Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California.
Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California.
Ophthalmol Glaucoma. 2022 May-Jun;5(3):262-274. doi: 10.1016/j.ogla.2021.09.012. Epub 2021 Oct 9.
To compare measurements of global and regional circumpapillary capillary density (cpCD) with retinal nerve fiber layer (RNFL) thickness and characterize their relationship with visual function in early primary open-angle glaucoma (POAG).
Cross-sectional study.
Eighty healthy eyes, 64 preperimetric eyes, and 184 mild POAG eyes from the Diagnostic Innovations in Glaucoma Study.
Global and regional RNFL thickness and cpCD measurements were obtained using OCT and OCT angiography (OCTA). For direct comparison at the individual and diagnostic group level, RNFL thickness and capillary density values were converted to a normalized relative loss scale.
Retinal nerve fiber layer thickness and cpCD normalized loss at the individual level and diagnostic group. Global and regional areas under the receiver operating characteristic curve (AUROC) for RNFL thickness and cpCD to detect preperimetric glaucoma and glaucoma, R for the strength of associations between RNFL thickness function and capillary density function in diagnostic groups.
Both global and regional RNFL thickness and cpCD decreased progressively with increasing glaucoma severity (P < 0.05, except for temporal RNFL thickness). Global and regional cpCD relative loss values were higher than those of RNFL thickness (P < 0.05) in preperimetric glaucoma (except for the superonasal region) and glaucoma (except for the inferonasal and superonasal regions) eyes. Race, intraocular pressure (IOP), and cpCD were associated with greater cpCD than RNFL thickness loss in early glaucoma at the individual level (P < 0.05). Global measurements of capillary density (whole image capillary density and cpCD) had higher diagnostic accuracies than RNFL thickness in detecting preperimetric glaucoma and glaucoma (P < 0.05; except for cpCD/RNFL thickness comparison in glaucoma [P = 0.059]). Visual function was significantly associated with RNFL thickness and cpCD globally and in all regions (P < 0.05, except for temporal RNFL thickness-function association [P = 0.070]).
Associations between capillary density and visual function were found in the regions known to be at highest risk for damage in preperimetric glaucoma eyes and all regions of mild glaucoma eyes. In early glaucoma, capillary density loss was more pronounced than RNFL thickness loss. Individual characteristics influence the relative magnitudes of capillary density loss compared with RNFL thickness loss. Retinal nerve fiber layer thickness and microvascular assessments are complementary and yield valuable information for the detection of early damages seen in POAG.
比较眼周毛细血管密度（cpCD）的整体和局部测量值与视网膜神经纤维层（RNFL）厚度，并描述其与早期原发性开角型青光眼（POAG）患者视功能的关系。
横断面研究。
来自诊断性青光眼研究中的 80 只健康眼、64 只亚临床青光眼眼和 184 只轻度 POAG 眼。
使用 OCT 和 OCT 血管造影（OCTA）获得整体和局部 RNFL 厚度和 cpCD 测量值。为了在个体和诊断组水平上进行直接比较，将 RNFL 厚度和毛细血管密度值转换为归一化相对损失尺度。
个体水平和诊断组的视网膜神经纤维层厚度和 cpCD 归一化损失。RNFL 厚度和 cpCD 的受试者工作特征曲线（ROC）下面积（AUROC），以检测亚临床青光眼和青光眼，诊断组中 RNFL 厚度与毛细血管密度功能之间关联的 R 值。
随着青光眼严重程度的增加，整体和局部 RNFL 厚度和 cpCD 逐渐降低（P<0.05，除颞侧 RNFL 厚度外）。在亚临床青光眼（除超鼻上象限外）和青光眼（除鼻下象限和超鼻上象限外）眼中，cpCD 的整体和局部相对损失值均高于 RNFL 厚度（P<0.05）。在个体水平上，种族、眼内压（IOP）和 cpCD 与早期青光眼患者中 cpCD 比 RNFL 厚度损失更大相关（P<0.05）。在检测亚临床青光眼和青光眼时，毛细血管密度的整体测量值（全像毛细血管密度和 cpCD）比 RNFL 厚度具有更高的诊断准确性（P<0.05；除青光眼时 cpCD/RNFL 厚度比较外 [P=0.059]）。视功能与 RNFL 厚度和 cpCD 整体及所有区域均显著相关（P<0.05，除颞侧 RNFL 厚度-功能关联外 [P=0.070]）。
在亚临床青光眼眼中已知最易受损的区域和所有轻度青光眼眼中的区域均发现了毛细血管密度与视功能之间的关联。在早期青光眼患者中，cpCD 损失比 RNFL 厚度损失更为明显。个体特征影响 cpCD 损失相对于 RNFL 厚度损失的相对幅度。视网膜神经纤维层厚度和微血管评估是互补的，可以为检测 POAG 早期损害提供有价值的信息。
