Relationship Between Macular Perfusion Density and Central Visual Field Loss in Primary Open Angle Glaucoma

Decreased outer nasal macular perfusion density correlates with worsening visual field defects across all glaucoma severity levels-particularly with central 10-2 sensitivity-highlighting its potential as a critical parameter for monitoring primary open angle glaucoma progression, including advanced stages.

To investigate whether sectoral macular perfusion density (MPD) from optical coherence tomography angiography (OCTA) relates to central visual field (VF) sensitivity (Humphrey 10-2) across mild, moderate, and advanced primary open angle glaucoma (POAG).

In this retrospective, cross-sectional analysis of 196 POAG eyes, OCTA (6×6 mm, superficial plexus) provided sectoral MPD. MPD in each sector was analyzed in relation to the sum of total deviation (TD) of the HFA central 10-2 sectors mapped to OCTA sectors. Glaucoma severity was staged by 30-2 mean deviation (MD) using Hodapp-Parrish-Anderson thresholds: mild (> -6 dB), moderate (-6 to -12 dB), severe (< -12 dB). Study design was clarified as a retrospective analysis of prospectively acquired clinical data.

Outer nasal MPD decreased stepwise from mild to moderate to severe (means 46.7%, 42.7%, 39.6%; ANOVA P<0.001, η²=0.135; Cohen f=0.395). Outer nasal MPD correlated with central 10-2 TD sums within strata (moderate r=0.298, P=0.013; severe r=0.286, P=0.022) and overall (r=0.364, P<1×10‒7). In multivariable analysis for MD10-2 (complete cases), outer nasal MPD (β=0.513, P<0.001) and mGCIPL thickness (β=0.288, P<0.001) were independently associated, whereas cpRNFL was not; model R²=0.386. Power analysis based on the observed 1-way ANOVA effect (f=0.395) indicated achieved power≈0.999 at α=0.05.

Outer nasal MPD is strongly associated with central functional loss across severities and adds information complementary to mGCIPL, supporting OCTA as a useful adjunct when structural OCT approaches a floor, including in advanced disease.