Optical Coherence Tomography Angiography and Visual Field Progression in Primary Angle Closure Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Medical Imaging

Background:

• Primary angle closure glaucoma (PACG) is a leading cause of irreversible blindness.
• Assessing visual field (VF) progression is crucial for managing PACG.
• Optical coherence tomography angiography (OCTA) offers novel insights into ocular microvasculature.

Purpose of the Study:

• To investigate the association between OCTA-derived vascular parameters and prior VF progression in PACG patients.
• To identify OCTA biomarkers predictive of glaucoma progression.

Main Methods:

• A cross-sectional study included 46 eyes from 31 PACG patients with at least 5 reliable VF tests over 3 years.
• OCTA imaging was performed to assess whole enface vessel density (disc and macula) and deep-layer microvascular dropout.
• Linear mixed models were used to evaluate the impact of clinical, OCT, and OCTA parameters on the rate of mean deviation (MD) change.

Main Results:

• Lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) were significantly associated with a faster rate of MD decline.
• Older age, systemic hypertension, and diabetes were also linked to faster VF progression.
• Microvascular dropout was observed in 33.3% of the eyes.

Conclusions:

• Reduced superficial vessel density in OCTA is a significant indicator of faster VF progression in PACG.
• OCTA parameters show promise as biomarkers for identifying past VF progression in PACG.
• These findings highlight the potential of OCTA in monitoring glaucoma progression.