Optical Microangiography and Progressive Retinal Nerve Fiber Layer Loss in Primary Open Angle Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Optical Imaging

Background:

• Primary open angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Retinal nerve fiber layer (RNFL) loss is a key indicator of glaucoma progression.
• Early detection of RNFL loss is crucial for timely intervention.

Purpose of the Study:

• To investigate the association between optical microangiography (OMAG) measurements and the rate of progressive RNFL loss in patients with POAG.
• To determine if OMAG-derived parameters can predict glaucoma progression.
• To evaluate the clinical utility of OMAG in managing POAG.

Main Methods:

• A prospective case series study involving 40 patients (64 eyes) with mild to moderate POAG.
• Longitudinal follow-up for at least 2 years with a minimum of 3 optical coherence tomography (OCT) examinations.
• OMAG imaging performed at baseline to assess peripapillary and macular perfusion density (PD) and vessel density (VD).
• Linear mixed models used to evaluate the effect of clinical parameters and OMAG measurements on RNFL change rate.

Main Results:

• Lower baseline peripapillary perfusion density (PD) was significantly associated with a faster rate of RNFL loss (coefficient = 0.08, P = 0.01).
• Lower baseline peripapillary vessel density (VD) was also significantly associated with a faster rate of RNFL loss (coefficient = 0.21, P = 0.02).
• The average rate of RNFL change was -1.8 ± 0.6 µm/y.

Conclusions:

• Baseline peripapillary PD and VD measured by OMAG are significant predictors of RNFL loss rate in POAG.
• OMAG imaging offers valuable insights into glaucoma progression risk.
• OMAG can help identify patients at higher risk of disease worsening, aiding in personalized treatment strategies.