Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma

Adeleh Yarmohammadi, Linda M. Zangwill, Alberto Diniz-Filho, Min Hee Suh, Siamak Yousefi, Luke J. Saunders, Akram Belghith, Patricia Isabel C. Manalastas, Felipe A. Medeiros, Robert N. Weinreb

Research output: Contribution to journalArticle

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Abstract

Purpose To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. Design Observational, cross-sectional study. Participants A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. Methods All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). Main Outcome Measures Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. Results Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. Conclusions Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.

Original languageEnglish (US)
Pages (from-to)2498-2508
Number of pages11
JournalOphthalmology
Volume123
Issue number12
DOIs
StatePublished - Dec 1 2016

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Optical Coherence Tomography
Visual Fields
Glaucoma
Angiography
Visual Field Tests
Nerve Fibers
Ocular Hypertension
Optic Disk
Microvessels
Blood Vessels
Healthy Volunteers
Multivariate Analysis
Cross-Sectional Studies
Regression Analysis
Outcome Assessment (Health Care)
Technology

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Yarmohammadi, A., Zangwill, L. M., Diniz-Filho, A., Suh, M. H., Yousefi, S., Saunders, L. J., ... Weinreb, R. N. (2016). Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma. Ophthalmology, 123(12), 2498-2508. https://doi.org/10.1016/j.ophtha.2016.08.041

Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma. / Yarmohammadi, Adeleh; Zangwill, Linda M.; Diniz-Filho, Alberto; Suh, Min Hee; Yousefi, Siamak; Saunders, Luke J.; Belghith, Akram; Manalastas, Patricia Isabel C.; Medeiros, Felipe A.; Weinreb, Robert N.

In: Ophthalmology, Vol. 123, No. 12, 01.12.2016, p. 2498-2508.

Research output: Contribution to journalArticle

Yarmohammadi, A, Zangwill, LM, Diniz-Filho, A, Suh, MH, Yousefi, S, Saunders, LJ, Belghith, A, Manalastas, PIC, Medeiros, FA & Weinreb, RN 2016, 'Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma', Ophthalmology, vol. 123, no. 12, pp. 2498-2508. https://doi.org/10.1016/j.ophtha.2016.08.041
Yarmohammadi, Adeleh ; Zangwill, Linda M. ; Diniz-Filho, Alberto ; Suh, Min Hee ; Yousefi, Siamak ; Saunders, Luke J. ; Belghith, Akram ; Manalastas, Patricia Isabel C. ; Medeiros, Felipe A. ; Weinreb, Robert N. / Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma. In: Ophthalmology. 2016 ; Vol. 123, No. 12. pp. 2498-2508.
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abstract = "Purpose To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. Design Observational, cross-sectional study. Participants A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. Methods All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). Main Outcome Measures Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. Results Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5{\%}, 51.3{\%}, 48.3{\%}, and 41.7{\%}, respectively) and for cpVD (62.8{\%}, 61.0{\%}, 57.5{\%}, 49.6{\%}, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1{\%} decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1{\%} decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. Conclusions Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.",
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AU - Yarmohammadi, Adeleh

AU - Zangwill, Linda M.

AU - Diniz-Filho, Alberto

AU - Suh, Min Hee

AU - Yousefi, Siamak

AU - Saunders, Luke J.

AU - Belghith, Akram

AU - Manalastas, Patricia Isabel C.

AU - Medeiros, Felipe A.

AU - Weinreb, Robert N.

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N2 - Purpose To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. Design Observational, cross-sectional study. Participants A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. Methods All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). Main Outcome Measures Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. Results Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. Conclusions Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.

AB - Purpose To evaluate the association between vessel density measurements using optical coherence tomography angiography (OCT-A) and severity of visual field loss in primary open-angle glaucoma. Design Observational, cross-sectional study. Participants A total of 153 eyes from 31 healthy participants, 48 glaucoma suspects, and 74 glaucoma patients enrolled in the Diagnostic Innovations in Glaucoma Study. Methods All eyes underwent imaging using OCT-A (Angiovue; Optovue, Fremont, CA), spectral-domain OCT (Avanti; Optovue), and standard automated perimetry (SAP). Retinal vasculature information was summarized as vessel density, the percentage of area occupied by flowing blood vessels in the selected region. Two measurements from the retinal nerve fiber layer (RNFL) were used: circumpapillary vessel density (cpVD) (750-μm-wide elliptical annulus around the optic disc) and whole-image vessel density (wiVD) (entire 4.5×4.5-mm scan field). Main Outcome Measures Associations between the severity of visual field loss, reported as SAP mean deviation (MD), and OCT-A vessel density. Results Compared with glaucoma eyes, normal eyes demonstrated a denser microvascular network within the RNFL. Vessel density was higher in normal eyes followed by glaucoma suspects, mild glaucoma, and moderate to severe glaucoma eyes for wiVD (55.5%, 51.3%, 48.3%, and 41.7%, respectively) and for cpVD (62.8%, 61.0%, 57.5%, 49.6%, respectively) (P < 0.001 for both). The association between SAP MD with cpVD and wiVD was stronger (R2 = 0.54 and R2 = 0.51, respectively) than the association between SAP MD with RNFL (R2 = 0.36) and rim area (R2 = 0.19) (P < 0.05 for all). Multivariate regression analysis showed that each 1% decrease in wiVD was associated with 0.66 decibel (dB) loss in MD and each 1% decrease in cpVD was associated with 0.64 dB loss in MD. In addition, the association between vessel density and severity of visual field damage was found to be significant even after controlling for the effect of structural loss. Conclusions Decreased vessel density was significantly associated with the severity of visual field damage independent of the structural loss. Optical coherence tomography angiography is a promising technology in glaucoma management, potentially enhancing the understanding of the role of vasculature in the pathophysiology of the disease.

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