Relationship Between Macular Microvasculature and Visual Acuity in Advanced and Severe Glaucoma

PURPOSE: To evaluate the correlation between structural parameters and visual acuity (VA) in advanced glaucoma. DESIGN: Prospective, cross-sectional study. METHODS: A total of 238 eyes from 238 patients (82 were men and mean +/- SD age was 59.9 +/- 13.8 years) from a tertiary center were divided into an advanced (mean deviation of 24-2 visual field tests from -12.01 to -20.0 dB) and severe (< -20 dB) glaucoma group. Structural parameters were obtained by RTVue (Optovue Inc) optical coherence tomography and angiography. Pearson correlation, partial correlation adjusted for age and axial length, and receiver operating characteristic curves to detect decreased VA (<20/25) were performed. RESULTS: In the advanced glaucoma group (133 eyes), superficial (Pearson correlation coefficient, r = -0.46, P < .001; partial correlation coefficient, r' = -0.30, P < .001) and deep macular vessel densities (VDs) (r = -0.47, P < .001; r' = -0.30, P < .001) showed highest correlation with VA. The area under the receiver operating characteristic curves of the superficial parafoveal/macular VDs were 0.816 (95% CI, 0.735-0.897) and 0.808 (95% CI, 0.725-0.891), respectively. In the severe glaucoma group (105 eyes), deep nasal grid VD (r = -0.31, P = 0.002; r' = -0.35, P < .001) showed highest correlation with VA. Deep macular VD showed better correlation with VA than other structural parameters. The area under the receiver operating characteristic curves of deep macular VD and deep nasal grid VD were 0.740 (95% CI, 0.632-0.849) and 0.748 (95% CI, 0.640-0.857), respectively. CONCLUSIONS: Macular VD showed better correlation with VA in advanced glaucoma. Deep macular VD, especially nasal grid, may be a promising structural parameter in severe glaucoma. (C) 2021 Elsevier Inc. All rights reserved.