Background
Glaucoma, the second leading cause of blindness, affects over 80 million patients worldwide, including 3 million patients in the USA. It is a progressive optic neuropathy affecting both the structure and vascular supply of the optic nerve and retina. Optical coherence tomography angiography (OCTA) is a new, noninvasive technique which excels at providing the vasculature and anatomy of these regions. Recent studies have demonstrated a possible link between vessel area density (VAD) and glaucoma progression. However, conflicting data indicates a need for more robust study of VAD and other quantitative parameters such as vessel length density (VLD) and branchpoint density (BPD). Therefore, our aim was to analyze and compare these three parameters in patients with primary open angle glaucoma (POAG) and healthy subjects using open-source ImageJ software.

Methods
This IRB-approved, retrospective study included 98 consecutive participants (49 healthy; 49 POAG) imaged at an academic center between January and May 2020. One eye was chosen at random from each subject. Exclusion criteria included OCTA scan quality < 6/10, significant artifacts, high myopia/hyperopia, and vitreoretinal diseases. We analyzed the superficial and deep plexuses of the retina as well as the radial peripapillary capillary (RPC) layer of the optic disc. VAD, VLD, and BPD were obtained for each layer using ImageJ and the relationship between healthy and glaucomatous eyes was analyzed via logistic regression. Diagnostic value
was determined using areas under receiver operating curves (AUC).

Results
VAD, VLD, and BPD were significantly reduced in glaucoma for all anatomical layers, with the greatest reduction occurring in the RPC layer (P < 0.001). The AUCs of the diagnostic models analyzing all parameters within the superficial, deep, and RPC layers were 0.883, 0.902, and 0.942, respectively. Combining all parameters from all layers into a single model yielded the best diagnostic performance (AUC = 0.974; p < 0.001).

Conclusion
Our study is among the first to quantitatively characterize OCTA scans of healthy and glaucomatous eyes using multiple parameters. Our combined model analyzing multiple ocular layers has shown excellent utility in the diagnosis of glaucoma.

Vascular Morphology of the Optic Nerve and Retina in Glaucoma

Clinical and Translational Research | Ophthalmology

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Haafiz Hashim

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Vascular Morphology of the Optic Nerve and Retina in Glaucoma

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