Quantification of the Peripapillary Microvasculature in Eyes with Glaucomatous Paracentral Visual Field Loss

Purpose: To quantify abnormalities in the peripapillary microvasculature in eyes with primary open-angle glaucoma (POAG) and paracentral visual field (VF) loss. Design: Prospective, cross-sectional study. Participants: Thirty-three POAG patients, including 15 with paracentral VF loss and 18 with peripheral VF loss, and 31 control participants underwent swept-source OCT angiography (OCTA) of the peripapillary region. Methods: The POAG groups were matched by VF mean deviation (MD). The peripapillary microvasculature from the internal limiting membrane to the retinal nerve fiber layer (RNFL) interface was quantified within a 0.70-mm annulus around Bruch's membrane opening after removal of large vessels. Both vessel density (VD) and the integrated OCTA by ratio analysis signal (IOS) suggestive of flow were measured. Regional VD and IOS were measured from the affected hemisphere corresponding to the VF hemifield of more severe loss, which was used to calculate the paracentral total deviation (PaTD), or total deviation within the central 10 degrees. One eye per participant was included. Main Outcome Measures: Difference in peripapillary OCTA measurements between paracentral and peripheral VF loss groups and correlation of peripapillary VD and IOS with PaTD. Results: The POAG groups had matched VF MD (-3.1 +/- 2.5 dB paracentral vs. -2.3 +/- 2.0 dB peripheral; P = 0.31), did not differ in average RNFL thickness (71.1 +/- 14.7 mu m vs. 78.1 +/- 15.0 mu m; P = 0.55), but differed in age (59.2 +/- 9.6 years paracentral vs. 67.4 +/- 6.6 years peripheral; P = 0.02). Compared with control participants, both paracentral and peripheral VF loss groups showed reduced VD (P < 0.001 and P = 0.009, respectively) and IOS (P < 0.001 and P = 0.01, respectively) in the affected hemisphere. Compared with POAG eyes with peripheral VF loss, the paracentral group showed reduced peripapillary VD (38.0 +/- 2.0%, 35.0 +/- 2.2%, respectively; P = 0.001) and IOS (44.3 +/- 3.1%, 40.4 +/- 4.0%, respectively; P = 0.02) in the affected hemisphere. Among all POAG eyes, peripapillary VD and IOS of the affected hemisphere correlated significantly with functional measurement of paracentral loss (PaTD, r = 0.40, P = 0.02; r = 0.45, P = 0.008; respectively). These correlations remained significant after adjusting for age (r = 0.41, P = 0.02; r = 0.47, P = 0.01; respectively). Conclusions: Regional peripapillary microvasculature showed decreased VD and flow in POAG with paracentral loss, supporting its importance in this glaucoma subtype. (C) 2020 by the American Academy of Ophthalmology