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A Sectoral Analysis of Vessel Density Measurements in Perimetrically Intact Regions of Glaucomatous Eyes: An Optical Coherence Tomography Angiography Study

Pradhan, Zia, S., DNB, FRCOphth, FICO*; Dixit, Shivani, MD*; Sreenivasaiah, Shruthi, DNB*; Rao, Harsha, L., MD, PhD*,†; Venugopal, Jayasree, P., MD*; Devi, Sathi, MD*; Webers, Carroll, A.B., MD, PhD

doi: 10.1097/IJG.0000000000000950
Original Studies

Purpose: To study sectoral vessel density (VD) and structural alterations in the peripapillary and parafoveal hemiretina corresponding to perimetrically intact regions of glaucomatous eyes with hemifield defects and to compare these with healthy eyes using optical coherence tomography.

Methods: This cross-sectional study included 37 eyes with open-angle glaucoma having visual fields defects restricted to 1 hemifield and 45 age-matched controls. Peripapillary VD and retinal nerve fiber layer (RNFL) thickness were measured in 8 sectors. Parafoveal VD and ganglion cell complex thickness were measured in the superior and inferior hemispheres of the macula. These parameters were compared between the intact hemiretinae of glaucomatous eyes and corresponding sectors of healthy eyes using the t test.

Results: Within the perimetrically intact regions of glaucomatous eyes, the mean VD and RNFL thickness were significantly reduced in inferotemporal, superonasal, and nasal upper peripapillary sectors as compared with healthy eyes (P<0.008). The temporal upper sector had reduced mean VD (60.3% vs. 62.9%, P=0.04) despite similar mean RNFL thickness (P=0.18). The superotemporal sector had decreased mean RNFL thickness (121 vs. 138 µm, P=0.0001) despite similar VD (P=0.06). At the macula, ganglion cell complex thickness was reduced in the superior and inferior hemispheres, but mean VD was reduced in the superior parafoveal region only.

Conclusions: Peripapillary and parafoveal vascular changes precede functional decline. The extent of VD reduction and RNFL thinning varies in different peripapillary sectors and longitudinal studies are required to better understand the temporal relationship of vascular and RNFL loss.

*Narayana Nethralaya, Rajajinagar

Narayana Nethralaya, Hulimavu, Bengaluru, Karnataka, India

University Eye Clinic Maastricht, University Medical Center, Maastricht, the Netherlands

Disclosure: H.L.R.: Pfizer (consultant) and Santen (consultant). C.A.B.W.: Alcon (research support), Allergan (consultant), Pfizer (consultant), and Santen (consultant, research support). The remaining authors declare no conflict of interest.

Reprints: Zia S. Pradhan, DNB, FRCOphth, FICO, Narayana Nethralaya Eye Hospital, 121/C, Chord Road, 1st “R” Block, Rajajinagar, Bengaluru 560010, Karnataka, India (e-mail: zedpradhan@gmail.com).

Received December 11, 2017

Accepted March 9, 2018

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