Optical Coherence Tomography Angiography and Visual Field Progression in Primary Angle Closure Glaucoma

PRECIS Lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) on OCT angiography were significantly associated with faster rate of mean deviation decline. PURPOSE To evaluate the association between optical coherence tomography angiography (OCTA) features and prior visual field (VF) progression in primary angle closure glaucoma (PACG). METHODS In a cross-sectional study, 46 eyes of 31 PACG patients with 5 reliable VF examinations performed over ≥3 years of follow-up underwent OCTA imaging. Effect of clinical (age, gender, number of anti-glaucoma medications, mean and SD of intraocular pressure during follow-up), OCT (average retinal nerve fiber layer and ganglion cell complex thickness) and OCTA (whole enface vessel density of disc and macular scan, deep-layer microvascular dropout [MvD]) parameters on the rate of mean deviation (MD) change was evaluated using linear mixed models. RESULTS Average (±standard deviation) MD of the baseline VF was -7.4±7.3▒dB, and rate of MD change was -0.32±0.29▒dB/year. Whole enface vessel density of disc and macular scans was 39.5%±8.1 and 38.7%±4.4, respectively. MvD was noted in 33.3% of the eyes. Multivariate mixed models showed that lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) were significantly associated with faster rate of MD decline. Other factors significantly associated with faster progression in multivariate models were older age (coefficient: -0.02, P<0.05) and the presence of systemic hypertension (coefficient: -0.37, P=0.01) and diabetes (coefficient: -0.28, P=0.05). CONCLUSIONS Lower superficial vessel density measured using OCTA was significantly associated with faster VF progression in PACG. In these eyes, OCTA parameters can serve as biomarker suggestive of past VF progression.