Association of Macular and Circumpapillary Microvasculature with Visual Field Sensitivity in Advanced Glaucoma

PURPOSE: To evaluate the association between optical coherence tomography angiography (OCTA) macular and circumpapillary vessel density and visual field mean deviation (MD) in advanced primary open angle glaucoma. DESIGN: Cross-sectional study. METHODS: Macula (superficial layer) and optic nerve head (ONH) with capillary density (CD) and without vessel density (VD) automated removal of large vessels OCTA of 34 eyes (34 patients, MD < -10 dB) were investigated as macula whole image VD (wiVD), parafoveal VD (pfVD), ONH wiVD, wiCD, circumpapillary VD, and cpCD. Spectral domain OCT circumpapillary retinal nerve fiber layer, macular ganglion cell complex, and ganglion cell inner plexiform layer were also analyzed. RESULTS: Macular and ONH VD decreased significantly with worsening MD. Each 1-dB decrease in MD was associated with a reduction of 0.43% and 0.46% for macular wiVD and pfVD with R-2 of 0.28 and 0.27, respectively (all P <.01). The association between MD and VD was strongest for measures of ONH with large vessels removed, wiCD, and cpCD, followed by wiVD and circumpapillary VD with R-2 of 0.26, 0.22, 0.17, 0.14, and a VD reduction of 0.43%, 0.51%, 0.33%, and 0.40%, respectively (all P <.02). There was a reduction of 1.19 mu m in Avanti parafoveal ganglion cell complex, 1.13 mu m in Spectralis ganglion cell inner plexiform layer, and 1.01 mu m in Spectralis circumpapillary retinal nerve fiber layer, with R-2 of 0.19 (P =.006), 0.23 (P =.002), and 0.24 (P =.002), respectively. CONCLUSIONS: ONH and macula OCTA VD and thickness are associated with the severity of visual field damage in advanced primary open angle glaucoma. (Am J Ophthalmol 2019;204:51-61. (C) 2019 Elsevier Inc. All rights reserved.)