The Artifacts in Macular and Peripapillary OCT Angiography in Patients with Different Severities of Glaucoma

To investigate the prevalence and types of artifacts in OCT angiography (OCTA) among patients with different glaucoma severities.

Prospective cross-sectional study.

Patients with open-angle glaucoma from a tertiary center were prospectively categorized into mild (mean deviation [MD] of 24-2 visual field ≥ -6 decibels [dB]), moderate (-6 to ≥ -12 dB), advanced (-12 to ≥ -20 dB), and severe glaucoma group (MD < -20 dB).

AngioVue OCTA was performed three times within a single visit to obtain superficial and deep macular vessel density (VD) with 3 x 3-mm macular scans, and peripapillary VD with 4.5 x 4.5-mm scans centered on the optic disc. The intrasession variability was assessed by the coefficient of variation (CoV). Different types of image artifacts were identified.

The prevalence of artifacts in patients with varying glaucoma severities, patient-related factors associated with artifact occurrence, and their impact on scan quality index (SQI) and variability of OCTA parameters.

Among the 57 mild, 46 moderate, 46 advanced, and 39 severe glaucoma eyes, half of OCTA images exhibited artifacts. Their prevalence increased from 30% in mild to 67% in severe glaucoma (P < 0.001) for peripapillary scans and from 39% to 62% (P = 0.001) for macular scans. Defocus was the most common artifact (26%) and increased with worsening MD (P = 0.006), contributing to greater CoV of superficial (P = 0.043) and deep (P = 0.024) macular VD and reduced macular SQI (P = 0.018). Peripapillary scans were more affected by artifacts, with defocus (P < 0.001) and eye movement (P = 0.025) increasing as MD worsened, which reduced the peripapillary SQI (P = 0.003 and P < 0.001, respectively). Lower SQI (P < 0.001), eye movement (P = 0.042), and quilt (P = 0.047) were linked to greater CoV of peripapillary VD.

Defocus is the most common OCTA artifact in glaucoma patients, increasing variability in OCTA metrics. Its prevalence rises with glaucoma severity and remains high even in scans with acceptable image quality, emphasizing the need for careful artifact assessment.

The authors have no proprietary or commercial interest in any materials discussed in this article.