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

Area of Science:

• Ophthalmology
• Medical Imaging
• Glaucoma Research

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Assessing glaucoma progression often relies on visual field (VF) testing and structural optical coherence tomography (OCT) measurements.
• There is a need for complementary imaging biomarkers to monitor disease progression, especially in advanced stages.

Purpose of the Study:

• To investigate the relationship between sectoral macular perfusion density (MPD) measured by OCT angiography (OCTA) and central visual field (VF) sensitivity (Humphrey 10-2).
• To analyze this relationship across different stages of primary open-angle glaucoma (POAG): mild, moderate, and advanced.

Main Methods:

• A retrospective cross-sectional study involving 196 eyes with POAG.
• Sectoral MPD was quantified using OCTA (6x6 mm superficial plexus).
• MPD was correlated with the sum of total deviation (TD) from Humphrey 10-2 visual field tests, mapped to corresponding OCTA sectors. Glaucoma severity was classified using 30-2 mean deviation (MD).

Main Results:

• Outer nasal MPD showed a stepwise decrease from mild to severe POAG (46.7% to 39.6%).
• Outer nasal MPD significantly correlated with central 10-2 TD sums overall (r=0.364, P<1×10‒7) and within moderate (r=0.298, P=0.013) and severe (r=0.286, P=0.022) stages.
• Multivariable analysis indicated that outer nasal MPD (β=0.513, P<0.001) and macular ganglion cell-inner plex layer (mGCIPL) thickness (β=0.288, P<0.001) were independently associated with 10-2 MD, while circumpapillary retinal nerve fiber layer (cpRNFL) thickness was not.

Conclusions:

• Decreased outer nasal MPD is strongly associated with central functional vision loss in POAG across all severity levels.
• Outer nasal MPD provides complementary information to mGCIPL thickness for monitoring glaucoma.
• OCTA is a valuable adjunct for assessing glaucoma progression, particularly when structural OCT measurements approach their limits, including in advanced disease stages.