Microangiography Values Associated With Retinal Layer Loss in Eyes With Glaucoma

Eye testing using a OCT machine
CARDIFF, UNITED KINGDOM – APRIL 28: An An optician carrying out an eye test using a Optical Coherence Tomography (OCT) machine on April 28, 2015 in Cardiff, United Kingdom. (Photo by Matthew Horwood/Getty Images)
Peripapillary vessel and perfusion density, age, gender, and disc hemorrhage served as prognostic factors in predicting GCIPL loss.

Patients with primary open angle glaucoma (POAG) who had lower baseline peripapillary optical microangiography (OMAG) measurements experience faster rates of ganglion cell-inner plexiform layer (GCIPL) loss, according to findings published in American Journal of Ophthalmology.

Researchers recruited healthy control group participants, patients with different subtypes of glaucoma, and glaucoma suspects for the study. Clinicians evaluated all participants for clinical characteristics with both functional and imaging tests every 6 to12 months. In total, 38 patients with POAG underwent analysis for GCIPL loss.

Patients were aged mean 59.6±11.4 years, 31 were men, 42.1% had diabetes mellitus, 39.5% hypertension, baseline hemifield mean deviation was -5.2±2.8 dB, quadrant retinal nerve fiber layer (RNFL) thickness was 94.5±20.0 μm, and GCIPL thickness 72.4±8.7 μm.

Baseline GCIPL revealed an association with baseline RNFL and GCIPL thickness, peripapillary and macular perfusion (P <.001), vessel densities (P <.001), spherical equivalent (P =.003), and mean deviation (P =.03).

The rate of GCIPL thickness change was -0.97 ± 0.15 μm/year (P <.001) with loss occurring more rapidly in the inferior sector (mean, -1.03; 95% CI, -1.39 to -0.67 μm/year) than in the superior sector (mean, -0.90; 95% CI, -1.26 to -0.54 μm/year).

Predictors of change in GCIPL loss included peripapillary perfusion density (coefficient; 0.04; P =.01), age (coefficient; -0.03; P =.02), presence of disc hemorrhage (coefficient; -0.93; P =.03), peripapillary vessel density (coefficient; 0.09; P =.04), and gender (coefficient; 0.77; P =.05).

Models for predicting the change in GCIPL found a combination of age (coefficient; -0.03; P =.007) and peripapillary perfusion density (coefficient; 0.04; P =.01), or age (coefficient; −0.03; P =.006) and peripapillary vessel density (coefficient; 0.09; P =.05) to be significant predictors.

A 1% lower baseline peripapillary perfusion density was associated with an increased 0.04 μm/year GCIPL loss (P =.01), and a 1 mm/mm2 lower peripapillary vessel density was associated with an increased 0.09 μm/year GCIPL loss (P =.05).

“Lower baseline peripapillary, but not macular, perfusion and vessel density measured using OMAG were significantly associated with a faster rate of GCIPL loss in POAG patients with mild to moderate severity of functional damage,” according to investigators. “Therefore, OMAG imaging may provide useful information about the risk of glaucoma progression and the rate of disease worsening.”

Study limitations include a small sample size, single center design, and dissimilar topography in the area of VF (180°), RNFL quadrant (90°), optical coherence tomography angiography (OCT-A) quadrant (90°) and GCIPL sector (60°).

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures


Rao HL, Dasari S, Puttaiah NK, et al. Optical microangiography and progressive ganglion cell-inner plexiform layer loss in primary open angle glaucoma. Am J Ophthalmol. Published online December 10, 2021. doi:10.1016/j.ajo.2021.11.029