Quantification of localised vascular wedge-shaped defects in glaucoma

Area of Science:

• Ophthalmology
• Vascular Biology
• Glaucoma Research

Background:

• Vascular dysfunction is a key factor in glaucoma pathogenesis.
• Localized wedge-shaped vascular defects have been previously noted in glaucoma.
• This study quantifies these defects in relation to primary open angle glaucoma (POAG).

Purpose of the Study:

• To investigate the prevalence and characteristics of vascular wedge defects in POAG.
• To correlate vascular wedge defects with POAG parameters, including RNFL and GCLIPL thickness, and visual field loss.

Main Methods:

• Inclusion of 608 eyes from 351 participants (POAG suspects/patients and controls).
• Observation of vascular wedge defects using optical coherence tomography angiography (OCTA).
• Quantification of wedge parameters, vessel densities, RNFL, GCLIPL, and visual field data.

Main Results:

• Vascular wedge defects were found in 13.2% and 19.7% of eyes in two POAG cohorts, and absent in controls.
• Defects were predominantly inferotemporal (80%) and present across all POAG stages.
• Association of wedge defects with visual field loss, thinner RNFL and GCLIPL, and focal RNFL loss.

Conclusions:

• Vascular wedge defects are present in all stages of POAG, preceding functional vision changes.
• These defects show strong concordance with focal RNFL loss.
• Further research is warranted to understand the temporal relationship between these defects and clinical POAG measures.