Lower baseline parapapillary vessel density in the choroid (pCVD) and choroidal microvasculature dropout (CMvD) in early-stage glaucoma, plus a reduced macular ganglion cell-inner plexiform layer (mGCIPL) at baseline in moderate to advanced glaucoma, were significantly associated with visual field (VF) progression in patients with open-angle glaucoma (OAG), according to a study in the American Journal of Ophthalmology.

The retrospective cohort analysis included 208 eyes of 208 patients with OAG who presented with central visual field (CVF) damage at baseline. Researchers used optical coherence tomography (OCT) angiography to measure circumpapillary and macular vessel density (VD) in the retina, and parapapillary VD in the choroid (pCVD) at baseline. They also measured circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thickness. Finally, they performed Cox proportional hazard analysis to identify clinical factors associated with VF progression by glaucoma stage and evaluated relationships between CVF mean sensitivity (MS) reduction rate at baseline and follow-up.

Investigators found VF progression in 54 eyes (26.0%) during 2.78 years of mean follow-up. They found that lower pCVD (hazard ratio [HR]=0.916; P  =.014) at baseline in eyes with early stage OAG, and a reduced average mGCIPL thickness (mGCIPLT) (HR=0.896; P =.001) in eyes with moderate to advanced glaucoma, were independent predictors of VF progression. The baseline pCVD (β=0.018; P =.028) in eyes with early-stage glaucoma, and the baseline average mGCIPLT (β=0.035; P =.013) in eyes with moderate to advanced glaucoma, were significantly correlated with the rate (dB/year) of CVF MS reduction.


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“Our current study findings demonstrate that a low pCVD and the presence of CMvD at baseline are predictive of subsequent VF deterioration, after controlling for other covariates related to VF progression, in eyes with early-stage glaucoma. Furthermore, we found from our analyses that a lower baseline average mGCIPLT was significantly associated with future VF progression in our subject eyes with moderate to advanced glaucoma,” according to the researchers. “Our findings may therefore have significant clinical implications for the frequent surveillance and aggressive treatment of glaucoma patients having these risk factors at baseline, depending on the stage of glaucoma.”

Study limitations include its retrospective nature, a single center design, and a lack of ethnic diversity among participants.

Reference


Lee JY, Shin JW, Song MK, Hong JW, Kook MS. Baseline vessel density parameters for predicting visual field progression in open-angle glaucoma eyes with central visual field damage. Am J Ophthalmol. Published online December 10, 2021. doi:10.1016/j.ajo.2021.11.028