Multilayer Macula Vessel Density and Visual Field Progression in Glaucoma.

Abstract Purpose To evaluate the association of macular superficial vessel density (SVD) and projection-resolved deep vessel density (DVD) with past visual field (VF) progression in primary open angle glaucoma patients. Design Retrospective cohort Materials and Methods In this longitudinal study, 208 eyes of 147 glaucoma patients from the Diagnostics Innovations in Glaucoma Study were included. Eligible participants were required to have at least five 24-2 VF tests over a minimum follow-up period of 3 years prior to macular optical coherence tomography angiography (OCTA) imaging. Visual field progression was defined based on both event-based pointwise linear regression (PLR) and trend-based methods. The association of macular SVD and DVD with the probability and rate of past VF progression was evaluated using linear mixed effects model. Results Fifty-two (25%) eyes had VF progression based on the PLR based criterion at the end of a mean (±SD) follow-up duration of 6.9 (±1.2) years. In the event-based multivariable analysis, lower baseline SVD was associated with a higher likelihood of past VF progression (OR per 1% lower = 1.28, 95% CI: 1.02, 1.59). Similarly, in the trend-based multivariable analysis, lower macular SVD was associated with a faster past rate of mean deviation decline (coefficient = -0.03 dB/year; 95% CI: -0.04, -0.01). Event-based and trend-based analyses found no significant associations for macular DVD with the likelihood/rate of past VF progression (P>0.05). Conclusions Lower macular SVD, and not DVD, was associated with a higher probability of past VF progression. Macular OCTA imaging shows promise for identifying eyes at risk of VF progression in glaucoma patients.