Quantitative optical coherence tomography angiography of macular vascular structure and foveal avascular zone in glaucoma

• Published in: PloS one Vol. 12; no. 9; p. e0184948
• Main Authors: Choi, Jaewan, Kwon, Junki, Shin, Joong Won, Lee, Jiyun, Lee, Saem, Kook, Michael S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.09.2017; Public Library of Science (PLoS)
• Subjects: Adjustment; Adult; Aged; Analysis; Angiography; Bioindicators; Biology and Life Sciences; Biomarkers; Case-Control Studies; Circularity; Coherence; Control methods; Cross-Sectional Studies; Diabetes; Diabetic retinopathy; Diagnostic systems; Disruption; Error analysis; Errors; Eye; Eye (anatomy); Fluorescein Angiography; Fovea; Fovea Centralis - blood supply; Fovea Centralis - pathology; Glaucoma; Glaucoma, Open-Angle - physiopathology; Health aspects; Humans; Hypoxia; Macula Lutea - blood supply; Macula Lutea - pathology; Male; Medical imaging; Medicine; Medicine and Health Sciences; Middle Aged; Optical Coherence Tomography; Optical tomography; Optics; Patients; Physical Sciences; Physiological aspects; Regression analysis; Regression models; Research and Analysis Methods; Retina; Retrospective Studies; Sex; Sex ratio; Tomography; Tomography, Optical Coherence - methods; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184948

The study aimed to evaluate the quantitative characteristics of the macular vessel density (VD) and foveal avascular zone (FAZ) in glaucoma using optical coherence tomography angiography (OCT-A). Cross-sectional, age- and sex-matched case-control study. Fifty-two eyes of 52 patients with primary open angle glaucoma and 52 eyes from 52 healthy participants were recruited retrospectively. OCT-A was performed on a 3 x 3-mm macular region centered on the fovea. OCT-A scans were manually graded to define the FAZ. Parafoveal VD in superficial and deep retina were analyzed in the circular- and quadrant-segmented zone. The FAZ parameters included size, perimeter, and circularity index. The regression analysis among VD and FAZ-related parameters and ocular parameters was performed, and the diagnostic ability was calculated with refractive error adjusted. For both groups, the mean age and the sex ratio was not different between groups. With refractive error adjusted, the average macular VD was lower in glaucoma than in the control group for superficial (P = 0.013), deep (P<0.001), and the whole retina (P = 0.002). There were increased FAZ perimeter and decreased FAZ circularity index in glaucoma when compared with controls (P<0.001). In the multivariate regression models, FAZ circularity index were significantly associated with decreased peripapillary RNFL thickness (P = 0.007) and macular GCIPL thickness (P = 0.009) measured by OCT. The refractive-error adjusted area under receiver operating characteristics was highest for FAZ circularity index (0.905; 95% CI, 0.844-0.966), followed by temporal deep retinal VD (0.870; 95% CI, 0.803-0.937) and FAZ perimeter (0.858; 95% CI, 0.784-0.932). Decreased macular VD, increased FAZ perimeter, and decreased FAZ circularity index were observed in eyes with glaucoma using OCT-A. With refractive error adjusted, these parameters showed considerable diagnostic value for glaucoma. FAZ circularity index may be a novel biomarker representing disruption of the parafoveal capillary network in glaucoma, as supported by its association with structural parameters.