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Macular Vascular Microcirculation in Eyes With Open-angle Glaucoma Using Different Visual Field Severity Classification Systems

Bojikian, Karine D. MD, PhD*; Nobrega, Priscilla MD*; Wen, Joanne C. MD*; Zhang, Qinqin PhD; Mudumbai, Raghu C. MD*; Johnstone, Murray A. MD*; Wang, Ruikang K. PhD*,†; Chen, Philip P. MD*

doi: 10.1097/IJG.0000000000001308
Original Studies

Precis: We found significant differences in macular vascular microcirculation between normal and glaucomatous eyes using optical coherence tomography angiography (OCTA). Macular vascular microcirculation changes also showed significant correlations with visual field (VF) severity classification systems.

Purpose: To correlate VF severity defined by different classification systems and macular vascular microcirculation in eyes with glaucoma using OCTA.

Patients and Methods: Twenty normal and 58 open-angle glaucoma (OAG) eyes were scanned using a swept-source OCTA (Plex Elite 9000) and macular vascular microcirculation was measured by calculating the overall blood flux index (BFI) and vessel area density (VAD) over the entire 6×6 mm area excluding the big retinal vessels. Glaucomatous eyes were staged into severity groups based on 4 VF severity classifications: Hodapp-Parrish-Anderson scale, Glaucoma Severity Staging system, ICD-10 glaucoma staging definitions, and VF mean deviation. Central 10-degree VF mean sensitivity (CMS) was calculated based on 24-2 VF. One-way analysis of variance was used to analyze the differences and correlation between macular vascular microcirculation and other clinical parameters.

Results: Glaucomatous eyes had significantly lower ganglion cell and inner plexiform layer BFI and VAD (P<0.0001) compared with normal eyes. In OAG patients, BFI and VAD were significantly higher in mild OAG compared with severe OAG with all VF disease severity classification systems (P<0.001). Glaucoma Severity Staging had the highest correlation with changes in macular vascular microcirculation metrics (r=0.734 for BFI; r=0.647 for VAD) and VF CMS had highest correlation with macular vascular microcirculation metrics (r=0.887 for BFI; r=0.903 for VAD).

Conclusion: Macular vascular microcirculation metrics detected by OCTA correlate with disease severity in glaucomatous eyes. VF CMS, calculated from only 12 tested central 10-degree points, correlated best with macular OCTA.

Departments of *Ophthalmology

Bioengineering, University of Washington, Seattle, WA

Supported in part by National Institutes of Health contract NEI R01-EY024158, Carl Zeiss Meditec Inc. and Research to Prevent Blindness (New York, NY).

Disclosure: R.K.W. receives royalty from intellectual property owned by Oregon Health & Science University and research support from Carl Zeiss Meditec Inc. The remaining authors declare no conflict of interest.

Reprints: Philip P. Chen, MD, Department of Ophthalmology, University of Washington, P.O. Box 359608, 325 Ninth Ave, Seattle, WA 98104-2499 (e-mail:

Received November 4, 2018

Accepted June 9, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.