Imaging the trabecular meshwork morphological changes in primary open angle glaucoma: An anterior segment OCT study

Dysfunction of the trabecular meshwork (TM) is implicated in the elevation of intra ocular pressure (IOP) and primary open angle glaucoma (POAG). High-resolution optical coherence tomography (AS-OCT) could highlight in vivo POAG-related changes of the TM, contributing to better detection and understanding of the disease.

A prospective, observational, cross-sectional, single center study was conducted. A total of 154 patients (POAG: 81; controls: 73) were included in an open label study. TM length, thickness, area, and reflectivity were compared between POAG eyes and healthy controls using an AS-OCT device (RTVue, Optovue Inc., Fremont, California). Additional analyses were conducted to identify putative correlations between TM changes and the other collected data. Diagnostic performance of the TM imaging by AS-OCT was also studied.

TM thickness and TM area were lower in the POAG group than in the healthy group (P<0.001). TM reflectivity was higher in the POAG group (P=0.007). TM length did not statistically differ. A receiver operating characteristic analysis showed an area under the curve of 0.81 [CI95%: 0.74; 0.87] and a maximal Youden index of 0.53 for a TM thickness threshold of 85.13μm (Se: 75%; Sp: 77%). No correlation was found between mean TM thickness and other parameters.

We observed significant morphological changes in the TM using AS-OCT, which may reflect the TM degeneration in POAG. In addition to the retina/optic nerve analyses, we suggest AS-OCT of the TM could contribute to better screen for and evaluate POAG.