Adeleh Yarmohammadi1, Linda M Zangwill1, Alberto Diniz-Filho1, Min Hee Suh2, Siamak Yousefi1, Luke J Saunders1, Akram Belghith1, Patricia Isabel C Manalastas1, Felipe A Medeiros1, Robert N Weinreb3. 1. Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California. 2. Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California; Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. 3. Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, California. Electronic address: rweinreb@ucsd.edu.
Abstract
PURPOSE: To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. DESIGN: Observational, cross-sectional study. PARTICIPANTS: A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. METHODS: All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). MAIN OUTCOME MEASURES: Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. RESULTS: Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. CONCLUSIONS: Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.
PURPOSE: To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. DESIGN: Observational, cross-sectional study. PARTICIPANTS: A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucomapatients enrolled in the Diagnostic Innovations in Glaucoma Study. METHODS: All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). MAIN OUTCOME MEASURES: Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. RESULTS: Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. CONCLUSIONS: Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.
Authors: Christopher Bowd; Linda M Zangwill; Felipe A Medeiros; Ivan M Tavares; Esther M Hoffmann; Rupert R Bourne; Pamela A Sample; Robert N Weinreb Journal: Invest Ophthalmol Vis Sci Date: 2006-07 Impact factor: 4.799
Authors: Gustavo C Munguba; Sanja Galeb; Yuan Liu; David C Landy; Daisy Lam; Andrew Camp; Sinthia Samad; Mary L Tapia; Richard K Lee Journal: Invest Ophthalmol Vis Sci Date: 2014-09-16 Impact factor: 4.799
Authors: Liang Liu; Yali Jia; Hana L Takusagawa; Alex D Pechauer; Beth Edmunds; Lorinna Lombardi; Ellen Davis; John C Morrison; David Huang Journal: JAMA Ophthalmol Date: 2015-09 Impact factor: 7.389
Authors: Yali Jia; Eric Wei; Xiaogang Wang; Xinbo Zhang; John C Morrison; Mansi Parikh; Lori H Lombardi; Devin M Gattey; Rebecca L Armour; Beth Edmunds; Martin F Kraus; James G Fujimoto; David Huang Journal: Ophthalmology Date: 2014-03-12 Impact factor: 12.079
Authors: Ryuna Chang; Andrew J Nelson; Vivian LeTran; Brian Vu; Bruce Burkemper; Zhongdi Chu; Ali Fard; Amir H Kashani; Benjamin Y Xu; Ruikang K Wang; Rohit Varma; Grace M Richter Journal: Am J Ophthalmol Date: 2019-06-21 Impact factor: 5.258
Authors: Adeleh Yarmohammadi; Linda M Zangwill; Alberto Diniz-Filho; Luke J Saunders; Min Hee Suh; Zhichao Wu; Patricia Isabel C Manalastas; Tadamichi Akagi; Felipe A Medeiros; Robert N Weinreb Journal: Ophthalmology Date: 2017-02-10 Impact factor: 12.079
Authors: Patricia I C Manalastas; Linda M Zangwill; Fabio B Daga; Mark A Christopher; Luke J Saunders; Takuhei Shoji; Tadamichi Akagi; Rafaella C Penteado; Adeleh Yarmohammadi; Min H Suh; Felipe A Medeiros; Robert N Weinreb Journal: J Glaucoma Date: 2018-03 Impact factor: 2.503
Authors: Liang Liu; Beth Edmunds; Hana L Takusagawa; Shandiz Tehrani; Lorinna H Lombardi; John C Morrison; Yali Jia; David Huang Journal: Am J Ophthalmol Date: 2019-06-03 Impact factor: 5.258
Authors: Takuhei Shoji; Linda M Zangwill; Tadamichi Akagi; Luke J Saunders; Adeleh Yarmohammadi; Patricia Isabel C Manalastas; Rafaella C Penteado; Robert N Weinreb Journal: Am J Ophthalmol Date: 2017-07-20 Impact factor: 5.258
Authors: Patricia I C Manalastas; Linda M Zangwill; Luke J Saunders; Kaweh Mansouri; Akram Belghith; Min Hee Suh; Adeleh Yarmohammadi; Rafaella C Penteado; Tadamichi Akagi; Takuhei Shoji; Robert N Weinreb Journal: J Glaucoma Date: 2017-10 Impact factor: 2.503