The repeatability of macular and peripapillary vessel density in participants with different severities of glaucoma

To investigate the repeatability of optical coherence tomography angiography (OCTA) parameters in participants with different severities of glaucoma.

Subjects with open-angle glaucoma were enrolled prospectively and categorised into mild (mean deviation [MD] of 24-2 visual field test ≥ -6 dB), moderate to advanced (-6 > MD ≥ -20 dB) and severe glaucoma groups (MD < -20 dB). OCTA was performed three times within a single visit to obtain superficial and deep macular vessel density (VD) and peripapillary vessel and capillary density. The association between the coefficient of variation (CoV) and intraclass correlation coefficient (ICC) of these OCTA parameters and glaucoma severity (MD, the thickness of the retinal nerve fibre layer and the ganglion cell complex) was analysed, along with factors associated with the CoV of OCTA parameters.

A total of 57 mild, 92 moderate to advanced and 39 severe glaucomatous eyes were included. CoV for superficial (p < 0.001) and deep macular VD (p < 0.001) and peripapillary VD (p = 0.004) increased with glaucoma severity. Greater CoV for superficial and deep macular VD and peripapillary VD was associated with worse MD and scan quality index in multivariable analysis. The association between a higher CoV of superficial and deep macular VD and worse MD was only noticeable in participants with a scan quality index <7. The relationship between the CoV of peripapillary VD and MD was consistent across varying image qualities.

The intrasession variability of OCTA parameters was greater in glaucoma participants with advanced disease, especially in those with suboptimal scan quality.