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Macular, ONH density may predict RNFL deterioration in glaucoma
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Lower macular and optic nerve head vessel density measured by OCT angiography were correlated in a study, with faster rates of retinal nerve fiber layer decline in patients with primary open angle glaucoma.
A correlation was also found with central corneal thickness measurements.
The study was carried out in 132 eyes of 83 patients enrolled in the Diagnostic Innovations in Glaucoma Study and continued for at least 2 years. All subjects underwent OCT-A (AngioVue, Optovue) for macular and optic nerve vessel density and SD-OCT (Heidelberg Engineering) examination for peripapillary retinal nerve fiber layer (RNFL) thickness.
OCT-A parameters, namely macular whole image vessel density (m-wiVD) and optic nerve head whole image vessel density (onh-wiVD), were significantly associated with the rate of RNFL decline over time. Each 1% reduction in m-wiVD and onh-wiVD was associated with 0.11 µm/year and 0.06 µm/year, respectively, faster rate of RNFL thickness decline.
Macular and optic nerve structural parameters, namely lower ganglion cell inner plexiform layer (GCIPL) thickness and lower minimum rim width (MRW), were also correlated with a faster rate of RNFL loss. In addition, average central corneal thickness showed significance in predicting RNFL thickness changes over time: Eyes with thinner corneas had faster slopes of change.
“These findings suggest that assessment of ONH and macular vessel density adds significant information to the evaluation of the risk of glaucoma progression and prediction of rates of change in the disease,” the authors wrote.
This study, they noted, further supports the role of OCT-A, “in the assessment of the risk of progression in patients with POAG.” – by Michela Cimberle
Disclosures: Moghimi reported no relevant financial disclosures. Please see the study for the other authors’ financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
One of the most challenging and critical aspects of managing patients with glaucoma is identifying those at risk of rapid progression. Rates of change greater than -1.5 dB/year in mean deviation (or less than 5%/year in visual field index) can be catastrophic, causing significant functional impairment within years. While vigilance is always warranted, a number of factors (in addition to ocular hypertension) that increase the risk and rate of progression have been identified.
Patients of increased age, African or Hispanic ethnicity, or patients with severe disease that involves both hemispheres or is rapidly progressing at baseline merit careful scrutiny. IOP fluctuations, particularly at relatively low pressures, may increase risk and rate of change. Exfoliation is now recognized as an independent risk factor, while disc hemorrhages and parapapillary atrophy are simultaneously glaucoma signs and harbingers of advancing disease. Low corneal hysteresis has joined thin central corneal thickness as a biomechanical proxy for poor retinal ganglion cell support and increased susceptibility to injury.
In this paper, Moghimi and colleagues suggest that lower OCTA-measured vessel density should accompany cardiovascular disease, systemic hypotension (including over-treated hypertension), and vascular dysregulation (Raynaud’s phenomenon and migraine) as perfusion-related influences.
Identifying risk informs treatment and follow-up decision-making and is a cornerstone of effective glaucoma care.
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