Download PDF
CC BY 4.0 · Libyan International Medical University Journal
DOI: 10.1055/s-0044-1779669
Original Article

Quantitative Measurement and Analysis of the Radial Peripapillary and Central Macular Microvasculature Density in Early Open-Angle Glaucoma Using OCT Angiography

Majdi Abdulhamid Abdala 
1   Department of Ophthalmology, Faculty of Medicine, University of Benghazi, Benghazi, Libya
,
Suliman Mohamed Masoud
1   Department of Ophthalmology, Faculty of Medicine, University of Benghazi, Benghazi, Libya
,
Nadia Abdelsalam Geilani 
2   Department of Ophthalmology, Benghazi Eye Hospital, Benghazi, Libya
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints


Abstract

Background Glaucoma is a prevalent cause of visual impairment, and early detection is critical to prevent progressive vision loss. Optical coherence tomography angiography (OCT-A) enables visualization of retinal and optic nerve microvasculature and holds promise for early glaucoma detection.

Aims This study aims to assess microvasculature density alterations in glaucoma using OCT-A.

Methods An observational cross-sectional case–control study was conducted at Benghazi Eye Hospital in Libya from December 2022 to August 2023. It included 160 eyes of 126 patients diagnosed with primary open-angle glaucoma and 120 eyes of 96 control subjects. OCT-A was performed using the Swept-Source OCT DRI Triton. Vessel density measurements were obtained from OCT-A images using new built-in software within the device. The data presented as mean ± standard deviation and percentages were analyzed using SPSS. The statistical significance of the differences between different groups was determined using independent t-tests, and the level of significance was set at p-value less than 0.05.

Results OCT-A demonstrated significantly reduced microvasculature density in glaucoma eyes across all optic nerve sectors including the inferior (29.0%), superior (25.2%), central (23.5%), nasal (9.9%), and temporal sectors (9.3%; p < 0.02). Moreover, glaucoma patients exhibited a significant reduction in vessel density in the superior macula (17% reduction), the temporal (15.7%,), nasal (12.9%), and inferior sectors (12.6%) (p < 0.002). No statistical difference was seen with vessel density of the central sector (0.49%, p >0.05).

Conclusion OCT-A demonstrated significant reductions in microvasculature density in glaucoma patients compared with healthy controls. These findings support the association between glaucoma and vascular changes. Additionally, the TOPCON Swept-Source OCT DRI Triton new software shows promise as a valuable tool for early detection and monitoring of glaucoma-related vascular changes.

Keywords

early detection - glaucoma - microvasculature density - optical coherence tomography angiography - TOPCON Swept-Source OCT DRI Triton


Publication History

Article published online:
01 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006; 90 (03) 262-267
    CrossrefPubMedGoogle Scholar
  • 2 Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014; 121 (11) 2081-2090
    CrossrefPubMedGoogle Scholar
  • 3 Flammer J, Mozaffarieh M. What is the present pathogenetic concept of glaucomatous optic neuropathy?. Surv Ophthalmol 2007; 52 (Suppl 2): S162-S173
    CrossrefPubMedGoogle Scholar
  • 4 Harris A, Kagemann L, Ehrlich R, Rospigliosi C, Moore D, Siesky B. Measuring and interpreting ocular blood flow and metabolism in glaucoma. Can J Ophthalmol 2008; 43 (03) 328-336
    CrossrefPubMedGoogle Scholar
  • 5 American Academy of Ophthalmology. Primary Open-Angle Glaucoma Preferred Practice Pattern. San Francisco, CA: American Academy of Ophthalmology; 2021
    Google Scholar
  • 6 Mwanza JC, Durbin MK, Budenz DL. et al. Glaucoma diagnostic accuracy of ganglion cell-inner plexiform layer thickness: comparison with nerve fiber layer and optic nerve head. Ophthalmology 2012; 119 (06) 1151-1158
    CrossrefPubMedGoogle Scholar
  • 7 Hood DC, Anderson SC, Wall M, Raza AS, Kardon RH. A test of a linear model of glaucomatous structure-function loss reveals sources of variability in retinal nerve fiber and visual field measurements. Invest Ophthalmol Vis Sci 2009; 50 (09) 4254-4266
    CrossrefPubMedGoogle Scholar
  • 8 Plange N, Kaup M, Weber A, Remky A, Arend O. Fluorescein filling defects and quantitative morphologic analysis of the optic nerve head in glaucoma. Arch Ophthalmol 2004; 122 (02) 195-201
    CrossrefPubMedGoogle Scholar
  • 9 O'Brart DP, de Souza Lima M, Bartsch DU, Freeman W, Weinreb RN. Indocyanine green angiography of the peripapillary region in glaucomatous eyes by confocal scanning laser ophthalmoscopy. Am J Ophthalmol 1997; 123 (05) 657-666
    CrossrefPubMedGoogle Scholar
  • 10 Rechtman E, Harris A, Kumar R. et al. An update on retinal circulation assessment technologies. Curr Eye Res 2003; 27 (06) 329-343
    CrossrefPubMedGoogle Scholar
  • 11 Nicolela MT, Hnik P, Drance SM. Scanning laser Doppler flowmeter study of retinal and optic disk blood flow in glaucomatous patients. Am J Ophthalmol 1996; 122 (06) 775-783
    CrossrefPubMedGoogle Scholar
  • 12 Hood DC, Raza AS, de Moraes CG. et al. Initial arcuate defects within the central 10 degrees in glaucoma. Invest Ophthalmol Vis Sci 2011; 52 (02) 940-946
    CrossrefPubMedGoogle Scholar
  • 13 Hood DC, Raza AS, de Moraes CG, Liebmann JM, Ritch R. Glaucomatous damage of the macula. Prog Retin Eye Res 2013; 32: 1-21
    CrossrefPubMedGoogle Scholar
  • 14 Jia Y, Tan O, Tokayer J. et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express 2012; 20 (04) 4710-4725
    CrossrefPubMedGoogle Scholar
  • 15 Spaide RF, Klancnik Jr JM, Cooney MJ. Retinal vascular layers imaged by fluorescein angiography and optical coherence tomography angiography. JAMA Ophthalmol 2015; 133 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 16 Zhang Q, Wang RK, Chen CL. et al. OCT angiography in glaucoma: comparison with conventional noninvasive methods such as OCT and HRT. Invest Ophthalmol Vis Sci 2015; 56 (09) 5247-5257
    Google Scholar
  • 17 Müller O, Todorova MG, Schlote T. OCT angiography of the central macular capillary network in glaucoma patients and healthy controls. Klin Monatsbl Augenheilkd 2018; 235 (04) 436-444
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Yarmohammadi A, Zangwill LM, Diniz-Filho A. et al. Optical coherence tomography angiography vessel density in healthy, glaucoma suspect, and glaucoma eyes. Invest Ophthalmol Vis Sci 2016; 57 (09) OCT451-OCT459
    CrossrefPubMedGoogle Scholar
  • 19 Liu L, Jia Y, Takusagawa HL. et al. Optical coherence tomography angiography of the peripapillary retina in glaucoma. JAMA Ophthalmol 2015; 133 (09) 1045-1052
    CrossrefPubMedGoogle Scholar
  • 20 Choi J, Kwon J, Shin JW, Lee J, Lee S, Kook MS. Quantitative optical coherence tomography angiography of macular vascular structure and foveal avascular zone in glaucoma. PLoS One 2017; 12 (09) e0184948
    CrossrefPubMedGoogle Scholar
  • 21 Rao HL, Pradhan ZS, Weinreb RN. et al. Regional comparisons of optical coherence tomography angiography vessel density in primary open-angle glaucoma. Am J Ophthalmol 2016; 171: 75-83
    CrossrefPubMedGoogle Scholar
  • 22 Lee EJ, Lee KM, Lee SH, Kim TW. OCT Angiography of the peripapillary retina in primary open-angle glaucoma. Invest Ophthalmol Vis Sci 2016; 57 (14) 6265-6270
    CrossrefPubMedGoogle Scholar
  • 23 Hodapp E, Parrish II RK, Anderson DR. Clinical Decisions in Glaucoma. St Louis: The CV Mosby Co; 1993: 52-61
    Google Scholar
  • 24 Topcon Triton OCT. Accessed January 12, 2023 at: https://topconhealthcare.eu/en_EU/products/triton
  • 25 Khayrallah O, Mahjoub A, Ben Abdesslam N. et al. Optical coherence tomography angiography vessel density parameters in primary open-angle glaucoma. Ann Med Surg (Lond) 2021; 69: 102671
    PubMedGoogle Scholar
  • 26 Weindler H, Spitzer MS, Schultheiß M, Kromer R. OCT angiography analysis of retinal vessel density in primary open-angle glaucoma with and without Tafluprost therapy. BMC Ophthalmol 2020; 20 (01) 444
    CrossrefPubMedGoogle Scholar
  • 27 Akil H, Huang AS, Francis BA, Sadda SR, Chopra V. Retinal vessel density from optical coherence tomography angiography to differentiate early glaucoma, pre-perimetric glaucoma and normal eyes. PLoS One 2017; 12 (02) e0170476
    CrossrefPubMedGoogle Scholar
  • 28 Jia Y, Morrison JC, Tokayer J. et al. Quantitative OCT angiography of optic nerve head blood flow. Biomed Opt Express 2012; 3 (12) 3127-3137
    CrossrefPubMedGoogle Scholar
  • 29 Kim SB, Lee EJ, Han JC, Kee C. Comparison of peripapillary vessel density between preperimetric and perimetric glaucoma evaluated by OCT-angiography. PLoS One 2017; 12 (08) e0184297
    CrossrefPubMedGoogle Scholar
  • 30 Dutta A, Thulasidas M, Sasidharan A, Pradeep B, Rajesh Prabu V. Comparison of peripapillary capillary plexus using optical coherence tomography angiography and retinal nerve fibre layer analysis using spectral domain optical coherence tomography in glaucoma patients, glaucoma suspects, and healthy subjects. Indian J Ophthalmol 2022; 70 (12) 4146-4151
    CrossrefPubMedGoogle Scholar
  • 31 Kamalipour A, Moghimi S, Jacoba CM. et al. Measurements of OCT angiography complement OCT for diagnosing early primary open-angle glaucoma. Ophthalmol Glaucoma 2022; 5 (03) 262-274
    CrossrefPubMedGoogle Scholar
  • 32 Wang X, Jiang C, Ko T. et al. Correlation between optic disc perfusion and glaucomatous severity in patients with open-angle glaucoma: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2015; 253 (09) 1557-1564
    CrossrefPubMedGoogle Scholar
  • 33 Simsek M, Oral Y, Inan S, Akdogan M, Cem Sabaner M. Comparison of peripapillary vascular density as measured by optical coherence tomography angiography between various types of open-angle glaucoma. J Fr Ophtalmol 2023; x: x
    Google Scholar
  • 34 Hwang JC, Konduru R, Zhang X. et al. Relationship among visual field, blood flow, and neural structure measurements in glaucoma. Invest Ophthalmol Vis Sci 2012; 53 (06) 3020-3026
    CrossrefPubMedGoogle Scholar
  • 35 Hou H, Moghimi S, Zangwill LM. et al. Macula vessel density and thickness in early primary open-angle glaucoma. Am J Ophthalmol 2019; 199: 120-132
    CrossrefPubMedGoogle Scholar
  • 36 Khallouli A, Oueslati Y, Gouider D, Bouchoucha S, Maalej A, Rannen R. Diagnostic accuracy and relationship between optical coherence tomography angiography vessel density and structural/functional parameters in healthy, preperimetric, and manifest glaucoma eyes. J Curr Ophthalmol 2022; 34 (02) 173-179
    CrossrefPubMedGoogle Scholar
  • 37 Lommatzsch C, Rothaus K, Koch JM, Heinz C, Grisanti S. OCTA vessel density changes in the macular zone in glaucomatous eyes. Graefes Arch Clin Exp Ophthalmol 2018; 256 (08) 1499-1508
    CrossrefPubMedGoogle Scholar
  • 38 Lu P, Xiao H, Liang C, Xu Y, Ye D, Huang J. Quantitative analysis of microvasculature in macular and peripapillary regions in early primary open-angle glaucoma. Curr Eye Res 2020; 45 (05) 629-635
    CrossrefPubMedGoogle Scholar
  • 39 Verticchio Vercellin A, Siesky B, Antman G. et al. Regional vessel density reduction in the macula and optic nerve head of patients with pre-perimetric primary open angle glaucoma. J Glaucoma 2023; 32 (11) 930-941
    CrossrefPubMedGoogle Scholar
  • 40 Gunasegaran G, Moghimi S, Nishida T. et al. Diagnostic ability of optical coherence tomography angiography macular vessel density for glaucoma in individuals of African and European descent. Invest Ophthalmol Vis Sci 2023; 64 (08) 4423
    Google Scholar