (-0.73 ± 0.40%/year vs. -0.56 ± 0.35%/year, p = 0.022). Moreover, this rate positively correlated with VF MD decline in NTG (estimate 0.278, 95% CI 0.122-0.433, p = 0.001). CONCLUSION: In individuals with NTG, faster VF progression was linked to a quicker reduction in pcVD, suggesting a positive correlation between pcVD decline and VF deterioration.
RESUMEN
PURPOSE: To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina are associated with the development of visual field (VF) loss in the fellow eyes of normal tension glaucoma (NTG) patients with unilateral VF loss. METHODS: A longitudinal study was conducted in which 61 eyes with normal VF (mean VF mean deviation -0.7±1.6 dB) from 61 NTG patients were included. All subjects underwent OCTA imaging, spectral-domain-OCT imaging and VF testing. OCTA metrics of superficial capillary plexus and deep capillary plexus (DCP) in the macular region were measured. Relationships between baseline OCTA metrics, demographics and ocular characteristics and the risk of VF glaucoma progression were analysed with a Cox proportional hazards model. RESULTS: During a mean follow-up of 38 months, 11 fellow eyes (18.0%) with normal VF at baseline were determined to have VF progression, while 21.3% of affected eyes had VF progression. After adjustment for potential confounding factors, decreased baseline DCP in the fellow eyes was significantly associated with future VF progression (HR 1.33, 95% CI 1.03 to 1.73, p=0.031). CONCLUSION: Decreased DCP was associated with a higher risk of developing VF damage in NTG patients with unilateral VF loss. Assessments of DCP may help improve the evaluation of the risk of functional deterioration in fellow eyes with an initially normal VF.
RESUMEN
PURPOSE: To characterize and compare the longitudinal change of macular vessel density (VD) in primary open angle glaucoma (POAG) eyes across different disease stages. METHODS: This is a sub-analysis of a prospective cohort study. A total of 103 eyes (53 eyes in the mild stage, 50 eyes in the moderate-to-advanced stage) of 75 POAG patients followed for more than 1 year with at least 2 qualified optical coherence tomography (OCT) angiography (OCTA) images were included. The rates of macular VD change were determined by linear regression and compared using the generalized linear mixed models between groups. Mixed effect models were used to evaluate the demographic and ocular parameters associated with the VD loss rate. RESULTS: With a mean follow-up time of 2.36 years, the rates of macular VD change were significantly different from zero in both groups. The rates of macular VD loss were significantly faster in moderate-to-advanced stage group than in mild stage group in whole image (-2.46%/yr vs -1.47%/yr, p=0.002), superior hemifield (-2.42%/yr vs -1.30%/yr, p=0.001), para fovea (-2.35%/yr vs -1.26, p=0.001), superior (-2.20%/yr vs -1.01%/yr, p=0.002), nasal (-2.41%/yr vs -1.04%/yr p=0.001), inferior (-2.46%/yr vs -1.43%/yr, p=0.018) and temporal sectors (-2.32%/yr vs -1.58%/yr, p=0.012). Baseline mean deviation (MD) and OCT parameters were associated with the rates of macular VD loss. CONCLUSIONS: OCTA measurements could detect vascular deterioration over time in POAG eyes at different stages. The rates of macular VD loss were significantly faster in more advanced POAG eyes.
