Progressive Vessel Density Reduction on OCT Angiography in Glaucoma Eyes with Disc Hemorrhages

Purpose: To identify longitudinal changes in peripapillary and parafoveal vessel density (VD) measured by OCT angiography (OCTA) in primary open-angle glaucoma (POAG) eyes with disc hemorrhages (DHs). Design: Prospective cohort study conducted from August 2016 through August 2020 Participants: Eighteen Asian-Indian participants with POAG (18 eyes) who sought treatment at the clinic with a single DH in the peripapillary region were recruited consecutively. Methods: The study was conducted at a tertiary eye care center. All participants who were recruited underwent a baseline OCT and OCTA, which were repeated every 4 to 6 months. Main Outcome Measures: Peripapillary VD and retinal nerve fiber layer (RNFL) thickness, parafoveal VD and ganglion celleinner plexiform layer (GCIPL) thickness in the DH sector, and the corresponding mirror-image sector across the horizontal meridian (control) were evaluated over time using linear mixed-effects models. Results: The baseline average RNFL thickness was 79 +/- 9 mm. Mean duration of follow-up was 2.6 +/- 0.7 years. In the DH sector, all VD and structural parameters showed a significant negative slope (P < 0.01). In the control sector, the slopes of the structural parameters (RNFL and GCIPL thickness) were not significant (P > 0.05), but the rate of change of the peripapillary and parafoveal VDs were significant (P < 0.01). The rate of change of peripapillary VD was greater in the DH sector compared with the non-DH sector (-2.86 +/- 0.6%/year vs. -1.71 +/- 0.7%/year; P < 0.01). However, the parafoveal VD slopes did not differ significantly between DH and control sectors (-2.9 +/- 0.17%/year vs. -2.8 +/- 0.8%/year; P = 0.51). Conclusions: Eyes with POAG harboring a DH showed not only progressive RNFL and GCIPL loss in the DH sector, but also progressive peripapillary and parafoveal VD reduction in the DH and non-DH regions as documented on OCTA. Ophthalmology Glaucoma 2022;5:421-427 (c) 2021 by the American Academy of Ophthalmology