Abstract
To evaluate superficial microvascular deficits of glaucomatous eyes with wide-field optical coherence tomography angiography (OCTA) and Euclidian distance (ED) analysis.PURPOSETo evaluate superficial microvascular deficits of glaucomatous eyes with wide-field optical coherence tomography angiography (OCTA) and Euclidian distance (ED) analysis.Cross-sectional study.DESIGNCross-sectional study.Swept-source OCTA (SS-OCTA) images of healthy and glaucomatous eyes.SUBJECTSSwept-source OCTA (SS-OCTA) images of healthy and glaucomatous eyes.12x12mm scans of healthy and glaucomatous eyes were acquired with SS-OCTA (PLEX® Elite 9000, ZEISS). The en face images of the superficial retina segmentation were exported and analyzed with ImageJ software. A fixed threshold that predicted the size of the foveal avascular zone (FAZ) was used to generate binarized images with vascular (white) or deficient (black) pixels. Four vascular parameters were measured within a macula-centered 9x10.8mm ellipse: vascular density (VD), average ED (EDavg), maximum ED (EDmax), and non-perfusion density (NPD). ED values were visualized with Heat-map color scale. The vascular parameters were compared between healthy and glaucomatous eyes (Student's t-test). Person coefficients were calculated to test correlations between the vascular parameters and retinal nerve fiber layer (RNFL) thickness, macular ganglion cell and inner plexiform layer (GCIPL) thickness, and visual field mean deviation (VFMD) in glaucomatous eyes. P<0.05 was considered significant.METHODS12x12mm scans of healthy and glaucomatous eyes were acquired with SS-OCTA (PLEX® Elite 9000, ZEISS). The en face images of the superficial retina segmentation were exported and analyzed with ImageJ software. A fixed threshold that predicted the size of the foveal avascular zone (FAZ) was used to generate binarized images with vascular (white) or deficient (black) pixels. Four vascular parameters were measured within a macula-centered 9x10.8mm ellipse: vascular density (VD), average ED (EDavg), maximum ED (EDmax), and non-perfusion density (NPD). ED values were visualized with Heat-map color scale. The vascular parameters were compared between healthy and glaucomatous eyes (Student's t-test). Person coefficients were calculated to test correlations between the vascular parameters and retinal nerve fiber layer (RNFL) thickness, macular ganglion cell and inner plexiform layer (GCIPL) thickness, and visual field mean deviation (VFMD) in glaucomatous eyes. P<0.05 was considered significant.VD, EDavg, EDmax, and NPD RESULTS: Forty glaucomatous and twenty-five healthy eyes were included. VD (fraction) was 0.442 ± 0.029 vs. 0.3205 ± 0.072 (P<0.001), EDavg (μm) was 17.37 ± 0.549 vs. 32.62 ± 9.545 (P<0.001), EDmax (μm) was 153.7 ± 49.15 vs. 248.5 ± 156.6 (P=0.005), and NPD (%) was 0.97 ± 0.82 vs. 7.09 ± 5.99 (P<0.001) in healthy vs. glaucomatous eyes. VD, ED, and NPD were better in ONH sectors than in temporal macula and retinal periphery sectors in both groups, but worse in the glaucoma group across all sectors of the ellipse (P<0.01 for all sectors). Microvascular deficits in glaucomatous eyes often exceeded structural and functional glaucomatous damage, and there was modest correlation between the vascular and structural/functional parameters. Pearson r of the correlation with average RNFL and GCIPL were highest for VD (r=0.46, P=0.002 and r=-0.49, P=0.001, respectively) and lowest for EDmax (r=-0.19, P=0.24 and r=-0.23, P=0.16, respectively).MAIN OUTCOMEVD, EDavg, EDmax, and NPD RESULTS: Forty glaucomatous and twenty-five healthy eyes were included. VD (fraction) was 0.442 ± 0.029 vs. 0.3205 ± 0.072 (P<0.001), EDavg (μm) was 17.37 ± 0.549 vs. 32.62 ± 9.545 (P<0.001), EDmax (μm) was 153.7 ± 49.15 vs. 248.5 ± 156.6 (P=0.005), and NPD (%) was 0.97 ± 0.82 vs. 7.09 ± 5.99 (P<0.001) in healthy vs. glaucomatous eyes. VD, ED, and NPD were better in ONH sectors than in temporal macula and retinal periphery sectors in both groups, but worse in the glaucoma group across all sectors of the ellipse (P<0.01 for all sectors). Microvascular deficits in glaucomatous eyes often exceeded structural and functional glaucomatous damage, and there was modest correlation between the vascular and structural/functional parameters. Pearson r of the correlation with average RNFL and GCIPL were highest for VD (r=0.46, P=0.002 and r=-0.49, P=0.001, respectively) and lowest for EDmax (r=-0.19, P=0.24 and r=-0.23, P=0.16, respectively).VD, ED, and NPD were worse in glaucomatous compared to healthy eyes throughout the wide-field OCTA image. High ED and NPD values accentuate regions of inadequate perfusion.CONCLUSIONSVD, ED, and NPD were worse in glaucomatous compared to healthy eyes throughout the wide-field OCTA image. High ED and NPD values accentuate regions of inadequate perfusion.