Progression in Preperimetric Glaucoma Eyes With and Without Microvasculature Dropout

Area of Science:

• Ophthalmology
• Neuroscience
• Medical Imaging

Background:

• Preperimetric glaucoma (PPG) is an early stage of glaucoma characterized by optic nerve damage but without detectable visual field defects.
• Microvasculature dropout (MvD) is a potential indicator of vascular compromise in the retina.
• Understanding early indicators in PPG is crucial for timely intervention and preventing vision loss.

Purpose of the Study:

• To determine if baseline microvasculature dropout (MvD) predicts future structural and functional changes in preperimetric glaucoma (PPG).
• To assess the association between MvD and the progression of retinal nerve fiber layer thickness (cpRNFL) and capillary density (cpCD).
• To evaluate the relationship between MvD and the development of visual field (VF) defects in PPG patients.

Main Methods:

• Analysis of prospective cohort study data from 70 participants (93 eyes) with PPG.
• Follow-up over approximately 4.9 years using optical coherence tomography (OCT) and OCT angiography (OCTA).
• Assessment of circumpapillary retinal nerve fiber layer thickness (cpRNFL) and circumpapillary capillary density (cpCD); grouping eyes by baseline MvD presence.

Main Results:

• Eyes with baseline MvD exhibited significantly faster loss of cpCD compared to those without MvD.
• Baseline MvD was independently associated with accelerated cpCD loss but not with cpRNFL loss.
• PPG eyes with MvD at baseline were more likely to develop visual field loss (62.5%) than those without MvD (26.2%).

Conclusions:

• Baseline MvD in PPG is a significant predictor of both accelerated vascular changes and subsequent visual field impairment.
• MvD assessment can aid in identifying high-risk PPG patients.
• The presence of MvD can inform clinical decisions regarding follow-up frequency for PPG management.